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Are metabolically healthy overweight and obesity benign conditions?: A systematic review and meta-analysis.
Ann Intern Med. 2013 Dec 03; 159(11):758-69.AIM

Abstract

BACKGROUND

Recent interest has focused on a unique subgroup of overweight and obese individuals who have normal metabolic features despite increased adiposity. Normal-weight individuals with adverse metabolic status have also been described. However, it remains unclear whether metabolic phenotype modifies the morbidity and mortality associated with higher body mass index (BMI).

PURPOSE

To determine the effect of metabolic status on all-cause mortality and cardiovascular events in normal-weight, overweight, and obese persons.

DATA SOURCES

Studies were identified from electronic databases.

STUDY SELECTION

Included studies evaluated all-cause mortality or cardiovascular events (or both) and clinical characteristics of 6 patient groups defined by BMI category (normal weight/overweight/obesity) and metabolic status (healthy/unhealthy), as defined by the presence or absence of components of the metabolic syndrome by Adult Treatment Panel III or International Diabetes Federation criteria.

DATA EXTRACTION

Two independent reviewers extracted the data. Metabolically healthy people of normal weight made up the reference group.

DATA SYNTHESIS

Eight studies (n = 61 386; 3988 events) evaluated participants for all-cause mortality and/or cardiovascular events. Metabolically healthy obese individuals (relative risk [RR], 1.24; 95% CI, 1.02 to 1.55) had increased risk for events compared with metabolically healthy normal-weight individuals when only studies with 10 or more years of follow-up were considered. All metabolically unhealthy groups had a similarly elevated risk: normal weight (RR, 3.14; CI, 2.36 to 3.93), overweight (RR, 2.70; CI, 2.08 to 3.30), and obese (RR, 2.65; CI, 2.18 to 3.12).

LIMITATION

Duration of exposure to the metabolic-BMI phenotypes was not described in the studies and could partially affect the estimates.

CONCLUSION

Compared with metabolically healthy normal-weight individuals, obese persons are at increased risk for adverse long-term outcomes even in the absence of metabolic abnormalities, suggesting that there is no healthy pattern of increased weight.

PRIMARY FUNDING SOURCE

Intramural funds from the Leadership Sinai Centre for Diabetes.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

24297192

Citation

Kramer, Caroline K., et al. "Are Metabolically Healthy Overweight and Obesity Benign Conditions?: a Systematic Review and Meta-analysis." Annals of Internal Medicine, vol. 159, no. 11, 2013, pp. 758-69.
Kramer CK, Zinman B, Retnakaran R. Are metabolically healthy overweight and obesity benign conditions?: A systematic review and meta-analysis. Ann Intern Med. 2013;159(11):758-69.
Kramer, C. K., Zinman, B., & Retnakaran, R. (2013). Are metabolically healthy overweight and obesity benign conditions?: A systematic review and meta-analysis. Annals of Internal Medicine, 159(11), 758-69. https://doi.org/10.7326/0003-4819-159-11-201312030-00008
Kramer CK, Zinman B, Retnakaran R. Are Metabolically Healthy Overweight and Obesity Benign Conditions?: a Systematic Review and Meta-analysis. Ann Intern Med. 2013 Dec 3;159(11):758-69. PubMed PMID: 24297192.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Are metabolically healthy overweight and obesity benign conditions?: A systematic review and meta-analysis. AU - Kramer,Caroline K, AU - Zinman,Bernard, AU - Retnakaran,Ravi, PY - 2013/12/4/entrez PY - 2013/12/4/pubmed PY - 2014/1/24/medline SP - 758 EP - 69 JF - Annals of internal medicine JO - Ann Intern Med VL - 159 IS - 11 N2 - BACKGROUND: Recent interest has focused on a unique subgroup of overweight and obese individuals who have normal metabolic features despite increased adiposity. Normal-weight individuals with adverse metabolic status have also been described. However, it remains unclear whether metabolic phenotype modifies the morbidity and mortality associated with higher body mass index (BMI). PURPOSE: To determine the effect of metabolic status on all-cause mortality and cardiovascular events in normal-weight, overweight, and obese persons. DATA SOURCES: Studies were identified from electronic databases. STUDY SELECTION: Included studies evaluated all-cause mortality or cardiovascular events (or both) and clinical characteristics of 6 patient groups defined by BMI category (normal weight/overweight/obesity) and metabolic status (healthy/unhealthy), as defined by the presence or absence of components of the metabolic syndrome by Adult Treatment Panel III or International Diabetes Federation criteria. DATA EXTRACTION: Two independent reviewers extracted the data. Metabolically healthy people of normal weight made up the reference group. DATA SYNTHESIS: Eight studies (n = 61 386; 3988 events) evaluated participants for all-cause mortality and/or cardiovascular events. Metabolically healthy obese individuals (relative risk [RR], 1.24; 95% CI, 1.02 to 1.55) had increased risk for events compared with metabolically healthy normal-weight individuals when only studies with 10 or more years of follow-up were considered. All metabolically unhealthy groups had a similarly elevated risk: normal weight (RR, 3.14; CI, 2.36 to 3.93), overweight (RR, 2.70; CI, 2.08 to 3.30), and obese (RR, 2.65; CI, 2.18 to 3.12). LIMITATION: Duration of exposure to the metabolic-BMI phenotypes was not described in the studies and could partially affect the estimates. CONCLUSION: Compared with metabolically healthy normal-weight individuals, obese persons are at increased risk for adverse long-term outcomes even in the absence of metabolic abnormalities, suggesting that there is no healthy pattern of increased weight. PRIMARY FUNDING SOURCE: Intramural funds from the Leadership Sinai Centre for Diabetes. SN - 1539-3704 UR - https://www.unboundmedicine.com/medline/citation/24297192/Are_metabolically_healthy_overweight_and_obesity_benign_conditions:_A_systematic_review_and_meta_analysis_ L2 - https://www.acpjournals.org/doi/10.7326/0003-4819-159-11-201312030-00008?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -