Association of Obesity Phenotypes with Electrocardiographic Markers of Poor Outcomes in the General Population

Obesity (Silver Spring). 2019 Dec;27(12):2076-2083. doi: 10.1002/oby.22647. Epub 2019 Oct 27.


Objective: This study aimed to investigate the association of metabolically healthy obesity (MHO) and other obesity phenotypes with electrocardiographic (ECG) markers to understand the pathophysiological basis of increased cardiovascular disease (CVD) risk associated with these phenotypes.

Methods: A total of 3,700 participants (58.7 ± 13.6 years, 52% women) without CVD from the third National Health and Nutrition Examination Survey (NHANES III) were included. Logistic regression was used to examine the cross-sectional association between obesity phenotypes (metabolically healthy without obesity [MHNO; reference], metabolically unhealthy without obesity, MHO, and metabolically unhealthy obesity) with ECG markers (PR interval, P-wave duration, QRS duration, and QT interval).

Results: Higher odds of prolonged PR interval, P-wave duration, and QRS duration were observed among all phenotypes compared with MHNO, with the highest in participants with obesity with or without metabolic syndrome. However, for QT interval, the trend of association with obesity phenotypes was as follows, from the strongest to the least strong: metabolically unhealthy obesity, metabolically healthy without obesity, and then MHO, compared with MHNO.

Conclusions: An association of obesity phenotypes with ECG abnormalities further raises doubt about the concept of MHO as a healthy state. Variations in associations with ECG markers may suggest that metabolic syndrome and obesity have a different relationship with different CVD outcomes and may explain some of the inconsistent CVD estimates for MHO.

MeSH terms

  • Cardiovascular Diseases / diagnosis*
  • Cardiovascular Diseases / etiology*
  • Cardiovascular Diseases / pathology
  • Cross-Sectional Studies
  • Electrocardiography / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Obesity / complications*
  • Obesity, Metabolically Benign / complications*