Abstract


Background
Some overweight or obese individuals have no metabolic risk factors. This condition has been termed metabolically healthy overweight/obesity (MHO). However their risk of developing metabolic disease is uncertain. The aim of the study was to assess the prevalence of the MHO phenotype and evaluate their risk for developing metabolic complications.

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Background
Some overweight or obese individuals have no metabolic risk factors. This condition has been termed metabolically healthy overweight/obesity (MHO). However their risk of developing metabolic disease is uncertain. The aim of the study was to assess the prevalence of the MHO phenotype and evaluate their risk for developing metabolic complications.

Methods
This is a retrospective cohort study of adults between 18-65 years of age living in Olmstead County, MN who were seen at our institution between 1998-2000. The participants were identified using an electronic database. Pertinent laboratory and clinical information was retrieved to assess the components of the metabolic syndrome. Individuals were classified into 4 groups: Metabolically Unhealthy Overweight/Obese (MUO): BMI ≥ 25 kg/m2 and at least 1 component of the metabolic syndrome; MHO: BMI ≥ 25 kg/m2 and no component of the metabolic syndrome; Metabolically Healthy Lean (MHL): BMI < 25 kg/m2 and no component of the metabolic syndrome; and Metabolically Unhealthy Lean (MUL)(not included in this analysis).
On follow up, the groups were assessed for metabolic complications, defined as development of the components of the metabolic syndrome (for the MHO group only) and the development of DM or CVD based on ICD-9 diagnostic codes.
 
Results
We identified 27856 adults (64% women), 18% (N= 5031) were MHL, 10% (N= 2810) were MHO, 51% (N= 14197) were MUO and 21% (N=5818) were MUL. Follow up information was available to ascertain metabolic and cardiovascular outcomes for 17319 patients, 1702 of whom were MHO at baseline. After a median follow up of 16 years (IQR 14-17), 79% of the MHO group developed at least one metabolic complication. Those MHO that developed metabolic complications had increased their body weight by 6.8 % whereas the MHO who remained free of metabolic complications gained only 4.4 % of their body weight (P < 0.01). There was no difference in the risk of developing CVD between the MHO and MHL groups (HR: 1.17, 95% CI 0.99-1.38). The risk of CVD was greater in the MUO compared to the MHL group (HR: 1.66, 95% CI 1.47-1.87). The risk of developing DM was greater in the MUO group compared to MHO (HR: 3.56, 95% CI 2.94-4.35).

Conclusion
The prevalence of MHO among adults 18-65 years of age is close to 10%, however over 3/4 of these will develop metabolic complications, especially if they gain weight.

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