Association between metabolically healthy obesity/overweight and cardiovascular disease risk: A representative cohort study in Taiwan

Abstract

Objectives To investigate the relationship between metabolically healthy obesity and cardiovascular disease risk in Taiwanese individuals. Methods Taiwanese individuals were recruited from a nationwide, representative community-based prospective cohort study and classified according to body mass index as follows: normal weight (18.5–23.9 kilogram (kg)/meter(m)2) and obesity/overweight (≥24 kg/m2). Participants without diabetes, hypertension, and hyperlipidemia and who did not meet the metabolic syndrome without waist circumference criteria were considered metabolically healthy. The study end points were cardiovascular disease morbidity and mortality. Multivariable adjusted hazard ratios and 95% confidence intervals were obtained from a Cox regression analysis. Results Among 5 358 subjects (mean [standard deviation] age, 44.5 [15.3] years; women, 48.2%), 1 479 were metabolically healthy with normal weight and 491 were metabolically healthy with obesity. The prevalence of metabolically healthy obesity/overweight was 8.6% in the Taiwanese general population, which included individuals who were >20 years old, not pregnant, and did not have CVD (n = 5,719). In the median follow-up period of 13.7 years, 439 cardiovascular disease events occurred overall and 24 in the metabolically healthy obesity group. Compared with the reference group, the metabolically healthy obesity group had a significantly higher cardiovascular disease risk (adjusted hazard ratio: 1.74, 95% confidence interval: 1.02, 2.99). Conclusions Individuals with metabolically healthy obesity have a higher risk of cardiovascular disease and require aggressive body weight control for cardiovascular disease control.

Peer Review #1 of "Obesity phenotypes and their relationships with atrial fibrillation (v0.1)"

“…MHO and Afib. A previous cohort study demonstrated an increased risk of cardiovascular disease in the MHO group, but no Afib data were presented (Yeh et al 2021). Our study reported a 1.97-fold higher risk in the MHOW/MHO group, although this result was not statistically significant.…”

Do Metabolically Healthy People with Obesity Have a Lower Health-Related Quality of Life? A Prospective Cohort Study in Taiwan

“…Meanwhile, the proportion of MUO increased. Poorer outcomes in the baseline MHO group would be observed more easily if we ignored the MHO individuals who may change to MUO over time [ 8 ]. In our study, we evaluated the MHO status at baseline and at an eight-year follow-up; the GLMMs contained the changes of metabolic health status and the effects of repeated measures in the analytical models.…”

“…However, MHO does not always mean truly healthy; rather, it typically refers to having fewer metabolic syndrome components than healthy people [ 7 ]. The risk of cardiovascular disease and type 2 diabetes for individuals with MHO is lower than that of individuals with metabolically unhealthy obesity but higher than that of people with metabolically healthy normal weight [ 8 , 9 ]. MHO may represent a period of transition between metabolically healthy to unhealthy states.…”

Obesity phenotypes and their relationships with atrial fibrillation

“…A previous cohort study demonstrated an increased risk of cardiovascular disease in the MHO group, but no Afib data were presented ( Yeh et al, 2021 ). Our study reported a 1.97-fold higher risk in the MHOW/MHO group, although this result was not statistically significant.…”