An Empirically Derived Definition of Metabolically Healthy Obesity Based on Risk of Cardiovascular and Total Mortality

Abstract

Key Points Question Can a definition of metabolic health be empirically derived that allows to stratify risk of mortality in people with obesity? Findings In this study including data from 386 420 individuals across 2 cohorts, a new definition of metabolically healthy obesity was established. People with a phenotype defined as metabolically unhealthy using this definition had significantly higher hazard ratios for cardiovascular disease mortality and total mortality irrespective of body mass index category, and people with phenotypes defined as having metabolically healthy obesity displayed no increased risk. Meaning A new definition of metabolic health identified in this study may allow to stratify risk of mortality not only in people with obesity but also in people with overweight and normal weight.

Independent and Joint Effects of Body Mass Index and Metabolic Health in Mid- and Late-life on All-Cause Mortality: A Cohort Study from the Swedish Twin Registry with a Mean Follow-up of 13 Years

“…It is noteworthy that the number of persons with MHO in our study dropped substantially when using the new de nitions or stricter criteria, which may have explained the rise in mortality risks associated with MHO in late-life. Since these new criteria were derived systematically from a younger population with a mean age of 41.6 years, the risk pattern yielded from our midlife group was consistent with the study [33], as expected. Nonetheless, the ndings from the late-life group were contradictory, thus raising concerns about whether criteria established in a midlife…”

“…It is important to note that only the magnitude of effects changed while the conclusions generally remained the same when various de nitions of metabolic health were explored. One exception was the recently proposed criteria of MHS established systematically to distinguish MHO with decreased mortality by Zembic et al [33].Applying these new de nitions did not substantially change our results in the midlife group. However, late-life MHO was signi cantly associated with a greater risk of mortality, corresponding with the ndings in our sensitivity analysis, when metabolic health was de ned with stricter criteria (absence of metabolic abnormality).…”

“…Since there is no consensus in the criteria for ascertaining metabolic health, we rst investigated if the HRs and 95% CI were affected by applying ve different ways of determining MHS: a) by including CVD history as an additional criterion in the de nition; b) excluding self-reports, such as the use of diabetic medications, lipid-lowering medications and diabetes diagnosis; c) de ning MH status as the absence of any metabolic abnormality; d) including waist circumference(WC) as an additional criterion in the de nition. The thresholds for WC to indicate metabolic abnormality were 80cm for females and 94cm for males; e)we applied the new criteria established by Zembic et al [33] and de ned MH as the absence of the following: 1) systolic BP less than 130 mmHg, 2)waist-hip-ratio (WHR) less than 0.95 for women and less than 1.03 in men, 3) no prevalent diabetes. Secondly, we added weight history as a confounder to correct for potential bias from reverse causation.…”

Independent and joint effects of body mass index and metabolic health in mid- and late-life on all-cause mortality: a cohort study from the Swedish Twin Registry with a mean follow-up of 13 Years

“…It is important to note that only the magnitude of effects changed while the conclusions generally remained the same when various definitions of metabolic health were explored. One exception was the recently proposed criteria of MHS established systematically to distinguish MHO with decreased mortality by Zembic et al [ 33 ]. Applying these new definitions did not substantially change our results in the midlife group (Additional file 1 , Table S6).…”

“…Since there is no consensus in the criteria for ascertaining metabolic health, we first investigated if the HRs and 95% CI were affected by applying five different ways of determining MHS: a) by including CVD history as an additional criterion in the definition; b) excluding self-reports, such as the use of diabetic medications, lipid-lowering medications and diabetes diagnosis; c) defining MH status as the absence of any metabolic abnormality; d) including waist circumference(WC) as an additional criterion in the definition. The thresholds for WC to indicate metabolic abnormality were 80 cm for females and 94 cm for males; e)we applied the new criteria established by Zembic et al [ 33 ] and defined MH as the absence of the following: 1) systolic BP less than 130 mmHg, 2)waist-hip-ratio (WHR) less than 0.95 for women and less than 1.03 in men, 3) no prevalent diabetes. Secondly, we added weight history as a confounder to correct for potential bias from reverse causation.…”