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Metabolically Healthy Obesity and Risk of Mortality: Does the definition of metabolic health matter?

OBJECTIVE: To assess the association of a “metabolically healthy obese” phenotype with mortality using five definitions of metabolic health. RESEARCH DESIGN AND METHODS: Adults (n = 5,269; 71.7% men) aged 39–62 years in 1991 through 1993 provided data on BMI and metabolic health, defined using data...

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Detalles Bibliográficos
Autores principales: Hinnouho, Guy-Marino, Czernichow, Sébastien, Dugravot, Aline, Batty, G. David, Kivimaki, Mika, Singh-Manoux, Archana
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Diabetes Association 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3714476/
https://www.ncbi.nlm.nih.gov/pubmed/23637352
http://dx.doi.org/10.2337/dc12-1654
Descripción
Sumario:OBJECTIVE: To assess the association of a “metabolically healthy obese” phenotype with mortality using five definitions of metabolic health. RESEARCH DESIGN AND METHODS: Adults (n = 5,269; 71.7% men) aged 39–62 years in 1991 through 1993 provided data on BMI and metabolic health, defined using data from the Adult Treatment Panel-III (ATP-III); criteria from two studies; and the Matsuda and homeostasis model assessment (HOMA) indices. Cross-classification of BMI categories and metabolic status (healthy/unhealthy) created six groups. Cox proportional hazards regression models were used to analyze associations with all-cause and cardiovascular disease (CVD) mortality during a median follow-up of 17.7 years. RESULTS: A total of 638 individuals (12.1% of the cohort) were obese, of whom 9–41% were metabolically healthy, depending on the definition. Regardless of the definition, compared with metabolically healthy, normal-weight individuals, both the metabolically healthy obese (hazard ratios [HRs] ranged from 1.81 [95% CI 1.16–2.84] for ATP-III to 2.30 [1.13–4.70] for the Matsuda index) and the metabolically abnormal obese (HRs ranged from 1.57 [1.08–2.28] for the Matsuda index to 2.05 [1.44–2.92] for criteria defined in a separate study) had an increased risk of mortality. The only exception was the lack of excess risk using the HOMA criterion for the metabolically healthy obese (1.08; 0.67–1.74). Among the obese, the risk of mortality did not vary as a function of metabolic health apart from when using the HOMA criterion (1.93; 1.15–3.22). Similar results were obtained for cardiovascular mortality. CONCLUSIONS: For most definitions of metabolic health, both metabolically healthy and unhealthy obese patients carry an elevated risk of mortality.