EPIC findings refute metabolically healthy obesity concept
medwireNews: Twelve years of follow-up data from the EPIC study support the assertion that obesity is a cardiovascular risk factor in its own right, even in the absence of metabolic abnormalities.
Camille Lassale (Imperial College London, UK) and colleagues found that such individuals had an intermediate risk for coronary heart disease (CHD) events, with a lower risk than obese people who were metabolically unhealthy, with at least three components of the metabolic syndrome, but a significantly higher risk than people with a healthy weight and fewer than three metabolic syndrome components.
“This is of particular importance as overweight people (BMI ≥25 and <30) with no traditional cardiometabolic risk factors are not recommended for weight loss treatment by recent UK or USA guidelines,” the team writes in the European Heart Journal.
Compared with metabolically healthy people of normal weight, those who were metabolically unhealthy had a greater than twofold increase in CHD risk irrespective of their bodyweight, after accounting for age, gender, study center, smoking, educational level, physical activity, Mediterranean diet score, energy expenditure, and alcohol intake. The risk increased by 2.15-, 2.33-, and 2.54-fold for those who were normal weight, overweight, and obese, respectively.
But metabolically healthy obese people (45% of all obese participants) had a significant 28% increased risk for CHD, and, notably, the risk increase was almost identical for overweight but metabolically healthy people.
Furthermore, the researchers found that only 6% of the obese participants were entirely free of cardiometabolic abnormalities, compared with 31% of the normal-weight participants. And the healthy obese group had significantly higher blood pressure than the normal-weight participants, as well as higher levels of glycated hemoglobin, atherogenic lipids, and C-reactive protein.
The study included 7637 EPIC participants who had incident CHD during a median follow-up of 12.2 years and 10,474 randomly selected EPIC participants who were representative of the overall cohort (more than 500,000 people). The participants were aged an average of 53.6 years at study baseline and their BMI was 26.1 kg/m2.
“Our results highlight the importance of both obesity and metabolic health in CHD prevention and do not support the concept of ‘metabolically healthy obesity’,” say the researchers.
In line with previous studies, CHD risk was driven by abdominal obesity rather than by bodyweight per se. The association between waist circumference and CHD outcomes remained significant after adjustment for BMI, whereas that between BMI and CHD lost statistical significance after adjustment for waist circumference.
“Overall, these results support a population-wide strategy for prevention of obesity and overweight regardless of the initial metabolic status of individuals,” the team concludes.
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