Diabetes and Cardiovascular Disease Outcomes in the Metabolically Healthy Obese Phenotype
A cohort study
- Sarah L. Appleton, PHD1⇑,
- Christopher J. Seaborn, BSC2,
- Renuka Visvanathan, MBBS, PHD1,3,
- Catherine L. Hill, MBBS, MD1,4,
- Tiffany K. Gill, PHD5,
- Anne W. Taylor, PHD5,
- Robert J. Adams, MBBS, MD1,
- on behalf of the North West Adelaide Health Study Team
- 1The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia
- 2Endocrinology Unit, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
- 3Aged and Extended Care Services, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
- 4Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
- 5Population Research and Outcome Studies, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
- Corresponding author: Sarah L. Appleton, .
OBJECTIVE To determine the correlates of the “metabolically healthy obese” (MHO) phenotype and the longitudinal risks of diabetes and cardiovascular disease (CVD)/stroke associated with this phenotype.
RESEARCH DESIGN AND METHODS The North West Adelaide Health Study is a prospective cohort study of 4,056 randomly selected adults aged ≥18 years. Participants free of CVD/stroke and not underweight (n = 3,743) were stratified by BMI categories and metabolic risk, defined as having two or more International Diabetes Federation metabolic syndrome criteria, excluding waist circumference.
RESULTS Correlates of the MHO (n = 454 [12.1%]) included smoking, socioeconomic disadvantage, and physical inactivity. Compared with metabolically healthy normal-weight subjects (n = 1,172 [31.3%]), the MHO were more likely to develop metabolic risk (15.5 vs. 33.1%, P < 0.001) and incident diabetes (odds ratio 2.09 [95% CI 0.87–5.03]) but not CVD/stroke (1.16 [0.58–2.29]) during 5.5–10.3 years of follow-up. These risks were not seen in MHO subjects maintaining metabolic health (n = 188 [67%]). Sustained metabolic health in obese participants was associated with age ≤40 years and lower waist circumference. Compared with the metabolically at-risk obese, MHO women demonstrated a significantly higher (mean [SE]) percentage of leg fat (49.9 [0.5] vs. 53.2 [0.7]) and lower waist circumference (104 [0.6] vs. 101 cm [0.8]), despite no significant differences in overall adiposity.
CONCLUSIONS “Healthy” obesity was a transient state for one-third of subjects. Persistence of a MHO phenotype, which was associated with favorable outcomes, was related to younger age and a more peripheral fat distribution. The MHO phenotype may be sustained by promoting lower waist circumferences.
This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc12-1971/-/DC1.
- Received September 26, 2012.
- Accepted January 15, 2013.
- © 2013 by the American Diabetes Association.
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