Nathalie Esser, MD; André J. Scheen, MD, PhD; Nicolas Paquot, MD, PhD
Potential Conflicts of Interest: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L14-0021.
Esser N., Scheen A., Paquot N.; Metabolically Healthy Overweight and Obesity. Ann Intern Med. 2014;160:514. doi: 10.7326/L14-5007-3
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Published: Ann Intern Med. 2014;160(7):514.
Kramer and colleagues (1) report that obese persons are at long-term risk for cardiovascular events and total mortality regardless of their metabolic status. The discrimination of participants according to a metabolic score is an oversimplified dichotomous classification that does not reflect the huge heterogeneity of obesity. Metabolically healthy persons, as classically defined, may still have metabolic disorders.
In Kramer and colleagues' meta-analysis, metabolically healthy obese persons had an intermediate risk for total mortality and cardiovascular events, higher than that for metabolically healthy lean and overweight persons but lower than that for metabolically unhealthy overweight and obese persons. However, the metabolically healthy obese group was only at increased risk in the studies with more than 10 years of follow-up. Variation in some components of the metabolic syndrome over time may have influenced these results. Indeed, metabolically healthy obesity is a transient state for one third of patients who may progress to metabolic risk and type 2 diabetes (2). Kramer and colleagues speculate that metabolically healthy obese persons probably have subclinical levels of risk factors that worsen over time (1).
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