The intriguing metabolically healthy but obese phenotype: cardiovascular prognosis and role of fitness
The intriguing metabolically healthy but obese phenotype: cardiovascular prognosis and role of fitness
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DOI：
10.1093/eurheartj/ehs174
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发表时间：
2013-02-01
影响因子：
39.3
通讯作者：
Blair, Steven N.
中科院分区：
文献类型：
--
作者：
Ortega, Francisco B.;Lee, Duck-chul;Blair, Steven N.
目前关于代谢健康但肥胖表型的预后知识有限，这是因为只使用体重指数来定义肥胖，并且缺乏关于心肺健康的信息。我们的目的是检验以下假设：(I)代谢健康但肥胖的个体比他们的代谢异常和肥胖的同龄人有更高的健康水平；(Ii)在考虑健康因素后，就心血管疾病和死亡率而言，代谢健康但肥胖的表型是良性的。身体健康通过跑步机上的最大运动试验进行评估，体脂百分比(BF)通过静水称重或皮褶(肥胖BF epsilon 25或epsilon 30，男性或女性，分别为男性或女性)在43 265名成年人(24.3女性)中评估。如果符合代谢综合征标准中的0或1，则认为代谢健康。代谢健康但肥胖的参与者(肥胖子样本中的46人)比代谢异常的肥胖参与者有更好的健康状况(P 0.001)。在调整了健康和其他混杂因素后，代谢健康的肥胖个体患全因死亡率、非致命性和致命性心血管疾病以及癌症死亡率的风险(根据风险比估计为3050)低于代谢健康的肥胖同龄人；而代谢健康但肥胖和代谢健康的正常脂肪参与者之间没有显著差异。(I)更高的健康应该被认为是代谢健康但肥胖的表型的特征。(Ii)一旦考虑到适合性，代谢健康但肥胖的表型是良性的，与代谢异常的肥胖者相比，死亡率和发病率的预后更好。
Current knowledge on the prognosis of metabolically healthy but obese phenotype is limited due to the exclusive use of the body mass index to define obesity and the lack of information on cardiorespiratory fitness. We aimed to test the following hypotheses: (i) metabolically healthy but obese individuals have a higher fitness level than their metabolically abnormal and obese peers; (ii) after accounting for fitness, metabolically healthy but obese phenotype is a benign condition, in terms of cardiovascular disease and mortality.Fitness was assessed by a maximal exercise test on a treadmill and body fat per cent (BF) by hydrostatic weighing or skinfolds (obesity BF epsilon 25 or epsilon 30, men or women, respectively) in 43 265 adults (24.3 women). Metabolically healthy was considered if meeting 0 or 1 of the criteria for metabolic syndrome. Metabolically healthy but obese participants (46 of the obese subsample) had a better fitness than metabolically abnormal obese participants (P 0.001). When adjusting for fitness and other confounders, metabolically healthy but obese individuals had lower risk (3050, estimated by hazard ratios) of all-cause mortality, non-fatal and fatal cardiovascular disease, and cancer mortality than their metabolically unhealthy obese peers; while no significant differences were observed between metabolically healthy but obese and metabolically healthy normal-fat participants.(i) Higher fitness should be considered a characteristic of metabolically healthy but obese phenotype. (ii) Once fitness is accounted for, the metabolically healthy but obese phenotype is a benign condition, with a better prognosis for mortality and morbidity than metabolically abnormal obese individuals.