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Epidemiology and Population Health

Metabolically healthy obesity and risks of cardiovascular disease and all-cause mortality, a matched cohort study: the Shizuoka study

International Journal of Obesity (2024)Cite this article

Subjects

Abstract

Background

Metabolically healthy obesity is not always a benign condition. It is associated with an increased incidence of cardiovascular disease and all-cause mortality. We investigated the prognostic significance of metabolically healthy obesity by comparing clinical profile-matched metabolically healthy obesity and non-obesity groups.

Methods

We analyzed a health insurance dataset with annual health checkup data from Japan. The analyzed data included 168,699 individuals aged <65 years. Obesity was defined as ≥25 kg/m2 body mass index. Metabolically healthy was defined as ≤1 metabolic risk factor (high blood pressure, low high-density lipoprotein cholesterol, high low-density lipoprotein cholesterol, or high hemoglobin A1c). Incidence rates of stroke, myocardial infarction, and all-cause mortality identified from the insurance data were compared between metabolically healthy obesity and non-obesity groups (n = 8644 each) using a log-rank test.

Results

The stroke (obesity: 9.2 per 10,000 person-years; non-obesity: 10.5; log-rank test p = 0.595), myocardial infarction (obesity: 3.7; non-obesity: 3.1; p = 0.613), and all-cause mortality (obesity: 26.6; non-obesity: 23.2; p = 0.304) incidence rates did not differ significantly between the metabolically healthy obesity and non-obesity groups, even when the abdominal obesity was considered in the analysis. The lack of association was also observed in the comparison between the metabolically unhealthy obesity and non-obesity groups (n = 10,965 each). The population with metabolically healthy obesity reported negligibly worse metabolic profiles than the population with non-obesity at the 5.6-year follow-up.

Conclusion

Obesity, when accompanied by a healthy metabolic profile, did not increase the risk of cardiovascular outcomes and all-cause mortality.

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Fig. 1: Flow diagram of study participants selection.

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Data availability

The datasets generated during and/or analyzed during the current study are not publicly available due ethical reason but are available from the corresponding author on reasonable request.

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Acknowledgements

We thank the Shizuoka Prefectural Government, 35 city and town offices in the Shizuoka Prefecture, and the Shizuoka Federation of National Health Insurance Organizations for their help in constructing the SKDB dataset. We also thank Crimson Interactive Pvt. Ltd. for their assistance in editing the English of this manuscript.

Funding

This study was supported by a public health research grant from Shizuoka Prefecture.

Author information

Authors and Affiliations

  1. Graduate School of Public Health, Shizuoka Graduate University of Public Health, Aoi-ku, Shizuoka, 420-0881, Japan

    Yasuharu Tabara, Aya Shoji-Asahina, Aya Ogawa & Yoko Sato

  2. Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan

    Yasuharu Tabara

Authors
  1. Yasuharu Tabara
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  2. Aya Shoji-Asahina
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  3. Aya Ogawa
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  4. Yoko Sato
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Contributions

YT was responsible for study designing, data analysis, and preparing manuscript, AA and AO contributed to revising the manuscript, YS contributed to preparing the dataset and revising the manuscript.

Corresponding author

Correspondence to Yasuharu Tabara.

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Competing interests

The authors declare no competing interests.

Ethical approval

The study was conducted in accordance with the Declaration of Helsinki, and the study protocol was approved by the ethics committee of Shizuoka Graduate University of Public Health (SGUPH_2021_001). Approval was obtained from the review board of each municipality to use the health insurance data in a medical study. All personal information was anonymized by the Shizuoka Federation of National Health Insurance Organizations before releasing the dataset. Information about this study is available on the websites of the Shizuoka Prefectural Government Office and the Shizuoka Graduate University of Public Health to ensure that study participants are able to opt out of inclusion in the dataset as an alternative to obtaining written informed consent from the study participants.

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Tabara, Y., Shoji-Asahina, A., Ogawa, A. et al. Metabolically healthy obesity and risks of cardiovascular disease and all-cause mortality, a matched cohort study: the Shizuoka study. Int J Obes (2024). https://doi.org/10.1038/s41366-024-01541-3

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