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The Metabolically Healthy Obese: A Prospective Study on Risk of Development of Cardiovascular Events« Back to Volume 26, Issue 1, September 2010 - Table of Contents From ENDO 2010 The Endocrine Society Annual Meeting, San Diego, June 19-22, 2010 Obesity is a major health problem with its associated elevated risk of cardiovascular disease (CVD). However, some obese subjects do not have concomitant impaired glucose tolerance, hypertension and dyslipidemia. There are no prospective data whether these metabolically healthy obese subjects are protected against CVD. In the ongoing prospective Dutch PREVEND study (n=7356) normal weight (body mass index [BMI] <25 kg/m2) at baseline was recorded in 43.2% of participants (3612), while 40.9% (3419) were overweight (BMI 25-29.9 kg/m2) and 15.9% (1325) obese (BMI >30kg/m2). In the group with normal weight 39.1% were metabolically healthy (defined as no history of CVD, the absence of diabetes [ADA criteria] and hypertension [JNC 7 criteria] and dyslipidemia [LDL cholesterol >3.50 mmol/L or HDL cholesterol <1.03 mmol/L for men and <1.29 mmol/L for women or triglycerides >1.7 mmol/L or the use of lipid lowering drugs.]) In the overweight or obese groups 13.3% and 6.8%, respectively, were metabolically healthy. During a median follow-up of 7.5 years CVD events occurred in 0.6% of participants with metabolically healthy normal weight, in 1.3% of healthy overweight subjects, and in 1.1% of the healthy obese (P=NS). In metabolically unhealthy participants these percentages were 6.3%, 9.4% and 10.6% for subjects with normal weight, overweight and obesity, respectively (Table). In addition, Cox regression analysis revealed that BMI was not associated with an elevated CVD risk (HR 1.09, p=0.473), when corrected for gender, year of birth, previous CVD and metabolic parameters. 
Metabolically healthy obesity represents only a small subset of the total obese population. Metabolically healthy obese persons do not have an elevated CVD risk when compared to normal weight or overweight subjects with a similar metabolic profile. Verburg FAJ, van Beek AP, Sluiter WJ, et al. University of Groningen, Groningen, Netherlands Editor's CommentImproved fitness may be the factor that determines metabolic health, in both normal weight individuals as well as in those with obesity. Exercise capacity is an independent predictor of all-cause mortality. The relationship is inverse and graded, with most survival benefits achieved in those individuals with an exercise capacity >5 METs. Survival improves significantly when unfit individuals became fit.1 During a 34-year follow-up, leisure-time physical activity in initially healthy middle-aged men had a graded association with reduced mortality that was independent of BMI, CVD risk, and glucose tolerance.2 Fima Lifshitz, MD References - (linked to
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Volume 26 Number 1
September 2010
www.GGHjournal.com
ISSN 1932-9032
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