Transition from metabolically benign to metabolically unhealthy obesity and 10-year cardiovascular disease incidence: The ATTICA cohort study

Matina Kouvari; Demosthenes B Panagiotakos; Mary Yannakoulia; Ekavi Georgousopoulou; Elena Critselis; Christina Chrysohoou; Dimitrios Tousoulis; Christos Pitsavos; ATTICA Study Investigators

doi:10.1016/j.metabol.2019.01.003

Transition from metabolically benign to metabolically unhealthy obesity and 10-year cardiovascular disease incidence: The ATTICA cohort study

Metabolism. 2019 Apr:93:18-24. doi: 10.1016/j.metabol.2019.01.003. Epub 2019 Jan 11.

Authors

Matina Kouvari¹, Demosthenes B Panagiotakos², Mary Yannakoulia¹, Ekavi Georgousopoulou³, Elena Critselis¹, Christina Chrysohoou⁴, Dimitrios Tousoulis⁴, Christos Pitsavos⁴; ATTICA Study Investigators

Affiliations

¹ Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
² Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; Department of Kinesiology and Health, School of Arts and Sciences, Rutgers University, NJ, USA; Faculty of Health, University of Canberra, Australia; School of Allied Health, College of Science, Health and Engineering, LA TROBE University, Australia. Electronic address: d.b.panagiotakos@usa.net.
³ Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; Medical School, Australian National University, Australia.
⁴ First Cardiology Clinic, School of Medicine, University of Athens, Greece.

PMID: 30639450
DOI: 10.1016/j.metabol.2019.01.003

Abstract

Background/objectives: Metabolically benign obesity remains a scientific field of considerable debate. The aim of the present work was to evaluate whether metabolically healthy obese (MHO) status is a transient condition which propagates 10-year cardiovascular disease (CVD) onset.

Methods: A prospective longitudinal study was conducted during 2001-2012, the ATTICA study studying 1514 (49.8%) men and 1528 (50.2%) women (aged >18 years old) free of CVD and residing in the greater Athens area, Greece. Follow-up assessment of first combined CVD event (2011-2012) was achieved in n = 2020 participants; of them, 317 (15.7%) incident cases were identified. Obesity was defined as body mass index ≥30 kg/m² and healthy metabolic status as absence of all NCEP ATP III (2005) metabolic syndrome components (excluding waist circumference).

Results: The MHO prevalence was 4.8% (n = 146) with 28.2% of obese participants presenting metabolically healthy status at baseline. Within this group, 52% developed unhealthy metabolic status during the 10-year follow up. MHO vs. metabolically healthy non-obese participants had a higher likelihood of presenting with 10-year CVD events, yet only the subset of them who lost their baseline status reached the level of significance (Hazard Ratio (HR) = 1.43, 95% Confidence Interval (95% CI) 1.02, 2.01). Sensitivity analyses revealed that MHO status was independently associated with elevated CVD risk in women and participants with low adherence to the Mediterranean diet, low grade inflammation, and insulin resistance.

Conclusions: MHO status is a transient condition where weight management is demanded to prevent the establishment of unhealthy cardiometabolic features. The existence of obese persons who remain "longitudinally" resilient to metabolic abnormalities is an emerging area of future research.

Keywords: Gender; Heart disease; Inflammation; Insulin resistance; Obesity metabolically benign; Primary prevention.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cardiovascular Diseases / etiology*
Cohort Studies
Diet, Mediterranean
Female
Greece
Health Status*
Humans
Inflammation
Insulin Resistance
Longitudinal Studies
Male
Obesity, Metabolically Benign / complications*
Obesity, Metabolically Benign / prevention & control
Prospective Studies
Risk Factors