-
In 13,239 participants, the prevalence values of metabolic health and obesity defined by BMI were 38.3% and 13.5%, respectively. The prevalence values of MHNO, MUNO, MHO, and MUO phenotypes were 35.9%, 50.5%, 2.4%, and 11.1%, respectively. The characteristics of the study population are shown in Table 1.
Characteristics Non-obesity Obesity χ2/F P Metabolically healthy Metabolically unhealthy Metabolically healthy Metabolically unhealthy N 4,755 6,694 315 1,475 Age, years 50.0 ± 10.7 52.2 ± 10.6 52.1 ± 10.2 53.2 ± 10.6 57.63 < 0.001 Female (%) 2,685 (56.5) 3,658 (54.7) 157 (49.8) 687 (46.6) 47.30 < 0.001 Race Han (%) 1,841 (38.7) 2,289 (34.2) 134 (42.5) 512 (34.7) 31.55 < 0.001 Geographical location Southern China (%) 2,499 (52.6) 3,441 (51.4) 84 (26.7) 456 (30.9) 295.44 < 0.001 Northern China (%) 2,256 (47.4) 3,253 (48.6) 231 (73.3) 1,019 (69.1) Marital status Married (%) 4,260 (93.1) 5,949 (93.0) 274 (95.5) 1,302 (93.1) 5.33 0.502 Education College or higher (%) 1,317 (28.5) 1,652 (25.5) 77 (25.7) 391 (27.6) 20.39 0.002 Smoking (%) 1,254 (26.4) 1,823 (27.2) 87 (27.6) 1,302 (93.1) 17.37 < 0.001 Alcohol drinking (%) 1,087 (22.9) 1,750 (26.1) 90 (28.6) 463 (31.4) 47.19 < 0.001 Regular physical activity (%) 1,233 (31.7) 1867 (34.9) 111 (40.2) 472 (38.9) 28.46 < 0.001 WC, cm 77.2 ± 8.0 81.7 ± 8.4 93.9 ± 8.2 95.5 ± 7.3 2131.3 < 0.001 FMP, % 22.0 ± 8.1 23.7 ± 7.7 28.9 ± 8.1 28.7 ± 7.3 319.67 < 0.001 BMI, kg/m2 22.6 ± 2.5 23.9 ± 2.5 30.0 ± 2.0 30.1 ± 1.9 4153.4 < 0.001 TC, mmol/L 4.81 ± 0.89 5.01 ± 1.09 4.99 ± 0.91 5.18 ± 1.07 64.77 < 0.001 TG, mmol/L 1.00 (0.76, 1.26) 1.79 (1.18, 2.50) 1.19 (0.94, 1.44) 2.13 (1.56, 3.01) 1675 < 0.001 HDL-C, mmol/L 1.58 ± 0.32 1.29 ± 0.35 1.43 ± 0.29 1.18 ± 0.28 928.06 < 0.001 LDL-C, mmol/L 2.74 ± 0.78 2.92 ± 0.87 2.97 ± 0.76 3.02 ± 0.87 65.08 < 0.001 FBG, mmol/L 4.99 ± 0.39 5.81 ± 1.49 5.06 ± 0.34 6.01 ± 1.65 519.19 < 0.001 SBP, mmHg 124.4 ± 17.2 130.2 ± 18.6 133.1 ± 18.1 139.5 ± 20.2 273.59 < 0.001 DBP, mmHg 78.3 ± 10.8 81.8 ± 11.0 85.7 ± 11.5 88.1 ± 11.8 324.79 < 0.001 Ten-year CVD risk score, % 1.00 (0.38, 2.64) 1.72 (0.72, 3.89) 1.87 (0.98, 4.31) 3.13 (1.55, 5.81) 305.51 < 0.001 Ten-year CVD risk score < 5.0% 4,157 (88.2) 5,352 (81.6) 247 (79.2) 991 (70.3) 260.12 < 0.001 ≥ 5.0% 554 (11.8) 1,204 (18.4) 65 (20.8) 418 (29.7) Note. WC, waist circumference; FMP, fat mass percentage; BMI, body mass index; TC, total cholesterol; TG, triglycerides; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; FBG, fasting blood glucose; SBP, systolic blood pressure; DBP, diastolic blood pressure. Table 1. Characteristics of the study population
The multiple linear regression models shown in Table 2 yielded β, which is the slope coefficient used for the prediction of the CVD risk score. After adjusting for sex, age, alcohol drinking, education, physical activity, marital status, race, smoking, and geographical location in model 3, CVD risk of all the three metabolic phenotypes increased compared with the MHNO phenotype in both BMI- and FMP-defined obesity models. After further adjusting for WC, the effect of the MHO phenotype on CVD risk disappeared. The effects of MUNO and MUO on CVD risk were higher than those of MHNO and MHO (Table 2). From the logistic regression analyses, in the BMI-defined obesity model, CVD risks of MHO, MUNO, and MUO significantly increased from model 1 to model 3 compared with the MHNO phenotype. In model 4, after further adjustment for WC, the MHO phenotype was no longer associated with CVD risk, whereas MUNO and MUO were still risk factors for CVD compared with the MHNO phenotype (Figure 1A). In the FMP-defined obesity model, MHO was not associated with CVD risk regardless of adjusting for any covariates in the four models; however, the other two phenotypes were significantly associated with CVD risk compared with the MHNO phenotype (Figure 1B).
Metabolic phenotype β Model 1 Model 2 Model 3 Model 4 BMI-defined obesity MHNO − − − − MHO 0.673* 0.430* 0.276* −0.003 MUNO 0.465* 0.265* 0.244* 0.173* MUO 1.027* 0.675* 0.540* 0.239* Adjusted R2 0.066* 0.713* 0.756* 0.767* FMP-defined obesity MHNO − − − − MHO 0.235* 0.085* 0.140* 0.025 MUNO 0.496* 0.293* 0.259* 0.177* MUO 0.738* 0.407* 0.414* 0.213* Adjusted R2 0.048* 0.702* 0.753* 0.767* Note. *P < 0.05. Model 1: Non-adjusted. Model 2: Adjusted for sex and age. Model 3: Model 2 + adjusted for sex, age, alcohol drinking, education, physical activity, marital status, race, smoking, geographical location. Model 4: Model 3 + adjusted for waist circumference. MHNO, metabolically healthy non-obese; MHO, metabolically healthy obese; MUNO, metabolically unhealthy non-obese; MUO, metabolically unhealthy obese. Table 2. Association between metabolic phenotypes and ten-year CVD risk score
Figure 1. Forest plot of metabolic phenotypes and CVD risk. (A) BMI-defined metabolic phenotypes and CVD risk. (B) FMP-defined metabolic phenotypes and CVD risk. Model 1: Non-adjusted. Model 2: Model 1 + adjusted for sex and age. Model 3: Model 2 + adjusted for sex, age, alcohol drinking, education, physical activity, marital status, race, smoking, and geographical location. Model 4: Model 3 + adjusted for waist circumference. MHNO, metabolically healthy non-obese; MHO, metabolically healthy obese; MUNO, metabolically unhealthy non-obese; MUO, metabolically unhealthy obese.
The subgroup analyses (Tables 3 and 4) were performed with stratification by sex, age, smoking, alcohol drinking, physical activity, and geographical location. In the BMI-defined obesity model, no significant difference was found among each factor between the MHO and MHNO phenotypes, except for alcohol drinking. However, the MUNO and MUO phenotypes were significantly different from the MHNO phenotype. For each factor, the CVD risk of MUNO or MUO was higher than that of MHNO when adjusting for the covariates, except for the categorical variables. In the FMP-defined obesity model, the factors of the MHO phenotype were not significantly different from those of the MHNO phenotype, except for the age group (< 60). The MUNO and MUO phenotype groups were more greatly associated with CVD risk than the MHNO phenotype for each of the factors.
Group OR (95% CI) MHNO MHO MUNO MUO Sex Male 1.00 1.44 (0.76–2.71) 2.21 (1.75–2.79) 3.32 (2.26–4.87) Female 1.00 0.74 (0.23–2.33) 3.72 (2.19–6.30) 4.60 (2.35–9.01) Age < 60 1.00 1.49 (0.78–2.85) 2.42 (1.84–3.18) 2.94 (2.00–4.32) ≥ 60 1.00 0.61 (0.28–1.33) 1.52 (1.16–2.00) 1.84 (1.18–2.87) Smoking No 1.00 1.35 (0.63–2.88) 2.84 (2.07–3.90) 4.48 (2.83–7.10) Yes 1.00 1.01 (0.44–2.31) 2.01 (1.51–2.67) 2.83 (1.78–4.51) Alcohol drinking No 1.00 0.58 (0.27–1.23) 1.98 (1.50–2.61) 3.32 (2.18–5.05) Yes 1.00 2.78 (1.26–6.15) 2.95 (2.11–4.11) 3.68 (2.21–6.13) Physical activity No 1.00 0.74 (0.35–1.58) 2.48 (1.87–3.28) 3.00 (1.94–4.65) Regular 1.00 1.94 (0.87–4.35) 2.17 (1.57–2.99) 4.19 (2.59–6.78) Geographical location Southern China 1.00 1.26 (0.33–4.82) 2.33 (1.76–3.09) 3.39 (2.00–5.75) Northern China 1.00 1.05 (0.59–1.86) 2.33 (1.82–2.97) 3.23 (2.27–4.61) Note. Except for the group factor, all other factors were adjusted in the above 6 models. BMI, body mass index; CVD, cardiovascular disease; MHNO, metabolically healthy non-obese; MHO, metabolically healthy obese; MUNO, metabolically unhealthy non-obese; MUO, metabolically unhealthy obese. Table 3. Odds ratios of metabolic phenotypes defined by BMI on CVD risk stratified by sociodemographic and lifestyle factors
Group OR (95% CI) MHNO MHO MUNO MUO Sex Male 1.00 1.38 (0.83–2.31) 2.26 (1.78–2.86) 2.56 (1.84–3.58) Female 1.00 0.62 (0.26–1.48) 3.56 (1.82–6.93) 2.88 (1.44–5.76) Age < 60 1.00 1.93 (1.05–3.52) 2.40 (1.83–3.15) 3.68 (2.58–5.
6)≥ 60 1.00 0.69 (0.43–1.10) 1.41 (1.03–1.92) 1.55 (1.07–2.25) Smoking No 1.00 1.02 (0.58–1.81) 2.81 (1.99–3.96) 3.18 (2.11–4.81) Yes 1.00 1.03 (0.58–1.83) 2.05 (1.53–2.75) 2.24 (1.50–3.35) Alcohol drinking No 1.00 0.63 (0.38–1.06) 2.00 (1.49–2.69) 2.02 (1.40–2.92) Yes 1.00 1.89 (0.98–3.65) 2.74 (1.96–3.83) 3.67 (2.35–5.74) Physical activity No 1.00 0.98 (0.56–1.72) 2.43 (1.81–3.26) 3.24 (2.24–4.70) Regular 1.00 0.89 (0.50–1.59) 2.15 (1.53–3.03) 1.99 (1.29–3.07) Geographical location Southern China 1.00 1.17 (0.70–1.96) 2.53 (1.84–3.46) 2.22 (1.50–3.29) Northern China 1.00 0.86 (0.54–1.38) 2.27 (1.76–2.93) 2.60 (1.88–3.59) Note. Except for the group factor, all other factors were adjusted in the above 6 models. FMP, fat mass percentage; CVD, cardiovascular disease; MHNO, metabolically healthy non-obese; MHO, metabolically healthy obese; MUNO, metabolically unhealthy non-obese; MUO, metabolically unhealthy obese. Table 4. Odds ratios of metabolic phenotypes defined by FMP on CVD risk stratified by sociodemographic or lifestyle factors
Joint Association of Metabolic Health and Obesity with Ten-Year Risk of Cardiovascular Disease among Chinese Adults
doi: 10.3967/bes2022.003
- Received Date: 2021-07-04
- Accepted Date: 2021-10-19
-
Key words:
- Body mass index /
- Fat mass /
- Obesity /
- Metabolic health /
- Metabolic phenotype /
- Cardiovascular risk
Abstract:
Citation: | LIU Jun Ting, YAO Hong Yan, YU Shi Cheng, LIU Jian Jun, ZHU Guang Jin, HAN Shao Mei, XU Tao. Joint Association of Metabolic Health and Obesity with Ten-Year Risk of Cardiovascular Disease among Chinese Adults[J]. Biomedical and Environmental Sciences, 2022, 35(1): 13-21. doi: 10.3967/bes2022.003 |