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Does metabolic health in overweight and obesity persist? - Individual variation and cardiovascular mortality over two decades

Title: Does metabolic health in overweight and obesity persist? - Individual variation and cardiovascular mortality over two decades
Authors: Kaur, A
Johnston, DG
Godsland, IF
Item Type: Journal Article
Abstract: 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.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 20years.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 sub-clinical inflammation (ESR and white blood cell count) were explored. Cardiovascular mortality risks and persistence of metabolic health status were evaluated.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 participants (median HOMA-IR 1.67, 95% CI: 1.08-2.67, P<0.001) as was sub-clinical inflammation but metabolically healthy overweight or obese individuals were not at increased risk of cardiovascular mortality compared with the metabolically healthy normal-weight individuals (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.Despite being insulin resistant and having greater sub-clinical 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.
Issue Date: 1-Jul-2016
Date of Acceptance: 26-May-2016
URI: http://hdl.handle.net/10044/1/34151
DOI: https://dx.doi.org/10.1530/EJE-16-0095
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/Funder: Imperial College Trust
Funder's Grant Number: PC2301
Keywords: Endocrinology & Metabolism
1103 Clinical Sciences
1114 Paediatrics And Reproductive Medicine
Publication Status: Published
Appears in Collections:Department of Medicine (up to 2019)