All-Cause Mortality Risk of Metabolically Healthy Obese Individuals in NHANES III

Abstract

Mortality risk across metabolic health-by-BMI categories in NHANES-III was examined. Metabolic health was defined as: (1) homeostasis model assessment-insulin resistance (HOMA-IR) <2.5; (2) ≤2 Adult Treatment Panel (ATP) III metabolic syndrome criteria; (3) combined definition using ≤1 of the following: HOMA-IR ≥1.95 (or diabetes medications), triglycerides ≥1.7 mmol/L, HDL-C <1.04 mmol/L (males) or <1.30 mmol/L (females), LDL-C ≥2.6 mmol/L, and total cholesterol ≥5.2 mmol/L (or cholesterol-lowering medications). Hazard ratios (HR) for all-cause mortality were estimated with Cox regression models. Nonpregnant women and men were included (n = 4373, mean ± SD, age 37.1 ± 10.9 years, BMI 27.3 ± 5.8 kg/m2, 49.4% female). Only 40 of 1160 obese individuals were identified as MHO by all definitions. MHO groups had superior levels of clinical risk factors compared to unhealthy individuals but inferior levels compared to healthy lean groups. There was increased risk of all-cause mortality in metabolically unhealthy obese participants regardless of definition (HOMA-IR HR 2.07 (CI 1.3–3.4), P < 0.01; ATP-III HR 1.98 (CI 1.4–2.9), P < 0.001; combined definition HR 2.19 (CI 1.3–3.8), P < 0.01). MHO participants were not significantly different from healthy lean individuals by any definition. While MHO individuals are not at significantly increased risk of all-cause mortality, their clinical risk profile is worse than that of metabolically healthy lean individuals.

Adipose-Lung Cell Crosstalk in the Obesity-ARDS Paradox

“…Some of these studies are retrospective in nature or do not allow the investigation of the concept that has been termed "Metabolically Healthy Obesity" (MHO) [22,23] terminology that refers to obese individuals with no associated metabolic comorbidities (insulin resistance, atherosclerosis, liver dysfunction). Interestingly, this MHO concept has been linked to lower adiposerelated inflammatory profiles and a lower mortality risk compared to individuals with metabolically unhealthy obesity [24]. How obesity may affect systemic and even pulmonary inflammatory responses is the key focus of this review.…”

Cortisol in tissue and systemic level as a contributing factor to the development of metabolic syndrome in severely obese patients

“…Obese patients do not always have MetS, thus constituting an intriguing metabolically 'healthy' obese phenotype, which is linked with a lower risk of all-cause mortality and CVD compared with obese subjects with MetS (23,24). Therefore, questions arise about the factors that contribute to the appearance of the metabolic features of MetS in obese patients.…”

Does metabolic health in overweight and obesity persist? – Individual variation and cardiovascular mortality over two decades

“…The question then arises, how many, if any, of the criteria may be allowed to be present before MH can be excluded? Previous studies of MHO employing similar criteria have allowed none (4,12,15), ≤1 (10,11,16,17) or ≤2 (18,19,20,21). In the present analysis, in the full dataset before exclusions (see below), each of the five risk factors was confirmed as a predictor of CVD and total mortality in univariate Cox proportional hazards models, unadjusted for any factors that might influence variation in risk factor levels.…”