The association of incident hypertension with metabolic health and obesity status: definition of metabolic health does not matter

Differences in the levels of inflammatory markers between metabolically healthy obese and other obesity phenotypes in adults: A systematic review and meta-analysis

AIMS

The aim of this study was to systematically review and analyze differences in the levels of C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) comparing metabolically healthy but obese (MHO) with metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), and metabolically unhealthy obese (MUO) subjects.

DATA SYNTHESIS

We searched PubMed, Embase, Web of Science, and Scopus for studies that matched the relevant search terms. Differences in inflammatory marker levels between MHO and the other three phenotypes were pooled as standardized mean differences (SMD) or differences of medians (DM) using a random-effects model. We included 91 studies reporting data on 435,007 individuals. The CRP levels were higher in MHO than in MHNO subjects (SMD = 0.63, 95% CI: 0.49, 0.76; DM = 0.83 mg/L, 95% CI: 0.56, 1.11). The CRP levels were higher in MHO than in MUNO subjects (SMD = 0.16, 95% CI: 0.05, 0.28; DM = 0.39 mg/L, 95% CI: 0.09, 0.69). The CRP levels were lower in MHO than in MUO individuals (SMD = -0.43, 95% CI: -0.54, -0.31; DM = -0.82 mg/L, 95% CI: -1.16, -0.48). The IL-6 levels in MHO were higher than in MHNO while lower than in MUO subjects. The TNF-α levels in MHO were higher than in MHNO individuals.

CONCLUSIONS

This review provides evidence that CRP levels in MHO are higher than in MHNO and MUNO subjects but lower than in MUO individuals. Additionally, IL-6 levels in MHO are higher than in MHNO but lower than in MUO subjects, and TNF-α levels in MHO are higher than in MHNO individuals.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO number: CRD42021234948.

Metabolically healthy obesity: Misleading phrase or healthy phenotype?

Obesity is a heterogenous condition with multiple different phenotypes. Among these a particular subtype exists named as metabolically healthy obesity (MHO). MHO has multiple definitions and its prevalence varies according to study. The potential mechanisms underlying the pathophysiology of MHO include the different types of adipose tissue and their distribution, the role of hormones, inflammation, diet, the intestinal microbiota and genetic factors. In contrast to the negative metabolic profile associated with metabolically unhealthy obesity (MUO), MHO has relatively favorable metabolic characteristics. Nevertheless, MHO is still associated with many important chronic diseases including cardiovascular disease, hypertension, type 2 diabetes, chronic kidney disease as well as certain types of cancer and has the risk of progression into the unhealthy phenotype. Therefore, it should not be considered as a benign condition. The major therapeutic alternatives include dietary modifications, exercise, bariatric surgery and certain medications including glucagon-like peptide-1 (GLP-1) analogs, sodium-glucose cotransporter-2 (SGLT-2) inhibitors and tirzepatide. In this review, we discuss the significance of MHO while comparing this phenotype with MUO.

Sex-specific differences in the association between metabolically healthy overweight/obesity and the risk of hypertension in Chinese ethnic minorities

OBJECTIVE

To estimate and compare sex-specific differences between metabolically healthy overweight/obesity (MHOO) and the risk of hypertension among Dong, Bouyei, and Miao adults in southwest China.

METHODS

MHOO was diagnosed when the patient had a body mass index ≥24 kg/m² and the presence of ≤1 component of metabolic syndrome. The main outcome was the occurrence of hypertension after the diagnosis or measurement by a physician at the baseline survey. Multivariate logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) between MHOO and the risk of hypertension.

RESULTS

We enrolled 16,433 Chinese Dong, Bouyei, and Miao adults. Using the metabolically healthy normal weight (MHNW) as a reference and after adjusting for confounders, the association between MHOO and the risk of hypertension was stronger in Dong (OR = 1.46, 95% CI: 1.07-2.00) and Miao (OR = 2.05, 95% CI: 1.48-2.85) men and did not exist in Bouyei men (OR = 1.14, 95% CI: 0.81-1.60). After adjusting for the age, the association between MHOO and the risk of hypertension was stronger in men than in women among Dong adults aged 30-59 years (OR = 1.64, 95% CI: 1.12-2.40) and did not differ between men and women among Dong adults aged 60-79 years or among Miao or Bouyei adults.

CONCLUSION

The results of this study demonstrated sex-specific differences in the association between MHOO and the risk of hypertension and that sex-specific differences further differed among Dong, Bouyei, and Miao adults.

Prognostic Value of Triglyceride and Glucose Index for Incident Type 2 Diabetes beyond Metabolic Health and Obesity

BACKGROUND

Metabolically healthy obese (MHO) phenotype is metabolically heterogeneous in terms of type 2 diabetes (T2D). Previously, the triglyceride and glucose (TyG) index has been considered for identifying metabolic health and future risk of T2D. This study aimed to evaluate the risk of incident T2D according to obesity status and metabolic health, categorized by four different criteria and the TyG index.

METHODS

The study included 39,418 Koreans without T2D at baseline. The risk of T2D was evaluated based on four different definitions of metabolic health and obesity status and according to the baseline TyG index within each metabolic health and obesity group.

RESULTS

During the median follow-up at 38.1 months, 726 individuals developed T2D. Compared with the metabolically healthy non-obese (MHNO) group with low TyG index, the MHO group with high TyG index showed increased risk of T2D in all four definitions of metabolic health with multivariate-adjusted hazard ratios of 2.57 (95% confidence interval [CI], 1.76 to 3.75), 3.72 (95% CI, 2.15 to 6.43), 4.13 (95% CI, 2.67 to 6.38), and 3.05 (95% CI, 2.24 to 4.15), when defined by Adult Treatment Panel III, Wildman, Karelis, and homeostasis model assessment (HOMA) criteria, respectively.

CONCLUSION

MHO subjects with high TyG index were at an increased risk of developing T2D compared with MHNO subjects, regardless of the definition of metabolic health. TyG index may serve as an additional factor for predicting the individual risk of incident T2D in MHO subjects.

Insulin Resistance Increases Serum Immunoglobulin E Sensitization in Premenopausal Women

Background

Although studies have shown that obesity is associated with aeroallergen sensitization (atopy), controversy still exists. We aimed to investigate the association between metabolic status, obesity, and atopy stratified by sex and menopausal status.

Methods

A total of 1,700 adults from the 2010 Korean National Health and Nutrition Examination Survey were classified into metabolically healthy nonobese (MHNO), metabolically unhealthy nonobese (MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO) by body mass index and insulin resistance. Atopy was defined as a positive response to at least one aeroallergen. Multiple regression analysis was used to evaluate the risk of immunoglobulin E (IgE) elevation or atopy in relation to the degree of metabolic abnormality and obesity.

Results

In premenopausal women, total IgE was positively correlated with obesity and insulin resistance. MUNO participants had a higher risk of having elevated total IgE compared to MHNO participants (odds ratio [OR], 2.271; 95% confidence interval [CI], 1.201 to 4.294), while MHO participants did not show a significant difference (OR, 1.435; 95% CI, 0.656 to 3.137) in premenopausal women. MUNO, but not MHO was also associated with atopy (OR, 2.157; 95% CI, 1.284 to 3.625). In men and postmenopausal women, there was no significant difference between metabolic status, obesity, and atopy among groups.

Conclusion

Increased insulin resistance is associated with total IgE and atopy in premenopausal women but not in postmenopausal women or men.

The patterns of lifestyle, metabolic status, and obesity among hypertensive Korean patients: a latent class analysis

OBJECTIVES

This study aimed to identify latent classes in hypertensive patients based on the clustering of factors including lifestyle risk factors, metabolic risk factors, and obesity in each sex.

METHODS

This cross-sectional study included 102,780 male and 103,710 female hypertensive patients who underwent health check-ups at 16 centers in Korea, in 2018. A latent class analysis approach was used to identify subgroups of hypertensive patients. Multinomial logistic regression was performed to examine the association between latent classes and comorbidities of hypertension.

RESULTS

A four-class model provided the best fit for each sex. The following latent classes were identified: Class I (male: 16.9%, female: 1.7%; high risk of lifestyle behaviors [HB] with metabolic disorders and obesity [MO]), Class II (male: 32.4%, female: 47.1%; low risk of lifestyle behaviors [LB] with MO), Class III (male: 15.3%, female: 1.8%; HB with metabolic disorders and normal weight [MNW]), Class IV (male: 35.5%, female: 49.4%; LB with MNW). Lifestyle patterns in the latent classes were classified as high-risk or low-risk according to smoking and high-risk drinking among male, and presented complex patterns including physical inactivity alone or in combination with other factors, among female. Stage 2 hypertensive or diabetic individuals were likely to belong to classes including obesity (HB-MO, LB-MO) in both sexes, and additionally belonged to the HB-MNW class in male.

CONCLUSIONS

Metabolic disorders were included in all latent classes, with or without lifestyle risk factors and obesity. Hypertensive females need to manage obesity, and hypertensive males need to manage lifestyle risk factors and obesity. Sex-specific lifestyle behaviors are important for controlling hypertension.

Metabolically healthy general and abdominal obesity are associated with increased risk of hypertension

Metabolically healthy obesity refers to a subset of obese people with a normal metabolic profile. We aimed to explore the association between metabolically healthy and obesity status and risk of hypertension among Chinese adults from The Rural Chinese Cohort Study. This prospective cohort study enrolled 9137 Chinese adults without hypertension, type 2 diabetes or treatment for lipid abnormality at baseline (2007–2008) and followed up during 2013–2014. Modified Poisson regression models were used to examine the risk of hypertension by different metabolically healthy and obesity status, estimating relative risks (RR) and 95 % CI. During 6 years of follow-up, we identified 1734 new hypertension cases (721 men). After adjusting for age, sex, smoking and other confounding factors, risk of hypertension was increased with metabolically healthy general obesity (MHGO) defined by BMI (RR 1·75, 95 % CI 1·02, 3·00) and metabolically healthy abdominal obesity (MHAO) defined by waist circumference (RR 1·51, 95 % CI 1·12, 2·04) as compared with metabolically healthy non-obesity. The associations between metabolically healthy and obesity status and hypertension outcome were consistent after stratifying by sex, age, smoking, alcohol drinking and physical activity. Both MHGO and MHAO were associated with increased risk of hypertension. Obesity control programmes should be implemented to prevent or delay the development of hypertension in rural China.

Risk of Incident Dementia According to Metabolic Health and Obesity Status in Late Life: A Population-Based Cohort Study

CONTEXT

The risk for dementia among subjects who are obese with normal metabolic profiles, or called metabolically healthy obese (MHO), remains uninvestigated.

OBJECTIVE

To determine the association between late-life metabolic health and obesity status and risk of incident dementia.

DESIGN

Retrospective cohort study.

SETTING

The National Health Insurance System, Republic of Korea.

PATIENTS

A total of 12,296,863 adults >50 years old who underwent health examinations from 2009 to 2012 without baseline history of dementia.

MAIN OUTCOME MEASURE

Incident overall dementia, Alzheimer's disease (AD), and vascular dementia (VaD).

RESULTS

Among subjects ≥60 years old, 363,932 (6.4%) developed dementia during a median follow-up of 65 months (interquartile range 51 to 74 months). The MHO group showed the lowest incidence of overall dementia [hazard ratio (HR) 0.85; 95% CI, 0.84 to 0.86] and AD (HR 0.87; 95% CI, 0.86 to 0.88), but not VaD, compared with the metabolically healthy nonobese group. All components of metabolic syndrome except obesity significantly elevated the risk of dementia, and these associations were more pronounced in VaD. In particular, being underweight dramatically increased the risk of dementia.

CONCLUSIONS

The MHO phenotype in late life demonstrated lower risk of overall dementia and AD but not VaD. Additional studies in other populations are warranted to elucidate current results and may predict individuals most at risk for developing dementia.

Racial/Ethnic Differences in Cardiometabolic Risk in a Community Sample of Sexual Minority Women

Purpose: To examine the intersection of sexual identity and race/ethnicity on self-reported cardiometabolic risk in sexual minority women (SMW). Methods: Data from the Chicago Health and Life Experiences of Women study were analyzed. Logistic regression models examined racial/ethnic differences in cardiometabolic risk (including obesity, hypertension, and diabetes) in SMW, accounting for psychosocial and behavioral factors. A variable accounting for the intersection of sexual identity and race/ethnicity was added to regression models (White lesbian women were the reference group). Results: The analytic sample included 601 SMW (237 White, 219 Black, 145 Latina). Black (adjusted odds ratio [AOR] 2.96, 95% confidence interval [CI]=1.48-5.94) and Latina (AOR 2.30, 95% CI=1.18-4.48) SMW had higher rates of lifetime trauma than White SMW. Black SMW reported higher rates of obesity (AOR 3.05, 95% CI=1.91-4.88), hypertension (AOR 1.99, 95% CI=1.08-3.66), and diabetes (AOR 3.77, 95% CI=1.46-9.74) relative to White SMW. Intersectional analyses revealed that Black lesbian (AOR 2.94, 95% CI=1.74-4.97) and Black bisexual (AOR 3.43, 95% CI=1.69-6.96) women were more likely to be obese than White lesbian women. Black lesbian women also reported higher rates of hypertension (AOR 2.09, 95% CI=1.08-4.04) and diabetes (AOR 3.31, 95% CI=1.26-8.67) than White lesbian women. No differences in cardiometabolic risk were found between Latina and White SMW. Conclusion: This study extends previous research on racial/ethnic differences in cardiometabolic risk among SMW. Prevention strategies are needed to reduce cardiometabolic risk in Black SMW. Findings highlight the need for cardiovascular disease research in SMW that incorporates longitudinal designs and objective measures.

Association of Variability in Body Mass Index and Metabolic Health With Cardiometabolic Disease Risk

Background Metabolic syndrome is associated with high risk of cardiovascular disease, although risk may differ according to the specific conditions present and variability in those conditions. Methods and Results We defined obesity (body mass index [BMI] ≥30 kg/m2) and metabolic health (<2 nonobesity National Cholesterol Education Program Adult Treatment Panel III conditions) among 3632 Framingham Heart Study offspring cohort participants (mean age, 50.8 years; 53.8% women) who were followed up from 1987 to 2014. We defined participants whose variance independent of the mean for a metabolic syndrome-associated measure was in the top quintile as being "variable" for that measure. Variable metabolic health was defined as ≥2 variable nonobesity metabolic syndrome components. We investigated the interaction between obesity and metabolic health in their associations with cardiometabolic disease and cardiovascular disease using Cox proportional hazards regression. In addition, we estimated the associations of BMI variability and variable metabolic health with study outcomes within categories of obesity and metabolic health status, respectively. We observed 567 incident obesity (41 439 person-years), 771 incident metabolically unhealthy state (25 765 person-years), 272 incident diabetes mellitus (56 233 person-years), 503 incident hypertension (12 957 person-years), 589 cardiovascular disease (60 300 person-years), and 195 chronic kidney disease (47 370 person-years) events on follow-up. Obesity and being metabolically unhealthy were independently and positively associated with all outcomes. BMI variability, compared with stable BMI, was associated with 163%, 67%, 58%, and 74% higher risks of having obesity, becoming metabolically unhealthy, having diabetes mellitus, and having hypertension, respectively, among nonobese participants. Variable metabolic health, compared with stable metabolic health, was associated with a 28% higher risk of cardiovascular disease, among metabolically healthy participants. Conclusions We did not observe evidence for a positive interaction between obesity and metabolic health status with regard to study outcomes. BMI and metabolic health variability are associated with adverse health outcomes.

Sex specific impact of different obesity phenotypes on the risk of incident hypertension: Tehran lipid and glucose study

Background

To investigate the association between different obesity phenotypes and the risk of incident hypertension among both genders.

Methods

The study population included 3659 Iranians (men = 1540), aged ≥20 years free of hypertension at baseline. Participants were classified into six categories of body mass index (BMI)-metabolic health status, in which unhealthy metabolic status was defined based on the presence of > 1 component of metabolic syndrome (MetS) using the joint interim statement (JIS) criteria or the presence of insulin resistance (IR). The association between different obesity phenotypes and incident hypertension was assessed using multivariate Cox's proportional hazard models adjusted for age, current smoking, low physical activity, diabetes mellitus, family history of premature cardiovascular disease, estimated glomerular filtration rate, phase of recruitment, BMI and systolic blood pressure, considering metabolically healthy normal weight group as the reference.

Results

After a median follow-up of 11.6 years 1122 participants (men = 493) experienced hypertension. Using JIS criteria, a significant higher risk of hypertension was observed among metabolically healthy obese and well as metabolically unhealthy groups among men in the age adjusted model; however, a significant higher risk in the fully adjusted model was seen among women in the metabolically healthy obese [hazard ratio (HR) 95% confidence interval (CI) 1.96(1.16-3.32)] as well as metabolically unhealthy normal weight [1.98(1.37-2.86)], overweight [2.08(1.49-2.90)] and obese [2.06(1.27-3.30)] groups. Using insulin sensitive normal weight group as the reference, among men, being overweight or obese with and without IR was significant predictors of incident hypertension in the age adjusted model; however, among women, insulin resistant overweight [1.46(1.06-2.02)] and obese groups, [1.63(1.01-2.62)] showed significant risk in the fully adjusted model.

Conclusion

We concluded that first, there was significant difference between genders in the associations between obesity phenotypes and incident hypertension. Second, in general, metabolic status defined by MetS components as compared to IR could do better in identifying high risk women for hypertension. Third, women populations who are metabolically healthy obese using MetS definition or those with either > 1 component of metabolic syndrome or overweight/obese ones with IR should be prioritized for implementing urgent preventive strategies against hypertension focusing on lifestyle changes.

Risk of hypertension among different metabolic phenotypes: a systematic review and meta-analysis of prospective cohort studies

We performed a meta-analysis to assess the association of body mass index (BMI) and metabolic status with the risk of incident hypertension. Relevant studies were identified by searching comprehensive search via PubMed and Scopus search engines up to May 2018 and were analyzed using a random-effects model. Eight prospective studies were included in the analyses with metabolically healthy normal weight (MHNW) as the reference group. Pooled relative risks (RRs) and their 95% confidence intervals (CI) were calculated using random-effects or fixed-effect models when appropriate. Subgroup analysis was applied to define possible sources of heterogeneity. Overall, among 79090 participants, the risk of hypertension in metabolically unhealthy obese (MUHO) and metabolically healthy obese phenotypes (MHO) increased compared with the reference group (pooled effect size = 1.95, 95%CI: 1.87-2.04, P < 0.001 vs pooled effect size: 1.54, 95%CI: 1.48-1.61, P < 0.001, respectively). Also, a significant positive association between metabolically unhealthy normal weight (MUHNW) phenotype and the risk of hypertension was observed (pooled effect size = 1.48, 95%CI: 1.41-1.55, P < 0.001). Metabolically unhealthy overweight (MUHOW) and metabolically healthy overweight (MHOW) phenotypes had greater risk of hypertension compared with the MHNW phenotype (pooled effect size = 1.50, 95%CI: 1.13-1.71, P < 0.001 and pooled effect size = 1.18, 95%CI: 1.11-1.27, P < 0.001). This meta-analysis revealed that individuals with metabolic abnormality had a higher risk for hypertension and also suggests that MHOW/ MHO are not a benign condition. We are refuting the notion that overweight and obesity without metabolic abnormalities are benign conditions in all population.

The effect of metabolic health and obesity phenotypes on risk of hypertension: A nationwide population-based study using 5 representative definitions of metabolic health

Although obesity is clearly identified as a risk factor for hypertension, the association between its different metabolic phenotypes and hypertension remains unclear. We aimed to investigate this association and compare the degree of association between metabolic health and obesity phenotypes defined by 5 representative criteria and hypertension risk.This study used data from the China Health and Nutrition Survey 2009 wave, and the final analysis included 7632 subjects aged 18 to 85 years with available fasting blood samples and anthropometric measurements. Body mass index was used to define nonobese and obese status in subjects (cut-off value, 25 kg/m), and metabolic health state was respectively defined by 5 published criteria: the Adult Treatment Panel (ATP)-III, the Wildman, the Karelis, the homeostasis model assessment (HOMA), and the fasting blood glucose × triglyceride (TyG) criteria. Subjects were categorized into 4 phenotypes according to their metabolic health and obesity status: metabolically healthy nonobese (MHNO), metabolically unhealthy nonobese (MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO).A total of 2171 subjects (28.4% of the study population) had hypertension, and hypertension prevalence was significantly increased as weight increased for both metabolically healthy and metabolically unhealthy subjects. Within the MHO phenotypes, the prevalence ranged from 22.7% to 38.6% according to the Wildman and HOMA criteria, respectively. Compared to the MHNO phenotype, the MHO phenotype had an increased risk of hypertension, and the adjusted odds ratios for hypertension in MHO subjects were 1.94 (95% confidence interval 1.60-2.35) using the ATP-III criteria, 1.98 (1.61-2.43) using the Wildman criteria, 2.37 (1.88-2.99) using the Karelis criteria, 2.26 (1.96-2.61) using the HOMA criteria, and 2.54 (2.14-3.00) using the TyG criteria, respectively. A similar significant pattern was found in the MUO and MUNO phenotypes for risk of hypertension. Furthermore, the MUO phenotype consistently revealed the strongest degree of association with hypertension, following by the MHO and the MUNO phenotype.Both metabolically unhealthy status and obese status contributed to a higher risk of hypertension in Chinese adults. The MHO phenotype was not a benign condition and had substantial risk of hypertension compared to the MHNO phenotype. Thus, metabolic health status and obesity should be monitored together when managing hypertension risk.

An Overview of Metabolic Phenotyping in Blood Pressure Research

PURPOSE OF THE REVIEW

This review presents the analytical techniques, processing and analytical steps used in metabolomics phenotyping studies, as well as the main results from epidemiological studies on the associations between metabolites and high blood pressure.

RECENT FINDINGS

A variety of metabolomic approaches have been applied to a range of epidemiological studies to uncover the pathophysiology of high blood pressure. Several pathways have been suggested in relation to blood pressure including the possible role of the gut microflora, inflammatory, oxidative stress, and lipid pathways. Metabolic changes have also been identified associated with blood pressure lowering effects of diets high in fruits and vegetables and low in meat intake. However, the current body of literature on metabolic profiling and blood pressure is still in its infancy, not fully consistent and requires careful interpretation. Metabolic phenotyping is a promising approach to uncover metabolic pathways associated with high blood pressure and throw light into the complex pathophysiology of hypertension.

Prevalence of Metabolically Healthy Obesity (MHO) and its relation with incidence of metabolic syndrome, hypertension and type 2 Diabetes amongst individuals aged over 20 years in Ahvaz: A 5 Year cohort Study (2009-2014)

BACKGROUND

Today, obesity epidemic is one of the major health problems of the present century. One of the phenotypes of obesity is metabolically healthy obesity. It seems that these obese individuals suffer less from cardiovascular disease and metabolically unhealthy obesity. This study aimed to investigate the prevalence of metabolically healthy obesity (MHO) and its relationship with incidence of metabolic syndrome, diabetes and hypertension in individuals over 20 years in the city of Ahvaz.

MATERIALS AND METHODS

This study was a 5-year cohort study, which was conducted on adults between years 2009 to 2014.Participants who were randomly selected from individuals covered by the health centers in the city of Ahvaz in baseline population, were again recalled by these centers. The subjects completed the question aires, and anthropometric measurements and blood samples were prepared for performing tests based on Phase 1.

RESULTS

A total of 591 individuals Participated in this study, 281 (47.5%) were males and 310 (52.5%) females with mean age of 42.2±13.3 years. The prevalence of MHO was 19.5% in the baseline population. The cumulative incidence of metabolic syndrome, diabetes and hypertension in MHO individuals were 29.6%, 24.3% and 13%, respectively.

CONCLUSION

The prevalence of MHO was 19.5% in the baseline population. There was a specific relationship between MHO and incidence of metabolic syndrome and diabetes; however, there was a less significant relationship between MHO and hypertension.

Incidence of components of metabolic syndrome in the metabolically healthy obese over 9 years follow-up: the Atherosclerosis Risk In Communities study

Background

Some obese adults are not afflicted by the metabolic abnormalities often associated with obesity [the “metabolically healthy obese” (MHO)], however, they may be at increased risk of developing cardiometabolic abnormalities in the future. Little is known about the relative incidence of individual components of metabolic syndrome (MetSyn).

Methods

We used data from a multi-center, community-based cohort aged 45–64 years at recruitment [the Atherosclerosis Risk in Communities (ARIC) study] to examine the first appearance of any MetSyn component, excluding waist circumference. Body mass index (BMI, kg/m²) and cardiometabolic data were collected at four triennial visits. Our analysis included 3,969 adults who were not underweight and free of the components of MetSyn at the initial visit. Participants were classified as metabolically healthy normal weight (MHNW), over weight (MHOW) and MHO at each visit. Adjusted hazard ratios (HR) and 95% confidence intervals were estimated with proportional hazards regression models.

Results

The relative rate of developing each risk factor was higher among MHO than MHNW with the strongest association noted for elevated fasting glucose [MHO vs. MHNW, HR: 2.33 (1.77, 3.06)]. MHO was also positively associated with elevated triglycerides [HR: 1.63 (1.27, 2.09)], low HDL-C [HR: 1.68 (1.32, 2.13)] and elevated blood pressure [HR: 1.54 (1.26, 1.88)]. A similar, but less pronounced pattern was noted among the MHOW vs. MHNW.

Conclusions

We conclude that even among apparently healthy individuals, obesity and overweight are related to more rapid development of at least 1 cardiometabolic risk factor, and that elevations in blood glucose develop most rapidly.

Impact of Cardiorespiratory Fitness and Risk of Systemic Hypertension in Nonobese Versus Obese Men Who Are Metabolically Healthy or Unhealthy

Few data are available regarding the influence of body phenotype on systemic hypertension (SH) and whether cardiorespiratory fitness (CRF) attenuates this relation. We tested the hypothesis that obesity phenotypes and CRF would predict incident hypertension, evaluating 3,800 Korean men who participated in 2 health examinations in1998 to 2009. All participants were normotensive at baseline and were divided into 4 groups based on body mass index using the Asia-Pacific descriptors for obesity and metabolic health status and the National Cholesterol Education Program's adult treatment panel III (ATP-III) criteria. A metabolically healthy obese (MHO) phenotype was defined as a body mass index of ≥25 kg/m² with <2 metabolic abnormalities. CRF was directly measured by peak oxygen uptake, and the participants were divided into unfit and fit categories based on age-specific peak oxygen uptake percentiles. Compared with the metabolically healthy nonobese phenotype, MHO and metabolically unhealthy nonobese (MUNO) phenotypes were at increased risk of SH (relative risk [RR] = 1.47; 95% confidence interval [CI], 1.07 to 2.02 and 1.62, 1.21 to 2.16) after adjusting for potential confounders. Joint analysis showed that MHO or MUNO unfit men had 1.91 and 2.27 greater risk of incident SH, respectively. However, MHO fit men had no significant RR of incident SH (RR 1.37; 95% CI, 0.93 to 2.03), whereas MUNO fit men remained at increased risk (RR 1.48; 95% CI, 1.04 to 2.11) compared with their metabolically healthy nonobese fit counterparts. In conclusion, MHO and MUNO men were at increased risk of SH, but these risks were attenuated by fitness.

Metabolically healthy obesity: a friend or foe?

Obesity is associated with a reduced life expectancy, largely because obese individuals are at an increased risk of type 2 diabetes, cardiovascular disease, and several types of cancer. Much interest has recently focused on the concept of "all obesity is not created equally." Obese individuals without the metabolic abnormalities that commonly accompany excess adiposity, a condition known as metabolically healthy obesity (MHO), account for a substantial proportion of the obese adult population. Numerous possible mechanisms underlying MHO have been suggested, including adipose tissue distribution and inflammation. However, the prognostic value of MHO is controversial and considerably challenging. The lack of a standard definition for metabolic health and obesity as well as the dynamic properties of MHO may have contributed to these inconsistent results. This review aimed to present several current issues regarding MHO including its definition, epidemiology, natural course, suggested mechanisms, and clinical implications in the context of patient prognosis.

Association between obesity phenotypes and incident hypertension among Chinese adults: a prospective cohort study

OBJECTIVES

To explore the association between obesity phenotype and the risk of hypertension among Chinese adults.

STUDY DESIGN

A prospective cohort study.

METHODS

Two waves of data were collected in 2009 and 2011 by the China Health Nutrition Survey. According to International Diabetes Federation and Chinese obesity criteria, participants were divided into four groups: metabolically healthy non-overweight/obesity (MHNO), metabolically healthy overweight/obesity (MHO), metabolically abnormal non-overweight/obesity (MANO), and metabolically abnormal overweight/obesity (MAO). Logistic regression model was performed to estimate the risk of hypertension with obesity phenotype.

RESULTS

Among a total of 4604 adults aged 18-65 years at baseline, 467 developed hypertension during the 2-year follow-up period. After adjusting for several potential confounders, significantly increased risks for hypertension were found for participants in MHO (odd ratio [OR]: 1.78, 95% confidence interval [CI]: 1.39-2.27), MANO (OR: 1.71, 95% CI: 1.02-2.86), and MAO (OR: 3.35, 95% CI: 2.54-4.42) group compared with the MHNO group.

CONCLUSION

Metabolically abnormal individuals, regardless of their body weight status, showed significantly higher risks for hypertension compared with healthy non-overweight/obese group. Furthermore, MHO individuals had significantly increased risk of incident hypertension.

Fatty liver disease determines the progression of coronary artery calcification in a metabolically healthy obese population

OBJECTIVES

Metabolically healthy obese (MHO) phenotype describes an obese state with a favorable metabolic profile. However, the prognosis of this subpopulation remains controversial. We aimed to examine whether MHO phenotype is associated with progression of atherosclerotic activity, reflected as the changes in coronary artery calcification (CAC) over time. If so, we sought to determine the role of fatty liver disease (FLD), the hallmark of hepatic steatosis, in this progression.

METHODS

We enrolled 1,240 asymptomatic subjects who underwent repeated CAC score measurement during routine health examinations. CAC score progression was defined as either incident CAC in a population free of CAC at baseline, or an increase by ≥2.5 units between the baseline and final square root of CAC scores in participants with detectable CAC at baseline. Subjects were stratified by body mass index (cut-off, 25.0 kg/m2) and metabolic health state using Adult Treatment Panel-III criteria. FLD was assessed via ultrasonography.

RESULTS

Over 2.9 years of follow-up, 25.2% of total subjects exhibited CAC score progression. The MHO phenotype was not significantly associated with CAC score progression (multivariate adjusted-odds ratio [OR], 1.45; 95% confidence interval [CI], 0.93-2.25), as compared to the metabolically healthy non-obese (MHNO) phenotype. However, subgroup analysis indicated that the MHO/FLD phenotype was significantly associated with CAC score progression (multivariate adjusted-OR, 2.37; 95% CI, 1.34-4.16), as compared to the MHNO/no FLD phenotype, whereas the MHO/no FLD phenotype was not (multivariate adjusted OR, 1.25; 95% CI, 0.71-2.24).

CONCLUSIONS

Obese individuals with FLD have an increased risk of atherosclerosis progression, despite their healthy metabolic profile. Preventive interventions targeting cardiometabolic risk factors should be considered in such individuals, regardless of the weight status.

Cardiovascular health in adults with type 1 diabetes

Adults with type 1 diabetes (T1D) are at risk for cardiovascular (CV) disease. Managing CV risk is an important prevention strategy. The American Heart Association has defined 7 factors for ideal CV health. The purpose of this 2016 secondary analysis was to assess the prevalence of 6 CV health factors in a sample of adults ≥18 (n=7153) in the T1D Exchange Clinic registry. CV health factors include: hemoglobin A1c (HbA1c) <7%, BMI<25kg/m2, blood pressure<120/80mmHg, total cholesterol <200mg/dL, non-smoking, and physical activity ≥150min/week. HbA1c<7% was substituted for the AHA health factor of fasting blood glucose. Frequencies of each factor were tabulated for the total sample and for each gender. Logistic regression examined variables associated with achievement of each CV health factor. The mean age was 37.14±17years. Mean HbA1c was 7.9±1.5%, and duration was 19.5±13.5years. The majority (54%) were working full or part-time. Achievement of CV health factors in the whole sample ranged from 27% (HbA1c<7%) to 94% nonsmoking. Achievement of some factors varied by gender. Common variables associated with several CV health factors included gender, education, employment, and T1D duration. This young sample exhibited low levels of some CV health factors, especially HbA1c and physical activity. Providers need to routinely assess and advise on management of all CV risk factors to prevent this common diabetes complication.