Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Germany German Center for Diabetes Research, Germany.
Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Germany.
Eur J Prev Cardiol. 2016 Jun;23(9):956-66. doi: 10.1177/2047487315623884. Epub 2015 Dec 23.
Previous studies have provided inconsistent results about the cardiovascular risks for participants with metabolically healthy obesity (MHO). These uncertainties might partly reflect the lack of a uniform definition of MHO. We conducted a systematic review and meta-analysis to examine whether there is a suitable approach that identifies obese participants who are not at an increased risk of cardiovascular events compared with healthy normal-weight participants.
Twenty-two prospective studies were eligible for the meta-analysis. Using random-effect models, pooled relative risks (RRs) were calculated for the combined effects of obesity with the presence or absence of metabolic syndrome, insulin resistance, hypertension, diabetes, hyperlipidaemia and any of these metabolic factors. Participants with MHO defined by the absence of metabolic syndrome were at increased risk for cardiovascular events compared with healthy normal-weight participants (pooled RR 1.45, 95% confidence interval (CI) 1.20-1.70), but had lower risks than unhealthy normal-weight (RR 2.07, 95% CI 1.62-2.65) and obese (RR 2.31, 95% CI 1.99-2.69) participants. The risk associated with participants who had MHO was particularly high over the long term. Similar risk estimates were observed when MHO was defined by other approaches.
None of the approaches clearly identified an obese subgroup not at increased risk of cardiovascular events compared with normal-weight healthy participants. A benign obese phenotype might be defined by strict definitions, but insufficient studies exist to support this. More research is needed to better define MHO.
先前的研究对于代谢健康型肥胖（MHO）患者的心血管风险提供了不一致的结果。这些不确定性可能部分反映了缺乏对 MHO 的统一定义。我们进行了系统评价和荟萃分析，以研究是否存在一种合适的方法，可以确定与健康正常体重参与者相比，肥胖参与者没有增加心血管事件风险。
22 项前瞻性研究符合荟萃分析的纳入标准。使用随机效应模型，计算了肥胖症与代谢综合征、胰岛素抵抗、高血压、糖尿病、血脂异常和这些代谢因素中的任何一种并存或缺失的综合影响的合并相对风险（RR）。与健康正常体重参与者相比，无代谢综合征的 MHO 参与者发生心血管事件的风险增加（合并 RR 1.45，95%置信区间 [CI] 1.20-1.70），但与不健康的正常体重参与者（RR 2.07，95% CI 1.62-2.65）和肥胖参与者（RR 2.31，95% CI 1.99-2.69）相比风险较低。长期来看，与 MHO 相关的风险尤其高。当 MHO 采用其他方法定义时，也观察到类似的风险估计。
没有一种方法能够明确识别与健康正常体重参与者相比，肥胖参与者没有增加心血管事件风险的亚组。严格定义的良性肥胖表型可能存在，但目前的研究还不足以支持这一点。需要更多的研究来更好地定义 MHO。
