부산대학교 도서관

Objective: We aimed to evaluate the risk of incident cardiovascular (CV) events and mortality according to metabolic health status and obesity. We also assessed the effect of transition in metabolic health status and obesity among participants with metabolically healthy obesity (MHO) on the cardiovascular risk and mortality. Methods: A total of 514,866 participants from Korean National Health Insurance Service-National Sample Cohort were enrolled. To evaluate the changes in metabolic health status and obesity since the baseline examination 2009-2010, we collected the data from the next biannual health examinations performed between 2011 and 2012. Study participants were categorized into one of four groups: (1) Metabolically healthy, non-obesity (MHNO), BMI < 25 kg/m2 and no or 1 metabolic risk factors; (2) metabolically unhealthy, non-obesity (MUNO), BMI < 25 kg/m2 and ≥ 2 metabolic risk factors; (3) MHO, BMI ≥ 25 kg/m2 and no metabolic risk factors; or (4) metabolically unhealthy, obese (MUO), BMI ≥ 25 kg/m2 and ≥ 2 metabolic risk factors. Results: MHO population had significantly greater risk of developing CV events than lean healthy subjects reaching 1.13 times higher risk of CV events (95% CI 1.04 - 1.22) after multivariate adjustment, although CV mortality rate was not increased. However, MHO group showed significantly decreased all-cause mortality compared to MHNO group: multivariate-adjusted HR 0.83, 95% CI 0.76 - 0.90. Among the subjects with MHO at baseline, 11.6% changed to MHNO, 6.0% progressed to MUNO, 45.6% remained with MHO and 36.8% progressed to MUO. Subjects with MHO at baseline who progressed to MUNO showed significantly increased risk of all-cause mortality rate compared to who remained MHO status, showing multivariate-adjusted HR (95% CI) of 2.04 (1.50-2.76). Conclusion: MHO is not a permanent situation but a transitory state. The transition from MHO to MUNO was related to the increased all-cause mortality.