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Title: Improving risk estimates for metabolically healthy obesity and mortality using a refined healthy reference group
Authors: Hamer, Mark
Johnson, William O.
Bell, Joshua A.
Keywords: Healthy obesity
Metabolic risk
Issue Date: 2017
Publisher: Bioscientifica © The authors
Citation: HAMER, M., JOHNSON, W. and BELL, J.A., 2017. Improving risk estimates for metabolically healthy obesity and mortality using a refined healthy reference group. European Journal of Endocrinology, 177 (2), pp. 169-174.
Abstract: Objective: We aimed to re-examine mortality risk estimates for metabolically healthy obesity by using a ‘stable’ healthy non-obese referent group. Design: prospective cohort study. Methods: Participants were 5,427 men and women (aged 65.9 ± 9.4 years, 45.9% men) from the English Longitudinal Study of Ageing. Obesity was defined as body mass index ≥ 30 kg/m2 (vs. non-obese as below this threshold). Based on blood pressure, HDL-cholesterol, triglycerides, glycated haemoglobin, and C-reactive protein, participants were classified as ‘healthy’ (0 or 1 metabolic abnormality) or ‘unhealthy’ (≥ 2 metabolic abnormalities). Results: 671 deaths were observed over an average follow up of 8 years. When defining the referent group based on 1 clinical assessment, the unhealthy non-obese (Hazard ratio = 1.22; 95% CI, 1.01, 1.45) and unhealthy obese (1.29; 1.05, 1.60) were at greater risk of all-cause mortality compared to the healthy non-obese, yet no excess risk was seen in the healthy obese (1.14; 0.83, 1.52). When we re-defined the referent group based on 2 clinical assessments, effect estimates were accentuated and healthy obesity was at increased risk of mortality (2.67; 1.64, 4.34). Conclusion: An unstable healthy referent group may make ‘healthy obesity’ appear less harmful by obscuring the benefits of remaining never obese without metabolic dysfunction.
Description: This is an Open Access Article. It is published by Bioscientifica under the Creative Commons Attribution 3.0 Unported Licence (CC BY). Full details of this licence are available at: http://creativecommons.org/licenses/by/3.0/
Sponsor: Hamer acknowledges support from the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, which is a partnership between University Hospitals of Leicester NHS Trust, Loughborough University and the University of Leicester. Bell is supported by CRUK (C18281/A19169).
Version: Published
DOI: 10.1530/EJE-17-0217
URI: https://dspace.lboro.ac.uk/2134/25296
Publisher Link: https://doi.org/10.1530/EJE-17-0217
ISSN: 0804-4643
Appears in Collections:Published Articles (Sport, Exercise and Health Sciences)

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