Transition from metabolically benign to metabolically unhealthy obesity and 10-year cardiovascular disease incidence

The ATTICA cohort study

The ATTICA Study Investigators, Demosthenes B. Panagiotakos

Research output: Contribution to journalArticle

5 Citations (Scopus)

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/m 2 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.

Original languageEnglish
Pages (from-to)18-24
Number of pages7
JournalMetabolism: clinical and experimental
Volume93
DOIs
Publication statusPublished - 1 Apr 2019

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Cohort Studies
Cardiovascular Diseases
Obesity
Incidence
Mediterranean Diet
Status Epilepticus
Greece
Waist Circumference
Longitudinal Studies
Insulin Resistance
Body Mass Index
Adenosine Triphosphate
Prospective Studies
Confidence Intervals
Inflammation
Weights and Measures

Cite this

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title = "Transition from metabolically benign to metabolically unhealthy obesity and 10-year cardiovascular disease incidence: The ATTICA cohort study",
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/m 2 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",
author = "{The ATTICA Study Investigators} and Matina Kouvari and Panagiotakos, {Demosthenes B.} and Mary Yannakoulia and Ekavi Georgousopoulou and Elena Critselis and Christina Chrysohoou and Dimitrios Tousoulis and Christos Pitsavos",
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Transition from metabolically benign to metabolically unhealthy obesity and 10-year cardiovascular disease incidence : The ATTICA cohort study. / The ATTICA Study Investigators; Panagiotakos, Demosthenes B.

In: Metabolism: clinical and experimental, Vol. 93, 01.04.2019, p. 18-24.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Transition from metabolically benign to metabolically unhealthy obesity and 10-year cardiovascular disease incidence

T2 - The ATTICA cohort study

AU - The ATTICA Study Investigators

AU - Kouvari, Matina

AU - Panagiotakos, Demosthenes B.

AU - Yannakoulia, Mary

AU - Georgousopoulou, Ekavi

AU - Critselis, Elena

AU - Chrysohoou, Christina

AU - Tousoulis, Dimitrios

AU - Pitsavos, Christos

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AB - 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/m 2 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.

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