Association of Metabolically Healthy Obesity and Risk of Cardiovascular Disease Among Adults in China: A Retrospective Cohort Study

Figures & data

Table 1 Baseline Characteristics of the Study Population

Variables	Overall	MHNW	MHOW	MHO	MANW	MAOW	MAO	P
Num	46,055	12,717	9,701	2,294	5,424	10,914	5,005
Age (years)	67.86±7.29	68.36±7.30	67.80±7.26	67.12±6.93	68.50±7.35	67.53±7.32	67.05±7.22	<0.001
BMI (kg/m^2)	25.04±3.05	22.08±1.38	25.59±1.09	29.92±1.89	22.55±1.14	25.86±1.12	30.16±2.08	<0.001
WC (cm)	84.77±9.00	79.01±7.19	84.34±8.20	91.27±10.30	82.92±6.93	87.39±6.91	93.57±8.90	<0.001
FPG (mmol/L)	5.93±1.76	5.44±1.41	5.43±1.21	5.40±1.19	6.49±2.27	6.49±1.90	6.57±1.96	<0.001
TG (mmol/L)	1.62±1.05	1.25±0.61	1.30±0.58	1.32±0.66	1.99±1.32	2.02±1.29	2.05±1.24	<0.001
HDL-C (mmol/L)	1.44±1.37	1.55±1.99	1.48±1.22	1.46±0.37	1.36±0.47	1.34±0.45	1.34±1.85	<0.001
SBP (mm Hg)	136.53±16.66	131.02±15.89	133.21±16.16	135.78±17.49	139.20±14.88	141.28±15.69	144.01±16.73	<0.001
DBP (mm Hg)	79.88±9.96	77.27±9.54	78.95±9.87	80.42±10.38	80.25±9.39	81.79±9.74	83.49±10.06	<0.001
WHR	0.52±0.06	0.49±0.04	0.52±0.05	0.57±0.06	0.51±0.04	0.54±0.04	0.58±0.06	<0.001
Gender (%)								<0.001
Woman	27,254(59.18)	7,084(55.70)	4,752(48.98)	1,237(53.92)	3,967(73.14)	6,978(63.94)	3,236(64.66)
Man	18,801(40.82)	5,633(44.30)	4,949(51.02)	1,057(46.08)	1,457(26.86)	3,936(36.06)	1,769(35.34)
Smoking status (%)								<0.001
Never	42,942(93.24)	11,888(93.48)	9,011(92.89)	2,107(91.85)	5,170(95.32)	10,133(92.84)	4,633(92.57)
Current and former	3,113(6.76)	829(6.52)	690(7.11)	187(8.15)	254(4.68)	781(7.16)	372(7.43)
Drinking status (%)								<0.001
Never	42,554(92.40)	11,914(93.69)	8,893(91.67)	2,070(90.24)	5,151(94.97)	9,985(91.49)	4,541(90.73)
Current and former	3,501(7.60)	803(6.31)	808(8.33)	224(9.76)	273(5.03)	929(8.51)	464(9.27)
Exercise status (%)								<0.001
Never	15,216(33.04)	4,284(33.69)	3,077(31.72)	788(34.35)	1,837(33.87)	3,472(31.81)	1,758(35.12)
Current	30,839(66.96)	8,433(66.31)	6,624(68.28)	1,506(65.65)	3,587(66.13)	7,442(68.19)	3,247(64.88)

Abbreviations: MHNW, metabolically healthy normal weight; MHOW, metabolically healthy overweight; MHO, metabolically healthy obesity; MANW, metabolic abnormality normal weight; MAOW, metabolically unhealthy overweight; MAO, metabolically abnormal obesity; BMI, body mass index; WC, waist circumference; FPG, fasting plasma glucose; TG, triglycerides; HDL-C, high-density lipoprotein cholesterol; SBP, systolic blood pressure; DBP, diastolic blood pressure; WHR, waist–height ratio.

Table 2 Incidence and Adjusted HRs for CVDs by BMI-Metabolic Health Status at Baseline

Variables	MHNW	MHOW	MHO	MANW	MAOW	MAO
Cardiovascular disease
Incident cases	542	489	172	277	642	380
Person-years of follow-up	25,969.30	20,545.07	5,093.42	11,173.23	23,286.82	11,034.16
Incidence rate (per 1000 person-years)	20.87	23.80	33.77	24.79	27.57	34.44
HR (95% CI) Model 1	Ref	1.13(0.99–1.27)	1.63(1.37–1.93)*	1.24(1.08–1.44)*	1.37(1.22–1.54)*	1.73(1.52–1.97)*
HR (95% CI) Model 2	Ref	1.13(1.01–1.28)*	1.62(1.36–1.92)*	1.24(1.07–1.44)*	1.37(1.22–1.54)*	1.72(1.50–1.96)*
Coronary heart disease
Incident cases	429	395	148	211	490	309
Person-years of follow-up	25,969.30	20,545.07	5,093.42	11,173.23	23,286.82	11,034.16
Incidence rate (per 1000 person-years)	16.52	19.23	29.06	18.88	21.04	28.00
HR (95% CI) Model 1	Ref	1.16(1.01–1.32)*	1.77(1.47–2.14)*	1.19(1.01–1.40)*	1.32(1.16–1.50)*	1.77(1.53–2.05)*
HR (95% CI) Model 2	Ref	1.16(1.01–1.33)*	1.76(1.46–2.13)*	1.19(1.01–1.40)*	1.32(1.16–1.51)*	1.76(1.52–2.04)*
Stroke
Incident cases	124	102	27	72	167	83
Person-years of follow-up	25,969.30	20,545.07	5,093.42	11,173.23	23,286.82	11,034.16
Incidence rate (per 1000 person-years)	4.77	4.96	5.30	6.44	7.17	7.52
HR (95% CI) Model 1	Ref	1.02(0.78–1.32)	1.12(0.74–1.70)	1.46(1.09–1.95)*	1.58(1.25–2.00)*	1.68(1.27–2.22)*
HR (95% CI) Model 2	Ref	1.03(0.79–1.34)	1.12(0.74–1.69)	1.45(1.08–1.94)*	1.56(1.24–1.98)*	1.64(1.24–2.18)*

Notes: *P<0.05. Model 1: adjusted for age and sex. Model 2: adjusted for age, sex, exercise, and smoking.

Abbreviations: MHNW, metabolically healthy normal weight; MHOW, metabolically healthy overweight; MHO, metabolically healthy obesity; MANW, metabolic abnormality normal weight; MAOW, metabolically unhealthy overweight; MAO, metabolically abnormal obesity; HR, hazard ratio; CI, confidential interval.

Figure 1 The cumulative incidence trends of CVD in the participants with different metabolic health statuses. The subjects with MAO had the highest incidences of CVD, followed by MHO, MAOW, MANW and MHOW. MHNW had relatively lower risks.

Figure 2 The hazard ratios (HRs) and 95% confidence intervals (CIs) between the subjects in each transition group and cardiovascular disease. HRs (95% CIs) were adjusted for age, sex, exercise, and smoking status.