Stability of metabolically healthy obesity over 8 years: the English Longitudinal Study of Ageing
Stability of metabolically healthy obesity over 8 years: the English Longitudinal Study of Ageing
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DOI：
10.1530/eje-15-0449
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发表时间：
2015-11-01
影响因子：
5.8
通讯作者：
Kivimaeki, Mika
中科院分区：
文献类型：
--
作者：
Hamer, Mark;Bell, Joshua A.;Kivimaeki, Mika
目的：代谢健康的肥胖可能反映了代谢功能障碍发生前的过渡阶段，但很少有研究描述这一过渡阶段。我们在8年的随访中检查了发展为不健康状态的健康肥胖成年人的行为和生物学特征。方法：参与者为2422名男性和女性（年龄63.3 +/- 7.7岁，男性44.2%），来自英国老龄化纵向研究。肥胖定义为BMI >= 30 kg/m(2)。根据血压（BP）、高密度脂蛋白胆固醇、甘油三酯、HbA1c和c反应蛋白（CRP），参与者被分为“健康”（0或1代谢异常）或“不健康”（>= 2代谢异常）。结果：在8年的随访中，44.5%的健康肥胖者转变为不健康状态，而正常体重和超重的健康成年人分别只有16.6%和26.2%。与保持稳定的健康肥胖成年人相比，那些进展到不健康状态的人更有可能在随访中出现高血压（75.0% vs 37.0%，年龄和性别调整的优势比（OR） 8.9, 95% CI 4.7-17.0）、高CRP （53.7% vs 17.0%， OR=8.6, 95% CI 4.1-18.0）、高HbA1c （46.3% vs 5.9%， OR=13.8, 95% CI 6.1-31.2）和高甘油三酯（45.4% vs 11.9%， OR=5.9, 95% CI 2.9-12.0），过度风险独立于生活方式因素，包括自我报告的身体活动。进展到不健康状态也与腰围的显著增加有关（B=2.7, 95% CI, 0.5-4.9 cm）。结论：这些数据表明健康的肥胖表型是相对不稳定的。向不健康状态过渡的特点是多种生物变化，这些变化不能完全用生活方式风险因素来解释。
Objective: Metabolically healthy obesity possibly reflects a transitional stage before the onset of metabolic dysfunction, but few studies have characterised this transition. We examined the behavioural and biological characteristics of healthy obese adults that progressed to an unhealthy state over 8 years follow-up.Methods: Participants were 2422 men and women (aged 63.3 +/- 7.7 years, 44.2% men) from the English Longitudinal Study of Ageing. Obesity was defined as BMI >= 30 kg/m(2). Based on blood pressure (BP), HDL-cholesterol, triglycerides, HbA1c and C-reactive protein (CRP) participants were classified as 'healthy' (0 or 1 metabolic abnormality) or 'unhealthy' (>= 2 metabolic abnormalities).Results: Over 8 years follow-up, 44.5% of healthy obese subjects had transitioned into an unhealthy state, compared to only 16.6 and 26.2% of healthy normal-weight and overweight adults respectively. Compared with healthy obese adults who remained stable, those who progressed to an unhealthy state were more likely to have high BP (75.0% vs 37.0%, age-and sex-adjusted odds ratio (OR) 8.9, 95% CI 4.7-17.0), high CRP (53.7% vs 17.0%, OR=8.6, 95% CI 4.1-18.0), high HbA1c (46.3% vs 5.9%, OR=13.8, 95% CI 6.1-31.2) and high triglycerides (45.4% vs 11.9%, OR=5.9, 95% CI 2.9-12.0) at follow-up, with excess risk remaining independent of lifestyle factors including self-reported physical activity. Progression to an unhealthy state was also linked with significant gains in waist circumference (B=2.7, 95% CI, 0.5-4.9 cm).Conclusion: These data show that a healthy obesity phenotype is relatively unstable. Transition to an unhealthy state is characterised by multiple biological changes that are not fully explained by lifestyle risk factors.