Luisa Gilardini1, Antonella Zambon2, Davide Soranna3, Marina Croci4, Cecilia Invitti4. 1. Dipartimento di Scienza Mediche e Riabilitative, Istituto Auxologico Italiano, IRCCS, Via Ariosto 13, 20145, Milan, Italy. l.gilardini@auxologico.it. 2. Dipartimento di Statistica e Metodi Quantitativi, Università Milano-Bicocca, Milan, Italy. 3. Istituto Auxologico Italiano, IRCCS, Milan, Italy. 4. Dipartimento di Scienza Mediche e Riabilitative, Istituto Auxologico Italiano, IRCCS, Via Ariosto 13, 20145, Milan, Italy.
Abstract
PURPOSE: Evidence that metabolically healthy obesity (MHO) is a stable benign condition is unclear. The aim of this study was to estimate the transition of MHO subjects to unhealthy obesity (occurrence of cardio-metabolic events and/or risk factors) and its predictors. METHODS: We conducted an explorative follow-up study in a subset of MHO patients > 40 years without any cardio-metabolic risk factors and with normal LDL cholesterol (LDLc) levels, identified among 1530 obese patients. Due to the low sample size, a bootstrap approach was applied to identify the variables to be included in the final multivariate discrete-time logit model. RESULTS: The prevalence of MHO was 3.7%. During the follow-up (mean 6.1 years, SD 2.0), none of the MHO reported cardiovascular events, diabetes or prediabetes; 26 subjects developed risk factors (53% high LDLc and 50% hypertension). At the 6 and 12-year of follow-up, the cumulative incidence of transition to unhealthy obesity was 44% (95% CI 31-59%) and 62% (95% CI 45-79%), the incidence of high LDLc was 23% (95% CI 13-37%) and 40% (95% CI 25-59%) and that of hypertension was 20% (95% CI 11-33%) and 30% (95% CI 17-48%). LDLc and duration of follow-up were independent predictors of the transition from MHO to unhealthy obesity [OR 1.038 (1.005-1.072) and 1.360 (1.115-1.659)]. CONCLUSIONS: Results suggest that (a) MHO individuals do not move over time forward diabetes/prediabetes but develop risk factors, such as hypertension and higher LDL c that worsen the cardiovascular prognosis; (b) LDLc and the flow of time independently predict the transition to unhealthy status. LEVEL OF EVIDENCE: Level III, cohort study.
PURPOSE: Evidence that metabolically healthy obesity (MHO) is a stable benign condition is unclear. The aim of this study was to estimate the transition of MHO subjects to unhealthy obesity (occurrence of cardio-metabolic events and/or risk factors) and its predictors. METHODS: We conducted an explorative follow-up study in a subset of MHO patients > 40 years without any cardio-metabolic risk factors and with normal LDL cholesterol (LDLc) levels, identified among 1530 obesepatients. Due to the low sample size, a bootstrap approach was applied to identify the variables to be included in the final multivariate discrete-time logit model. RESULTS: The prevalence of MHO was 3.7%. During the follow-up (mean 6.1 years, SD 2.0), none of the MHO reported cardiovascular events, diabetes or prediabetes; 26 subjects developed risk factors (53% high LDLc and 50% hypertension). At the 6 and 12-year of follow-up, the cumulative incidence of transition to unhealthy obesity was 44% (95% CI 31-59%) and 62% (95% CI 45-79%), the incidence of high LDLc was 23% (95% CI 13-37%) and 40% (95% CI 25-59%) and that of hypertension was 20% (95% CI 11-33%) and 30% (95% CI 17-48%). LDLc and duration of follow-up were independent predictors of the transition from MHO to unhealthy obesity [OR 1.038 (1.005-1.072) and 1.360 (1.115-1.659)]. CONCLUSIONS: Results suggest that (a) MHO individuals do not move over time forward diabetes/prediabetes but develop risk factors, such as hypertension and higher LDL c that worsen the cardiovascular prognosis; (b) LDLc and the flow of time independently predict the transition to unhealthy status. LEVEL OF EVIDENCE: Level III, cohort study.
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