期刊
DIABETES CARE
卷 36, 期 8, 页码 2294-2300出版社
AMER DIABETES ASSOC
DOI: 10.2337/dc12-1654
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资金
- European Science Foundation
- Economic and Social Research Council
- Academy of Finland
- British Medical Research Council (MRC)
- British Heart Foundation
- British Health and Safety Executive
- British Department of Health
- National Heart, Lung, and Blood Institute, National Institutes of Health (NIH) [R01HL036310]
- National Institute on Aging, NIH [R01AG013196, R01AG034454]
- British Heart Foundation [RG/13/2/30098, PG/11/63/29011] Funding Source: researchfish
- Economic and Social Research Council [ES/J023299/1] Funding Source: researchfish
- Medical Research Council [MR/K013351/1] Funding Source: researchfish
- ESRC [ES/J023299/1] Funding Source: UKRI
- MRC [MR/K013351/1] Funding Source: UKRI
OBJECTIVETo assess the association of a metabolically healthy obese phenotype with mortality using five definitions of metabolic health.RESEARCH DESIGN AND METHODSAdults (n = 5,269; 71.7% men) aged 39-62 years in 1991 through 1993 provided data on BMI and metabolic health, defined using data from the Adult Treatment Panel-III (ATP-III); criteria from two studies; and the Matsuda and homeostasis model assessment (HOMA) indices. Cross-classification of BMI categories and metabolic status (healthy/unhealthy) created six groups. Cox proportional hazards regression models were used to analyze associations with all-cause and cardiovascular disease (CVD) mortality during a median follow-up of 17.7 years.RESULTSA total of 638 individuals (12.1% of the cohort) were obese, of whom 9-41% were metabolically healthy, depending on the definition. Regardless of the definition, compared with metabolically healthy, normal-weight individuals, both the metabolically healthy obese (hazard ratios [HRs] ranged from 1.81 [95% CI 1.16-2.84] for ATP-III to 2.30 [1.13-4.70] for the Matsuda index) and the metabolically abnormal obese (HRs ranged from 1.57 [1.08-2.28] for the Matsuda index to 2.05 [1.44-2.92] for criteria defined in a separate study) had an increased risk of mortality. The only exception was the lack of excess risk using the HOMA criterion for the metabolically healthy obese (1.08; 0.67-1.74). Among the obese, the risk of mortality did not vary as a function of metabolic health apart from when using the HOMA criterion (1.93; 1.15-3.22). Similar results were obtained for cardiovascular mortality.CONCLUSIONSFor most definitions of metabolic health, both metabolically healthy and unhealthy obese patients carry an elevated risk of mortality.
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