Kabat G C, Wu W Y-Y, Bea J W, Chen C, Qi L, Stefanick M L, Chlebowski R T, Lane D S, Wactawski-Wende J, Wassertheil-Smoller S, Rohan T E
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
Department of Radiation Sciences Oncology, Umeå University, Umeå, Sweden.
Int J Obes (Lond). 2017 Jan;41(1):170-177. doi: 10.1038/ijo.2016.179. Epub 2016 Oct 17.
The possibility that a subset of persons who are obese may be metabolically healthy-referred to as the 'metabolically healthy obese' (MHO) phenotype-has attracted attention recently. However, few studies have followed individuals with MHO or other obesity phenotypes over time to assess change in their metabolic profiles. The aim of the present study was to examine transitions over a 6-year period among different states defined simultaneously by body mass index (BMI) and the presence/absence of the metabolic syndrome (MetS).
We used repeated measurements available for a subcohort of participants enrolled in the Women's Health Initiative (N=3512) and followed for an average of 6 years to examine the frequency of different metabolic obesity phenotypes at baseline, the 6-year transition probabilities to other states and predictors of the risk of different transitions. Six phenotypes were defined by cross-tabulating BMI (18.5-<25.0, 25.0-<30.0, ⩾30.0 kg m) by MetS (yes, no). A continuous-time Markov model was used to estimate 6-year transition probabilities from one state to another.
Over the 6 years of follow-up, one-third of women with the healthy obese phenotype transitioned to the metabolically unhealthy obese (MUO) phenotype. Overall, there was a marked tendency toward increased metabolic deterioration with increasing BMI and toward metabolic improvement with lower BMI. Among MHO women, the 6-year probability of becoming MUO was 34%, whereas among unhealthy normal-weight women, the probability of 'regressing' to the metabolically healthy normal-weight phenotype was 52%.
The present study demonstrated substantial change in metabolic obesity phenotypes over a 6-year period. There was a marked tendency toward metabolic deterioration with greater BMI and toward metabolic improvement with lower BMI.
一部分肥胖人群可能代谢健康，即所谓的“代谢健康型肥胖”（MHO）表型，这一可能性近来受到了关注。然而，很少有研究对MHO或其他肥胖表型个体进行长期跟踪，以评估其代谢特征的变化。本研究的目的是考察在6年时间里，由体重指数（BMI）和代谢综合征（MetS）的有无同时定义的不同状态之间的转变情况。
我们利用了参与女性健康倡议（N = 3512）的一个亚队列参与者的重复测量数据，平均随访6年，以考察基线时不同代谢肥胖表型的频率、向其他状态转变的6年概率以及不同转变风险的预测因素。通过将BMI（18.5 - <25.0、25.0 - <30.0、⩾30.0 kg/m）与MetS（是、否）交叉制表来定义六种表型。使用连续时间马尔可夫模型来估计从一种状态到另一种状态的6年转变概率。
在6年的随访中，三分之一具有健康肥胖表型的女性转变为代谢不健康型肥胖（MUO）表型。总体而言，随着BMI升高，代谢恶化有明显趋势，而随着BMI降低，代谢有改善趋势。在MHO女性中，6年转变为MUO的概率为34%，而在不健康的正常体重女性中，“回归”到代谢健康正常体重表型的概率为52%。
本研究表明，在6年时间里代谢肥胖表型发生了显著变化。随着BMI升高，代谢有明显的恶化趋势，而随着BMI降低，代谢有改善趋势。
