Cardiometabolic healthy obesity paradigm and all-cause mortality risk

To examine the cardiometabolic healthy obesity paradigm as it relates to all-cause mortality risk, with effect moderation evaluated for physical activity and demographic characteristics.

Data from the 1999-2006 NHANES were used. The analytic sample included 7579 dietary fasting adults (20+ yrs). All-cause mortality was linked with participant data from the National Death Index. Metabolic health was based on fasting levels of triglycerides, high-density lipoprotein cholesterol, glucose and blood pressure. Weight status was determined from measured height and weight. Physical activity was assessed via self-report. Six mutually exclusive groups were evaluated, including 1) Metabolically Healthy and Normal Weight (Referent), 2) Metabolically Healthy and Overweight, 3) Metabolically Healthy and Obese, 4) Metabolically Abnormal and Normal Weight, 5) Metabolically Abnormal and Overweight, and 6) Metabolically Abnormal and Obese. A Cox proportional hazards model was used to evaluate the association between these 6 groups and all-cause mortality.

The unweighted median follow-up was 103months; 770,568 person-months occurred with an incidence rate of 1.18 deaths per 1000 person-months. When compared to those who were metabolically healthy and of normal BMI, all other metabolic and weight configurations had an increased mortality risk. There was no evidence of effect modification by physical activity or demographic characteristics.

These findings emphasize the importance of optimizing body habitus and increasing public awareness of the detrimental effects of metabolic abnormalities.