Visceral abdominal fat accumulation predicts the conversion of metabolically healthy obese subjects to an unhealthy phenotype

Background: A proportion of obese subjects appear metabolically healthy (MHO) but little is known about the natural history of MHO and factors predicting its future conversion to metabolically unhealthy obese (MUO). Objectives: The aim was to determine prospectively the frequency of conversion of MH...

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Published inInternational Journal of Obesity Vol. 39; no. 9; pp. 1365 - 1370
Main Authors Hwang, Y-C, Hayashi, T, Fujimoto, W Y, Kahn, S E, Leonetti, D L, McNeely, M J, Boyko, E J
Format Journal Article
LanguageEnglish
Published London Nature Publishing Group UK 01.09.2015
Nature Publishing Group
Subjects
692/163
692/699/2743/393
692/700/139/2818
692/700/478/174
Abdomen
Adiposity
Adult
Aged
Asian Americans - statistics & numerical data
Blood Glucose - metabolism
Body Composition
Body Mass Index
Body size
Cholesterol
Cholesterol, HDL - blood
Computed tomography
Confidence intervals
Conversion
Diabetes
Dyslipidemia
Epidemiology
Exercise
Fasting
Female
Females
Genetic aspects
Genotype & phenotype
Health care
Health Promotion and Disease Prevention
High density lipoprotein
Humans
Insulin
Insulin Resistance
Internal Medicine
Intra-Abdominal Fat - metabolism
Japanese Americans
Laboratory testing
Lifestyles
Lipoproteins, LDL - blood
Male
Medicine
Medicine & Public Health
Men
Metabolic Diseases
Metabolic disorders
Metabolic syndrome
Metabolic Syndrome - blood
Metabolic Syndrome - epidemiology
Metabolic Syndrome - metabolism
Metabolism
Middle Aged
Multivariate analysis
Obesity
Obesity - metabolism
original-article
Phenotype
Phenotypes
Population
Preventive medicine
Prospective Studies
Public Health
Questionnaires
Sex
Statistical analysis
Thigh
Tomography
United States - epidemiology
Womens health
United States
United States > US
Puget Sound
Online AccessGet full text
ISSN0307-0565
1476-5497
1476-5497
DOI10.1038/ijo.2015.75

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Abstract Background: A proportion of obese subjects appear metabolically healthy (MHO) but little is known about the natural history of MHO and factors predicting its future conversion to metabolically unhealthy obese (MUO). Objectives: The aim was to determine prospectively the frequency of conversion of MHO to MUO and the clinical variables that independently predicted this conversion, with a particular focus on the role of body composition. Methods: We identified 85 Japanese Americans with MHO (56 men, 29 women), aged 34–73 years (mean age 49.8 years) who were followed at 2.5, 5 and 10 years after enrollment with measurements of metabolic characteristics, lifestyle and abdominal and thigh fat areas measured by computed tomography. Obesity was defined using the Asian body mass index criterion of ⩾25 kg m −2 . Metabolically healthy was defined as the presence of ⩽2 of 5 metabolic syndrome components proposed by the National Cholesterol Education Program Adult Treatment Panel III, while metabolically unhealthy was defined as ⩾3 components. Results: Over 10 years of follow-up, 55 MHO individuals (64.7%) converted to MUO. Statistically significant univariate predictors of conversion included dyslipidemia, greater insulin resistance and greater visceral abdominal (VAT) and subcutaneous abdominal fat area (SAT). In multivariate analysis, VAT (odds ratio per 1-s.d. increment (95% confidence interval) 2.04 (1.11–3.72), P =0.021), high-density lipoprotein (HDL) cholesterol (0.24 (0.11–0.53), P <0.001), fasting plasma insulin (2.45 (1.07–5.62), P =0.034) and female sex (5.37 (1.14–25.27), P =0.033) were significantly associated with future conversion to MUO. However, SAT was not an independent predictor for future conversion to MUO. Conclusions: In this population, MHO was a transient state, with nearly two-thirds developing MUO over 10 years, with higher conversion to MUO independently associated with VAT, female sex, higher fasting insulin level and lower baseline HDL cholesterol level.
AbstractList A proportion of obese subjects appear metabolically healthy (MHO) but little is known about the natural history of MHO and factors predicting its future conversion to metabolically unhealthy obese (MUO).BACKGROUNDA proportion of obese subjects appear metabolically healthy (MHO) but little is known about the natural history of MHO and factors predicting its future conversion to metabolically unhealthy obese (MUO).The aim was to determine prospectively the frequency of conversion of MHO to MUO and the clinical variables that independently predicted this conversion, with a particular focus on the role of body composition.OBJECTIVESThe aim was to determine prospectively the frequency of conversion of MHO to MUO and the clinical variables that independently predicted this conversion, with a particular focus on the role of body composition.We identified 85 Japanese Americans with MHO (56 men, 29 women), aged 34-73 years (mean age 49.8 years) who were followed at 2.5, 5 and 10 years after enrollment with measurements of metabolic characteristics, lifestyle and abdominal and thigh fat areas measured by computed tomography. Obesity was defined using the Asian body mass index criterion of ⩾25 kg m(-2). Metabolically healthy was defined as the presence of ⩽2 of 5 metabolic syndrome components proposed by the National Cholesterol Education Program Adult Treatment Panel III, while metabolically unhealthy was defined as ⩾3 components.METHODSWe identified 85 Japanese Americans with MHO (56 men, 29 women), aged 34-73 years (mean age 49.8 years) who were followed at 2.5, 5 and 10 years after enrollment with measurements of metabolic characteristics, lifestyle and abdominal and thigh fat areas measured by computed tomography. Obesity was defined using the Asian body mass index criterion of ⩾25 kg m(-2). Metabolically healthy was defined as the presence of ⩽2 of 5 metabolic syndrome components proposed by the National Cholesterol Education Program Adult Treatment Panel III, while metabolically unhealthy was defined as ⩾3 components.Over 10 years of follow-up, 55 MHO individuals (64.7%) converted to MUO. Statistically significant univariate predictors of conversion included dyslipidemia, greater insulin resistance and greater visceral abdominal (VAT) and subcutaneous abdominal fat area (SAT). In multivariate analysis, VAT (odds ratio per 1-s.d. increment (95% confidence interval) 2.04 (1.11-3.72), P=0.021), high-density lipoprotein (HDL) cholesterol (0.24 (0.11-0.53), P<0.001), fasting plasma insulin (2.45 (1.07-5.62), P=0.034) and female sex (5.37 (1.14-25.27), P=0.033) were significantly associated with future conversion to MUO. However, SAT was not an independent predictor for future conversion to MUO.RESULTSOver 10 years of follow-up, 55 MHO individuals (64.7%) converted to MUO. Statistically significant univariate predictors of conversion included dyslipidemia, greater insulin resistance and greater visceral abdominal (VAT) and subcutaneous abdominal fat area (SAT). In multivariate analysis, VAT (odds ratio per 1-s.d. increment (95% confidence interval) 2.04 (1.11-3.72), P=0.021), high-density lipoprotein (HDL) cholesterol (0.24 (0.11-0.53), P<0.001), fasting plasma insulin (2.45 (1.07-5.62), P=0.034) and female sex (5.37 (1.14-25.27), P=0.033) were significantly associated with future conversion to MUO. However, SAT was not an independent predictor for future conversion to MUO.In this population, MHO was a transient state, with nearly two-thirds developing MUO over 10 years, with higher conversion to MUO independently associated with VAT, female sex, higher fasting insulin level and lower baseline HDL cholesterol level.CONCLUSIONSIn this population, MHO was a transient state, with nearly two-thirds developing MUO over 10 years, with higher conversion to MUO independently associated with VAT, female sex, higher fasting insulin level and lower baseline HDL cholesterol level.
Background:A proportion of obese subjects appear metabolically healthy (MHO) but little is known about the natural history of MHO and factors predicting its future conversion to metabolically unhealthy obese (MUO).Objectives:The aim was to determine prospectively the frequency of conversion of MHO to MUO and the clinical variables that independently predicted this conversion, with a particular focus on the role of body composition.Methods:We identified 85 Japanese Americans with MHO (56 men, 29 women), aged 34–73 years (mean age 49.8 years) who were followed at 2.5, 5 and 10 years after enrollment with measurements of metabolic characteristics, lifestyle and abdominal and thigh fat areas measured by computed tomography. Obesity was defined using the Asian body mass index criterion of ⩾25 kg m−2. Metabolically healthy was defined as the presence of ⩽2 of 5 metabolic syndrome components proposed by the National Cholesterol Education Program Adult Treatment Panel III, while metabolically unhealthy was defined as ⩾3 components.Results:Over 10 years of follow-up, 55 MHO individuals (64.7%) converted to MUO. Statistically significant univariate predictors of conversion included dyslipidemia, greater insulin resistance and greater visceral abdominal (VAT) and subcutaneous abdominal fat area (SAT). In multivariate analysis, VAT (odds ratio per 1-s.d. increment (95% confidence interval) 2.04 (1.11–3.72), P=0.021), high-density lipoprotein (HDL) cholesterol (0.24 (0.11–0.53), P<0.001), fasting plasma insulin (2.45 (1.07–5.62), P=0.034) and female sex (5.37 (1.14–25.27), P=0.033) were significantly associated with future conversion to MUO. However, SAT was not an independent predictor for future conversion to MUO.Conclusions:In this population, MHO was a transient state, with nearly two-thirds developing MUO over 10 years, with higher conversion to MUO independently associated with VAT, female sex, higher fasting insulin level and lower baseline HDL cholesterol level.
BACKGROUND: A proportion of obese subjects appear metabolically healthy (MHO) but little is known about the natural history of MHO and factors predicting its future conversion to metabolically unhealthy obese (MUO). OBJECTIVES: The aim was to determine prospectively the frequency of conversion of MHO to MUO and the clinical variables that independently predicted this conversion, with a particular focus on the role of body composition. METHODS: We identified 85 Japanese Americans with MHO (56 men, 29 women), aged 34-73 years (mean age 49.8 years) who were followed at 2.5, 5 and 10 years after enrollment with measurements of metabolic characteristics, lifestyle and abdominal and thigh fat areas measured by computed tomography. Obesity was defined using the Asian body mass index criterion of [greater than or equal to] 25 kg [m.sup.-2]. Metabolically healthy was defined as the presence of [less than or equal to] 2 of 5 metabolic syndrome components proposed by the National Cholesterol Education Program Adult Treatment Panel III, while metabolically unhealthy was defined as [greater than or equal to] 3 components. RESULTS: Over 10 years of follow-up, 55 MHO individuals (64.7%) converted to MUO. Statistically significant univariate predictors of conversion included dyslipidemia, greater insulin resistance and greater visceral abdominal (VAT) and subcutaneous abdominal fat area (SAT). In multivariate analysis, VAT (odds ratio per 1-s.d. increment (95% confidence interval) 2.04 (1.11-3.72), P = 0.021), highdensity lipoprotein (HDL) cholesterol (0.24 (0.11-0.53), P < 0.001), fasting plasma insulin (2.45 (1.07-5.62), P = 0.034) and female sex (5.37 (1.14-25.27), P = 0.033) were significantly associated with future conversion to MUO. However, SAT was not an independent predictor for future conversion to MUO. CONCLUSIONS: In this population, MHO was a transient state, with nearly two-thirds developing MUO over 10 years, with higher conversion to MUO independently associated with VAT, female sex, higher fasting insulin level and lower baseline HDL cholesterol level. International Journal of Obesity (2015) 39, 1365-1370; doi: 10.1038/ijo.2015.75
Background: A proportion of obese subjects appear metabolically healthy (MHO) but little is known about the natural history of MHO and factors predicting its future conversion to metabolically unhealthy obese (MUO). Objectives: The aim was to determine prospectively the frequency of conversion of MHO to MUO and the clinical variables that independently predicted this conversion, with a particular focus on the role of body composition. Methods: We identified 85 Japanese Americans with MHO (56 men, 29 women), aged 34-73 years (mean age 49.8 years) who were followed at 2.5, 5 and 10 years after enrollment with measurements of metabolic characteristics, lifestyle and abdominal and thigh fat areas measured by computed tomography. Obesity was defined using the Asian body mass index criterion of [egs]25 kg m super(-2). Metabolically healthy was defined as the presence of [els]2 of 5 metabolic syndrome components proposed by the National Cholesterol Education Program Adult Treatment Panel III, while metabolically unhealthy was defined as [egs]3 components. Results: Over 10 years of follow-up, 55 MHO individuals (64.7%) converted to MUO. Statistically significant univariate predictors of conversion included dyslipidemia, greater insulin resistance and greater visceral abdominal (VAT) and subcutaneous abdominal fat area (SAT). In multivariate analysis, VAT (odds ratio per 1-s.d. increment (95% confidence interval) 2.04 (1.11-3.72), P=0.021), high-density lipoprotein (HDL) cholesterol (0.24 (0.11-0.53), P<0.001), fasting plasma insulin (2.45 (1.07-5.62), P=0.034) and female sex (5.37 (1.14-25.27), P=0.033) were significantly associated with future conversion to MUO. However, SAT was not an independent predictor for future conversion to MUO. Conclusions: In this population, MHO was a transient state, with nearly two-thirds developing MUO over 10 years, with higher conversion to MUO independently associated with VAT, female sex, higher fasting insulin level and lower baseline HDL cholesterol level.
Background: A proportion of obese subjects appear metabolically healthy (MHO) but little is known about the natural history of MHO and factors predicting its future conversion to metabolically unhealthy obese (MUO). Objectives: The aim was to determine prospectively the frequency of conversion of MHO to MUO and the clinical variables that independently predicted this conversion, with a particular focus on the role of body composition. Methods: We identified 85 Japanese Americans with MHO (56 men, 29 women), aged 34–73 years (mean age 49.8 years) who were followed at 2.5, 5 and 10 years after enrollment with measurements of metabolic characteristics, lifestyle and abdominal and thigh fat areas measured by computed tomography. Obesity was defined using the Asian body mass index criterion of ⩾25 kg m −2 . Metabolically healthy was defined as the presence of ⩽2 of 5 metabolic syndrome components proposed by the National Cholesterol Education Program Adult Treatment Panel III, while metabolically unhealthy was defined as ⩾3 components. Results: Over 10 years of follow-up, 55 MHO individuals (64.7%) converted to MUO. Statistically significant univariate predictors of conversion included dyslipidemia, greater insulin resistance and greater visceral abdominal (VAT) and subcutaneous abdominal fat area (SAT). In multivariate analysis, VAT (odds ratio per 1-s.d. increment (95% confidence interval) 2.04 (1.11–3.72), P =0.021), high-density lipoprotein (HDL) cholesterol (0.24 (0.11–0.53), P <0.001), fasting plasma insulin (2.45 (1.07–5.62), P =0.034) and female sex (5.37 (1.14–25.27), P =0.033) were significantly associated with future conversion to MUO. However, SAT was not an independent predictor for future conversion to MUO. Conclusions: In this population, MHO was a transient state, with nearly two-thirds developing MUO over 10 years, with higher conversion to MUO independently associated with VAT, female sex, higher fasting insulin level and lower baseline HDL cholesterol level.
Background:A proportion of obese subjects appear metabolically healthy (MHO) but little is known about the natural history of MHO and factors predicting its future conversion to metabolically unhealthy obese (MUO).Objectives:The aim was to determine prospectively the frequency of conversion of MHO to MUO and the clinical variables that independently predicted this conversion, with a particular focus on the role of body composition.Methods:We identified 85 Japanese Americans with MHO (56 men, 29 women), aged 34-73 years (mean age 49.8 years) who were followed at 2.5, 5 and 10 years after enrollment with measurements of metabolic characteristics, lifestyle and abdominal and thigh fat areas measured by computed tomography. Obesity was defined using the Asian body mass index criterion of [= or >, slanted]25 kg m-2 . Metabolically healthy was defined as the presence of [= or <, slanted]2 of 5 metabolic syndrome components proposed by the National Cholesterol Education Program Adult Treatment Panel III, while metabolically unhealthy was defined as [= or >, slanted]3 components.Results:Over 10 years of follow-up, 55 MHO individuals (64.7%) converted to MUO. Statistically significant univariate predictors of conversion included dyslipidemia, greater insulin resistance and greater visceral abdominal (VAT) and subcutaneous abdominal fat area (SAT). In multivariate analysis, VAT (odds ratio per 1-s.d. increment (95% confidence interval) 2.04 (1.11-3.72), P=0.021), high-density lipoprotein (HDL) cholesterol (0.24 (0.11-0.53), P<0.001), fasting plasma insulin (2.45 (1.07-5.62), P=0.034) and female sex (5.37 (1.14-25.27), P=0.033) were significantly associated with future conversion to MUO. However, SAT was not an independent predictor for future conversion to MUO.Conclusions:In this population, MHO was a transient state, with nearly two-thirds developing MUO over 10 years, with higher conversion to MUO independently associated with VAT, female sex, higher fasting insulin level and lower baseline HDL cholesterol level.
International Journal of Obesity (2015) 39, 1365-1370; doi: 10.1038/ijo.2015.75
A proportion of obese subjects appear metabolically healthy (MHO) but little is known about the natural history of MHO and factors predicting its future conversion to metabolically unhealthy obese (MUO). The aim was to determine prospectively the frequency of conversion of MHO to MUO and the clinical variables that independently predicted this conversion, with a particular focus on the role of body composition. We identified 85 Japanese Americans with MHO (56 men, 29 women), aged 34-73 years (mean age 49.8 years) who were followed at 2.5, 5 and 10 years after enrollment with measurements of metabolic characteristics, lifestyle and abdominal and thigh fat areas measured by computed tomography. Obesity was defined using the Asian body mass index criterion of ⩾25 kg m(-2). Metabolically healthy was defined as the presence of ⩽2 of 5 metabolic syndrome components proposed by the National Cholesterol Education Program Adult Treatment Panel III, while metabolically unhealthy was defined as ⩾3 components. Over 10 years of follow-up, 55 MHO individuals (64.7%) converted to MUO. Statistically significant univariate predictors of conversion included dyslipidemia, greater insulin resistance and greater visceral abdominal (VAT) and subcutaneous abdominal fat area (SAT). In multivariate analysis, VAT (odds ratio per 1-s.d. increment (95% confidence interval) 2.04 (1.11-3.72), P=0.021), high-density lipoprotein (HDL) cholesterol (0.24 (0.11-0.53), P<0.001), fasting plasma insulin (2.45 (1.07-5.62), P=0.034) and female sex (5.37 (1.14-25.27), P=0.033) were significantly associated with future conversion to MUO. However, SAT was not an independent predictor for future conversion to MUO. In this population, MHO was a transient state, with nearly two-thirds developing MUO over 10 years, with higher conversion to MUO independently associated with VAT, female sex, higher fasting insulin level and lower baseline HDL cholesterol level.
Audience Academic
Author Boyko, E J
McNeely, M J
Hwang, Y-C
Fujimoto, W Y
Leonetti, D L
Hayashi, T
Kahn, S E
AuthorAffiliation 2 Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
6 Department of Anthropology, University of Washington, Seattle, WA, United States
4 Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
5 Hospital and Specialty Medicine Service, VA Puget Sound Health Care System, Seattle, WA, United States
3 Department of Preventive Medicine and Environmental Health, Graduate School of Medicine, Osaka City University, Osaka, Japan
1 Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, United States
AuthorAffiliation_xml – name: 2 Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
– name: 4 Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
– name: 5 Hospital and Specialty Medicine Service, VA Puget Sound Health Care System, Seattle, WA, United States
– name: 3 Department of Preventive Medicine and Environmental Health, Graduate School of Medicine, Osaka City University, Osaka, Japan
– name: 1 Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, United States
– name: 6 Department of Anthropology, University of Washington, Seattle, WA, United States
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  givenname: Y-C
  surname: Hwang
  fullname: Hwang, Y-C
  organization: Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong
– sequence: 2
  givenname: T
  surname: Hayashi
  fullname: Hayashi, T
  organization: Department of Preventive Medicine and Environmental Health, Graduate School of Medicine, Osaka City University
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  givenname: W Y
  surname: Fujimoto
  fullname: Fujimoto, W Y
  organization: Department of Medicine, University of Washington School of Medicine
– sequence: 4
  givenname: S E
  surname: Kahn
  fullname: Kahn, S E
  organization: Department of Medicine, University of Washington School of Medicine, Hospital and Specialty Medicine Service, VA Puget Sound Health Care System
– sequence: 5
  givenname: D L
  surname: Leonetti
  fullname: Leonetti, D L
  organization: Department of Anthropology, University of Washington
– sequence: 6
  givenname: M J
  surname: McNeely
  fullname: McNeely, M J
  organization: Department of Medicine, University of Washington School of Medicine
– sequence: 7
  givenname: E J
  surname: Boyko
  fullname: Boyko, E J
  email: eboyko@uw.edu
  organization: Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Department of Medicine, University of Washington School of Medicine
BackLink https://www.ncbi.nlm.nih.gov/pubmed/25920773$$D View this record in MEDLINE/PubMed
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Snippet Background: A proportion of obese subjects appear metabolically healthy (MHO) but little is known about the natural history of MHO and factors predicting its...
A proportion of obese subjects appear metabolically healthy (MHO) but little is known about the natural history of MHO and factors predicting its future...
BACKGROUND: A proportion of obese subjects appear metabolically healthy (MHO) but little is known about the natural history of MHO and factors predicting its...
International Journal of Obesity (2015) 39, 1365-1370; doi: 10.1038/ijo.2015.75
Background:A proportion of obese subjects appear metabolically healthy (MHO) but little is known about the natural history of MHO and factors predicting its...
Background: A proportion of obese subjects appear metabolically healthy (MHO) but little is known about the natural history of MHO and factors predicting its...
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pubmed
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springer
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Index Database
Enrichment Source
Publisher
StartPage 1365
SubjectTerms 692/163
692/699/2743/393
692/700/139/2818
692/700/478/174
Abdomen
Adiposity
Adult
Aged
Asian Americans - statistics & numerical data
Blood Glucose - metabolism
Body Composition
Body Mass Index
Body size
Cholesterol
Cholesterol, HDL - blood
Computed tomography
Confidence intervals
Conversion
Diabetes
Dyslipidemia
Epidemiology
Exercise
Fasting
Female
Females
Genetic aspects
Genotype & phenotype
Health care
Health Promotion and Disease Prevention
High density lipoprotein
Humans
Insulin
Insulin Resistance
Internal Medicine
Intra-Abdominal Fat - metabolism
Japanese Americans
Laboratory testing
Lifestyles
Lipoproteins, LDL - blood
Male
Medicine
Medicine & Public Health
Men
Metabolic Diseases
Metabolic disorders
Metabolic syndrome
Metabolic Syndrome - blood
Metabolic Syndrome - epidemiology
Metabolic Syndrome - metabolism
Metabolism
Middle Aged
Multivariate analysis
Obesity
Obesity - metabolism
original-article
Phenotype
Phenotypes
Population
Preventive medicine
Prospective Studies
Public Health
Questionnaires
Sex
Statistical analysis
Thigh
Tomography
United States - epidemiology
Womens health
Title Visceral abdominal fat accumulation predicts the conversion of metabolically healthy obese subjects to an unhealthy phenotype
URI https://link.springer.com/article/10.1038/ijo.2015.75
https://www.ncbi.nlm.nih.gov/pubmed/25920773
https://www.proquest.com/docview/1710312600
https://www.proquest.com/docview/2331643391
https://www.proquest.com/docview/1710654480
https://www.proquest.com/docview/1732811192
https://pubmed.ncbi.nlm.nih.gov/PMC4564328
Volume 39
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