Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui-Jin 2nd Road, Shanghai, 200025, China.
Department of Endocrine and Metabolic Diseases Rui-Jin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Diabetologia. 2020 Jul;63(7):1312-1323. doi: 10.1007/s00125-020-05116-5. Epub 2020 Mar 4.
AIMS/HYPOTHESIS: The cardiometabolic risk associated with metabolically healthy obesity (MHO) remains the subject of debate. It is unclear whether MHO is a transient condition that affects subclinical atherosclerosis risk. In this study, we aimed to investigate the association of MHO and its transition over time with incident subclinical atherosclerosis.
A prospective study was conducted with 6220 Chinese adults who were free of cardiovascular disease (CVD) at baseline. Obesity was defined as BMI ≥25.0 kg/m. Metabolic health was defined as an individual having fewer than two of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP ATP III) criteria for components of the metabolic syndrome (excluding waist circumference). Subclinical atherosclerosis was measured by brachial-ankle pulse wave velocity, pulse pressure and albuminuria, separately or combined. Participants were cross-classified by BMI categories and by metabolic health status and its transition during follow-up. Inverse probability weighted logistic regression models were used to estimate ORs and 95% CIs for subclinical atherosclerosis.
The MHO phenotype accounted for 16.3% of the total population and 32.8% of the population with obesity at baseline. Baseline MHO was not significantly associated with incident subclinical atherosclerosis. During a follow-up period of 4.4 years, 46.8% of individuals with MHO developed a metabolically unhealthy status. Those with transient MHO had an increased risk of composite subclinical atherosclerosis compared with those in the metabolically healthy non-obesity reference group (OR 2.52 [95% CI 1.89, 3.36]). A transition from metabolically unhealthy to healthy status was shown to decrease the outcome risk. The relationship between BMI and subclinical atherosclerosis was partly mediated by BP and plasma glucose.
CONCLUSIONS/INTERPRETATION: MHO is not a stable condition and transient MHO conferred an increased risk of subclinical atherosclerosis, the early stage of CVD. Hence, individuals may benefit from early behavioural or medical management in order to avoid a deterioration of metabolic status and prevent atherosclerosis and CVD.
目的/假设：代谢健康型肥胖（MHO）与心脏代谢风险之间的关系仍存在争议。目前尚不清楚 MHO 是否是一种影响亚临床动脉粥样硬化风险的短暂状态。在这项研究中，我们旨在研究 MHO 及其随时间的变化与亚临床动脉粥样硬化事件的相关性。
本前瞻性研究纳入了 6220 名基线时无心血管疾病（CVD）的中国成年人。肥胖定义为 BMI≥25.0kg/m²。代谢健康定义为个体的成人国家胆固醇教育计划专家组对检测、评估和治疗成人高胆固醇血症（NCEP ATP III）标准中，代谢综合征的组成部分（不包括腰围）不超过两个。亚临床动脉粥样硬化通过肱踝脉搏波速度、脉压和白蛋白尿分别或联合进行测量。参与者根据 BMI 类别和随访期间的代谢健康状况及其变化进行交叉分类。采用逆概率加权逻辑回归模型估计亚临床动脉粥样硬化的比值比（OR）和 95%置信区间（CI）。
MHO 表型占总人群的 16.3%，占基线肥胖人群的 32.8%。基线 MHO 与亚临床动脉粥样硬化的发生无显著相关性。在 4.4 年的随访期间，46.8%的 MHO 患者发展为代谢不健康状态。与代谢健康非肥胖参考组相比，短暂 MHO 患者的复合亚临床动脉粥样硬化风险增加（OR 2.52[95%CI 1.89, 3.36]）。从代谢不健康状态转变为健康状态可降低结果风险。BMI 与亚临床动脉粥样硬化之间的关系部分由血压和血浆葡萄糖介导。
结论/解释：MHO 不是一种稳定的状态，短暂的 MHO 会增加亚临床动脉粥样硬化的风险，这是 CVD 的早期阶段。因此，个体可能受益于早期的行为或医疗管理，以避免代谢状态的恶化，预防动脉粥样硬化和 CVD。
