The Impact of Metabolic Heterogeneity of Obesity and Transitions on Cardiovascular Disease Incidence in Chinese Middle-aged and Elderly Population: A Nationwide Prospective Cohort Study

Overview

Journal Diabetes Obes Metab

Specialty Endocrinology

Date 2024 Nov 5

PMID 39497471

Authors

Qiang He

Rujie Zheng

Wenjuan Song

Xiaotong Sun

Chengzhi Lu

Affiliations

Soon will be listed here.

Abstract

Background: Previous studies indicated that metabolic heterogeneity of obesity would affect the risk of cardiovascular disease (CVD). However, the alterations in CVD risk associated with transitions between various metabolic health statuses influenced by obesity status remain unclear.

Methods: We utilized data from the China Health and Retirement Longitudinal Study (CHARLS), a longitudinal cohort study involving Chinese residents aged 45 years and older. Baseline data were collected in 2011-2012, with follow-up surveys conducted up to 2020. Participants in the study were categorized into four body mass index-metabolic phenotypes: metabolically healthy normal weight (MHNW), metabolically healthy overweight/obesity (MHOO), metabolically unhealthy normal weight (MUNW) and metabolically unhealthy overweight/obesity (MUOO). Transitions in these phenotypes over 4 years were analysed. Cox regression models were used to assess the associations of these phenotypes and their transitions with CVD incidence.

Results: Among 7721 participants, 1353 (17.5%) developed CVD during the follow-up period. Both overweight/obese and metabolically unhealthy statuses were associated with increased CVD risk. The highest risk was observed in the MUOO group (hazard ratio [HR]: 1.74, 95% confidence interval [CI]: 1.50-2.09, p < 0.0001), followed by the MUNW (HR 1.35, 95% CI: 1.13-1.66, p < 0.001) and MHOO (HR: 1.29, 95% CI: 1.08-1.56, p = 0.002) groups compared to the MHNW group. The deteriorations of obesity and metabolic health status elevated the incidence of CVD, whereas improvements in these statuses reduced the risk of CVD. Additionally, alterations in metabolic health status conferred greater benefits in overweight/obese individuals compared to those with normal weight.

Conclusion: The study highlights the importance of maintaining and promoting metabolic health, particularly in overweight/obese individuals, to reduce CVD risk. Metabolic health status plays a more crucial role than obesity status in predicting CVD incidence.

Citing Articles

Joint assessment of abdominal obesity and non-traditional lipid parameters for primary prevention of cardiometabolic multimorbidity: insights from the China health and retirement longitudinal study 2011-2018.

Lai H, Tu Y, Liao C, Zhang S, He L, Li J Cardiovasc Diabetol. 2025; 24(1):109.

PMID: 40057762 PMC: 11890515. DOI: 10.1186/s12933-025-02667-y.

The impact of metabolic heterogeneity of obesity and transitions on cardiovascular disease incidence in Chinese middle-aged and elderly population: A nationwide prospective cohort study.

He Q, Zheng R, Song W, Sun X, Lu C Diabetes Obes Metab. 2024; 27(2):501-510.

PMID: 39497471 PMC: 11701191. DOI: 10.1111/dom.16040.

References

Roth G, Forouzanfar M, Moran A, Barber R, Nguyen G, Feigin V . Demographic and epidemiologic drivers of global cardiovascular mortality. N Engl J Med. 2015; 372(14):1333-41. PMC: 4482354. DOI: 10.1056/NEJMoa1406656. View

Boutari C, DeMarsilis A, Mantzoros C . Obesity and diabetes. Diabetes Res Clin Pract. 2023; 202:110773. DOI: 10.1016/j.diabres.2023.110773. View

. 2016 Chinese guidelines for the management of dyslipidemia in adults. J Geriatr Cardiol. 2018; 15(1):1-29. PMC: 5803534. DOI: 10.11909/j.issn.1671-5411.2018.01.011. View

He Q, Zheng R, Song W, Sun X, Lu C . The impact of metabolic heterogeneity of obesity and transitions on cardiovascular disease incidence in Chinese middle-aged and elderly population: A nationwide prospective cohort study. Diabetes Obes Metab. 2024; 27(2):501-510. PMC: 11701191. DOI: 10.1111/dom.16040. View

Lin L, Zhang J, Jiang L, Du R, Hu C, Lu J . Transition of metabolic phenotypes and risk of subclinical atherosclerosis according to BMI: a prospective study. Diabetologia. 2020; 63(7):1312-1323. DOI: 10.1007/s00125-020-05116-5. View

Lee H, Choi E, Lee S, Han K, Rhee T, Park C . Atrial fibrillation risk in metabolically healthy obesity: A nationwide population-based study. Int J Cardiol. 2017; 240:221-227. DOI: 10.1016/j.ijcard.2017.03.103. View

Huang Q, Liu Z, Wei M, Feng J, Huang Q, Liu Y . Metabolically healthy obesity, transition from metabolic healthy to unhealthy status, and carotid atherosclerosis. Diabetes Metab Res Rev. 2024; 40(2):e3766. DOI: 10.1002/dmrr.3766. View

Chen G, Arthur R, Iyengar N, Kamensky V, Xue X, Wassertheil-Smoller S . Association between regional body fat and cardiovascular disease risk among postmenopausal women with normal body mass index. Eur Heart J. 2019; 40(34):2849-2855. PMC: 6933870. DOI: 10.1093/eurheartj/ehz391. View

Elagizi A, Kachur S, Lavie C, Carbone S, Pandey A, Ortega F . An Overview and Update on Obesity and the Obesity Paradox in Cardiovascular Diseases. Prog Cardiovasc Dis. 2018; 61(2):142-150. DOI: 10.1016/j.pcad.2018.07.003. View

10.

Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M . 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018; 39(33):3021-3104. DOI: 10.1093/eurheartj/ehy339. View

11.

Liu J, Fox C, Hickson D, May W, Hairston K, Carr J . Impact of abdominal visceral and subcutaneous adipose tissue on cardiometabolic risk factors: the Jackson Heart Study. J Clin Endocrinol Metab. 2010; 95(12):5419-26. PMC: 2999970. DOI: 10.1210/jc.2010-1378. View

12.

Li H, Konja D, Wang L, Wang Y . Sex Differences in Adiposity and Cardiovascular Diseases. Int J Mol Sci. 2022; 23(16). PMC: 9409326. DOI: 10.3390/ijms23169338. View

13.

Smith G, Mittendorfer B, Klein S . Metabolically healthy obesity: facts and fantasies. J Clin Invest. 2019; 129(10):3978-3989. PMC: 6763224. DOI: 10.1172/JCI129186. View

14.

Chen C, Lu F . The guidelines for prevention and control of overweight and obesity in Chinese adults. Biomed Environ Sci. 2005; 17 Suppl:1-36. View

15.

Stefan N . Causes, consequences, and treatment of metabolically unhealthy fat distribution. Lancet Diabetes Endocrinol. 2020; 8(7):616-627. DOI: 10.1016/S2213-8587(20)30110-8. View

16.

Zhang X, Zhu J, Kim J, Sumerlin T, Feng Q, Yu J . Metabolic health and adiposity transitions and risks of type 2 diabetes and cardiovascular diseases: a systematic review and meta-analysis. Diabetol Metab Syndr. 2023; 15(1):60. PMC: 10045173. DOI: 10.1186/s13098-023-01025-w. View

17.

Gao M, Lv J, Yu C, Guo Y, Bian Z, Yang R . Metabolically healthy obesity, transition to unhealthy metabolic status, and vascular disease in Chinese adults: A cohort study. PLoS Med. 2020; 17(10):e1003351. PMC: 7598496. DOI: 10.1371/journal.pmed.1003351. View

18.

. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2011; 34 Suppl 1:S62-9. PMC: 3006051. DOI: 10.2337/dc11-S062. View

19.

Kouvari M, Panagiotakos D, Yannakoulia M, Georgousopoulou E, Critselis E, Chrysohoou C . Transition from metabolically benign to metabolically unhealthy obesity and 10-year cardiovascular disease incidence: The ATTICA cohort study. Metabolism. 2019; 93:18-24. DOI: 10.1016/j.metabol.2019.01.003. View

20.

Chooi Y, Ding C, Magkos F . The epidemiology of obesity. Metabolism. 2018; 92:6-10. DOI: 10.1016/j.metabol.2018.09.005. View