Factors associated with metabolically healthy status in obesity, overweight, and normal weight at baseline of ELSA-Brasil

Abstract

The primary aim of this study was to evaluate metabolically healthy status (MHS) among participants in obesity, overweight, and normal weight groups and characteristics associated with this phenotype using baseline data of Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The secondary aim was to investigate agreement among 4 different MHS criteria. This cross-sectional study included 14,545 participants aged 35 to 74 years with a small majority (54.1%) being women. Of all participants, 22.7% (n = 3298) were obese, 40.8% (n = 5934) were overweight, and 37.5% (n = 5313) were of normal weight.Socio-demographic, behavioral, and anthropometric factors related to MHS were ascertained. Logistic regression models estimated the odds of associations. We used 4 different criteria separately and in combination to define MHS: the National Health and Nutrition Examination Survey (NHANES), the National Cholesterol Education Program (NCEP-ATPIII), the International Diabetes Federation (IDF) and comorbidities, and the agreement between them were evaluated by Cohen-kappa coefficient.MHS was present among 12.0% (n = 396) of obese, 25.5% (n = 1514) of overweight, and 48.6% (n = 2582) of normal weight participants according to the combination of the 4 criteria. The agreement between all the 4 MHS criteria was strong (kappa 0.73 P < 0.001). In final logistic models, MHS was associated with lower age, female sex, lower body mass index (BMI), and weight change from age 20 within all BMI categories.This study showed that, despite differences in prevalence among the 4 criteria, MHS was associated with common characteristics at every BMI category.

Figure 1

Obesity (A), overweight (B), and normal weight (C) metabolically healthy or unhealthy according to the 4 criteria, and metabolically healthy status according to the combination of all the 4 criteria (D). Comorb = comorbidities criteria, IDF = International Diabetes Federation criteria, NCEP = National Cholesterol Education Panel, NHANES = National Health Examination Surveys, MH = metabolically healthy, MUH = metabolically unhealthy.

Figure 2

Odds ratio for factors associated with being metabolically healthy, among obese, overweight and normal weight individuals. Educational level-university degree as reference, occupation: Nonroutine, nonmanual as reference; social class: high as reference, smoking: never as reference, physical activity highly active as reference, fruit consumption: ≥5 times/week as reference, Regular/Poor/Very poor self-rated health: very good or good as reference. BMI = body mass index, Fruit consump = regular consumption of fruit (≥5 times/week), Rout.N-manual occupation = Routine nonmanual occupation, Reg./poor health = Regular/Poor/Very poor self-rated health, %RWC = relative weight change.