RT Journal Article
T1 Separate and combined associations of obesity and metabolic health with coronary heart disease: a pan-European case-cohort analysis.
A1 Lassale, Camille
A1 Tzoulaki, Ioanna
A1 Moons, Karel G M
A1 Sweeting, Michael
A1 Boer, Jolanda
A1 Johnson, Laura
A1 Huerta, José María
A1 Agnoli, Claudia
A1 Freisling, Heinz
A1 Weiderpass, Elisabete
A1 Wennberg, Patrik
A1 van der A, Daphne L
A1 Arriola, Larraitz
A1 Benetou, Vassiliki
A1 Boeing, Heiner
A1 Bonnet, Fabrice
A1 Colorado-Yohar, Sandra M
A1 Engström, Gunnar
A1 Eriksen, Anne K
A1 Ferrari, Pietro
A1 Grioni, Sara
A1 Johansson, Matthias
A1 Kaaks, Rudolf
A1 Katsoulis, Michail
A1 Katzke, Verena
A1 Key, Timothy J
A1 Matullo, Giuseppe
A1 Melander, Olle
A1 Molina-Portillo, Elena
A1 Moreno-Iribas, Concepción
A1 Norberg, Margareta
A1 Overvad, Kim
A1 Panico, Salvatore
A1 Quirós, J Ramón
A1 Saieva, Calogero
A1 Skeie, Guri
A1 Steffen, Annika
A1 Stepien, Magdalena
A1 Tjønneland, Anne
A1 Trichopoulou, Antonia
A1 Tumino, Rosario
A1 van der Schouw, Yvonne T
A1 Verschuren, W M Monique
A1 Langenberg, Claudia
A1 Di Angelantonio, Emanuele
A1 Riboli, Elio
A1 Wareham, Nicholas J
A1 Danesh, John
A1 Butterworth, Adam S
K1 Adiposity
K1 Coronary heart disease
K1 Epidemiology
K1 Metabolic syndrome
K1 Obesity
AB The hypothesis of 'metabolically healthy obesity' implies that, in the absence of metabolic dysfunction, individuals with excess adiposity are not at greater cardiovascular risk. We tested this hypothesis in a large pan-European prospective study. We conducted a case-cohort analysis in the 520 000-person European Prospective Investigation into Cancer and Nutrition study ('EPIC-CVD'). During a median follow-up of 12.2 years, we recorded 7637 incident coronary heart disease (CHD) cases. Using cut-offs recommended by guidelines, we defined obesity and overweight using body mass index (BMI), and metabolic dysfunction ('unhealthy') as ≥ 3 of elevated blood pressure, hypertriglyceridaemia, low HDL-cholesterol, hyperglycaemia, and elevated waist circumference. We calculated hazard ratios (HRs) and 95% confidence intervals (95% CI) within each country using Prentice-weighted Cox proportional hazard regressions, accounting for age, sex, centre, education, smoking, diet, and physical activity. Compared with metabolically healthy normal weight people (reference), HRs were 2.15 (95% CI: 1.79; 2.57) for unhealthy normal weight, 2.33 (1.97; 2.76) for unhealthy overweight, and 2.54 (2.21; 2.92) for unhealthy obese people. Compared with the reference group, HRs were 1.26 (1.14; 1.40) and 1.28 (1.03; 1.58) for metabolically healthy overweight and obese people, respectively. These results were robust to various sensitivity analyses. Irrespective of BMI, metabolically unhealthy individuals had higher CHD risk than their healthy counterparts. Conversely, irrespective of metabolic health, overweight and obese people had higher CHD risk than lean people. These findings challenge the concept of 'metabolically healthy obesity', encouraging population-wide strategies to tackle obesity.
YR 2018
FD 2018
LK http://hdl.handle.net/10668/11672
UL http://hdl.handle.net/10668/11672
LA en
DS RISalud
RD Apr 9, 2025