ICAO: Future Chronic Disease Risk Goes Beyond BMI (CME/CE)

When it comes to predicting chronic disease, body mass index doesn’t tell the whole story, according to a population-based study that found elevated risk with obesity and other metabolic risk factors independently.

Metabolically-healthy obese people tended toward being at least twice as likely to develop multiple metabolic risk factors and diabetes as healthy, normal weight individuals over the subsequent 3.5 years of a study led by Sarah Appleton, a postgraduate student at the University of Adelaide, Australia.

However, normal weight individuals with metabolic risk factors — a group the researchers called “metabolically obese” — were at greater risk, she told attendees at the International Congress on Abdominal Obesity in Hong Kong, a conference sponsored by the International Chair on Cardiometabolic Risk.

Overall, just 4.1% of the 3,743 adults in the population-based, North West Adelaide Health Study were in the normal body mass index range at baseline but had at least two of the following metabolic risk factors:

Triglyceride levels of 1.7 mmol/L or greater HDL cholesterol under 1.0mmol/L for men or 1.3 mmol/L for women Blood pressure of 130/85 mm Hg or higher A fasting plasma glucose of at least 5.6mmol/L or self-reported diabetes Treatment for any of these disorders

Although free of cardiovascular disease when they entered the study through a random population sample of the northwest region of Adelaide, after a mean of 3.5 years of follow-up, this group was 2.48 times at risk of incident cardiovascular disease or stroke events (95% CI 1.1 to 5.4).

Compared with metabolically-healthy, normal weight individuals, those with metabolic risk factors tended to be 3.27 times as likely to develop diabetes (P=0.07).

Identifying these individuals for prevention efforts may require less emphasis on BMI and increased surveillance of central obesity in primary care, the researchers told the congress.

“The problem with BMI is it doesn’t tell you where the fat is,” Appleton added in an interview. “Visceral fat is really bad for you.”

Obese individuals without multiple metabolic risk factors at baseline comprised a larger group (12.1%).

They were more likely to be middle age, live in a disadvantaged neighborhood, have smoked at some point, and get less exercise than their metabolically similar, but slimmer peers.

Over the subsequent 3.5 years, they were 2.82 times more likely to develop more than one metabolic risk factor than metabolically-healthy, normal weight individuals (95% CI 2.0 to 4.0).

The metabolically-normal obese also tended to be 2.36 times more likely to develop diabetes (95% CI 0.8 to 7.1). On the other hand, their risk of cardiovascular disease wasn’t elevated, “which likely related to the younger age of that group,” Appleton told MedPage Today.

Notably, abdominal obesity as determined by a waist circumference of 80 cm and over for men or 95 cm and greater for women was 6.1 times more likely among metabolically healthy individuals if their BMI was in the obese versus normal range.

But those who were in the normal BMI range were 2.2-fold more likely to be overweight or obese according to waist circumference if they had metabolic risk factors, which was statistically significant as well and likely contributed to the health risks they faced over the short-term future, Appleton said.

Maintenance of metabolic health in the obese population was more likely for younger individuals (OR 2.83 for age 40 or younger, 95% CI 1.1 to 7.6) and those who were at least moderately physically active (OR 2.04, 95% CI 1.01 to 4.1).

Appleton noted that these findings generally fit with data from the U.S. National Health Assessment Survey and Examination.

Regardless of whether patients have abdominal obesity, BMI obesity, or other metabolic risk factors, the solution is likely similar — improved diet and exercise, she said.

The study was supported by the University of Adelaide and the South Australian Department of Health.

Appleton reported no conflicts of interest.

source : www.medpagetoday.com

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