Study of almost 3 million people finds “health”

Adults who are obese but appear healthy (without common metabolic abnormalities such as high blood pressure, abnormal blood lipids, or diabetes) are no greater risk of heart attack, stroke, or cardiovascular death than healthy individuals of normal weight, but they are 33% more likely to develop heart failure and arrhythmias , Atrial fibrillation, according to a nationwide study from France that followed nearly 3 million hospitalized patients (aged 18+) for at least 5 years.

The results, presented at the annual meeting of the European Association for the Study of Diabetes (EASD), this year (27 their weight.

“This new and best available evidence tells us that at the population level, the idea that large numbers of people can be obese but metabolically healthy is simply wrong,” says lead author Dr. Laurent Fauchier from the Center Hospitalier Universitaire Trousseau, Tours, France. “Promoting weight loss in people with obesity, whether they are metabolically healthy or not, will help prevent atrial fibrillation and heart failure. Our results also underscore the importance of preventing poor metabolic health and suggest that even people of normal weight can benefit from early behavioral and medical treatment to improve their diet and increase physical activity to protect themselves from stroke. “

Obesity (BMI greater than 30 kg / m²) affects almost all risk factors for cardiovascular disease, especially those related to metabolic syndrome, including high blood pressure, poor blood sugar control or diabetes and abnormal blood lipids that increase the risk for cardiovascular disease -Double diseases like heart attack and stroke. However, some people with obesity appear to be free from these metabolic abnormalities – it is estimated that up to a third of obese people could be metabolically healthy.

Whether this so-called “metabolically healthy obesity” is associated with a higher risk of cardiovascular disease has been debated for many years, and research has so far produced conflicting results. It remains unclear how weight and metabolic status affect the development of various cardiovascular events in both healthy and obese individuals due to the limitations of previous studies, including: a lack of analysis of various cardiovascular events and a lack of adaptation to confounding factors such as age, gender, and smoking history.

To investigate this further, the researchers analyzed the medical records of all patients admitted to French hospitals between January and December 2013, with at least 5 years of full follow-up data. Around 2.9 million adults (including 272,838 [9.5%] Had obesity) who did not have a major cardiovascular event (d abnormalities – high blood pressure, abnormally high levels of cholesterol and other fats in the blood, or diabetes). Participants who did not have any of these abnormalities were classified as “metabolically healthy obesity”. The researchers corrected several factors that could have influenced the results, including age, gender, and smoking status.

During an average follow-up of 5 years, 510,439 new major cardiovascular events were registered, including 77,924 heart attacks, 391,637 cases of heart failure, 84,042 strokes and 100,633 deaths from cardiovascular disease. In addition, 257,287 patients developed atrial fibrillation.

The analysis found that people with metabolically healthy obesity had a 22% higher risk of a new major cardiovascular event than people of normal weight without metabolic abnormalities. They also had a 34% increased risk of developing heart failure and a 33% increased risk of developing atrial fibrillation – which can significantly affect quality of life and lead to stroke. However, they were no higher risk of heart attack, stroke, or cardiovascular death than metabolically healthy people of normal weight.

Importantly, the analysis also showed that men are at higher risk than women – compared to men of normal weight without metabolic abnormalities, men with metabolically healthy obesity were 61% more likely to have cardiovascular events; while women with metabolically healthy obesity are 50% less likely to have a heart attack than people of normal weight.

The authors acknowledge that their results show observational associations rather than cause and effect. They note some limitations, including the fact that the study included people from a country with a predominantly white Caucasian population, so the results cannot be generalized to all ethnic groups in other countries. They also find that they were unable to explain some potential confounders, such as socioeconomic status, physical activity, diet, and metabolic control (e.g., blood sugar levels, blood pressure, BMI) that could have influenced the results.


Diabetes obesity and metabolism

COI declaration

The authors do not indicate any conflicts of interest.

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