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. 2018 Oct;8(5):305-312.
doi: 10.1111/cob.12263. Epub 2018 Jul 12.

Individuals With Obesity but No Other Metabolic Risk Factors Are Not at Significantly Elevated All-Cause Mortality Risk in Men and Women

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Free PMC article

Individuals With Obesity but No Other Metabolic Risk Factors Are Not at Significantly Elevated All-Cause Mortality Risk in Men and Women

J L Kuk et al. Clin Obes. .
Free PMC article

Abstract

Studies have examined mortality risk for metabolically healthy obesity, defined as zero or one metabolic risk factors but not as zero risk factors. Thus, we sought to determine the independent mortality risk associated with obesity or elevated glucose, blood pressure or lipids in isolation or clustered together. The sample included 54 089 men and women from five cohort studies (follow-up = 12.8 ± 7.2 years and 4864 [9.0%] deaths). Individuals were categorized as having obesity or elevated glucose, blood pressure or lipids alone or clustered with obesity or another metabolic factor. In our study sample, 6% of individuals presented with obesity but no other metabolic abnormalities. General obesity (hazard ratios [HR], 95% CI = 1.10, 0.8-1.6) and abdominal obesity (HR = 1.24, 0.9-1.7) in the absence of metabolic risk factors were not associated with mortality risk compared to lean individuals. Conversely, diabetes, hypertension and dyslipidaemia in isolation were significantly associated with mortality risk (HR range = 1.17-1.94, P < 0.05). However, when using traditional approaches, obesity (HR = 1.12, 1.02-1.23) is independently associated with mortality risk after statistical adjustment for the other metabolic risk factors. Similarly, metabolically healthy obesity, when defined as zero or one risk factor, is also associated with increased mortality risk (HR = 1.15, 1.01-1.32) as compared to lean healthy individuals. Obesity in the absence of metabolic abnormalities may not be associated with higher risk for all-cause mortality compared to lean healthy individuals. Conversely, elevation of even a single metabolic risk factor is associated with increased mortality risk.

Keywords: Body mass index; hypertension; metabolic syndrome; waist circumference.

Figures

Figure 1
Figure 1
Hazards ratio of all‐cause mortality by health status. *HR significantly different from No RF (Referent, P < 0.05). Figures are adjusted for age, gender, white ethnicity, smoking status and follow‐up time. No RF = low risk for the other metabolic variables and no obesity. RF = at least one additional preclinical or clinical metabolic risk factor or obesity (Table 1). Dlipid, dyslipidaemia; HTN, hypertension; OW, overweight; PreDiab, preclinical diabetes; PreDL, preclinical Dyslipidaemia; PreHTN, preclinical hypertension.
Figure 2
Figure 2
Association between waist circumference and metabolic status and all‐cause mortality risk. *HR significantly different from No RF (Referent, P < 0.05). Figures are adjusted for age, gender, white ethnicity, smoking status and follow‐up time. No RF = low risk for the metabolic variables. RF = at least one additional preclinical or clinical metabolic risk factor. PreAbOB = preclinical abdominal obesity (Men: waist circumference: 94–101.9 cm; Women: waist circumference: 80–87.9 cm). AbOB = abdominal obesity (Men: waist circumference: ≥102 cm; Women: waist circumference: ≥88 cm).

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