Association of body mass index and other factors with metabolically unhealthy status: Results from the national health examination survey IV
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Abstract
Increasing evidence about non-proportionally high cardiovascular risk in individuals with normal body mass index (BMI) suggested a need for alternative approaches to risk classification, one of which is metabolic health status (MHS). This study aimed to estimate the prevalence of MHS, and examine the association of BMI, other factors and being metabolically unhealthy in a contemporary Thai population, using data on 19,640 participants in the National Health Examination Survey IV (NHES IV) in 2009. Metabolically unhealthy (MUH) was defined as individuals having abnormality in at least one metabolic parameter based on the International Diabetes Federation (IDF) criteria. The prevalence was estimated for the overall population and across BMI categories. Multivariable logistic regression was performed to examine the association between BMI categories, other characteristics and MUH status. The results show that the prevalence of MUH individuals in the Thai population is 73.1%. The prevalence of metabolic parameter abnormalities rose significantly with increasing BMI category, from the prevalence of 54.1%, 63.6%, 75.9% and 87.4% with corresponding odds ratios of 1.55, 2.77, and 6.31 for BMI ≥18.5-22.9 kg/m2, 23-24.9 kg/m2 and ≥25 kg/m2, respectively. The odds of being MUH tends to increase when BMI level increases. Other characteristics associated with MUH were being female, being older, having a low level of education, living in a rural area and currently smoking tobacco. In this national representative sample of the Thai general population, the prevalence of MUH was high and rose continuously with increasing BMI levels. MUH was also prevalent in normal weight and underweight individuals.
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Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2014;384(9945):766-781.
Somi MH, Nikniaz Z, Ostadrahimi A, Sadat AT, Faramarzi E. Is normal body mass index a good indicator of metabolic health in Azar cohort population. J Cardiovasc Thorac Res. 2019;11(1):53-60.
Roberson LL, Aneni EC, Maziak W, Agatston A, Feldman T, Rouseff M, et al. Beyond BMI: the "metabolically healthy obese" phenotype & its association with clinical/subclinical cardiovascular disease and all-cause mortality - a systematic review. BMC Public Health. 2014;14(1):14.
Hwang LC, Bai CH, Sun CA, Chen CJ. Prevalence of metabolically healthy obesity and its impacts on incidences of hypertension, diabetes and the metabolic syndrome in Taiwan.Asia Pac J Clin Nutr. 2012;21(2):227-233.
Eckel N, Li Y, Kuxhaus O, Stefan N, Hu FB, Schulze MB. Transition from metabolic healthy to unhealthy phenotypes and association with cardiovascular disease risk across BMI categories in 90 257 women (the nurses' health study): 30 year follow-up from a prospective cohort study. Lancet Diabetes Endocrinol. 2018;6(9):714-724.
Stefan N, Schick F, Haring HU. Causes, characteristics, and consequences of metabolically unhealthy normal weight in humans. Cell Meta. 2017;26(2):292-300.
Diniz M, Beleigoli AMR, Ribeiro ALP, Vidigal PG, Bensenor IM, Lotufo PA, et al. Factors associated with metabolically healthy status in obesity, overweight, and normal weight at baseline of ELSA-Brasil. Medicine (Baltimore). 2016;95(27):e4010. PMID: 27399079.
Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International diabetes federation task force on epidemiology and prevention; national heart, lung, and blood institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the study of obesity. Circulation. 2009;120(16):1640-1645.
Lotta LA, Abbasi A, Sharp SJ, Sahlqvist AS, Waterworth D, Brosnan JM, et al. Definitions of metabolic health and risk of future type 2 diabetes in BMI categories: a systematic review and network meta-analysis. Diabetes Care. 2015;38(11):2177-2187.
Zhang WW, Liu CY, Wang YJ, Xu ZQ, Chen Y, Zhou HD. Metabolic syndrome increases the risk of stroke: a 5-year follow-up study in a Chinese population. J Neurol. 2009;256(9):1493-1499.
Choi KM, Cho HJ, Choi HY, Yang SJ, Yoo HJ, Seo JA, et al. Higher mortality in metabolically obese normal-weight people than in metabolically healthy obese subjects in elderly Koreans. Clin Endocrinol. 2013;79(3):364-370.
Araújo J, Cai J, Stevens J. Prevalence of optimal metabolic health in American adults: national health and nutrition examination survey 2009-2016. Metab Syndr Relat Disord. 2019;17(1):46-52.
Aekplakorn W, Satheannoppakao W, Putwatana P, Taneepanichskul S, Kessomboon P, Chariyalertsak S, et al. Dietary pattern and metabolic syndrome in Thai adults. Med J Nutrition Metab. 2015;2015(6):1-10.
Bull FC, Maslin TS, Armstrong T. Global physical activity questionnaire (GPAQ): nine country reliability and validity study. J Phys Act Health. 2009;6(6):790-804.
Lin H, Zhang L, Zheng R, Zheng Y. The prevalence, metabolic risk and effects of lifestyle intervention for metabolically healthy obesity: a systematic review and meta-analysis: A PRISMA-compliant article. Medicine. 2017;96(47):e8838. PMID: 29381992.
Liu C, Wang C, Guan S, Liu H, Wu X, Zhang Z, et al. The prevalence of metabolically healthy and unhealthy obesity according to different criteria. Obes Facts. 2019;12(1):78-90.
Slagter SN, Ostaptchouk JV, Vonk JM, Boezen HM, Dullaart RP, Kobold AC, et al. Combined effects of smoking and alcohol on metabolic syndrome: the lifelines cohort study. PloS One. 2014;9(4):e96406. PMID: 24781037.
Rahmanian K, Shojaei M, Jahromi SA. Prevalence and clinical characteristics of metabolically unhealthy obesity in an Iranian adult population. Diabetes Metab Syndr Obes. 2019;12:1387-1395.
Pajunen P, Kotronen A, Hyovalti EK, Kiukaanniemi SK, Oksa H, Niskanen L, et al. Metabolically healthy and unhealthy obesity phenotypes in the general population: the FIN-D2D survey. BMC Public Health. 2011;11:754. PMID: 21962038.
Larsen PG, Adair LS, Meigs JB, Davis EM, Herring A, Yan SK, et al. Discordant risk: overweight and cardiometabolic risk in Chinese adults. Obes Res. 2013;21(1):E166-174.
Repiso CG, Soriguer F, Martinez GR, Fuentes EG, Valdes S, Goday A, et al. Variable patterns of obesity and cardiometabolic phenotypes and their association with lifestyle factors in the Di@bet.es study. Nutr Metab Cardiovasc Dis. 2014;24(9):947-955.
Song Y, Manson JE, Meigs JB, Ridker PM, Buring JE, Liu S. Comparison of usefulness of body mass index versus metabolic risk factors in predicting 10-year risk of cardiovascular events in women. Am J Cardiol. 2007;100(11):1654-1658.
Hosseinpanah F, Barzin M, Sheikholeslami F, Azizi F. Effect of different obesity phenotypes on cardiovascular events in Tehran Lipid and Glucose Study (TLGS). Am J Cardiol. 2011;107(3):412-416.
Shi TH, Wang BH, Nantarajam SD. The influence of metabolic syndrome in predicting mortality risk among US adults: importance of metabolic syndrome even in adults with normal weight. Prev Chronic Dis. 2020;17(5):E36.
Aekplakorn W, Kessomboon P, Sangthong R, Chariyalertsak S, Putwatana P, Inthawong R, et al. Urban and rural variation in clustering of metabolic syndrome components in the Thai population: results from the fourth National Health Examination Survey 2009. BMC Public Health. 2011;11:854.
McKeown NM, Meigs JB, Liu S, Rogers G, Yoshida M, Saltzman E, et al. Dietary carbohydrates and cardiovascular disease risk factors in the Framingham offspring cohort. J Am Coll Nutr. 2009;28(2):150-158.
Wang Y, Rimm EB, Stampfer MJ, Willett WC, Hu FB. Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men. Am J Clin Nutr. 2005;81(3):555-563.
Abolfotouh MA, Alwan IA, Rowaily MA. Prevalence of metabolic abnormalities and association with obesity among Saudi college students. Int J Hyperten. 2012;2012:819726.
Cornier MA, Dabelea D, Hernandez TL, Lindstrom RC, Steig AJ, Stob NR, et al. The Metabolic syndrome. endocrine reviews. Endocr Rev. 2008;29(7):777-822.
Kokubo Y, Okamura T, Yoshimasa Y, Miyamoto Y, Kawanishi K, Kotani Y, et al. Impact of metabolic syndrome components on the incidence of cardiovascular disease in a general urban Japanese population: the suita study. Hyperten Res. 2008;31(11):2027-2035.