Do rapid BMI growth in childhood and early-onset obesity offer cardiometabolic protection to obese adults in mid-life? Analysis of a longitudinal cohort study of Danish men

Abstract

ObjectiveSome obese individuals have no cardiometabolic abnormalities; they are ‘metabolically healthy, but obese’ (MHO). Similarly, some non-obese individuals have cardiometabolic abnormalities, that is, ‘metabolically at risk, normal weight’ (MANW). Previous studies have suggested that early-onset obesity may be associated with MHO. We aimed to assess whether body mass index (BMI) in childhood and early-onset obesity are associated with MHO.SettingGeneral population longitudinal cohort study, Denmark.ParticipantsFrom 362 200 young men (mean age 20) examined for Danish national service between 1943 and 1977, all obese men (BMI ≥31 kg/m2, N=1930) were identified along with a random 1% sample of the others (N=3601). Our analysis includes 2392 of these men attending a research clinic in mid-life (mean age 42). For 613 of these men, data on childhood BMI are available. We summarised childhood BMI growth (7–13 years) using a multilevel model. Early-onset obesity was defined as obesity at examination for national service.Outcome measurementWe defined metabolic health at the mid-life clinic as non-fasting serum cholesterol <6.6 mmol/L, non-fasting glucose <8.39 mmol/L and pulse pressure <48 mm Hg. Participants were categorised into four groups according to their obesity (BMI ≥30 kg/m2) and metabolic health in mid-life.Results297 of 1097 (27.1%) of obese men were metabolically healthy; 826 of 1295 (63.8%) non-obese men had at least one metabolic abnormality. There was no evidence that rapid BMI growth in childhood or early-onset obesity was associated with either MHO or the MANW phenotype, for example, among obese men in mid-life, the OR for MHO comparing early-onset obesity with non-early-onset obesity was 0.97 (95% CI 0.85 to 1.10).ConclusionsWe found no robust evidence that early-onset obesity or rapid BMI growth in childhood is protective for cardiometabolic health.

Fasting insulin resistance affects the prevalence of metabolically healthy obesity in Brazilian adolescents

“…The current study added to this knowledge base by examining the associations between obesity level adjusting for gender and pubertal stage categories and by differentiating the two definitions, including insulin resistance. We recognise, though, that our study would have been further strengthened by studying the association of the duration and timing of the onset of obesity , as well as fat mass degree and distribution , with metabolic phenotypes.…”

Metabolically healthy obesity across the life course: epidemiology, determinants, and implications

“…Collectively, the data indicate that MHO children are more likely to be younger (and in earlier stages of puberty) and female, of high birth weight with less visceral fat, exhibiting preserved insulin sensitivity, high adiponectin concentrations, altered ghrelin levels, more favorable lipid profiles, reduced concentrations of transaminases and uric acid, and without hepatic steatosis . Although early weight gain was originally identified as a determinant of childhood MHO, a larger study of Danish men for whom childhood BMI was available failed to find robust evidence to support a role for either rapid BMI growth or early‐onset obesity in the development of MHO . Aside from laboratory and clinically based predictors, limited data regarding the roles of environmental, lifestyle, behavioral, or genetic factors in determining MHO status among children exist.…”

“…[17][18][19][22][23][24][25][26][27][28] Although early weight gain was originally identified as a determinant of childhood MHO, 23 a larger study of Danish men for whom childhood BMI was available failed to find robust evidence to support a role for either rapid BMI growth or early-onset obesity in the development of MHO. 29 Aside from laboratory and clinically based predictors, limited data regarding the roles of environmental, lifestyle, behavioral, or genetic factors in determining MHO status among children exist. Prince et al 17 examined lifestyle predictors of MHO among 8-to 17-year-olds attending a weight-management clinic.…”

“…It has been suggested that the MHO phenotype starts in childhood and persists into adulthood. The Bogalusa Heart Study is unique in the context of examining MHO stability over time, in that the 1098 individuals participated in the study both as children (aged 5-17) and also as young adults (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43), with an average follow-up of 24 years (range 14.1-28.6 years). 16 Importantly, this study provides the opportunity to examine what happens to MHO status, as individuals age from childhood, through adolescence, and into adulthood.…”

Body size trajectories and cardio‐metabolic resilience to obesity

“…() found higher BMI at ages 2–11 years to protect obese adults ( n = 499) from the metabolic syndrome, whereas Howe et al . () found no robust evidence that rapid BMI gain between 7 and 13 years was protective for cardio‐metabolic health in obese Danish men ( n = 284). The two studies that have investigated early‐onset obesity also reported equivocal results (Brochu et al .…”