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Title: Stability of metabolically healthy obesity over 8 years: the English Longitudinal Study of Ageing.
Authors: Hamer, Mark
Bell, Joshua A.
Sabia, Severine
Batty, G. David
Kivimaki, Mika
Issue Date: 2015
Publisher: © European Society of Endocrinology
Citation: HAMER, M. ...et al., 2015. Stability of metabolically healthy obesity over 8 years: the English Longitudinal Study of Ageing. European Journal of Endocrinology, 173, pp. 703-708.
Abstract: Objective Metabolically healthy obesity possibly reflects a transitional stage before the onset of metabolic dysfunction, but few studies have characterised this transition. We examined the behavioural and biological characteristics of healthy obese adults that progressed to an unhealthy state over 8 years follow-up. Methods Participants were 2422 men and women (aged 63.3±7.7 years, 44.2% men) from the English Longitudinal Study of Ageing. Obesity was defined as BMI ≥30 kg/m2. Based on blood pressure (BP), HDL-cholesterol, triglycerides, HbA1c and C-reactive protein (CRP) participants were classified as ‘healthy’ (0 or 1 metabolic abnormality) or ‘unhealthy’ (≥2 metabolic abnormalities). Results Over 8 years follow-up, 44.5% of healthy obese subjects had transitioned into an unhealthy state, compared to only 16.6 and 26.2% of healthy normal-weight and overweight adults respectively. Compared with healthy obese adults who remained stable, those who progressed to an unhealthy state were more likely to have high BP (75.0% vs 37.0%, age- and sex-adjusted odds ratio (OR) 8.9, 95% CI 4.7–17.0), high CRP (53.7% vs 17.0%, OR=8.6, 95% CI 4.1–18.0), high HbA1c (46.3% vs 5.9%, OR=13.8, 95% CI 6.1–31.2) and high triglycerides (45.4% vs 11.9%, OR=5.9, 95% CI 2.9–12.0) at follow-up, with excess risk remaining independent of lifestyle factors including self-reported physical activity. Progression to an unhealthy state was also linked with significant gains in waist circumference (B=2.7, 95% CI, 0.5–4.9 cm). Conclusion These data show that a healthy obesity phenotype is relatively unstable. Transition to an unhealthy state is characterised by multiple biological changes that are not fully explained by lifestyle risk factors.
Description: This manuscript has been accepted for publication in European Journal of Endocrinology, but the version presented here has not yet been copy-edited, formatted or proofed. Consequently, Bioscientifica accepts no responsibility for any errors or omissions it may contain. The definitive version is now freely available at http://dx.doi.org/10.1530/EJE-15-0449 2016.
Sponsor: The funding for this paper was provided by the National Institute on Ageing in the United States (grants 2R01AG7644-01A1 and 2R01AG017644) and a consortium of UK government departments coordinated by the Office of National Statistics.
Version: Accepted for publication
DOI: 10.1530/EJE-15-0449
URI: https://dspace.lboro.ac.uk/2134/19093
Publisher Link: http://dx.doi.org/10.1530/EJE-15-0449
ISSN: 1479-683X
Appears in Collections:Published Articles (Sport, Exercise and Health Sciences)

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