Original Article | Published:

Epidemiology and Population Health

Long-term metabolic risk for the metabolically healthy overweight/obese phenotype

International Journal of Obesity volume 42, pages 302309 (2018) | Download Citation

Abstract

Background/Objectives:

The clinical relevance of the metabolically healthy overweight/obese (MHO) phenotype is controversial and the relationships between weight change and the development of cardiometabolic risk factors is unknown. Therefore, we aim to: (1) Assess the long-term risk of developing one or more components of the metabolic syndrome in MHO adults compared with metabolically healthy normal weight (MHNW); (2) Evaluate risk of a composite of death, cardiovascular disease (CVD), and risk of developing type 2 diabetes between adults defined according to baseline body mass index and metabolic health.

Subjects/Methods:

Retrospective cohort study of adults 18–65 years of age seen at our institution between 1998 and 2000 who lived in Olmsted County. Metabolically healthy was defined as the absence of all components of the metabolic syndrome (except for waist circumference). Main outcome was the development of metabolic risk factors. The secondary outcome was a composite of mortality, CVD and heart failure.

Results:

Of the 18 070 individuals with complete data at baseline, 1805 (10%) were MHO (mean age 38±11 years) and 3047 were MHNW (mean age 35±11 years). After a median follow-up of 15 years, interquartile range 10–17, 80% of MHO vs 68% of MHNW developed at least one cardiometabolic risk factor (P<0.001). In multivariate analysis, MHO individuals who gained 10% of their body weight were more likely to have developed metabolic complications compared to MHO individuals that did not gain weight (P=0.001 for 10–15%, P<0.001 for >15% weight gain). The risk for the secondary composite end point was similar between MHO and MHNW, number of events 218/1805 vs 217/3048 for MHO and MHNW, respectively, (hazard ratio: 1.16, 95% confidence interval: 0.96–1.40).

Conclusions:

MHO are more likely to develop metabolic complications than MHNW, especially if they gain weight.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    , , , , , et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation 2014; 129: S102–S138.

  2. 2.

    , , , , , et al. Determinants of the transition from a cardiometabolic normal to abnormal overweight/obese phenotype in a Spanish population. Eur J Nutr 2014; 53: 1345–1353.

  3. 3.

    , , , , , et al. Diabetes and cardiovascular disease outcomes in the metabolically healthy obese phenotype: a cohort study. Diabetes Care 2013; 36: 2388–2394.

  4. 4.

    , , , , , et al. Metabolically healthy obesity and the risk of cardiovascular disease and type 2 diabetes: the Whitehall II cohort study. Eur Heart J 2015; 36: 551–559.

  5. 5.

    , , , , , et al. Cardiorespiratory fitness and adiposity in metabolically healthy overweight and obese youth. Pediatrics 2013; 132: e85–e92.

  6. 6.

    , , , , . Metabolically healthy obesity: different prevalences using different criteria. Eur J Clin Nutr 2010; 64: 1043–1051.

  7. 7.

    , , . Are metabolically healthy overweight and obesity benign conditions?: A systematic review and meta-analysis. Ann Intern Med 2013; 159: 758–769.

  8. 8.

    , , , , . Risk of myocardial infarction and heart failure among metabolically healthy but obese individuals: HUNT (Nord-Trondelag Health Study), Norway. J Am Coll Cardiol 2014; 63: 1071–1078.

  9. 9.

    , , , , , . Incident cardiovascular disease events in metabolically benign obese individuals. Obesity 2012; 20: 651–659.

  10. 10.

    , , . The long-term prognosis of cardiovascular disease and all-cause mortality for metabolically healthy obesity: a systematic review and meta-analysis. J Epidemiol Community Health 2016; 70: 1024–1031.

  11. 11.

    , , , , , et al. Metabolically healthy but obese, a matter of time? Findings from the prospective Pizarra study. J Clin Endocrinol Metab 2013; 98: 2318–2325.

  12. 12.

    . Is there an increased cardiovascular risk in metabolically healthy obese individuals? Lessons from the HUNT (Nord-Trondelag Health) study. Glob Cardiol Sci Pract 2014; 2014: 44–47.

  13. 13.

    , . Metabolically healthy obesity and risk of all-cause and cardiovascular disease mortality. J Clin Endocrinol Metab 2012; 97: 2482–2488.

  14. 14.

    World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000; 894, i-xii 1–253, .

  15. 15.

    , , . The metabolic syndrome—a new worldwide definition. Lancet 2005; 366: 1059–1062.

  16. 16.

    , , , , , . Accuracy of ICD-9-CM codes for identifying cardiovascular and stroke risk factors. Med Care 2005; 43: 480–485.

  17. 17.

    , , , , , et al. A systematic review of validated methods for identifying cerebrovascular accident or transient ischemic attack using administrative data. Pharmacoepidemiol Drug Saf 2012; 21 (Suppl 1): 100–128.

  18. 18.

    , , , , , et al. Evaluation of medicare claims data to ascertain peripheral vascular events in the Women's Health Initiative. J Vasc Surg 2014; 60: 98–105.

  19. 19.

    R Development Core Team. (2008). R Foundation for Statistical Computing. Vienna, Austria. .

  20. 20.

    , , , . Misclassification of cardiometabolic health when using body mass index categories in NHANES 2005-2012. Int J Obes 2016; 40: 883–886.

  21. 21.

    , , , , , . The natural course of healthy obesity over 20 years. J Am Coll Cardiol 2015; 65: 101–102.

  22. 22.

    , , , , , et al. Duration and degree of weight gain and incident diabetes in younger versus middle-aged Black and White Adults: ARIC, CARDIA, and the Framingham Heart Study. Diabetes Care 2015; 38: 2042–2049.

  23. 23.

    , , , , , et al. Predictors of new-onset diastolic and systolic hypertension: the Framingham Heart Study. Circulation 2005; 111: 1121–1127.

  24. 24.

    , , , , . Three-year weight change and cardiometabolic risk factors in obese and normal weight adults who are metabolically healthy: the atherosclerosis risk in communities study. Int J Obes 2015; 39: 1203–1208.

  25. 25.

    , , , , , et al. Weight gain continues in the 1990s: 10-year trends in weight and overweight from the CARDIA study. Coronary Artery Risk Development in Young Adults. Am J Epidemiol 2000; 151: 1172–1181.

  26. 26.

    , , , , . Influence of body fat distribution on free fatty acid metabolism in obesity. J Clin Invest 1989; 83: 1168–1173.

  27. 27.

    , . Fat depots, free fatty acids, and dyslipidemia. Nutrients 2013; 5: 498–508.

Download references

Acknowledgements

We would like to thank Dr Arlene Calvo and Morgan Hess-Holtz from the University of South Florida Health Panama for their help with cumulative incidence analysis. This manuscript was supported by CTSA Grant Number TL1 TR000137 from the National Center for Advancing Translational Science (NCATS), grant DK050456 from the US Public Health Service and the Mayo Foundation.

Disclaimer

Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

Author information

Affiliations

  1. Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    • AE Espinosa De Ycaza
    • , D Donegan
    •  & M D Jensen
  2. Facultad de Medicina, Universidad de Panamá, Panama City, Republic of Panama

    • AE Espinosa De Ycaza
    •  & D Donegan
  3. Department of Internal Medicine, Endocrine Research Unit, Mayo Clinic, Rochester, MN, USA

    • M D Jensen

Authors

  1. Search for AE Espinosa De Ycaza in:

  2. Search for D Donegan in:

  3. Search for M D Jensen in:

Competing interests

The authors declare no conflict of interest.

Corresponding author

Correspondence to M D Jensen.

Supplementary information

About this article

Publication history

Received

Revised

Accepted

Published

DOI

https://doi.org/10.1038/ijo.2017.233

Supplementary Information accompanies this paper on International Journal of Obesity website (http://www.nature.com/ijo)

Further reading