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. 2019 Aug 15;8(8):1228.
doi: 10.3390/jcm8081228.

The Relationship between Metabolically Healthy Obesity and the Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis

Tzu-Lin Yeh  1   2 , Hsin-Hao Chen  1   3   4 , Szu-Ying Tsai  5 , Chien-Yu Lin  6 , Shu-Jung Liu  7 , Kuo-Liong Chien  8   9
Affiliations

The Relationship between Metabolically Healthy Obesity and the Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis

Tzu-Lin Yeh et al. J Clin Med. .

Abstract

Cardiovascular disease (CVD) risk in individuals with metabolically healthy obesity (MHO) is unclear. We searched databases from inception to May 2019. Data were pooled using a random effects model. Newcastle-Ottawa Scale assessment was performed. Primary and secondary outcomes were CVD risk and all-cause mortality. Forty-three studies involving 4,822,205 cases were included. The median percentage of females, age and duration of follow-up was 52%, 49.9 years and 10.6 years, respectively. The mean Newcastle-Ottawa Scale score of the articles was 7.9 ± 1.0. Compared to individuals with a metabolically healthy normal weight, individuals with MHO had higher adjusted risk of CVD and all-cause mortality. We identified a significant linear dose-response relationship between body mass index (BMI) and CVD risk among metabolically healthy individuals (p < 0.001); every unit increase in BMI increased the CVD risk. Multivariate meta-regression analysis showed that an increased proportion of women and age resulted in the risk of CVD affected by MHO reduction (p = 0.014, p = 0.030, respectively). Age and sex explained the observed heterogeneity and reported the adjusted R2. MHO resulted in a significantly increased risk for CVD; therefore, long-term weight loss should be encouraged.

Keywords: all-cause mortality; cardiovascular disease; meta-analysis; metabolically healthy obesity.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the study selection process.
Figure 2
Figure 2
Cumulative forest plot of risk of cardiovascular disease from all included studies. CI, confidence interval; OR, odds ratio.
Figure 3
Figure 3
Dose-response analysis of body mass index and the risk of cardiovascular disease.
Figure 4
Figure 4
Meta-regression bubble plot of correlation between log odds ratio of cardiovascular disease and the proportion of women.
See this image and copyright information in PMC

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