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Association of metabolically healthy obesity in young adulthood with myocardial structure and function

International Journal of Obesity (2023)Cite this article

Subjects

Abstract

Background

Obesity is major cause of cardiovascular diseases. Metabolically healthy obesity (MHO) may increase heart failure risk early in life, and may be reflected in impaired cardiac structure and function. Therefore, we aimed to examine the relationship between MHO in young adulthood and cardiac structure and function.

Methods

A total of 3066 participants from the Coronary Artery Risk Development in Young Adults (CARDIA) study were included, who completed echocardiography in young adulthood and middle age. The participants were grouped by obesity status (body mass index ≥30 kg/m2) and poor metabolic health (≥2 criteria for metabolic syndrome) into four metabolic phenotypes as follows: metabolically healthy non-obesity (MHN), MHO, metabolically unhealthy non-obesity (MUN), metabolically unhealthy obesity (MUO). The associations of the metabolic phenotypes (MHN serving as the reference) with left ventricular (LV) structure and function were evaluated using multiple linear regression models.

Results

At baseline, mean age was 25 years, 56.4% were women, and 44.7% were black. After a follow-up 25 years, MUN in young adulthood was associated with worse LV diastolic function (E/é ratio, β [95% CI], 0.73 [0.18, 1.28]), worse systolic function (global longitudinal strain [GLS], 0.60 [0.08, 1.12]) in comparison with MHN. MHO and MUO were associated with LV hypertrophy (LV mass index, 7.49 g/m2 [4.63, 10.35]; 18.23 g/m2 [12.47, 23.99], respectively), worse diastolic function (E/é ratio, 0.67 [0.31, 1.02]; 1.47 [0.79, 2.14], respectively), and worse systolic function (GLS, 0.72 [0.38, 1.06]; 1.35 [0.64, 2.05], respectively) in comparison with MHN. These results were consistent in several sensitivity analyses.

Conclusions

In this community-based cohort using data from the CARDIA study, obesity in young adulthood was significantly associated with LV hypertrophy, worse systolic and diastolic function regardless of metabolic status.

Relationship of Baseline Metabolic Phenotypes with Young Adulthood and Midlife Cardiac Structure and Function. Adjusted for year 0 covariates: age, sex, race, educational level, smoking status, drinking status, and physical activity; metabolically healthy non-obesity was used as a reference category for comparison. † Criteria for metabolic syndrome are listed in Supplementary Table S6. MUN metabolically unhealthy non-obesity, MHO metabolically healthy obesity, LVMi left ventricular mass index, LVEF left ventricular ejection fraction, E/A early to late peak diastolic mitral flow velocity ratio, E/é mitral inflow velocity to early diastolic mitral annular velocity, CI confidence interval.

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Fig. 1: Flowchart of selection of study participants.
Fig. 2: Relationship of metabolic phenotypes at year 0 with year-5 cardiac structure and function.
Fig. 3: Relationship of metabolic phenotypes at year 0 with year-25 cardiac structure and function.

Data availability

The data used and/or analyzed in this study are available to all researchers upon reasonable request.

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Acknowledgements

We thank all the staff and participants of the CARDIA study for their contributions. This study was supported by the National Natural Science Foundation of China (81870195, 82070384 to XL; 81900329 to YG), Guangdong Basic and Applied Basic Research Foundation (2019A1515011582, 2021A1515011668 to XL; 2019A1515011098, 2022A1515010416 to YG).

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Author notes

  1. These authors contributed equally: Peng Wang, Menghui Liu.

Authors and Affiliations

  1. Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

    Peng Wang, Menghui Liu, Xiaodong Zhuang, Yue Guo, Zhenyu Xiong, Lixiang He, Xiaojie Cai, Zhuohui Chen, Longyun Peng & Xinxue Liao

  2. NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, China

    Peng Wang, Menghui Liu, Xiaodong Zhuang, Yue Guo, Zhenyu Xiong, Lixiang He, Xiaojie Cai, Zhuohui Chen, Longyun Peng & Xinxue Liao

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  1. Peng Wang
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Contributions

XL, LP, PW and ML conceived and designed the study. XL, LP, PW, ML, XZ, ZX, YG, LH, ZZ and ZC contributed to the acquisition, analysis and interpretation of the data. PW and ML were responsible for writing the manuscript. All authors contributed to revising the manuscript draft for important intellectual content and approved the final submitted manuscript.

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Correspondence to Longyun Peng or Xinxue Liao.

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Wang, P., Liu, M., Zhuang, X. et al. Association of metabolically healthy obesity in young adulthood with myocardial structure and function. Int J Obes (2023). https://doi.org/10.1038/s41366-023-01288-3

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