Metabolically unhealthy phenotype in normal weight population and risk of mortality and major adverse cardiac events: A meta-analysis of 41 prospective cohort studies

Putra, Iwan Cahyo Santosa; Kamarullah, William; Prameswari, Hawani Sasmaya; Pramudyo, Miftah; Iqbal, Mohammad; Achmad, Chaerul; Akbar, Mohammad Rizki; Tiksnadi, Badai Bhatara

doi:10.1016/j.dsx.2022.102635

Cited by 10 publications

(5 citation statements)

References 69 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This compensatory mechanism could hide the potential negative effects of a declining adherence to the Mediterranean diet, requiring a closer examination of both diet and activity levels to fully understand their combined impact on general health. The metabolically unhealthy normal-weight phenotype is now recognized, which may pose the same or even a greater risk of cardiometabolic disease compared to overweight individuals [ 43 ]. Therefore, in normal weight populations, it is highly recommended to perform metabolic and lifestyle screening.…”

Section: Discussionmentioning

confidence: 99%

Reciprocal and Differential Influences of Mediterranean Diet and Physical Activity on Adiposity in a Cohort of Young and Older than 40 Years Adults

Higuera-Gómez,

de Cuevillas,

Ribot-Rodríguez

et al. 2024

Nutrients

View full text Add to dashboard Cite

Translational research has documented the conjoint beneficial relationships between dietary and physical activity habits concerning weight maintenance. However, the precise interplay between diet and exercise impacting body composition remains unclear, challenging personalized interventions. This study aimed to explore potential interactions and effect modifications of these factors affecting the body mass index (BMI) within an online adult cohort. Data from 11,883 NUTRiMDEA cohort participants were analyzed in this cross-sectional study, categorizing individuals by age, sex, and BMI using linear regression models to assess the interactions between lifestyle factors and adiposity. Significant differences emerged in anthropometry, lifestyle, and health-related quality of life (HRQoL) across categories. The combined effect of diet and physical activity had a greater impact on BMI than physical activity or Mediterranean diet adherence alone, with lower BMI as physical activity levels increased (β: −0.5) and adherence to the Mediterranean diet decreased, where a modification effect between them was identified (β: −0.28). Participants with lower Mediterranean diet adherence displayed superior BMI when physical activity was low, but when activity levels were higher, their BMI aligned with those with healthier dietary habits. An interaction link between lifestyle factors and BMI was found, showing the differential effects of the Mediterranean diet and physical activity combination concerning adiposity.

show abstract

Section: Discussionmentioning

confidence: 99%

Reciprocal and Differential Influences of Mediterranean Diet and Physical Activity on Adiposity in a Cohort of Young and Older than 40 Years Adults

Higuera-Gómez,

de Cuevillas,

Ribot-Rodríguez

et al. 2024

Nutrients

View full text Add to dashboard Cite

show abstract

“…In 1998, due to research funded by the weight loss industry, the National Institutes of Health (NIH) lowered the BMI cutoff for the female overweight category from 27.3 to 25 kg/m 2 27 . This is problematic, as current research demonstrates that health is made up of more than an individual's anthropometric characteristics, and the approach of assigning a positive or negative health status based solely on BMI does not accurately reflect overall well‐being, nor is it associated with mortality risk 28–32 . For example, in a systematic review of 141 studies, individuals categorized as overweight (BMI of 25 to <30 kg/m 2 ) had lower all‐cause mortality than those with lower BMIs, and there was no associated excess mortality for individuals categorized as overweight or those in the grade 1 category (BMI of 30 to <35 kg/m 2 ) 33 …”

Section: Factors Associated With Weight Biasmentioning

confidence: 99%

“…27 This is problematic, as current research demonstrates that health is made up of more than an individual's anthropometric characteristics, and the approach of assigning a positive or negative health status based solely on BMI does not accurately reflect overall well-being, nor is it associated with mortality risk. [28][29][30][31][32] For example, in a systematic review of 141 studies, individuals categorized as overweight (BMI of 25 to <30 kg/m 2 ) had lower all-cause mortality than those with lower BMIs, and there was no associated excess mortality for individuals categorized as overweight or those in the grade 1 category (BMI of 30 to <35 kg/m 2 ). 33 In June 2023, the American Medical Association (AMA) released a report reviewing their recommendations regarding use of the BMI and the potential flaws associated with its use, including the historical and racial harms that have stemmed from its adoption within health care.…”

Section: Body Mass Indexmentioning

confidence: 99%

Mitigating Weight Bias in the Clinical Setting: A New Approach to Care

Olson,

Muñoz,

Solis

et al. 2023

J Midwife Womens Health

View full text Add to dashboard Cite

Weight bias toward patients in larger bodies is pervasive among health care providers and can negatively influence provider‐patient communication, as well as patients’ behavior and health outcomes. Weight bias has historical roots that perpetuate thinness and Whiteness as the cultural norm. Although weight bias remains socially acceptable in US culture, contributing factors to an individual's body size are complex and multifactorial. Providers and health care systems also consistently use body mass index (BMI) as an indicator of health status, despite its limitations and harmful effects in the clinical setting. This state of the science review presents 8 evidence‐based strategies that demonstrate how to mitigate harm from weight bias and improve quality of care and health outcomes for patients living in larger bodies. Person‐centered approaches to care include (1) eliminating clinical recommendations to lose weight; (2) shifting from a focus on weight to health; (3) implementing a size and weight‐inclusive approach; (4) engaging in weight bias self‐evaluation; (5) creating a welcoming environment for patients of all sizes; (6) seeking permission and learning the patient's story; (7) using weight‐inclusive language; and (8) re‐evaluating clinical guidelines and policies based on BMI. Midwives and other health care providers may benefit from training that re‐imagines the delivery of health care to patients in larger bodies.

show abstract

“…8 Such individuals are usually considered to have metabolically healthy obesity (MHO) 9 and may display distinct disease outcomes compared to metabolically healthy normal weight (MHN) and metabolically unhealthy obesity (MUO) status, 10 which could have important implications for targeted preventive strategies in practice. According to recent largescale cohort studies [10][11][12] and meta-analyses, [13][14][15] the MHO phenotype is transient and dynamic; its transition to a metabolically unhealthy phenotype is associated with an increased risk of CVDs and atherosclerosis; however, inconsistent findings have also been reported. 14,16,17 This inconsistency might be due to ignoring the dynamic nature of the MHO phenotype, a substantially limited sample size, or a lack of a uniform definition of MHO.…”

Section: Introductionmentioning

confidence: 99%

Metabolically healthy obesity, transition from metabolic healthy to unhealthy status, and carotid atherosclerosis

Huang,

Liu,

Wei

et al. 2024

Diabetes Metabolism Res

View full text Add to dashboard Cite

BackgroundEvidence of the effects of metabolically healthy obesity (MHO) on atherosclerosis is limited; the transition effects of metabolic health and obesity phenotypes have been ignored. We examined the association between metabolic health and the transition to atherosclerosis risk across body mass index (BMI) categories in a community population.MethodsThis cross‐sectional study was based on a national representative survey that included 50,885 community participants aged ≥40 years. It was conducted from 01 December 2017 to 31 December 2020, in 13 urban and 13 rural regions across Hunan China. Metabolic health was defined as meeting less than three abnormalities in blood pressure, glucose, high‐density lipoprotein cholesterol, triglycerides, or waist circumference. The participants were cross‐classified at baseline based on their metabolic health and obesity. In addition, the relationship between atherosclerosis and transitions in metabolic health status based on 4733 participants from baseline to the second survey after 2 years was considered. The relationship between metabolic health status and the risk of transition to Carotid atherosclerosis (CA) was assessed using logistic regression and Cox proportional hazards regression analyses.ResultsIn this study, the mean age of the participants was 60.7 years (standard deviation [SD], 10.91), 53.0% were female, and 51.2% had CA. As compared with metabolically healthy normal weight (MHN), those with MHO phenotype (odd ratio [OR] 1.10, 95% confidence interval [CI] 1.02–1.21), metabolically unhealthy normal weight (OR 1.27, 95% CI 1.19–1.35), metabolically unhealthy overweight (OR 1.41, 95% CI 1.33–1.48), and metabolically unhealthy obese (OR 1.54, 95% CI 1.44–1.64) had higher risk for CA. However, during the follow‐up of 2 years, almost 33% of the participants transitioned to a metabolically unhealthy status. As compared with stable healthy normal weight, transition from metabolically healthy to unhealthy status (hazard ratios [HR] 1.21, 95% [CI] 1.02–1.43) and stable metabolically unhealthy overweight or obesity (MUOO) (HR 1.32, 95% CI 1.17–1.48) were associated with higher risk of CA.ConclusionsIn the community population, obesity remains a risk factor for CA despite metabolic health. However, the risks were highest for metabolically unhealthy status across all BMI categories. A large proportion of metabolically healthy overweight or participants with obesity converts to an unhealthy phenotype over time, which is associated with an increased risk of CA.

show abstract

Metabolically unhealthy phenotype in normal weight population and risk of mortality and major adverse cardiac events: A meta-analysis of 41 prospective cohort studies

Cited by 10 publications

References 69 publications

Reciprocal and Differential Influences of Mediterranean Diet and Physical Activity on Adiposity in a Cohort of Young and Older than 40 Years Adults

Reciprocal and Differential Influences of Mediterranean Diet and Physical Activity on Adiposity in a Cohort of Young and Older than 40 Years Adults

Mitigating Weight Bias in the Clinical Setting: A New Approach to Care

Metabolically healthy obesity, transition from metabolic healthy to unhealthy status, and carotid atherosclerosis

Contact Info

Product

Resources

About