All-Cause Mortality Risk of Metabolically Healthy Obese Individuals in NHANES IIIReport as inadecuate

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Journal of ObesityVolume 2012 2012, Article ID 460321, 12 pages

Research ArticleDepartment of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Building, University Park, PA 16801, USA

Received 1 August 2012; Revised 29 October 2012; Accepted 29 October 2012

Academic Editor: Jack A. Yanovski

Copyright © 2012 C. M. Durward et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Mortality risk across metabolic health-by-BMI categories in NHANES-III was examined. Metabolic health was defined as: 1 homeostasis model assessment-insulin resistance HOMA-IR <2.5; 2 ≤2 Adult Treatment Panel ATP III metabolic syndrome criteria; 3 combined definition using ≤1 of the following: HOMA-IR ≥1.95 or diabetes medications, triglycerides ≥1.7 mmol-L, HDL-C <1.04 mmol-L males or <1.30 mmol-L females, LDL-C ≥2.6 mmol-L, and total cholesterol ≥5.2 mmol-L or cholesterol-lowering medications. Hazard ratios HR for all-cause mortality were estimated with Cox regression models. Nonpregnant women and men were included , mean ± SD, age years, BMI  kg-m

, 49.4% female. Only 40 of 1160 obese individuals were identified as MHO by all definitions. MHO groups had superior levels of clinical risk factors compared to unhealthy individuals but inferior levels compared to healthy lean groups. There was increased risk of all-cause mortality in metabolically unhealthy obese participants regardless of definition HOMA-IR HR 2.07 CI 1.3–3.4, ; ATP-III HR 1.98 CI 1.4–2.9, ; combined definition HR 2.19 CI 1.3–3.8, . MHO participants were not significantly different from healthy lean individuals by any definition. While MHO individuals are not at significantly increased risk of all-cause mortality, their clinical risk profile is worse than that of metabolically healthy lean individuals.

Author: C. M. Durward, T. J. Hartman, and S. M. Nickols-Richardson



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