Unab I Khan1, Dan Wang, Carrie A Karvonen-Gutierrez, Naila Khalil, Kelly R Ylitalo, Nanette Santoro. 1. Departments of Pediatrics (U.I.K.) and Epidemiology and Population Health (D.W.), Albert Einstein College of Medicine, Bronx, New York 10467; Center for Global Health (N.K.), Boonshoft School of Medicine, Wright State University, Dayton, Ohio 45435; Department of Epidemiology (C.A.K.-G. and K.R.Y.), University of Michigan School of Public Health, Ann Arbor, Michigan 48109; and Department of Obstetrics and Gynecology and Women's Health (N.S.), University of Colorado-Denver School of Medicine, Aurora, Colorado 80045.
Abstract
BACKGROUND: Little is known about the natural history of progression from a metabolically benign overweight/obese (MBO) to at-risk overweight/obese (ARO) phenotype. Improved understanding would help clinicians focus on controlling risk factors that predispose an obese individual to progression. METHODS: Using discrete-time proportional hazard modeling on data from the Study of Women's Health Across the Nation (SWAN), we examined the incident progression from MBO (less than two metabolic syndrome abnormalities) to ARO (two or more metabolic syndrome abnormalities) and factors associated with progression over a 7-year period. RESULTS: Of 866 MBO women at baseline, 43% progressed to the ARO phenotype. Compared with those who remained MBO, those who progressed had higher baseline BMI and a higher prevalence of cardiometabolic abnormalities (elevated glucose, triglycerides, blood pressure and low high-density lipoprotein cholesterol). In multivariable analyses, an increase in body mass index was associated with a modest increase in the risk of progression. Although all cardiometabolic abnormalities were associated with an increased risk, the baseline impaired fasting glucose showed the strongest association with the risk of progression [hazard ratio 3.24; 95% confidence interval 2.10, 4.92; P < .001]. Physical activity played a protective role in decreasing the risk of progression [hazard ratio 0.86; 95% confidence interval 0.80, 0.92; P < .001]. CONCLUSIONS: Increasing obesity and the presence of cardiometabolic abnormalities increase the risk of progression, whereas physical activity is the only lifestyle factor protective against progression from metabolically benign to the at-risk overweight/obese phenotype, a state that is unanimously associated with an elevated risk of cardiovascular morbidity and mortality.
BACKGROUND: Little is known about the natural history of progression from a metabolically benign overweight/obese (MBO) to at-risk overweight/obese (ARO) phenotype. Improved understanding would help clinicians focus on controlling risk factors that predispose an obese individual to progression. METHODS: Using discrete-time proportional hazard modeling on data from the Study of Women's Health Across the Nation (SWAN), we examined the incident progression from MBO (less than two metabolic syndrome abnormalities) to ARO (two or more metabolic syndrome abnormalities) and factors associated with progression over a 7-year period. RESULTS: Of 866 MBO women at baseline, 43% progressed to the ARO phenotype. Compared with those who remained MBO, those who progressed had higher baseline BMI and a higher prevalence of cardiometabolic abnormalities (elevated glucose, triglycerides, blood pressure and low high-density lipoprotein cholesterol). In multivariable analyses, an increase in body mass index was associated with a modest increase in the risk of progression. Although all cardiometabolic abnormalities were associated with an increased risk, the baseline impaired fasting glucose showed the strongest association with the risk of progression [hazard ratio 3.24; 95% confidence interval 2.10, 4.92; P < .001]. Physical activity played a protective role in decreasing the risk of progression [hazard ratio 0.86; 95% confidence interval 0.80, 0.92; P < .001]. CONCLUSIONS: Increasing obesity and the presence of cardiometabolic abnormalities increase the risk of progression, whereas physical activity is the only lifestyle factor protective against progression from metabolically benign to the at-risk overweight/obese phenotype, a state that is unanimously associated with an elevated risk of cardiovascular morbidity and mortality.
Authors: Unab I Khan; Alexandra D Ogorodnikova; Linzhi Xu; Dan Wang; Sylvia Wassertheil-Smoller; Gloria Y F Ho; Mary Fran R Sowers; Swapnil N Rajpathak; Matthew A Allison; Rachel H Mackey; Mara Z Vitolins; Joann E Manson; Rachel P Wildman Journal: Obesity (Silver Spring) Date: 2013-12-20 Impact factor: 5.002
Authors: Samar R El Khoudary; Rachel P Wildman; Karen Matthews; Rebecca C Thurston; Joyce T Bromberger; Kim Sutton-Tyrrell Journal: Menopause Date: 2013-01 Impact factor: 2.953
Authors: Unab I Khan; Dan Wang; Rebecca C Thurston; Maryfran Sowers; Kim Sutton-Tyrrell; Karen A Matthews; Emma Barinas-Mitchell; Rachel P Wildman Journal: Atherosclerosis Date: 2011-01-21 Impact factor: 5.162
Authors: Alice Tang; Adelle C F Coster; Katherine T Tonks; Leonie K Heilbronn; Nicholas Pocock; Louise Purtell; Matthew Govendir; Jackson Blythe; Jialiang Zhang; Aimin Xu; Donald J Chisholm; Nathan A Johnson; Jerry R Greenfield; Dorit Samocha-Bonet Journal: J Clin Med Date: 2019-05-08 Impact factor: 4.241