Separate and combined associations of obesity and metabolic health with coronary heart disease: a pan-European case-cohort analysis

Publikation: Forskning - peer reviewTidsskriftartikel

DOI

  • Camille Lassale
    Camille LassaleDepartment of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.Department of Epidemiology and Biostatistics, Imperial College, London, UK.Storbritannien
  • Ioanna Tzoulaki
    Ioanna TzoulakiDepartment of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, 45110, Greece.Department of Epidemiology and Biostatistics, Imperial College, London, UK.Grækenland
  • Karel G M Moons
    Karel G M MoonsJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 Utrecht, The Netherlands.Holland
  • Michael Sweeting
    Michael SweetingDepartment of Public Health and Primary Care, MRC/BHF Cardiovascular Epidemiology Unit, University of Cambridge, 2 Worts' Causeway, Cambridge CB1 8RN, UK.Storbritannien
  • Jolanda Boer
    Jolanda BoerNational Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands.Holland
  • Laura Johnson
    Laura JohnsonCentre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Senate House, Tyndall Ave, Bristol BS8 1TH, UK.Storbritannien
  • José María Huerta
    José María HuertaCIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5, 28029 Madrid, Spain.Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, E-30008 Murcia, Spain.Spanien
  • Claudia Agnoli
    Claudia AgnoliEpidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milan, Italy.Italien
  • Heinz Freisling
    Heinz FreislingSection of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), 150 Cours Albert Thomas, 69008 Lyon, France.Frankrig
  • Elisabete Weiderpass
    Elisabete WeiderpassGenetic Epidemiology Group, Folkhälsan Research Center, Topeliuksenkatu 20, 00250 Helsinki, Finland.Department of Community Medicine, Faculty of Medicine, University of TromsøDepartment of Research, Cancer Registry of NorwayDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, SwedenNorge
  • Patrik Wennberg
    Patrik WennbergDepartment of Public Health and Clinical Medicine, Family medicine, Umeå University, 901 87 Umeå, Sweden.Sverige
  • Daphne L van der A
    Daphne L van der ANational Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands.Holland
  • Larraitz Arriola
    Larraitz ArriolaPublic Health Division of Gipuzkoa, Instituto Bio-Donostia, Basque Government, Calle Doctor Begiristain, 20014 Donostia/Gipuzkoa, Spain.Spanien
  • Vassiliki Benetou
    Vassiliki Benetou1] Bureau of Epidemiologic Research, Academy of Athens, 23 Alexandroupoleos Street, Athens GR-115 27, Greece [2] Hellenic Health Foundation, 13 Kaisareias Street, Athens GR-115 27, Greece.WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Dept. of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.Grækenland
  • Heiner Boeing
    Heiner BoeingGerman Institute of Human Nutrition, Potsdam-Rehbrücke (DIfE), Department of Epidemiology, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.Tyskland
  • Fabrice Bonnet
    Fabrice BonnetInserm (Institut National De La Santé Et De La Recherche Médical), Centre for Research in Epidemiology and Population Health (CESP), U1018, 16 Avenue Paul Vaillant Couturier, 94800 Villejuif, France.Université de RennesFrankrig
  • Sandra M Colorado-Yohar
    Sandra M Colorado-YoharNational School of Public Health, Research Group on Demography and Health, University of Antioquia, Cl. 67 #53 - 108 Medellín, Colombia.Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, E-30008 Murcia, Spain.Spanien
  • Gunnar Engström
    Gunnar EngströmDepartment of Clinical Sciences Malmö, Lund University, Bergsgatan 31 B, 214 45 Malmö, Sweden.Sverige
  • Anne K Eriksen
    Anne K EriksenDanish Cancer Society Research Center, Unit of Diet, Genes and Environment, Strandboulevarden 49, Copenhagen DK-2100, Denmark.Danmark
  • Pietro Ferrari
    Pietro FerrariSection of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), 150 Cours Albert Thomas, 69008 Lyon, France.Frankrig
  • Sara Grioni
    Sara GrioniEpidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milan, Italy.Italien
  • Matthias Johansson
    Matthias JohanssonSection of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), 150 Cours Albert Thomas, 69008 Lyon, France.Frankrig
  • Rudolf Kaaks
    Rudolf KaaksDivision of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, 69120 Heidelberg, Germany.Tyskland
  • Michail Katsoulis
    Michail Katsoulis1] Bureau of Epidemiologic Research, Academy of Athens, 23 Alexandroupoleos Street, Athens GR-115 27, Greece [2] Hellenic Health Foundation, 13 Kaisareias Street, Athens GR-115 27, Greece.Grækenland
  • Verena Katzke
    Verena KatzkeDivision of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, 69120 Heidelberg, Germany.Tyskland
  • Timothy J Key
    Timothy J KeyCancer Epidemiology Unit, Nuffield Department of Population Health University of Oxford, Old Road Campus, Oxford OX3 7LF, UK.Storbritannien
  • Giuseppe Matullo
    Giuseppe MatulloDepartment of Medical Sciences, University of Turin, Via Giuseppe Verdi, 8, 10124 Turin, Italy.Human Genetics Foundation - HuGeF, Turin, Italy.Italien
  • Olle Melander
    Olle MelanderDepartment of Clinical Sciences Malmö, Lund University, Bergsgatan 31 B, 214 45 Malmö, Sweden.Sverige
  • Elena Molina-Portillo
    Elena Molina-PortilloEscuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Av. del Hospicio, s/n, 18010 Granada, Spain.CIBER Epidemiología y Salud Pública (CIBERESP), Spain.Spanien
  • Concepción Moreno-Iribas
    Concepción Moreno-IribasPublic Health Institute of Navarra, IdiSNA, Calle de Irunlarrea, 3, 31008 Pamplona, Spain.Spanien
  • Margareta Norberg
    Margareta NorbergDepartment of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden.Sverige
  • Kim Overvad
  • Salvatore Panico
    Salvatore PanicoDipartimento di Medicina Clinica e Chirurgia, Federico II University, Corso Umberto I, 40, 80138 Naples, Italy.Italien
  • J Ramón Quirós
    J Ramón QuirósPublic Health Directorate, Asturias, General Elorza 32, 33001 Oviedo, Spain.Spanien
  • Calogero Saieva
    Calogero SaievaCancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Via Cosimo Il Vecchio, 2, 50139 Florence, Italy.Italien
  • Guri Skeie
    Guri SkeieDepartment of Community Medicine, University of Tromsø-the Arctic University of Norway, Hansine Hansens veg 18, 9019 Tromsø, Norway.Norge
  • Annika Steffen
    Annika SteffenGerman Institute of Human Nutrition, Potsdam-Rehbrücke (DIfE), Department of Epidemiology, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.Tyskland
  • Magdalena Stepien
    Magdalena StepienSection of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), 150 Cours Albert Thomas, 69008 Lyon, France.Frankrig
  • Anne Tjønneland
    Anne TjønnelandDanish Cancer Society Research Center, Unit of Diet, Genes and Environment, Strandboulevarden 49, Copenhagen DK-2100, Denmark.Danmark
  • Antonia Trichopoulou
    Antonia Trichopoulou1] Bureau of Epidemiologic Research, Academy of Athens, 23 Alexandroupoleos Street, Athens GR-115 27, Greece [2] Hellenic Health Foundation, 13 Kaisareias Street, Athens GR-115 27, Greece.Grækenland
  • Rosario Tumino
    Rosario TuminoCancer Registry and Histopathology Unit, Civic-M.P. Arezzo Hospital, ASP Contrada Rito, 97100 Ragusa, Italy.Italien
  • Yvonne T van der Schouw
    Yvonne T van der SchouwJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 Utrecht, The Netherlands.Holland
  • W M Monique Verschuren
    W M Monique VerschurenNational Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands.Julius Center for Health Sciences and Primary Care, University Medical Center UtrechtHolland
  • Claudia Langenberg
    Claudia LangenbergMedical Research Council Epidemiology Unit, University of Cambridge, 2 Worts' Causeway, Cambridge CB1 8RN, UK.Storbritannien
  • Emanuele Di Angelantonio
    Emanuele Di AngelantonioNational Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Trinity Ln, Cambridge CB2 1TN, UK.MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK.Storbritannien
  • Elio Riboli
    Elio RiboliDepartment of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, Cambridge.Storbritannien
  • Nicholas J Wareham
    Nicholas J WarehamMedical Research Council Epidemiology Unit, University of Cambridge, 2 Worts' Causeway, Cambridge CB1 8RN, UK.Storbritannien
  • John Danesh
    John DaneshDepartment of Human Genetics, Wellcome Trust Sanger Institute, Hinxton CB10 1SA, UK.MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK.NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge CB1 8RN, UK.Storbritannien
  • Adam S Butterworth
    Adam S ButterworthNational Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Trinity Ln, Cambridge CB2 1TN, UK.MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK.Storbritannien

Aims: The hypothesis of 'metabolically healthy obesity' implies that, in the absence of metabolic dysfunction, individuals with excess adiposity are not at greater cardiovascular risk. We tested this hypothesis in a large pan-European prospective study.

Methods and results: We conducted a case-cohort analysis in the 520 000-person European Prospective Investigation into Cancer and Nutrition study ('EPIC-CVD'). During a median follow-up of 12.2 years, we recorded 7637 incident coronary heart disease (CHD) cases. Using cut-offs recommended by guidelines, we defined obesity and overweight using body mass index (BMI), and metabolic dysfunction ('unhealthy') as ≥ 3 of elevated blood pressure, hypertriglyceridaemia, low HDL-cholesterol, hyperglycaemia, and elevated waist circumference. We calculated hazard ratios (HRs) and 95% confidence intervals (95% CI) within each country using Prentice-weighted Cox proportional hazard regressions, accounting for age, sex, centre, education, smoking, diet, and physical activity. Compared with metabolically healthy normal weight people (reference), HRs were 2.15 (95% CI: 1.79; 2.57) for unhealthy normal weight, 2.33 (1.97; 2.76) for unhealthy overweight, and 2.54 (2.21; 2.92) for unhealthy obese people. Compared with the reference group, HRs were 1.26 (1.14; 1.40) and 1.28 (1.03; 1.58) for metabolically healthy overweight and obese people, respectively. These results were robust to various sensitivity analyses.

Conclusion: Irrespective of BMI, metabolically unhealthy individuals had higher CHD risk than their healthy counterparts. Conversely, irrespective of metabolic health, overweight and obese people had higher CHD risk than lean people. These findings challenge the concept of 'metabolically healthy obesity', encouraging population-wide strategies to tackle obesity.

OriginalsprogEngelsk
TidsskriftEuropean Heart Journal
Vol/bind39
Tidsskriftsnummer5
Sider (fra-til)397-406
Antal sider10
ISSN0195-668X
DOI
StatusUdgivet - 1 feb. 2018

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