“Metabolically healthy” obesity is associated with poor health

A large cohort study in the United Kingdom provided new evidence that “metabolically healthy” obesity is, after all, less healthy.

Of the 381,363 individuals with a median follow-up of 11 years, those with metabolically healthy obesity were at risk of developing diabetes (HR 4.32, 95% CI 3.83-4.89), atherosclerosis (HR 1.18,). The risk of 95% CI 1.10-1.27) was significantly higher. And heart failure (HR 1.76, 95% CI 1.61-1.92) was compared to metabolically healthy non-obese individuals, reported Dr. Frederick Ho of the University of Glasgow, Scotland.

As shown in the online study DiabetologyMetabolistically healthy individuals are at increased risk of respiratory illness (HR 1.28, 95% CI 1.24-1.33) and all-cause mortality (HR 1.22, 95% CI 1.14-1.31) and are metabolically healthy obese individuals About a quarter of them become metabolically unhealthy within 3 to 5 years.

“Therefore, the important point is that the risk of many important consequences, such as heart failure and respiratory illness, is increased even if obese patients have a normal metabolic profile. To illustrate this group. Use the label “metabolically healthy”. It can be misleading in clinical medicine and should be avoided, “the researchers write.

“These findings, and the unstable nature of MHO [metabolically healthy obesity]It suggests that weight management may be beneficial for obese patients, even if there are currently no abnormalities in their metabolic profile. Weight management strategies include lifestyle changes such as diet and physical activity, and combination medications during risk assessment, “the team continued. Or obesity surgery in severe obesity. “

The data was taken from UK Biobank, a population-based prospective cohort study of the general population of England, Scotland and Wales. Height and weight were measured by trained staff, and people with a body mass index (BMI) of 30 or higher were classified as obese.

In order for an obese person to be classified as metabolically healthy, blood pressure, glycated hemoglobin, low-density lipoprotein and high-density lipoprotein cholesterol, C-reactive protein, and at least four of the six metabolic markers are normal. Must have been in range. Triglyceride. All of these were measured at the Central Laboratory from 2014 to 2017.

Of the total of 381,363 individuals in the database, the researchers identified 35,103 metabolically healthy obese individuals. 55%).

Ho’s group uses the Cox proportional hazards model to adjust factors including age, gender, ethnicity, smoking, alcohol intake, physical activity, and eating habits to determine obesity, metabolic health, and health outcomes. I searched for the relevance to associate. The main results included the occurrence of diabetes, cardiovascular disease and fatal accidents.

In general, researchers say that metabolically healthy obesity is associated with a lower risk of adverse health effects than metabolically unhealthy obesity. For example, people with metabolically healthy obesity had about one-third the risk of developing diabetes compared to people with metabolically unhealthy obesity (HR 4.32 vs. 12.86). Metabolic healthy obese people tended to be younger, more active, and more educated.

A sub-analysis of 8,521 people who traversed BMI and metabolic data over a median of 4.4 years found that more than a quarter of obese people who were metabolically healthy became metabolically unhealthy (accurate numbers). Not reported). Another 20% lost weight and became non-obese, the researchers said.

However, the sub-analysis also identified metabolically healthy obese individuals who, at least in the short term, do not appear to be at increased risk of adverse outcomes. “It is noteworthy that half of the participants continued MHO after 4.4 years of follow-up. Significant increased risk compared to those who were metabolically healthy and non-obese during the study period. It could not be detected. People in this group are at lower risk than people with other MHO trajectories, “the investigator wrote.

“But we didn’t have enough events to determine if they were at the same risk as MHN patients. [metabolically healthy non-obesity]Or, the risk was moderately high. Future prospective studies need to take this agenda into account. “

According to the research team, the main limitation of this study was that fasting glucose and insulin resistance were not measured, limiting how accurately researchers could define metabolic health. In addition, this study does not consider other potential markers of metabolic health, such as genetic data or hospitalization.

Last updated June 10, 2021