Does metabolic health in overweight and obesity persist? - Individual variation and cardiovascular mortality over two decades
Author(s)
Kaur, A
Johnston, DG
Godsland, IF
Type
Journal Article
Abstract
Objective: Overweight and obese individuals may be metabolically healthy but attention needs to be given to long-term persistence of this trait and any associated variation in cardiovascular risk.
Design: Cross-sectional and longitudinal variation in metabolic health and associated cardiovascular mortality were analysed in 1099 white European-origin normal weight and overweight or obese males followed for 20 years.
Methods: Definitions of metabolic health were based on LDL and HDL cholesterol, triglycerides, blood pressure, fasting glucose and cardiovascular risk. Insulin resistance (e.g. HOMA-IR) and subclinical inflammation (ESR and white blood cell count) were explored. Cardiovascular mortality risks and persistence of metabolic health status were evaluated.
Results: There were 87 cardiovascular deaths. Insulin resistance was increased in metabolically healthy overweight or obese participants (median HOMA-IR 2.63, 95%ci 1.79-3.65, p<0.001) relative to normal weight (median HOMA-IR 1.67, 95%ci 1.08-2.67, p<0.001) as was subclinical inflammation but metabolically healthy overweight or obese individuals were not at increased risk of cardiovascular mortality compared with the metabolically healthy normal-weight (hazard ratio 1.13, 95% ci 0.34-3.72, p=0.8). The proportions of initially metabolically healthy overweight or obese who remained metabolically healthy for visits 2, 3 and 4 were 54, 48 and 39%, respectively, and for initially normal-weight individuals, 68, 51 and 41%. A lower proportion of metabolically healthy overweight or obese individuals remained metabolically healthy at visit 2 compared with normal weight individuals (p=0.007) but proportions converged thereafter..
Conclusions: Despite being insulin resistant and having greater subclinical inflammation, and despite instability in metabolic health status, metabolically healthy overweight or obese individuals were at no greater risk of cardiovascular mortality than their normal-weight equivalents.
Design: Cross-sectional and longitudinal variation in metabolic health and associated cardiovascular mortality were analysed in 1099 white European-origin normal weight and overweight or obese males followed for 20 years.
Methods: Definitions of metabolic health were based on LDL and HDL cholesterol, triglycerides, blood pressure, fasting glucose and cardiovascular risk. Insulin resistance (e.g. HOMA-IR) and subclinical inflammation (ESR and white blood cell count) were explored. Cardiovascular mortality risks and persistence of metabolic health status were evaluated.
Results: There were 87 cardiovascular deaths. Insulin resistance was increased in metabolically healthy overweight or obese participants (median HOMA-IR 2.63, 95%ci 1.79-3.65, p<0.001) relative to normal weight (median HOMA-IR 1.67, 95%ci 1.08-2.67, p<0.001) as was subclinical inflammation but metabolically healthy overweight or obese individuals were not at increased risk of cardiovascular mortality compared with the metabolically healthy normal-weight (hazard ratio 1.13, 95% ci 0.34-3.72, p=0.8). The proportions of initially metabolically healthy overweight or obese who remained metabolically healthy for visits 2, 3 and 4 were 54, 48 and 39%, respectively, and for initially normal-weight individuals, 68, 51 and 41%. A lower proportion of metabolically healthy overweight or obese individuals remained metabolically healthy at visit 2 compared with normal weight individuals (p=0.007) but proportions converged thereafter..
Conclusions: Despite being insulin resistant and having greater subclinical inflammation, and despite instability in metabolic health status, metabolically healthy overweight or obese individuals were at no greater risk of cardiovascular mortality than their normal-weight equivalents.
Date Issued
2016-07-01
Date Acceptance
2016-05-26
Citation
European Journal of Endocrinology, 2016, 175, pp.133-143
ISSN
1479-683X
Publisher
BioScientifica
Start Page
133
End Page
143
Journal / Book Title
European Journal of Endocrinology
Volume
175
Copyright Statement
Disclaimer: this is not the definitive version of record of this article.This manuscript has been accepted for publication in European Journal of Endocrinology, but the version presented here has not yet been copy-edited, formatted or proofed. Consequently, Bioscientifica accepts no responsibility for any errors or omissions it may contain. The definitive version is now freely available at https://dx.doi.org/10.1530/EJE-16-0095 2016.
Sponsor
Imperial College Trust
Grant Number
PC2301
Subjects
Endocrinology & Metabolism
1103 Clinical Sciences
1114 Paediatrics And Reproductive Medicine
Publication Status
Published