Lin Hanli, Zhang Liqun, Zheng Ruizhi, Zheng Yishan
Department of Cardiology Department of Intensive Care Unit, Zhejiang Putuo Hospital, Zhoushan Department of Epidemiology and Statistic, Zhejiang University, Hangzhou, Zhejiang Department of Intensive Care Unit, The Second Hospital of Nanjing. Teaching Hospital of Medical School of Nanjing University, Nanjing, Jiangsu, China.
Medicine (Baltimore). 2017 Nov;96(47):e8838. doi: 10.1097/MD.0000000000008838.
We conducted a systematic review and meta-analysis to firstly obtain a reliable estimation of the prevalence of metabolically healthy obese (MHO) individuals in obesity, then assessed the risk of developing metabolic abnormalities (MA) among MHO individuals. At last, we evaluated the effects of traditional lifestyle interventions on metabolic level for MHO subjects.
A systematic review and meta-analysis (PRISMA) guideline were conducted, and original studies were searched up to December 31, 2016. The prevalence of MHO in obesity from each study was pooled using random effects models. The relative risks (RRs) were pooled to determine the risk of developing MA for MHO compared with metabolically healthy normal-weight (MHNW) subjects. For the meta-analysis of intervention studies, the mean difference and standardized mean differences were both estimated for each metabolic parameter within each study, and then pooled using a random-effects model.
Overall, 40 population-based studies reported the prevalence of MHO in obesity, 12 cohort studies and 7 intervention studies were included in the meta-analysis. About 35.0% obese individuals were metabolically healthy in the obese subjects. There were dramatic differences in the prevalence among different areas. However, 0.49 (95% confidence intervals [CI]: 0.38 to 0.60) of the MHO individuals would develop one or more MA within 10 years. Compared with MHNW subjects, the MHO subjects presented higher risk of incident MA (pooled RR = 1.80, 95%CI: 1.53-2.11). Following intervention, there was certain and significant improvement of metabolic state for metabolically abnormal obesity (MAO) subjects. Only diastolic blood pressure had reduced for MHO individuals after intervention.
Almost one-third of the obese individuals are in metabolic health. However, they are still at higher risk of advancing to unhealthy state. Therefore, it is still needed to advise MHO individuals to maintain or adopt a healthy lifestyle, so as to counterbalance the adverse effects of obesity.
我们进行了一项系统评价和荟萃分析，首先要获得肥胖人群中代谢健康肥胖（MHO）个体患病率的可靠估计值，然后评估MHO个体发生代谢异常（MA）的风险。最后，我们评估了传统生活方式干预对MHO受试者代谢水平的影响。
按照系统评价和荟萃分析（PRISMA）指南进行研究，检索截至2016年12月31日的原始研究。使用随机效应模型汇总每项研究中肥胖人群中MHO的患病率。汇总相对风险（RRs）以确定MHO与代谢健康正常体重（MHNW）受试者相比发生MA的风险。对于干预研究的荟萃分析，估计每项研究中每个代谢参数的平均差和标准化平均差，然后使用随机效应模型进行汇总。
总体而言，40项基于人群的研究报告了肥胖人群中MHO的患病率，荟萃分析纳入了12项队列研究和7项干预研究。肥胖受试者中约35.0%的肥胖个体代谢健康。不同地区的患病率存在显著差异。然而，49%（95%置信区间[CI]：0.38至0.60）的MHO个体在10年内会发生一种或多种MA。与MHNW受试者相比，MHO受试者发生MA的风险更高（汇总RR = 1.80，95%CI：1.53 - 2.11）。干预后，代谢异常肥胖（MAO）受试者的代谢状态有一定且显著的改善。干预后MHO个体仅舒张压有所降低。
几乎三分之一的肥胖个体处于代谢健康状态。然而，他们仍有较高风险发展为不健康状态。因此，仍需建议MHO个体保持或采用健康的生活方式，以抵消肥胖的不利影响。
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