Cited by 574Diabetes, Cardiovascular Risks, and LipoproteinsCardiovascular Disease and AdiposityCardiovascular Function and Risk Factors

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Metabolically healthy obese and incident cardiovascular disease events among 3.5 million men and women.

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Caleyachetty, Rishi, Thomas, G. Neil, Toulis, Konstantinos A., Mohammed, Nuredin, Gokhale, Krishna M., Balachandran, Kumarendran, Nirantharakumar, Krishnarajah·2017·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2017.07.763

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Abstract

Background Previous studies have been unclear about the cardiovascular risks for metabolically healthy obese individuals.Objectives This study examined the associations among metabolically healthy obese individuals and 4 different presentations of incident cardiovascular disease in a contemporary population.Methods We used linked electronic health records (1995 to 2015) in The Health Improvement Network (THIN) to assemble a cohort of 3.5 million individuals, 18 years of age or older and initially free of cardiovascular disease. We created body size phenotypes defined by body mass index categories (underweight, normal weight, overweight, and obesity) and 3 metabolic abnormalities (diabetes, hypertension, and hyperlipidemia). The primary endpoints were the first record of 1 of 4 cardiovascular presentations (coronary heart disease [CHD], cerebrovascular disease, heart failure, and peripheral vascular disease).Results During a mean follow-up of 5.4 years, obese individuals with no metabolic abnormalities had a higher risk of CHD (multivariate-adjusted hazard ratio [HR]: 1.49; 95% confidence interval [CI]: 1.45 to 1.54), cerebrovascular disease (HR: 1.07; 95% CI: 1.04 to 1.11), and heart failure (HR: 1.96; 95% CI: 1.86 to 2.06) compared with normal weight individuals with 0 metabolic abnormalities. Risk of CHD, cerebrovascular disease, and heart failure in normal weight, overweight, and obese individuals increased with increasing number of metabolic abnormalities.Conclusions Metabolically healthy obese individuals had a higher risk of coronary heart disease, cerebrovascular disease, and heart failure than normal weight metabolically healthy individuals. Even individuals who are normal weight can have metabolic abnormalities and similar risks for cardiovascular disease events.

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Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants.
(2016) · The Lancet · doi:10.1016/s0140-6736(16)30054-x · Cited by 5,212
The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis
Guh, D. P., Zhang, W., Bansback, N., Amarsi, Z., Birmingham, C. L., & Anis, A. H. (2009) · BMC Public Health · doi:10.1186/1471-2458-9-88 · Cited by 3,855
Mechanisms linking obesity with cardiovascular disease
Van Gaal, L. F., Mertens, I. L., & De Block, C. E. (2006) · Nature · doi:10.1038/nature05487 · Cited by 2,814 · cited 1×
“Our finding that obesity was associated with a lower risk of PVD was surprising, considering that it may influence the atherosclerotic process (25).”
Epidemiology of Peripheral Artery Disease
Criqui, M. H., & Aboyans, V. (2015) · Circulation Research · doi:10.1161/circresaha.116.303849 · Cited by 1,785
The Obese Without Cardiometabolic Risk Factor Clustering and the Normal Weight With Cardiometabolic Risk Factor Clustering: Prevalence and Correlates of 2 Phenotypes Among the US Population (NHANES 1999-2004)
Wildman, R. P. (2008) · Archives of Internal Medicine · doi:10.1001/archinte.168.15.1617 · Cited by 1,618
Beyond body mass index
Prentice, A. M., & Jebb, S. A. (2001) · Obesity Reviews · doi:10.1046/j.1467-789x.2001.00031.x · Cited by 1,267
Ankle-arm index as a marker of atherosclerosis in the Cardiovascular Health Study. Cardiovascular Heart Study (CHS) Collaborative Research Group.
Newman, A. B., Siscovick, D. S., Manolio, T. A., Polak, J. F., Fried, L. P., Borhani, N. O., & Wolfson, S. K. (1993) · Circulation · doi:10.1161/01.cir.88.3.837 · Cited by 1,150
Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1·8 million participants
(2014) · The Lancet · doi:10.1016/s0140-6736(13)61836-x · Cited by 1,121
Are Metabolically Healthy Overweight and Obesity Benign Conditions?
Kramer, C. K., Zinman, B., & Retnakaran, R. R. (2013) · Annals of Internal Medicine · doi:10.7326/0003-4819-159-11-201312030-00008 · Cited by 979
Metabolically healthy obesity: Epidemiology, mechanisms, and clinical implications
Stefan, N., Häring, H.-U., Hu, F. B., & Schulze, M. B. (2013) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(13)70062-7 · Cited by 857

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Association of Metabolically Healthy Overweight Phenotype With Abnormalities of Glucose Levels and Blood Pressure Among Chinese Adults
Xu, R., Gao, X., Wan, Y., & Fan, Z. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.14025 · Cited by 18
Facing Challenges for Reducing Weight Stigma in Public Health Policy and Practice
Puhl, R. M. (2025) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-060722-024519 · Cited by 30
The burden of end-stage osteoarthritis in Australia: a population-based study on the incidence of total knee replacement attributable to overweight/obesity
Chen, L., Zheng, M., Chen, Z., Peng, Y., Jones, C. W., Graves, S. E., Chen, P., Ruan, R., Papadimitriou, J. M., Carey-Smith, R. L., et al. (2021) · Osteoarthritis and Cartilage · doi:10.1016/j.joca.2021.10.017 · Cited by 17
The New Paradigm of Non-Alcoholic Fatty Liver Disease: Phenotypic Diversity of Metabolically Associated Fatty Liver Disease
Vinnitskaya, Y. V., Sandler, Y. G., & Bordin, D. S. (2020) · Effective Pharmacotherapy · doi:10.33978/2307-3586-2020-16-24-54-63 · Cited by 20
The role of protein kinase D (PKD) in intracellular nutrient sensing and regulation of adaptive responses to the obese environment
Renton, M. C., McGee, S., & Howlett, K. F. (2020) · Obesity Reviews · doi:10.1111/obr.13145 · Cited by 17
Obesity measures, metabolic health and their association with 15-year all-cause and cardiovascular mortality in the SAMINOR 1 Survey: a population-based cohort study
Michalsen, V. L., Wild, S. H., Kvaløy, K., Svartberg, J. B., Melhus, M., & Broderstad, A. R. (2021) · BMC Cardiovascular Disorders · doi:10.1186/s12872-021-02288-9 · Cited by 18
Increased fractalkine and vascular dysfunction in obesity and in type 2 diabetes. Effects of oral antidiabetic treatment
Schinzari, F., Tesauro, M., Campia, U., & Cardillo, C. (2020) · Vascular Pharmacology · doi:10.1016/j.vph.2020.106676 · Cited by 17
Trajectories of body mass index and risk for coronary heart disease: A 38-year follow-up study
Calling, S., Johansson, S.-E., Nymberg, V. M., Sundquist, J., & Sundquist, K. (2021) · PLoS ONE · doi:10.1371/journal.pone.0258395 · Cited by 18
Assessment of Cardiovascular Risk Factors and Their Interactions in the Risk of Coronary Heart Disease in Patients with Type 2 Diabetes with Different Weight Levels, 2013–2018
Wang, C., Ye, D., Xie, Z., Huang, X., Wang, Z., Shangguan, H., Zhu, W., & Wang, S. (2021) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s335017 · Cited by 17
Vitamin D and Swimming Exercise Prevent Obesity in Rats under a High-Fat Diet via Targeting FATP4 and TLR4 in the Liver and Adipose Tissue
Kolieb, E., Maher, S. A., Shalaby, M. N., Alsuhaibani, A. M., Alharthi, A., Hassan, W. A., & El-Sayed, K. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192113740 · Cited by 17
Non-alcoholic fatty liver disease and type 2 diabetes mellitus: the problem of conjunction and phasing
Kiseleva, E. V., & Demidova, T. Y. (2021) · Obesity and metabolism · doi:10.14341/omet12758 · Cited by 17
Association Between Dietary Patterns and Different Metabolic Phenotypes in Japanese Adults: WASEDA'S Health Study
Tanisawa, K., Ito, T., Kawakami, R., Usui, C., Kawamura, T., Suzuki, K., Sakamoto, S., Ishii, K., Muraoka, I., Oka, K., et al. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.779967 · Cited by 16
“On the other hand, a large-scale cohort study reported that normal-weight individuals with metabolic abnormalities were at an increased risk of cardiovascular diseases compared to those without metabolic abnormalities (5).”
Background
Central role of obesity in endothelial cell dysfunction and cardiovascular risk
Júnior, J. C. D. L., Moura‐Assis, A., Cintra, R. M. R., Quinaglia, T., Velloso, L. A., & Sposito, A. C. (2019) · Revista da Associação Médica Brasileira · doi:10.1590/1806-9282.65.1.87 · Cited by 16
Triglyceride–Glucose Index Predicts Cardiovascular Outcome in Metabolically Unhealthy Obese Population: A Nationwide Population-Based Cohort Study
Cho, Y. K., Kim, H. S., Park, J., Lee, W. J., Kim, Y., & Jung, C. H. (2022) · Journal of Obesity & Metabolic Syndrome · doi:10.7570/jomes21086 · Cited by 16
Association of obesity with cardiovascular disease in the absence of traditional risk factors
Luo, H., Liu, Y., Tian, X., Zhao, Y., Liu, L., Zhao, Z., Luo, L., Zhang, Y., Jiang, X., Liu, Y., et al. (2023) · International Journal of Obesity · doi:10.1038/s41366-023-01408-z · Cited by 16
Glucose tolerance and insulin sensitivity define adipocyte transcriptional programs in human obesity
Gerlini, R., Berti, L., Darr, J., Lassi, M., Brandmaier, S., Fritsche, L., Scheid, F., Böhm, A., Königsrainer, A., Grallert, H., et al. (2018) · Molecular Metabolism · doi:10.1016/j.molmet.2018.09.004 · Cited by 16
“T morbidities when compared to a lean population [3] they are still protected as the onset of co-morbidities is delayed compared to an unhealthy obese population [1].”
Background
Is metabolically healthy obesity a useful concept?
Beh, S. (2018) · Diabetic Medicine · doi:10.1111/dme.13869 · Cited by 16
Metabolically Healthy Obesity and Bariatric Surgery
Cătoi, A. F., & Busetto, L. (2019) · Obesity Surgery · doi:10.1007/s11695-019-03964-8 · Cited by 18
Children with metabolically healthy obesity have a worse metabolic profile compared to normal-weight peers: a cross-sectional study
Serbis, A., Giapros, V., Paschou, S. Α., & Siomou, E. C. (2021) · Endocrine · doi:10.1007/s12020-021-02762-6 · Cited by 16
“showed that adults with MHO had a higher risk of coronary heart disease, CVD, and heart failure than NW counterparts [17].”
Background
Risk of Stroke Among Different Metabolic Obesity Phenotypes: A Systematic Review and Meta-Analysis
Meng, M., Guo, Y., Kuang, Z., Liu, L., Cai, Y., & Ni, X. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.844550 · Cited by 15
“Caleyachetty (24) √ √ √ √ √ √ √ √ √ 9 High”
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Zhao, M., Du, W., Zhao, Q., Chen, Y., Li, B., Xie, Z., Fu, Z., Zhang, N., Cheng, X., Li, X., et al. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.888062 · Cited by 15
“It has been reported that there is an unique subset of obese individuals having a relatively favorable metabolic profile, termed as metabolically healthy obese (MHO) (9, 10).”
Background
Expression of ICAM-1 and E-selectin in different metabolic obesity phenotypes: discrepancy for endothelial dysfunction
Liu, M., Wang, P., Xie, P., Xu, X., He, L., Chen, X., Zhang, S., Lin, Y., Huang, Y., Xia, W., et al. (2023) · Journal of Endocrinological Investigation · doi:10.1007/s40618-023-02094-4 · Cited by 17
Tirzepatide and potential use for metabolically healthy obesity
Copur, S., Tanrıöver, C., Yavuz, F., Tuttle, K. R., & Kanbay, M. (2023) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2023.05.012 · Cited by 15
Stratification of obesity phenotypes to optimize future therapy (SOPHIA)
Tahrani, A. A., Panova‐Noeva, M., Schloot, N. C., Hennige, A. M., Söderberg, J. A. E., Nadglowski, J. F., Tarasenko, L. C., Ahmad, N. N., Sleypen, B. S., Bravo, R., et al. (2023) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2023.2264783 · Cited by 15
Computed tomography evaluation of skeletal muscle quality and quantity in people with morbid obesity with and without metabolic abnormality
Oh, E., Cho, N., Kang, H., Kim, S. H., Park, H. K., & Kwon, S. H. (2023) · PLoS ONE · doi:10.1371/journal.pone.0296073 · Cited by 15
Relationship between metabolic status, physical activity and cardiovascular disease in participants with obesity
Liu, Y., Zhao, A., Sun, G., Wang, R., Zhang, J., Lip, G. Y. H., & Li, G. (2024) · International Journal of Obesity · doi:10.1038/s41366-024-01469-8 · Cited by 15
Transitions in metabolic health status over time and risk of heart failure: A prospective study
Bi, J., Song, L., Wang, L., Su, B., Wu, M., Li, D., Chen, S., Liu, Y., Yang, Y., Zhou, Z., et al. (2021) · Diabetes & Metabolism · doi:10.1016/j.diabet.2021.101266 · Cited by 15
Current prospects of metabolically healthy obesity
Ahmad, M. N., & Zawatia, A. A. (2021) · Obesity Medicine · doi:10.1016/j.obmed.2021.100361 · Cited by 16
Pathogenesis, Murine Models, and Clinical Implications of Metabolically Healthy Obesity
Cho, Y. K., Lee, Y. L., & Jung, C. H. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23179614 · Cited by 16
“Although CVE risk is higher in patients with MHO than in metabolically healthy individuals with normal body weight, the risk is substantially lower in individuals with MHO, compared to those with MUO [95,96,102].”
Background
Cellular reprogramming, chemoresistance, and dietary interventions in breast cancer
Pereira, I. C., Mascarenhas, I. F., Capetini, V. C., Ferreira, P. M. P., Rogero, M. M., & Torres‐Leal, F. L. (2022) · Critical Reviews in Oncology/Hematology · doi:10.1016/j.critrevonc.2022.103796 · Cited by 17
The myth of innocent obesity
Blüher, M. (2017) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2017.146 · Cited by 15
Associations of Metabolic/Obesity Phenotypes with Insulin Resistance and C-Reactive Protein: Results from the CNTR Study
Liao, C., Gao, W., Cao, W., Lv, J., Yu, C., Wang, S., Pang, Z., Cong, L., Wang, H., Wu, X., et al. (2021) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s298499 · Cited by 18
Body size, insulin sensitivity, metabolic health and risk of cardiovascular disease in Chinese adults: Insights from the China Cardiometabolic Disease and Cancer Cohort (4C) study
Hu, C., Wang, S., Lin, H., Wan, Q., Zheng, R., Zhu, Y., Li, M., Xu, Y., Xu, M., Zheng, J., et al. (2024) · Diabetes Obesity and Metabolism · doi:10.1111/dom.15525 · Cited by 14
“19,22,23,25 Furthermore, some studies suspected that individuals with MHO still had a higher risk, 25 and even attempted to challenge the concept of MHO.”
Background
Associations of metabolic changes and polygenic risk scores with cardiovascular outcomes and all-cause mortality across BMI categories: a prospective cohort study
Li, C., Meng, X., Zhang, J., Wang, H., Lu, H., Cao, M., Sun, S., & Wang, Y. (2024) · Cardiovascular Diabetology · doi:10.1186/s12933-024-02332-w · Cited by 14
“One cohort study investigating the relationship between BMI-metabolic status and the incidence of cardiovascular events revealed that MHN individuals had a lower risk of CVD, CAD, and MI than MUO individuals [19].”
BackgroundMethodInfluential
Association between the triglyceride-glucose (TyG) index and stroke risk in Chinese normal-weight adults: a population-based study
Wu, M., Li, C., Yu, Y., Zeng, L., Qiu, Y., Liu, J., Yang, F., & Han, Y. (2024) · Diabetology & Metabolic Syndrome · doi:10.1186/s13098-024-01421-w · Cited by 14
“Alternatively, a large study also discovered that people with metabolic abnormalities are more susceptible to CVD than those without metabolic abnormalities [29].”
Background
Circulating Inflammatory Markers May Mediate the Relationship between Healthy Plant‐Based Diet and Metabolic Phenotype Obesity in Women: A Cross‐Sectional Study
Mohamadi, A., Shiraseb, F., Mirzababaei, A., Hosseininasab, D., Rasaei, N., Clark, C. C. T., & Mirzaei, K. (2022) · International Journal of Clinical Practice · doi:10.1155/2022/8099382 · Cited by 13
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Cho, Y. K., & Jung, C. H. (2022) · Journal of Obesity & Metabolic Syndrome · doi:10.7570/jomes22036 · Cited by 15
Chinese famine exposure in early life and metabolic obesity phenotype in middle age: Results from the China health and retirement longitudinal study
Xu, Y., Yi, Q., Shan, S., Zhou, J., Li, S., Hou, L., Ye, X., Ying, J., Song, P., & An, L. K. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.975824 · Cited by 14
Do worse baseline risk factors explain the association of healthy obesity with increased mortality risk? Whitehall II Study
Johnson, W., Bell, J. A., Robson, E., Norris, T., Mika Kivimaki, B., & Hamer, M. (2018) · International Journal of Obesity · doi:10.1038/s41366-018-0192-0 · Cited by 14
Prevalence of metabolically healthy obese phenotype and associated factors in South American overweight adolescents: A cross-sectional study.
Remor, J. M., Lopes, W. A., Locateli, J. C., Oliveira, R. P., Simões, C. F., Barrero, C. A. L., & Nardo, N. (2019) · Nutrition (Burbank, Los Angeles County, Calif.) · doi:10.1016/j.nut.2018.08.017 · Cited by 16
Adipose Tissue Plasticity in Response to Pathophysiological Cues: A Connecting Link between Obesity and Its Associated Comorbidities
De Fano, M., Bartolini, D., Tortoioli, C., Vermigli, C., Malara, M., Galli, F., & Murdolo, G. (2022) · doi:10.20944/preprints202204.0011.v1 · Cited by 41
Associations of metabolic heterogeneity of obesity with the risk of dementia in middle-aged adults: three prospective studies
Ding, Y., Ge, T., Shen, J., Duan, M., Yuan, C., Zhu, Y., & Zhou, D. (2024) · Alzheimer s Research & Therapy · doi:10.1186/s13195-024-01581-x · Cited by 13
Retracted: Arterial Stiffness and Obesity as Predictors of Diabetes: Longitudinal Cohort Study
Cui, C., Wu, Z., Zheng, J., Chu, J., Zhu, J., Qi, Y., Zhang, Z., Wang, Z., Zhang, M., Mo, Z., et al. (2024) · JMIR Public Health and Surveillance · doi:10.2196/46088 · Cited by 14
Retracted
Proteomic Signature of BMI and Risk of Cardiovascular Disease
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Weight loss breaks the bond between nonalcoholic fatty liver disease and cardiovascular diseases: A clinical and epidemiological perspective
Ala, M., & Eftekhar, S. P. (2023) · Obesity Reviews · doi:10.1111/obr.13563 · Cited by 15
Human cold adaptation: An unfinished agenda v2.0
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“The existence of a MHOP is still controversial with some researchers claiming it does not exist (Malhotra et al., 2015) or that the studies supporting the existence of an MHOP are too short in duration to identify increased health risks (Caleyachetty et al., 2017).”
Background
Healthy obesity: time to give up the ghost?
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“…of the American College of Cardiology (SJR 2016— 11.488; impact factor 2017—19.896) published an analysis among 3.5 million adults, finding that healthy obese individuals had higher risk for incident cardiovascular disease events than their healthy normal weight peers (Caleyachetty et al., 2017).”
BackgroundInfluential
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Lim, S.-A., Ji, L., Tham, K. W., Misra, A., & Kadowaki, T. (2026) · Nature Reviews Endocrinology · doi:10.1038/s41574-026-01239-8 · Cited by 14
“A large study of over 3.5 million adults found that individuals with metabolically healthy obesity still had elevated cardiovascular risk compared with metabolically healthy people with a BMI within the normal range 39 .”
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“Research shows that the presence of even one metabolic risk factor confers an increased risk of CVD [15, 27].”
Background
Joint effect of BMI and metabolic status on mortality among adults: a population-based longitudinal study in United States
Chen, F., Shi, Y., Yu, M., Hu, Y., Li, T., Cheng, Y., Xu, T., & Liu, J. (2024) · Scientific Reports · doi:10.1038/s41598-024-53229-3 · Cited by 12
“…have found a significant association between the severity and duration of obesity and the incidence of metabolic abnormalities 29 , and individuals with the MHO phenotype have a higher risk of coronary heart disease, cerebrovascular disease, and heart failure than those with the MHNO phenotype 30 .”
Background
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Du, S., Li, R., Liu, Y., Yang, W., & Ye, Z. (2025) · Food Bioscience · doi:10.1016/j.fbio.2025.106225 · Cited by 13
Metabolically healthy obesity: Is it really healthy for type 2 diabetes mellitus?
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Effect of Acupoint Catgut Embedding for Middle-Aged Obesity: A Multicentre, Randomised, Sham-Controlled Trial
Chen, X., Huang, W. M., Wei, D., Zhao, J., Zhang, W., Ding, D.-G., Yang, J., Pan, H.-L., Zhang, J.-J., Zhong, F., et al. (2022) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2022/4780019 · Cited by 12
The Harm of Metabolically Healthy Obese and the Effect of Exercise on Their Health Promotion
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BMI, Body Perception, and Approach to Eating and Diet in Adolescent Girls
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Background
Beyond the BMI Paradox: Unraveling the Cellular and Molecular Determinants of Metabolic Health in Obesity
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Transitions in Metabolic Health Status and Obesity Over Time and Risk of Diabetes: The Dongfeng–Tongji Cohort Study
Wei, Y., Wang, R., Wang, J., Han, X., Wang, F., Zhang, Z., Xu, Y., Zhang, X., Guo, H., Yang, H., et al. (2023) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgad047 · Cited by 11
La definición del síndrome cardiovascular-reno-metabólico (cardiovascular-kidney-metabolic syndrome) y su papel en la prevención, estatificación del riesgo y tratamiento. Una oportunidad para la Nefrología
Cases, A., Broseta, J. J., Marqués, M., Guldris, S. C., Mauro, J. C. J., Arroyo, R. A., & Ortíz, A. (2024) · Nefrología · doi:10.1016/j.nefro.2024.05.001 · Cited by 14
Metabolically healthy obesity and risks of cardiovascular disease and all-cause mortality, a matched cohort study: the Shizuoka study
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GLP ‐1 receptor agonists and cardiovascular events in metabolically healthy or unhealthy obesity
Bucci, T., Alam, U., Fauchier, G., Lochon, L., Bisson, A., Ducluzeau, P., Lip, G. Y. H., & Fauchier, L. (2025) · Diabetes Obesity and Metabolism · doi:10.1111/dom.16238 · Cited by 11
“A total of 2 983 151 patients with obesity (512 434 with MHO and 2 470 717 patients with MUHO) (mean [SD] age, 52.7 [16.8] years; 42.9% men and 57.1% women) were enrolled in the study.”
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Relevance of Physical Fitness and Cardiovascular Disease Risk
Huang, C.-P., & Chen, W. (2021) · Circulation Journal · doi:10.1253/circj.cj-20-0510 · Cited by 12
Adipocyte Phenotype Flexibility and Lipid Dysregulation
Preston, K. J., Scalia, R. G., & Autieri, M. V. (2022) · Cells · doi:10.3390/cells11050882 · Cited by 12
An integrated multi-omic approach demonstrates distinct molecular signatures between human obesity with and without metabolic complications: a case–control study
Mir, F. A., Mall, R., Ullah, E., Iskandarani, A., Cyprian, F. S., Samra, T. A., Alkasem, M., Abdalhakam, I., Farooq, F., Taheri, S., et al. (2023) · Journal of Translational Medicine · doi:10.1186/s12967-023-04074-x · Cited by 11
Relationship between metabolically healthy obesity and coronary artery calcification
Seo, Y. B., Kang, S. G., & Song, S.-W. (2024) · Obesity Research & Clinical Practice · doi:10.1016/j.orcp.2024.01.006 · Cited by 10
Non-Pharmacological Treatment for Cardiovascular Risk Prevention in Children and Adolescents with Obesity
Genovesi, S., Vania, A., Caroli, M., Orlando, A., Lieti, G., Parati, G., & Giussani, M. (2024) · Nutrients · doi:10.3390/nu16152497 · Cited by 10
Different associations between body mass index and Alzheimer’s markers depending on metabolic health
Lee, E. H., Yoo, H., Kim, Y. J., Cheon, B. K., Ryu, S., Chang, Y., Yun, J., Jang, H., Kim, J. P., Kim, H. J., et al. (2024) · Alzheimer s Research & Therapy · doi:10.1186/s13195-024-01563-z · Cited by 10
Obesity phenotypes and atherogenic dyslipidemias
Choe, H. J., Almas, T., Neeland, I. J., Lim, S. K., & Després, J. (2025) · European Journal of Clinical Investigation · doi:10.1111/eci.70151 · Cited by 14
“29,42 In the Framingham Heart Study, VAT volume was strongly associated with incident CVD independent of BMI and subcutaneous fat.”
Momentary predictors of dietary lapse from a mobile health weight loss intervention
Crochiere, R. J., Abber, S. R., Taylor, L. C., Sala, M., Schumacher, L. M., Goldstein, S. P., & Forman, E. M. (2021) · Journal of Behavioral Medicine · doi:10.1007/s10865-021-00264-4 · Cited by 10
Heterogeneity of obesity phenotypes in relation to cardiovascular risk
Druzhilov, М. A., & Kuznetsova, Т. Y. (2019) · CARDIOVASCULAR THERAPY AND PREVENTION · doi:10.15829/1728-8800-2019-1-161-167 · Cited by 10
Prevalence of Optimal Metabolic Health in U.S. Adolescents, NHANES 2007–2016
Choi, Y. S., Beltran, T., & Klaric, J. (2020) · Metabolic Syndrome and Related Disorders · doi:10.1089/met.2020.0099 · Cited by 10
Metabolically healthy obesity: time for a change of heart?
Cuthbertson, D. J., & Wilding, J. P. H. (2021) · Nature Reviews Endocrinology · doi:10.1038/s41574-021-00537-7 · Cited by 10
Whole‐Genome Transcriptomics of PBMC to Identify Biomarkers of Early Metabolic Risk in Apparently Healthy People with Overweight‐Obesity and in Normal‐Weight Subjects
Costa, A., van der Stelt, I., Reynés, B., Konieczna, J., Fiol, M., Keijer, J., Palou, A., Romaguera, D., van Schothorst, E. M., & Oliver, P. (2022) · Molecular Nutrition & Food Research · doi:10.1002/mnfr.202200503 · Cited by 11
Metabolically healthy obesity and risk of incident type 2 diabetes in 1077 statin-treated individuals: A six-year retrospective study
Barkas, F., Liamis, G. L., Elisaf, M., Anastasiou, G., & Liberopoulos, E. N. (2020) · European Journal of Preventive Cardiology · doi:10.1177/2047487319899191 · Cited by 10
Metabolically healthy obesity increases the prevalence of stroke in adults aged 40 years or older: Result from the China National Stroke Screening survey
Zhang, N., Liang, G., Liu, M., Zheng, G., Yu, H., Shi, Y., Zhang, Y., Wang, H., Li, Y., Xu, Y., et al. (2021) · Preventive Medicine · doi:10.1016/j.ypmed.2021.106551 · Cited by 10
Association between metabolic phenotypes of overweight/obesity and cardiovascular diseases in postmenopausal women
Deng, D., Nie, Z., Wang, J.-B., Chen, C., Wang, W., Zhu, Y., Guan, Q., Ou, Y., & Feng, Y. (2024) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2024.04.001 · Cited by 9
Association between cardiometabolic index and coronary artery calcification in young and middle-aged adults with coronary heart disease
Wu, X., Wu, M., Huang, H., Liu, Z., Huang, H., & Wang, L. (2025) · BMC Cardiovascular Disorders · doi:10.1186/s12872-025-04950-y · Cited by 9
Obesity-related heart failure with preserved ejection fraction: new treatment strategies
Chrysant, S. G., & Chrysant, G. S. (2019) · Hospital Practice · doi:10.1080/21548331.2019.1575662 · Cited by 9
“[4,5], and also, heart failure with preserved ejection fraction”
Background
Cardiovascular disease risk factors and anthropometry features among seemingly healthy young adults
Kalanjati, V. P., Oktariza, R. T., Suwito, B. E., Pradana, K. A., Rahmawan, D., & Abdurachman, A. (2021) · International Journal of Public Health Science (IJPHS) · doi:10.11591/ijphs.v10i1.20554 · Cited by 10
“These patterns are influenced by the unique actions of sex hormones and adipokines in each sex as well as by nutritional status and physical fitness in both sexes [8, 9, 12].”
Background
Metabolic Health, Obesity, and Renal Function: 2013–2018 National Health and Nutrition Examination Surveys
Adair, K. E., Bowden, R. G., Funderburk, L., Forsse, J. S., & Ylitalo, K. R. (2021) · Life · doi:10.3390/life11090888 · Cited by 8
“Several large studies [13,14,22] have previously used this definition, and several more [11,12,23] have adopted it since it was first proposed by Lavie et al.”
Method
Women With Obesity Are Not as Curvy as They Think: Consequences on Their Everyday Life Behavior
Urdapilleta, I., Lahlou, S., Demarchi, S., & Catheline, J. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.01854 · Cited by 8
“For example, the link between obesity or overweight with an increased risk of cardiovascular disease is well-established (Poirier and Eckel, 2002; Poirier et al., 2006; Caleyachetty et al., 2017).”
Background
Impact of metabolically healthy obesity on carotid intima-media thickness - The Brazilian Longitudinal Study of Adult Health
Romagnolli, C., Benseñor, I. M., Santos, I. S., Lotufo, P. A., & Bittencourt, M. S. (2020) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2020.02.012 · Cited by 9
Gender and age related features of metabolically healthy obesity phenotype prevalence
Mustafina, S. V., Винтер, Д. А., Щербакова, Л. В., Malyutina, S. K., Ragino, Y. I., & Rymar, O. D. (2020) · Bulletin of Siberian Medicine · doi:10.20538/1682-0363-2020-1-76-84 · Cited by 9
A Bayesian Network Analysis of the Probabilistic Relationships Between Various Obesity Phenotypes and Cardiovascular Disease Risk in Chinese Adults: Chinese Population-Based Observational Study
Tian, S., Bi, M., Bi, Y., Che, X., & Liu, Y. (2022) · JMIR Medical Informatics · doi:10.2196/33026 · Cited by 9
Identification of chronic kidney disease risk in relatively lean Southern Chinese: the hypertriglyceridemic waist phenotype vs. anthropometric indexes
Zhou, C., Li, Y., Shao, X., & Zou, H. (2018) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-017-0476-8 · Cited by 9
Comorbidities as an Indication for Metabolic Surgery
Schwarz, A.-C., Billeter, A. T., Scheurlen, K. M., Blüher, M., & Müller-Stich, B. P. (2018) · Visceral Medicine · doi:10.1159/000493291 · Cited by 9
Risk of Heart Failure between Different Metabolic States of Health and Weight: A Meta-Analysis of Cohort Studies
Wang, X., Dong, J.-Y., Du, Z., Jiang, J., Hu, Y., Qin, L., & Hao, Y. (2022) · Nutrients · doi:10.3390/nu14245223 · Cited by 8
“06) for women, suggesting that sex may be a possible source of the heterogeneity [18].”
Background
Dyslipidemia and associated cardiovascular risk factors in HIV-positive and HIV-negative patients visiting ambulatory clinics: A hospital-based study
Woldu, M. A., Minzi, O., & Engidawork, E. (2022) · JRSM Cardiovascular Disease · doi:10.1177/20480040221114651 · Cited by 8
Differences in the vascular and metabolic profiles between metabolically healthy and unhealthy obesity
Candi, E., Campanelli, M., Sica, G. S., Schinzari, F., Rovella, V., Daniele, N. D., Melino, J., & Tesauro, M. (2021) · Endocrine and Metabolic Science · doi:10.1016/j.endmts.2020.100077 · Cited by 9
Neural networks applied to 12-lead electrocardiograms predict body mass index, visceral adiposity and concurrent cardiometabolic ill-health
Li, X., Patel, K. H. K., Sun, L., Peters, N. S., & Ng, F. S. (2021) · Cardiovascular Digital Health Journal · doi:10.1016/j.cvdhj.2021.10.003 · Cited by 8
“Our findings are consistent with studies that have shown over a third of normal-weight individuals may be metabolically unhealthy,(29) which confers a cardiometabolic risk similar to that associated with obesity.(30) Importantly, our data suggest that NN-derived BMI estimates based on ECGs may provide a better indicat…”
Result
Natural histories of metabolite BMI phenotypes and their impacts on cardiovascular disease risk over a decade-long follow-up
Wang, Y., Zhu, X., Chen, Z., Yang, P., Liu, L., Liu, X., Wu, L., He, Q., & Li, Y. (2021) · Obesity Research & Clinical Practice · doi:10.1016/j.orcp.2021.10.002 · Cited by 8
Decreasing severity of obesity from early to late adolescence and young adulthood associates with longitudinal metabolomic changes implicated in lower cardiometabolic disease risk
Mansell, T., Magnussen, C. G., Nuotio, J., Laitinen, T. T., Harcourt, B. E., Bekkering, S., McCallum, Z., Kao, K., Sabin, M. A., Juonala, M., et al. (2022) · International Journal of Obesity · doi:10.1038/s41366-021-01034-7 · Cited by 8
“reversible with weight loss (26) and refine CVD prediction beyond BMI alone (27).”
Background
Biochemical basis and therapeutic potential of mitochondrial uncoupling in cardiometabolic syndrome
dos Santos, B. G., Brisnovali, N. F., & Goedeke, L. (2024) · Biochemical Journal · doi:10.1042/bcj20240005 · Cited by 7
Obesity, Metabolic Health, and Diabetic Complications in People With Type 1 Diabetes
Mao, Y., Gau, J., & Jiang, N. (2024) · Endocrinology Diabetes & Metabolism · doi:10.1002/edm2.70017 · Cited by 7
Skeletal mass indices are inversely associated with metabolically unhealthy phenotype in overweight/obese and normal-weight men: a population-based cross-sectional study
de Carvalho, C. J., Longo, G. Z., Kakehasi, A. M., Pereira, P. F., Segheto, K. J., Juvanhol, L. L., & Ribeiro, A. Q. (2020) · British Journal Of Nutrition · doi:10.1017/s0007114520004262 · Cited by 7
Association between BMI trajectories in late-middle age and subsequent dementia risk in older age: a 26-year population-based cohort study
Qin, Z., Liu, Z., Li, R., Luo, Y., Wei, Z., He, L., Pei, Y., Su, Y., Hu, X., & Peng, X. (2023) · BMC Geriatrics · doi:10.1186/s12877-023-04483-z · Cited by 7
The Relationship of Waist Circumference with the Morbidity of Cardiovascular Diseases and All-Cause Mortality in Metabolically Healthy Individuals: A Population-Based Cohort Study
Su, Y., Sun, J., Zhou, Y., & Sun, W. (2024) · Reviews in Cardiovascular Medicine · doi:10.31083/j.rcm2506212 · Cited by 12
“…research also indicated a higher risk of long-term cardiovascular events (including cerebrovascular disease, heart failure, coronary heart disease and peripheral vascular disease) in overweight individuals, with heart failure risk nearly doubling after an average 5.4 years of follow-up time [8,9].”
BackgroundInfluential

Authors: Caleyachetty, R., Thomas, G. N., Toulis, K. A., Mohammed, N., Gokhale, K. M., Balachandran, K., & Nirantharakumar, K.
Affiliations: University of Birmingham (GB)
424 General Military Hospital (GR)
Corresponding author: Thomas, G. Neil
ORCID: Caleyachetty, Rishi
Thomas, G. Neil
Toulis, Konstantinos A.
Mohammed, Nuredin
Gokhale, Krishna M.
Nirantharakumar, Krishnarajah
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 2017-09
Volume: 70
Issue: 12
Pages: 1429-1437
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/j.jacc.2017.07.763
OpenAlex: W2755267305
Cited by: 574
References: 37
Citations by year: 2026: 48 · 2025: 65 · 2024: 73 · 2023: 60 · 2022: 71 · 2021: 68 · 2020: 66 · 2019: 51 · 2018: 64 · 2017: 8
FWCI: 40.67
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 383 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
University of Birmingham Research Portal (University of Birmingham) (publishedVersion, cc-by-nc-nd)
Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
Funders: Medical Research Council (MC_PC_15079)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
Keywords: metabolically healthy obesity, cardiovascular risk, coronary artery disease, cerebrovascular disease, heart failure, peripheral vascular disease, body mass index, metabolic abnormalities, diabetes mellitus, hypertension, hyperlipidemia, normal-weight individuals
MeSH terms: Adult, Cardiovascular Diseases, Female, Humans, Male, Middle Aged, Obesity, Prospective Studies, Incidence, Risk Assessment

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Metabolically healthy obese and incident cardiovascular disease events among 3.5 million men and women.

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