Do worse baseline risk factors explain the association of healthy obesity with increased mortality risk? Whitehall II Study

• Published in: International Journal of Obesity 2019-08, Vol.43 (8), p.1578-1589
• Main Authors: Johnson, William, Bell, Joshua A., Robson, Ellie, Norris, Tom, Kivimäki, Mika, Hamer, Mark
• Format: Article
• Language: English
• Subjects: 692/163/2743/393; 692/308/174; Adult; Body mass index; Body size; Body Weight; Body-Weight Trajectory; Case-Control Studies; Cholesterol; Epidemiology; Female; Glucose; Hazards; Health aspects; Health Promotion and Disease Prevention; Health risk assessment; Health risks; Health Status; Healthy Volunteers - statistics & numerical data; High density; High density lipoprotein; Humans; Hypertension; Insulin; Internal Medicine; Longitudinal Studies; Male; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Mortality; Mortality risk; Obesity; Obesity, Metabolically Benign - mortality; Overweight persons; Patient outcomes; Proportional Hazards Models; Public Health; Residential density; Risk analysis; Risk Factors; Surveys and Questionnaires; Trajectories; Triglycerides; United Kingdom; Weight
• ISSN: 0307-0565; 1476-5497
• DOI: 10.1038/s41366-018-0192-0

Objective To describe 20-year risk factor trajectories according to initial weight/health status and investigate the extent to which baseline differences explain greater mortality among metabolically healthy obese (MHO) individuals than healthy non-obese individuals. Methods The sample comprised 6529 participants in the Whitehall II study who were measured serially between 1991–1994 and 2012–2013. Baseline weight (non-obese or obese; body mass index (BMI) ≥30 kg/m 2 ) and health status (healthy or unhealthy; two or more of hypertension, low high-density lipoprotein cholesterol (HDL-C), high triglycerides, high glucose, and high homeostatic model assessment of insulin resistance (HOMA-IR)) were defined. The relationships of baseline weight/health status with 20-year trajectories summarizing ~25,000 observations of systolic and diastolic blood pressures, HDL-C, triglycerides, glucose, and HOMA-IR were investigated using multilevel models. Relationships of baseline weight/health status with all-cause mortality up until July 2015 were investigated using Cox proportional hazards regression. Results Trajectories tended to be consistently worse for the MHO group compared to the healthy non-obese group (e.g., glucose by 0.21 (95% CI 0.09, 0.33; p