title: Cardiometabolic disease risk in metabolically healthy and unhealthy obesity: Stability of metabolic health status in adults.
abstract: OBJECTIVE
  To assess the stability of metabolic status and body mass index (BMI) status and their relative contribution to risk of diabetes, cardiovascular events, and mortality.
  
  
  METHODS
  A total of 14,685 participants from the Atherosclerosis Risk in Communities Study and 4,990 from the Coronary Artery Risk Development in Young Adults Study were included. People with healthy obesity (HO) are defined as those meeting all three indices of blood pressure, blood glucose, and blood lipids. People with unhealthy obesity crossed the risk threshold for all three criteria.
  
  
  RESULTS
  In both healthy and unhealthy subgroups, risks for coronary heart disease (CHD), stroke, and mortality were comparable among BMI status during a mean 18.7-year follow-up. When compared with HO, hazard ratios were increased for diabetes (5.56, 95% confidence interval [CI] 4.12-7.48), CHD (5.60, 95% CI 3.14-9.98), stroke (4.84, 95% CI 2.13-10.97), and mortality (2.6, 95% CI 1.88-3.61) in people with unhealthy obesity. BMI only moderately increased the risks for diabetes among healthy subjects. In the Coronary Artery Risk Development in Young Adults Study over 20 years, 17.5% of lean subjects and 67.3% of overweight subjects at baseline developed obesity during follow-up. Despite rising BMI, metabolic status remained relatively stable.
  
  
  CONCLUSIONS
  Metabolic status is relatively stable despite rising BMI. HO had lower risks for diabetes, CHD, stroke, and mortality than unhealthy subjects but increased diabetes risks than healthy lean people. Cardiometabolic risk factors confer much higher risk than obesity per se.
authors.affiliation: Department of Obstetrics & Gynecology and Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch, Galveston, Texas, USA.
authors.forename: Fangjian
authors.initials: F
authors.lastname: Guo
authors.affiliation: Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA.|Geriatric Research Education and Clinical Center (GRECC), Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA.
authors.forename: W Timothy
authors.initials: WT
authors.lastname: Garvey
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D015992:Body Mass Index; D003327:Coronary Disease / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D009765:Obesity / Q000097:blood / Q000150:complications* / Q000401:mortality; D000067329:Obesity, Metabolically Benign / Q000097:blood / Q000150:complications* / Q000401:mortality; D050177:Overweight / Q000097:blood / Q000150:complications / Q000401:mortality; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D008055:Lipids