Impact of metabolically healthy obesity on the risk of incident gastric cancer: a population-based cohort study

Abstract Aims/hypothesis People with obesity and a normal metabolic profile are sometimes referred to as having ‘metabolically healthy obesity’ (MHO). However, whether this group of individuals are actually ‘healthy’ is uncertain. This study aims to examine the associations of MHO with a wide range of obesity-related outcomes. Methods This is a population-based prospective cohort study of 381,363 UK Biobank participants with a median follow-up of 11.2 years. MHO was defined as having a BMI ≥ 30 kg/m2 and at least four of the six metabolically healthy criteria. Outcomes included incident diabetes and incident and fatal atherosclerotic CVD (ASCVD), heart failure (HF) and respiratory diseases. Results Compared with people who were not obese at baseline, those with MHO had higher incident HF (HR 1.60; 95% CI 1.45, 1.75) and respiratory disease (HR 1.20; 95% CI 1.16, 1.25) rates, but not higher ASCVD. The associations of MHO were generally weaker for fatal outcomes and only significant for all-cause (HR 1.12; 95% CI 1.04, 1.21) and HF mortality rates (HR 1.44; 95% CI 1.09, 1.89). However, when compared with people who were metabolically healthy without obesity, participants with MHO had higher rates of incident diabetes (HR 4.32; 95% CI 3.83, 4.89), ASCVD (HR 1.18; 95% CI 1.10, 1.27), HF (HR 1.76; 95% CI 1.61, 1.92), respiratory diseases (HR 1.28; 95% CI 1.24, 1.33) and all-cause mortality (HR 1.22; 95% CI 1.14, 1.31). The results with a 5 year landmark analysis were similar. Conclusions/interpretation Weight management should be recommended to all people with obesity, irrespective of their metabolic status, to lower risk of diabetes, ASCVD, HF and respiratory diseases. The term ‘MHO’ should be avoided as it is misleading and different strategies for risk stratification should be explored. Graphical abstract

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Impact of metabolically healthy obesity on the risk of incident gastric cancer: a population-based cohort study

10.21203/rs.2.10798/v1 ◽

2019 ◽

Author(s):

Yoshitaka Hashimoto ◽

Masahide Hamaguchi ◽

Akihiro Obora ◽

Takao Kojima ◽

Michiaki Fukui

Keyword(s):

Gastric Cancer ◽

Cohort Study ◽

Density Lipoprotein ◽

Population Based ◽

Metabolic Abnormalities ◽

Historical Cohort ◽

Metabolically Healthy Obese ◽

Hazard Ratios ◽

Metabolically Healthy ◽

Meta Analyses

Abstract Background Previous meta-analyses revealed that obesity confers a risk of gastric cancer. On the other hand, metabolically healthy obese (MHO) individuals, who are healthier than metabolically abnormal obese (MAO) individuals, have lower risks of colon cancer and breast cancer. However, the association between MHO and incident gastric cancer is unclear. Methods This historical cohort study included 19,685 Japanese individuals who participated in health-checkup programs from 2003 to 2016. Each subject was classified as metabolically healthy (MH) (no metabolic abnormalities) or metabolically abnormal (MA) (one or more metabolic abnormalities), according to four metabolic factors (hypertension, impaired fasting glucose, hypertriglyceridemia and low high density lipoprotein-cholesterol). Obese (O) or non-obese (NO) was classified by a body mass index cutoff of 25.0 kg/m2. Hazard ratios of metabolic phenotypes for incident gastric cancer were calculated by the Cox proportional hazard model with adjustments for age, sex, alcohol consumption, smoking and exercise. Results Over the median follow-up period of 5.5 years, 78 participants developed gastric cancer. Five-years cumulative incident rate of gastric cancer was 0.2% (case/n = 17/8,331) in MHNO, 0.2% (1/653) in MHO, 0.5% (35/7,276) in MANO and 0.7% (25/3,425) in MAO. Compared with MHNO, the adjusted hazard ratios for development of gastric cancer were 0.69 (95%CI 0.04–3.39, p = 0.723) in MHO, 1.16 (95%CI 0.63–2.12, p = 0.636) in MANO and 2.09 (95%CI 1.10–3.97, p = 0.024) in MAO. Conclusions This study shows that individuals with MAO, but not those with MHO, had an elevated risk for incident gastric cancer.

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Impact of metabolically healthy obesity on the risk of incident gastric cancer: a population-based cohort study

10.21203/rs.2.10798/v2 ◽

2019 ◽

Author(s):

Yoshitaka Hashimoto ◽

Masahide Hamaguchi ◽

Akihiro Obora ◽

Takao Kojima ◽

Michiaki Fukui

Keyword(s):

Gastric Cancer ◽

Cohort Study ◽

Density Lipoprotein ◽

Population Based ◽

Metabolic Abnormalities ◽

Historical Cohort ◽

Metabolically Healthy Obese ◽

Hazard Ratios ◽

Metabolically Healthy ◽

Meta Analyses

Abstract Background Previous meta-analyses revealed that obesity confers a risk of gastric cancer. On the other hand, metabolically healthy obese (MHO) individuals, who are healthier than metabolically abnormal obese (MAO) individuals, have lower risks of colon cancer and breast cancer. However, the association between MHO and incident gastric cancer is unclear. Methods This historical cohort study included 19,685 Japanese individuals who participated in health-checkup programs from 2003 to 2016. Each subject was classified as metabolically healthy (MH) (no metabolic abnormalities) or metabolically abnormal (MA) (one or more metabolic abnormalities), according to four metabolic factors (hypertension, impaired fasting glucose, hypertriglyceridemia and low high density lipoprotein-cholesterol). Obese (O) or non-obese (NO) was classified by a body mass index cutoff of 25.0 kg/m2. Hazard ratios of metabolic phenotypes for incident gastric cancer were calculated by the Cox proportional hazard model with adjustments for age, sex, alcohol consumption, smoking and exercise. Results Over the median follow-up period of 5.5 years, 78 participants developed gastric cancer. Five-years cumulative incident rate of gastric cancer was 0.2% (case/n = 17/8,331) in MHNO, 0.2% (1/653) in MHO, 0.5% (35/7,276) in MANO and 0.7% (25/3,425) in MAO. Compared with MHNO, the adjusted hazard ratios for development of gastric cancer were 0.69 (95%CI 0.04–3.39, p = 0.723) in MHO, 1.16 (95%CI 0.63–2.12, p = 0.636) in MANO and 2.09 (95%CI 1.10–3.97, p = 0.024) in MAO. Conclusions This study shows that individuals with MAO, but not those with MHO, had an elevated risk for incident gastric cancer.

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Impact of metabolically healthy obesity on the risk of incident gastric cancer: a population-based cohort study

10.21203/rs.2.10798/v3 ◽

2019 ◽

Author(s):

Yoshitaka Hashimoto ◽

Masahide Hamaguchi ◽

Akihiro Obora ◽

Takao Kojima ◽

Michiaki Fukui

Keyword(s):

Gastric Cancer ◽

Cohort Study ◽

Hdl Cholesterol ◽

Population Based ◽

Metabolic Abnormalities ◽

Historical Cohort ◽

Metabolically Healthy Obese ◽

Hazard Ratios ◽

Metabolically Healthy ◽

Incident Rate

Abstract Background The risk of colon or breast cancer in metabolically healthy obese (MHO) were lower than that in metabolically abnormal obese (MAO). We hypothesized that the risk of incident gastric cancer in MHO is lower than that in MAO.Methods This historical cohort study included 19,685 Japanese individuals who received health-checkup programs from 2003 to 2016. Each subject was classified as metabolically healthy (MH) (no metabolic abnormalities) or metabolically abnormal (MA) (one or more metabolic abnormalities), according to four metabolic factors (hypertension, impaired fasting glucose, hypertriglyceridemia and low HDL-cholesterol). Obese (O) or non-obese (NO) was classified by a BMI cutoff of 25.0 kg/m2. Hazard ratios of metabolic phenotypes for incident gastric cancer were calculated by the Cox proportional hazard model with adjustments for age, sex, alcohol consumption, smoking and exercise.Results Over the median follow-up period of 5.5 (2.9-9.4) years, incident rate of gastric cancer was 0.65 per 1000 persons-years. Incident rate of MHNO, MHO, MANO and MAO were 0.33, 0.25, 0.80 and 1.21 per 1000 persons-years, respectively. Compared with MHNO, the adjusted hazard ratios for development of gastric cancer were 0.69 (95%CI 0.04–3.39, p = 0.723) in MHO, 1.16 (95%CI 0.63–2.12, p = 0.636) in MANO and 2.09 (95%CI 1.10–3.97, p = 0.024) in MAO.Conclusions This study shows that individuals with MAO, but not those with MHO, had an elevated risk for incident gastric cancer. Thus, we should focus more on the presence of metabolic abnormalities rather than obesity itself for incident gastric cancer.

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