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Improving risk estimates for metabolically healthy obesity and mortality using a refined healthy reference group

Research output: Contribution to journalArticle

Original languageEnglish
JournalEuropean Journal of Endocrinology
Early online date31 May 2017
DOIs
DateAccepted/In press - 30 May 2017
DateE-pub ahead of print (current) - 31 May 2017

Abstract

Objective: We aimed to re-examine mortality risk estimates for metabolically healthy obesity by using a 'stable' healthy non-obese referent group.

Design: prospective cohort study

Methods: Participants were 5,427 men and women (aged 65.9 ± 9.4 years, 45.9% men) from the English Longitudinal Study of Ageing. Obesity was defined as body mass index ≥ 30 kg/m2 (vs. non-obese as below this threshold). Based on blood pressure, HDL-cholesterol, triglycerides, glycated haemoglobin, and C-reactive protein, participants were classified as 'healthy' (0 or 1 metabolic abnormality) or 'unhealthy' (≥ 2 metabolic abnormalities).

Results: 671 deaths were observed over an average follow up of 8 years. When defining the referent group based on 1 clinical assessment, the unhealthy non-obese (Hazard ratio = 1.22; 95% CI, 1.01, 1.45) and unhealthy obese (1.29; 1.05, 1.60) were at greater risk of all-cause mortality compared to the healthy non-obese, yet no excess risk was seen in the healthy obese (1.14; 0.83, 1.52). When we re-defined the referent group based on 2 clinical assessments, effect estimates were accentuated and healthy obesity was at increased risk of mortality (2.67; 1.64, 4.34).

Conclusion: An unstable healthy referent group may make 'healthy obesity' appear less harmful by obscuring the benefits of remaining never obese without metabolic dysfunction.

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    Rights statement: This is the author accepted manuscript (AAM). The final published version (version of record) is available online via BioScientifica at http://www.eje-online.org/content/early/2017/05/30/EJE-17-0217.abstract. Please refer to any applicable terms of use of the publisher.

    Accepted author manuscript, 522 KB, PDF document

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