Abstract P230: Metabolically Healthy Obesity and QT interval. The Polish Norwegian Study

Introduction: Obesity has been linked to increased risk of sudden cardiac death and ventricular arrhythmia. Whether the metabolically healthy obese phenotype is a benign condition, is debatable and few studies examined its ventricular repolarization profile. Purpose: To examine the association of metabolically healthy/unhealthy obesity phenotypes with prolonged corrected QT (QTc) interval in a large population-based study. Methods: Cross-sectional data from an ongoing cohort study in Poland. Data was collected using a standardized protocol. The QT intervals were obtained from digital standard 12-lead resting ECG and were corrected for heart rate by Bazett’s formula. Plasma lipids and glucose were measured in a fasting state. After excluding drugs known to affect the QT interval (antiarrhythmics, digoxin, antipsychotics), the analytic sample size was 11068 participants, ages 45 to 64 years. Based on the presence of obesity (BMI ge 30 kg/ m 2 ) and metabolic syndrome (per the AHA/NHLBI harmonized definition), we defined four phenotypes: metabolically healthy non-obese (MHNO), metabolically unhealthy nonobese (MUNO), metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO). Multivariable linear and logistic regression models were used for analyses. Results: The prevalence of the 4 phenotypes was: MHNO: 51.34%, MUNO: 18.07%, MHO: 10.07%, MUO: 20.52%. The prevalence of an increased QTc interval (greater than >430ms in men/450ms in women) was 14.28%, and the prevalence of a highly prolonged QTc interval (greater than 450ms in men/470ms in women) was 5.2%. The age- and sex-adjusted mean QTc across the 4 phenotypes was: MHNO: 417.05ms (416.39- 417.71; MUNO: 418.82 ms (417.71-419.92); MHO: 420.46 ms (418.99 -421.93); MUO: 422.45 ms (421.41-423.49). The age- and sex adjusted odds (OR, 95% CI) of an increased QTc interval (greater than 430/450ms in men/women) were increased in MUNO (1.11, 0.96-1.29), MHO (1.44, 1.20-1.72) and MUO (1.47, 1.28-1.69), compared to MHNO phenotype. These estimates were minimally attenuated after additional adjustment for prevalent CVD, LVH on ECG, smoking, alcohol intake, physical activity and education: MUNO (1.10, 0.94-1.28), MHO (1.45, 1.21-1.73) and MUO (1.44, 1.26-1.66). We did not detect effect modification by sex. We obtained similar results in subgroup analyses restricted to those without diabetes and after excluding those with third degree atrioventricular blocks or conduction abnormalities with QRS>120ms. Conclusion: Both metabolically healthy- and non-healthy obese phenotypes had a higher likelihood of an increased/borderline QTc interval compared to the MHNO phenotype. Our study furthered our understanding of ventricular repolarization as reflected in the QTc interval, in the setting of different obesity phenotypes.

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Abstract 13508: Obesity Phenotype and the Risk of Hypertension and Type 2 Diabetes: Does Cardiorespiratory Fitness Matter?

Circulation ◽

10.1161/circ.130.suppl_2.13508 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Sae Young Jae ◽

Mercedes Carnethon ◽

Won Hah Park ◽

Bo Fernhall

Keyword(s):

Type 2 Diabetes ◽

Body Mass Index ◽

Cardiorespiratory Fitness ◽

Normal Weight ◽

Incident Hypertension ◽

Metabolically Healthy Obese ◽

Increased Risk ◽

Healthy Obese ◽

Metabolically Healthy

There is conflicting evidence regarding the association between metabolically healthy obese (MHO) and metabolically unhealthy normal weight (MUNW) with incident hypertension and type 2 diabetes. The role of cardiorespiratory fitness on these associations has not been fully explored. We tested the hypothesis that obesity phenotypes predict incident hypertension and type 2 diabetes, but cardiorespiratory fitness modifies these associations in a prospective study of apparently healthy men. 3800 men (mean age 48±6 yrs, range 20-76 yrs) participated in two health examinations during 1998-2009. All subjects were free of hypertension and type 2 diabetes at baseline examination. MHO was defined as obesity (body mass index ≥ 25 kg/m2) with no more than one metabolic abnormality, and MUNW was defined as body mass index < 23 kg/m2) with two or more abnormalities. Cardiorespiratory fitness was directly measured by peak oxygen uptake during a treadmill test. Incident hypertension and type 2 diabetes were defined as blood pressure ≥140/90mmHg and as ≥6.5% of HbA1c or ≥126mg/dl of fasting glucose at second examination, respectively. During an average follow-up of 5 years (1-12 yrs), there were 371 (9.8%) men incident hypertension and 170 (4.5%) men incident type 2 diabetes. MHO and MUNW were present in 844 (22%) and 249 (6.6%) men. Compared with metabolically healthy normal weight men, MHO and MUNW men were at increased risk for hypertension (relative risk (RR) =1.82, 95% Confidence Interval (CI): 1.29-2.56 and 1.75, 1.11-2.74) and type 2 diabetes (RR=3.68, 1.92-7.07 and 5.35, 2.61-10.94), respectively. These risks in MHO and MUNW men were still persisted with adjustment for confounder variables and cardiorespiratory fitness (hypertension=1.57, 1.05-2.34 and 1.59, 1.01-2.51; type 2 diabetes=3.35, 1.63-6.89 and 4.76, 2.32-9.77). Metabolically healthy obese or metabolically unhealthy normal weight men were at increased risk of hypertension and type 2 diabetes compared with metabolically healthy normal weight men. However, these associations were not attenuated by cardiorespiratory fitness or other confounder factors.

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The Risk of Incident Type 2 Diabetes in a Korean Metabolically Healthy Obese Population: The Role of Systemic Inflammation

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2014-3885 ◽

2015 ◽

Vol 100 (3) ◽

pp. 934-941 ◽

Cited By ~ 42

Author(s):

Chang Hee Jung ◽

Min Jung Lee ◽

Yu Mi Kang ◽

Jung Eun Jang ◽

Jaechan Leem ◽

...

Keyword(s):

Type 2 Diabetes ◽

Systemic Inflammation ◽

Incident Type ◽

Metabolically Healthy Obese ◽

Increased Risk ◽

Incident Type 2 Diabetes ◽

Healthy Obese ◽

Metabolically Healthy ◽

Inflammation Group

Abstract Objective: This study sought to investigate whether the metabolically healthy obese (MHO) phenotype is associated with an increased risk of incident type 2 diabetes in a Korean population and, if so, whether systemic inflammation affects this risk in MHO individuals. Design and Methods: The study population comprised 36 135 Koreans without type 2 diabetes. Participants were stratified by body mass index (cutoff value, 25.0 kg/m2) and metabolic health state (assessed using Adult Treatment Panel-III criteria). High-sensitive C-reactive protein (hsCRP) was used as a surrogate marker of systemic inflammation. Subjects were classified into low (ie, hsCRP < 0.5 mg/L) and high (ie, hsCRP ≥ 0.5 mg/L) systemic inflammation groups. Results: During a median followup of 36.5 months (range, 4.8–81.7 mo), 635 of the 36 135 individuals (1.8%) developed type 2 diabetes. The MHO group had a significantly higher risk of incident type 2 diabetes (multivariate-adjusted hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.16–2.11) than the metabolically healthy nonobese (MHNO) group. However, the risk of the MHO group varied according to the degree of systemic inflammation. Compared with the MHNO/low systemic inflammation group, the risk of type 2 diabetes in the MHO/low systemic inflammation group was not significantly elevated (multivariate-adjusted HR, 1.61; 95% CI, 0.77–3.34). However, the MHO/high systemic inflammation group had an elevated risk of incident type 2 diabetes (multivariate-adjusted HR, 3.73; 95% CI 2.36–5.88). Conclusions: MHO subjects show a substantially higher risk of incident type 2 diabetes than MHNO subjects. The level of systemic inflammation partially explains this increased risk.

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Risk of Arterial Stiffness According to Metabolically Healthy Obese Phenotype: A Combined Cross-Sectional and Longitudinal Study in Kailuan Cohort

10.21203/rs.3.rs-97966/v1 ◽

2020 ◽

Author(s):

Anxin Wang ◽

Yu Wang ◽

Yingting Zuo ◽

Xue Tian ◽

Shuohua Chen ◽

...

Keyword(s):

Longitudinal Study ◽

Health Status ◽

Arterial Stiffness ◽

Metabolic Health ◽

Cross Sectional ◽

Metabolically Healthy Obese ◽

Increased Risk ◽

Healthy Obese ◽

Metabolically Healthy ◽

Healthy Participants

Abstract BackgroundTo investigate the risk of incident arterial stiffness according to metabolically healthy obese (MHO) phenotype in Chinese population.Materials and methodsThe Kailuan study is an ongoing prospective cohort study, 37,180 participants with at least one-time measurement of branchial-ankle pulse wave velocity (baPWV) were included in the cross-sectional analysis, and 16,236 participants with repeated measurement of baPWV during the follow-ups were included in the longitudinal study from March 1, 2010, to January 31, 2020. Cross-classification of body mass index (BMI) categories and metabolic health status created six groups. Linear and logistic regression analyses were used to assess the association between BMI-metabolic status phenotypes and baPWV in mono-factor and multi-factor models. ResultsThe results of cross-sectional and longitudinal investigation were basically the same, as the abnormality of baPWV increased with BMI categories in metabolically healthy participants, while the increasing tendency disappeared in metabolically unhealthy participants. A 1.6-fold, 2.8-fold increased risk for the new occurrence of arterial stiffness were documented in MHO and metabolically unhealthy obese participants compared to metabolically healthy normal weight controls in the fully adjusted model. Further stratified analysis shown that metabolic health status was an interaction factor between BMI and arterial stiffness in either study population (P<0.0001 for cross-sectional study and P=0.0003 for longitudinal study).ConclusionsMetabolic health status and BMI categories contribute to the progression of arterial stiffness, while BMI is positively associated with arterial stiffness only in metabolically healthy participants. Moreover, MHO is an intermediate stage between metabolically healthy and unhealthy status.Trial registration: ChiCTR-TNRC-11001489. Registered 24 August 2011 - Retrospectively registered, http://www.chictr.org.cn/showprojen.aspx?proj=8050

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Apolipoproteins A-I, B, and C-III and Obesity in Young Adult Cherokee

Journal of Lipids ◽

10.1155/2017/8236325 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Wenyu Wang ◽

Piers Blackett ◽

Sohail Khan ◽

Elisa Lee

Keyword(s):

Young Adult ◽

Logistic Regression Model ◽

Height Ratio ◽

Metabolically Healthy Obese ◽

Related Risk ◽

Increased Risk ◽

Healthy Obese ◽

Metabolically Healthy ◽

Atherogenic Lipid ◽

Waist Height Ratio

Since young adult Cherokee are at increased risk for both diabetes and cardiovascular disease, we assessed association of apolipoproteins (A-I, B, and C-III in non-HDL and HDL) with obesity and related risk factors. Obese participants (BMI ≥ 30) aged 20–40 years (n=476) were studied. Metabolically healthy obese (MHO) individuals were defined as not having any of four components of the ATP-III metabolic syndrome after exclusion of waist circumference, and obese participants not being MHO were defined as metabolically abnormal obese (MAO). Associations were evaluated by correlation and regression modeling. Obesity measures, blood pressure, insulin resistance, lipids, and apolipoproteins were significantly different between groups except for total cholesterol, LDL-C, and HDL-apoC-III. Apolipoproteins were not correlated with obesity measures with the exception of apoA-I with waist and the waist : height ratio. In a logistic regression model apoA-I and the apoB : apoA-I ratio were significantly selected for identifying those being MHO, and the result (C-statistic = 0.902) indicated that apoA-I and the apoB : apoA-I ratio can be used to identify a subgroup of obese individuals with a significantly less atherogenic lipid and apolipoprotein profile, particularly in obese Cherokee men in whom MHO is more likely.

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Metabolically healthy obesity: Is it really benign?

Journal of Atherosclerosis Prevention and Treatment ◽

10.53590/japt.02.1019 ◽

2021 ◽

pp. 24-26

Author(s):

Nikolaos Kourris ◽

Konstantinos Tziomalos

Keyword(s):

Cardiovascular Disease ◽

Metabolic Abnormalities ◽

Metabolically Healthy Obesity ◽

Metabolically Healthy Obese ◽

Increased Risk ◽

Healthy Obese ◽

Metabolically Healthy ◽

Metabolically Unhealthy Obesity

Recently, a subgroup of patients with obesity but without cardiometabolic abnormalities has attracted considerable attention and has been characterized as metabolically healthy obese (MHO) patients. MHO is quite prevalent among patients with obesity. Even though these subjects have less pronounced metabolic abnormalities compared with patients with metabolically unhealthy obesity (MUO), they are at increased risk for progressing to MUO and for developing cardiovascular disease. Accordingly, diet, exercise and appropriate pharmacotherapy should be recommended to patients with MHO as strongly as in those with MUO.

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Association between the metabolically healthy obese phenotype and the risk of myocardial infarction: results from the Kailuan study

Acta Endocrinologica ◽

10.1530/eje-18-0356 ◽

2018 ◽

Vol 179 (6) ◽

pp. 343-352 ◽

Cited By ~ 6

Author(s):

Yijie Xu ◽

Haibin Li ◽

Anxin Wang ◽

Zhaoping Su ◽

Guang Yang ◽

...

Keyword(s):

Myocardial Infarction ◽

Cox Model ◽

Normal Weight ◽

Metabolically Healthy Obese ◽

Increased Risk ◽

Confounding Variables ◽

History Of ◽

Healthy Obese ◽

Metabolically Healthy

Objective This study aimed to determine if the metabolically healthy obese (MHO) is associated with an increased risk of myocardial infarction (MI) in Chinese population. Design The Kailuan study is a community-based prospective cohort study. Methods BMI and metabolic syndrome (MetS) were assessed in 91 866 participants without a history of MI or stroke. Participants were categorised into six mutually exclusive groups according to the BMI-MetS status: normal weight (BMI: ≤ 18.5to < 24.0 kg/m2) without MetS (MH-NW), normal weight with MetS (MUH-NW), overweight (BMI: ≤ 24.0to < 28.0 kg/m2) without MetS (MH-OW), overweight with MetS (MUH-OW), obese (BMI ≥ 28.0 kg/m2) without MetS (MHO) and obese with MetS (MUO). The hazard ratio (HR) with 95% CI was calculated for the incidence of MI using a multivariable Cox model. Results A total of 6745 (7.34%) individuals were classified as MHO. During a median 8-year follow-up, 1167 (1.27%) participants developed MI. The MHO group had an increased risk of MI (HR: 1.76, 95% CI: 1.37–2.25) in comparison with the MH-NW group after adjusting for potential confounding variables. After a similar adjustment, the risk of MI was significantly elevated in the MUH-NW (HR: 1.62, 95% CI: 1.28–2.05), MUH-OW (HR: 1.98, 95% CI: 1.67–2.35) and MUO group (HR: 2.06, 95% CI: 1.70–2.49). Conclusions MHO subjects showed a substantially higher risk of MI in comparison with MH-NW subjects. That said, even without measurable metabolic abnormalities, obesity was associated with a higher risk of MI.

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Risk of incident ischemic stroke according to the metabolic health and obesity states in the Vascular-Metabolic CUN cohort

International Journal of Stroke ◽

10.1177/1747493016672083 ◽

2016 ◽

Vol 12 (2) ◽

pp. 187-191 ◽

Cited By ~ 17

Author(s):

Laura Sánchez-Iñigo ◽

David Navarro-González ◽

Alejandro Fernández-Montero ◽

Juan Pastrana-Delgado ◽

JA Martínez

Keyword(s):

Ischemic Stroke ◽

Hazard Analysis ◽

Normal Weight ◽

Metabolic Health ◽

Stroke Incidence ◽

Metabolically Healthy Obese ◽

Increased Risk ◽

Healthy Obese ◽

Metabolically Healthy

Background Whether obesity is a major risk factor for cardiovascular disease in the absence of metabolic comorbidities remains under debate. Indeed, some obese individuals may be at low risk of metabolic-related complications, while normal-weight individuals may not be “healthy.” Aims To assess the incidence of ischemic stroke according to the metabolic health and obesity states of 5171 participants from the Vascular-Metabolic CUN cohort. Methods A Cox proportional-hazard analysis was conducted to estimate the hazard ratio and their 95% confidence interval of stroke according to the metabolic health and obesity states based on TyG index and Adult Treatment Panel-III criteria, during 9.1 years of follow-up. Results After 50,056.2 person-years of follow-up, 162 subjects developed an ischemic stroke (incidence rate 3.23 per 1000 person-years). Metabolically healthy obese subjects did not show greater risk of stroke, while metabolically unhealthy participants, obese and non-obese, had an increased risk of stroke, compared with healthy non-obese. The hazard ratios for the multivariable adjusted model were 1.55 (95% CI: 1.36–1.77) and 1.86 (95% CI: 1.57–2.21), respectively. Conclusions Metabolically unhealthy individuals exhibited a greater risk of ischemic stroke than metabolically healthy obese individuals.

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Circulating Adipokines in Healthy versus Unhealthy Overweight and Obese Subjects

International Journal of Endocrinology ◽

10.1155/2014/170434 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 18

Author(s):

Assim A. Alfadda

Keyword(s):

Hdl Cholesterol ◽

Metabolic Health ◽

Bioactive Substances ◽

Metabolically Healthy Obese ◽

Cholesterol Levels ◽

Increased Risk ◽

Obese Subjects ◽

Healthy Obese ◽

Metabolically Healthy

It is now well established that not all obese subjects are at increased risk of cardiometabolic complications; such patients are termed the metabolically healthy obese. Despite their higher-than-normal body fat mass, they are still insulin sensitive, with a favorable inflammatory and lipid profile and no signs of hypertension. It remains unclear which factors determine an individual's metabolic health. Adipose tissue is known to secrete multiple bioactive substances, called adipokines, that can contribute to the development of obesity-associated complications. The goal of this study was to determine whether the circulating adipokine profiles differs between metabolically healthy and metabolically unhealthy overweight and obese subjects, thereby obtaining data that could help to explain the link between obesity and its related cardiometabolic complications. We defined metabolic health in terms of several metabolic and inflammatory risk factors. The serum adiponectin levels were higher in the healthy group and showed a positive correlation with HDL cholesterol levels in the unhealthy group. There were no differences between the two groups in the levels of serum leptin, chemerin and orosomucoid. Accordingly, adiponectin might play a role in protecting against obesity-associated cardiometabolic derangements. More studies are needed to clarify the role of different chemerin isoforms in this system.

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