Prevalence Of Metabolically Healthy Obesity And Its Dynamic Change On Incidences Of Diabetes And Cardiovascular Diseases

BACKGROUND:Obesity cloud significantly increase the incidence of multiple chronic diseases and it is a major cause of global epidemics,such as diabetes mellitus(DM),hypertension,.fatty liver,and cardiovascular disease(CVD).In recent years,some obese individuals have been found to have higher insulin sensitivity,better blood pressure,blood glucose,blood lipids,hormone levels,and a good inflammatory state,although they have more fat accumulation.They are called metabolically healthy obesity(MHO).At present,most relevant researches have been done in Europe and the United States and other regions,and there are few in China,especially the prospective cohort study.Objective:To understand the prevalence and related factors of MHO in Chinese population and the relationship between MHO and CVD,and to observe the characteristics of MHO over time and the incidence of DM and CVD in MHO population.Methods:This study was derived from the REACTION study,the Risk Evaluation of cAncers in Chinese diabeTic Individuals:AlONgitudinal study.1)Cross-sectional study:We selected nine research centers(Beijing,Shanghai,Sichuan,Guangxi,Gansu,Henan,Guangdong,Liaoning,and Hubei)as the source of the cross-sectional study population.Original data were collected through questionnaires,physical examinations,and blood collection and testing.Multivariate regression analysis was used to analyze factors related to MHO in obese people.A logistic regression model was used to analyze the risk of MHO and cardiovascular disease.2)Prospective cohort study:Beijing community population was selected as the baseline study subject,and data collection has been described above.After an average of 3.3 years' follow-up,the incidence of new-onset DM and CVD was collected in the same population.A cox regression model was established to analyze the risk of DM and CVD in the MHO population.Results:1)A total of 66,560 subjects were included in the cross-sectional study,among which 67.8%were female.The prevalence of MHO was 5.0%in the total population,and the prevalence of MHO in males and females was 3.9%and 5.6%,respectively.In the obese population,the prevalence of MHO was 29.2%,and the prevalence among males and females was 22.4%and 32.4%,respectively.With aging,the prevalence of MHO gradually decreased from 5.8%before 50 years old to 3.2%after 70 years old.Multivariate analysis showed that women and high-intensity exercise were positively correlated with MHO,while age,family history of diabetes,and abdominal obesity were negatively correlated with MHO.In the logistic regression model,the risk of CVD in males and females was ORmale=2.1(95%CI:1.6-2.8)?ORfemale=1.8(95%CI:1.5-2.2),and the 10-year risk of heart disease was:ORmale = 2.3(95%CI:1.9,-2.8)?ORfemale ?2.1(95%CI:1.7-2.5)2)The prospective cohort study included 9678 subjects,of whom 64.5%were women.After 3.3 years' follow-up,39.5%of MHO were converted to metabolic abnormalities.Analysis showed that weight loss helps maintain helathy metabolic status,but abdominal obesity,elevated blood pressure,and triglyceride contributed to the conversion of MHO to metabolic abnormalities.According to the baseline status,cox regression analysis showed that compared with the metabolically healthy normal-weight(MHNW)population,women in the MHO population had higher risk of DM(HR:1.7,95%Cl:1.1-2.5).The risk of CVD(HR:2.1,95%CI:1.1-3.7),but not the male.Considering the dynamic shift of MHO,it was found that people who maintained MHO did not increase the risk of developing DM or CVD compared with those who maintained MHNW.However,increased diabetes was found in people who converted MHO to MUO(HR:6.0,95%CI:3.8-9.5)and risk of cardiovascular disease,but the latter can only be observed in the female population(HR = 2.9,95%Cl:1.3-6.8).Conclusions:a)1.The prevalence of MHO,which was not uncommon among middle-aged and elderly people in China,increased with age,and women were higher than men and pre-menopausal are higher than post-menopausal women.There are also significant differences in different regions of China.2.In obese patients,MHO was positively associated with women and strength of physical activity,and was negatively associated with age,family history of DM and abdominal obesity.3.MHO was associated with the elevated the risk of CVD and the risk of 10-year CVD.b)1.MHO is not a stable state,and more than one-third changes after 3.3 years of follow-up;2.MHO will increase the incidence of diabetes and cardiovascular events,only among female populations;3.Metabolic state changes(MHO?MUO)will significantly increase the incidence of diabetes(male and female),cardiovascular disease(female);4,weight loss can prevent the MHO to metabolic abnormalities,and abdominal obesity,high triglycerides,high blood pressure of baseline will lead MHO to metablolic abnormalities.