新诊断标准下代谢健康型肥胖与心血管疾病风险之间概率关系的贝叶斯网络分析

A Bayesian network analysis of the probabilistic relationships between metabolically healthy obesity and cardiovascular disease risk under new diagnostic criteria.

作者信息

Chen Shuo, Wu Peixian, Peng Weiqun, Zhang Hongai

机构信息

Department of Endocrinology, Peking University Shenzhen Hospital, Shenzhen, China.

Department of Cardiology, Ankang Hospital of Traditional Chinese Medicine, Ankang, China.

出版信息

Technol Health Care. 2025;33(1):649-658. doi: 10.3233/THC-241472.

DOI:10.3233/THC-241472

PMID:39269875

Abstract

BACKGROUND

The relationship between metabolically healthy obesity (MHO) and cardiovascular disease (CVD) risk remains debated. The critical point may be the lack of consensus on MHO's definition and diagnostic criteria.

OBJECTIVE

This study aimed to investigate the association of MHO status with arteriosclerosis-CVD (ASCVD) risk in Chinese under new diagnostic criteria.

METHODS

Participants aged 35-79 in the 2009 China Health and Nutrition Survey cohort were included. The 10-year ASCVD risk was predicted by the prediction for ASCVD risk in China, and participants with a predicted risk of ⩾ 10% were classified into the high-risk group. The Bayesian network (BN) models were constructed to characterize the multivariable probabilistic connections between metabolically obesity phenotypes and ASCVD risk.

RESULTS

The 10-year ASCVD risk score and the proportion of individuals at ASCVD high risk were significantly different between metabolically obesity phenotypes (P< 0.001). BN reasoning results showed that MHO individuals were not significantly associated with a 10-year ASCVD risk. Among metabolically unhealthy individuals, the conditional probability of high ASCVD risk increased with the Body Mass Index (BMI), with the conditional probability of high ASCVD risk was 24.63% (95% CI: 22.81-26.55%), 32.97% (95% CI: 30.75-35.27%) and 40.2% (95% CI: 36.64-43.86%) for metabolically unhealthy normal weight (MUNW), metabolically healthy overweight weight (MHOW), and metabolically unhealthy obesity (MUO) group, respectively. Subgroup analysis showed that MHO individuals were at increased risk of CVD compared with metabolically healthy normal weight (MHNW) individuals only in females.

CONCLUSION

These results showed that there was no significant increase in ASCVD risk of MHO phenotype based on the new diagnostic criteria, suggesting that MHO is in a relatively healthy state.

摘要

背景

代谢健康型肥胖（MHO）与心血管疾病（CVD）风险之间的关系仍存在争议。关键点可能在于对MHO的定义和诊断标准缺乏共识。

目的

本研究旨在根据新的诊断标准，探讨中国人群中MHO状态与动脉硬化性心血管疾病（ASCVD）风险的关联。

方法

纳入2009年中国健康与营养调查队列中年龄在35 - 79岁的参与者。采用中国ASCVD风险预测模型预测10年ASCVD风险，预测风险≥10%的参与者被归类为高危组。构建贝叶斯网络（BN）模型，以描述代谢性肥胖表型与ASCVD风险之间的多变量概率联系。

结果

代谢性肥胖表型之间的10年ASCVD风险评分和ASCVD高危个体比例存在显著差异（P<0.001）。BN推理结果显示，MHO个体与10年ASCVD风险无显著关联。在代谢不健康个体中，ASCVD高风险的条件概率随体重指数（BMI）增加而升高，代谢不健康正常体重（MUNW）、代谢健康超重（MHOW）和代谢不健康肥胖（MUO）组的ASCVD高风险条件概率分别为24.63%（95%CI：22.81 - 26.55%）、32.97%（95%CI：30.75 - 35.27%）和40.2%（95%CI：36.64 - 43.86%）。亚组分析显示，仅在女性中，MHO个体与代谢健康正常体重（MHNW）个体相比，CVD风险增加。