Association between metabolically healthy obesity and atrial fibrillation: A systematic review and meta-analysis of longitudinal studies

Xiao Liu; Jitao Ling; Yifan Wu; Huilei Zhao; Yuzhe Hu; Zhiwei Yan; Wengen Zhu; Peng Yu; Jinfeng Wang; Yuling Zhang; Tommaso Bucci; Gregory Y H Lip

doi:10.1016/j.dsx.2025.103228

Association between metabolically healthy obesity and atrial fibrillation: A systematic review and meta-analysis of longitudinal studies

Diabetes Metab Syndr. 2025 Apr 21;19(4):103228. doi: 10.1016/j.dsx.2025.103228. Online ahead of print.

Authors

Xiao Liu¹, Jitao Ling², Yifan Wu², Huilei Zhao³, Yuzhe Hu², Zhiwei Yan⁴, Wengen Zhu⁵, Peng Yu⁶, Jinfeng Wang⁷, Yuling Zhang⁷, Tommaso Bucci⁸, Gregory Y H Lip⁹

Affiliations

¹ Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, Guangdong, China; Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore. Electronic address: liux587@mail.sysu.edu.cn.
² Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
³ Anesthesiology Department, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
⁴ Department of Sports Rehabilitation, College of Human Kinesiology, Shenyang Sport University, Shenyang, China.
⁵ Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
⁶ Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China. Electronic address: PEYU1@mgh.harvard.edu.
⁷ Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, Guangdong, China; Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore.
⁸ Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool JohnMoores University and Liverpool Heart and Chest Hospital, Liverpool, UK; Department of General and Specialized Surgery, Sapienza University of Rome, Rome, Italy.
⁹ Liverpool Centre of Cardiovascular Science at University of Liverpool, Liverpool JohnMoores University and Liverpool Heart and Chest Hospital, Liverpool, UK; Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

PMID: 40306065
DOI: 10.1016/j.dsx.2025.103228

Abstract

Introduction: Obesity is not a single diagnosis, and the association of 'metabolically unhealthy' obesity with cardiovascular disease is well-described. However, the relationship between metabolically healthy obesity (MHO) and atrial fibrillation (AF) is still debated.

Objective: Our objective is to investigate the association between MHO and the risk of AF.

Methods: A comprehensive search of databases, including PubMed, EMBASE, Web of Science, and the Cochrane Library regarding longitudinal studies of MHO and risk of AF was performed. Random effects were used to pool the effect estimates.

Results: Nine cohort studies comprising 4,250,557 participants were included. The pooled results revealed that individuals with MHO were associated with a greater incidence of AF than those with a metabolically healthy normal weight (HR: 1.34, 95 % CI: 1.26 to 1.42) with moderate certainty according to the Grading of Recommendations Assessment, Development, and Evaluation assessment. Individuals with MHO were associated with a lower risk of AF compared with participants with metabolically unhealthy obesity (RR: 0.48, 95 % CI: 0.36 to 0.64). Individuals with MHO were not significantly associated with the risk of AF as compared to metabolically unhealthy normal weight (HR: 1.04, 95 % CI: 0.89 to 1.22).

Conclusion: MHO is associated with a greater incidence of AF, highlighting the importance of weight reduction in individuals without metabolic disorders in reducing the risk of AF.

Registration: PROSPERO - registration number CRD42023432195.

Keywords: Atrial fibrillation; Meta-analysis; Metabolically healthy obesity; Metabolically unhealthy obesity; Obesity.