Metabolically unhealthy phenotype in normal weight population and risk of mortality and major adverse cardiac events: A meta-analysis of 41 prospective cohort studies. Issue 10 (October 2022)

• Record Type: Journal Article
• Authors: Putra, Iwan Cahyo Santosa; Kamarullah, William; Prameswari, Hawani Sasmaya; Pramudyo, Miftah; Iqbal, Mohammad; Achmad, Chaerul; Akbar, Mohammad Rizki; Tiksnadi, Badai Bhatara
• Is Part Of: Diabetes & metabolic syndrome. Volume 16:Issue 10(2022)
• Publication Date: 2022-10
• Subjects: Normal weight -- Obesity -- Metabolic status -- Mortality -- Major adverse cardiac events; Diabetes -- Periodicals; Metabolism -- Disorders -- Periodicals; Diabetes Mellitus -- Periodicals; Metabolic Diseases -- Periodicals; Diabète -- Périodiques; Métabolisme, Troubles du -- Périodiques; Endocrinologie -- Périodiques; Diabète -- Physiopathologie -- Périodiques; Diabetes; Metabolism -- Disorders; Electronic journals; Periodicals; 616.462
• DOI: 10.1016/j.dsx.2022.102635
• Languages: English
• ISSNs: 1871-4021

Abstract

Abstract: Background and aims: It is still debatable whether metabolic status in normal weight population increases the risk of mortality (all-cause mortality (ACM), cardiovascular mortality (CVM)) and major adverse cardiac events (MACE) as compared to the obese population. Therefore, this meta-analysis aims to evaluate the association of the metabolically unhealthy normal weight (MUH-NW) phenotype with all-cause mortality, cardiovascular mortality, and MACE in comparison to metabolically healthy obesity (MH-O), along with the association of metabolically unhealthy obesity (MUH-O) phenotype regarding the same outcomes compared to MUH-NW. Methods: A systematic literature search was conducted using online databases from inception to June 20, 2022, to comprehensively search all prospective cohort studies comprising three variables including adults aged ≥18 years, obesity and four metabolic phenotypes, and interest outcomes (ACM, CVM, and MACE). Results: Forty-one prospective cohort studies with a total of 4, 028, 750 participants was included in this study. Compared to MH-O, MUH-NW had a substantially higher risk of ACM (RR = 1.47 (95%CI = 1.32–1.64); P < 0.001; I 2 = 89.8%, P-heterogeneity<0.001), CVM (RR = 2.37 (95%CI = 1.97–2.86); P < 0.001; I 2 = 83.7%, P-heterogeneity<0.001), and MACE (RR = 1.73 (95%CI = 1.49–2.00); P < 0.001; I 2 = 74.3%, P-heterogeneity<0.001). Moreover, MUH-O did not have a significantly elevated risk of ACM (RR = 0.97 (95%CI = 0.82–1.15); P = 0.736; I 2 = 98.3%, P-heterogeneity<0.001), CVM (RR = 0.96 (95%CI = 0.88–1.05); P = 0.394; I 2 = 77.0%, P-heterogeneity<0.001), and MACE (RR = 0.95 (95%CI = 0.80–1.13); P = 0.570; I 2 = 92.2%, P-heterogeneity<0.001) compared to MUH-NW. Conclusion: In conclusion, MUH-NW was superior but not inferior to MH-O and MUH-O in terms of increased risk of interest outcomes, refuting the notion that normal weight population is a benign condition. Hence, in normal weight population, metabolic screening is highly suggested to measure the baseline of obesity and metabolic phenotypes, thus preventing the risk of CVD and mortality in the future. Highlights: Various novel phenotypes reflecting metabolic health have been discovered including MUH-NW, MH-NW, MUH-O, and MH-O. It is still being argued if the metabolic phenotype of normal weight is truly innocuous as compared to those in the obese population. MUH-NW was superior but not inferior to MH-O and MUH-O, respectively with reference to increased risk of poor outcomes. Our meta-analysis refutes the notion that normal weight is a benign condition.