Are Metabolically Normal but Obese Individuals at Lower Risk for All-Cause Mortality?

  1. Jennifer L. Kuk, PHD and
  2. Chris I. Ardern, PHD
  1. From the School of Kinesiology and Health Science, York University, Toronto, Canada.
  1. Corresponding author: Jennifer L. Kuk, jennkuk{at}


OBJECTIVE The clinical relevance of the metabolically normal but obese phenotype for mortality risk is unclear. This study examines the risk for all-cause mortality in metabolically normal and abnormal obese (MNOB and MAOB, respectively) individuals.

RESEARCH DESIGN AND METHODS The sample included 6,011 men and women from the Third National Health and Nutrition Examination Survey (NHANES III) with public-access mortality data linkage (follow-up = 8.7 ± 0.2 years; 292 deaths). Metabolically abnormal was defined as insulin resistance (IR) or two or more metabolic syndrome (MetSyn) criteria (excluding waist).

RESULTS A total of 30% of obese subjects had IR, and 38.4% had two or more MetSyn factors, whereas only 6.0% (or 1.6% of the whole population) were free from both IR and all MetSyn factors. By MetSyn factors or IR alone, MNOB subjects (hazard ratio [HR]MetSyn 2.80 [1.18–6.65]; HRIR 2.58 [1.00–6.65]) and MAOB subjects (HRMetSyn 2.74 [1.46–5.15]; HRIR 3.09 [1.55–6.15]) had similar elevations in mortality risk compared with metabolically normal, normal weight subjects.

CONCLUSIONS Although a rare phenotype, obesity, even in the absence of overt metabolic aberrations, is associated with increased all-cause mortality risk.


  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Received March 24, 2009.
    • Accepted August 24, 2009.
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This Article

  1. Diabetes Care vol. 32 no. 12 2297-2299
  1. All Versions of this Article:
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