NOTES
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CONFLICTS OF INTEREST
No potential conflict of interest relevant to this article was reported.
-
AUTHOR CONTRIBUTIONS
Conception or design: S.M., J.G.K.
Acquisition, analysis, or interpretation of data: W.C., S.M., O.H.R.
Drafting the work or revising: H.W.C., W.C., S.M., M.K.K., J.G.K.
Final approval of the manuscript: H.W.C., W.C., S.M., O.H.R., M.K.K., J.G.K.
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FUNDING
This work was supported by Research Resettlement Fund for the new faculty of Seoul National University and the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (grant No. 2017R1D1A1B03029575).
Fig. 1Weighted odds ratio (OR) (95% confidence interval [CI]) for cardiovascular events in terms of (A, B) obesity phenotype and sarcopenia, or (C, D) tertiles of A Body Shape Index (ABSI). (A) Compared to metabolically healthy normal weight (MHNW) without sarcopenia, (B) compared to MHNW with sarcopenia, (C) compared to MHNW with the first ABSI tertile, and (D) compared to MHNW with the third ABSI tertile. Values were adjusted for age, sex, ethnicity, and smoking status. MHO, metabolically healthy overweight/obese; MUNW, metabolically healthy normal weight; MUO, metabolically unhealthy overweight/obese.
Fig. 2Relationship between continuous A Body Shape Index (ABSI) and the odds ratios for cardiovascular events according to obesity phenotypes. (A) Total population, and (B) obesity phenotype subgroups. Values were adjusted for age, sex, ethnicity, and smoking status. MUO, metabolically unhealthy overweight/obese; MUNW, metabolically unhealthy normal weight; MHO, metabolically healthy overweight/obese; MHNW, metabolically healthy normal weight.
Table 1.Characteristics of the participants according to obesity phenotype
Variable |
Metabolically healthy
|
Metabolically unhealthy
|
P value |
Normal weight (MHNW) (n=5,176) |
Overweight/obesity (MHO) (n=6,688) |
Normal weight (MUNW) (n=2,671) |
Overweight/obesity (MUO) (n=10,735) |
Age, yr |
38.2 (37.6–38.8) |
40.9 (40.4–41.5) |
54.7 (53.8–55.5) |
51.7 (51.3–52.2) |
<0.001 |
Men, % |
39.6 (38.0–41.2) |
47.6 (46.3–49.0) |
48.1 (45.8–50.3) |
54.1 (53.0–55.2) |
<0.001 |
Ethnicity/Race, % |
|
|
|
|
<0.001 |
|
Mexican American |
6.2 (5.4–7.2) |
9.2 (7.7–10.9) |
4.6 (3.8–5.5) |
8.2 (6.7–9.8) |
|
|
Other Hispanic |
4.3 (3.3–5.4) |
6.1 (4.8–7.7) |
4.4 (3.2–6.1) |
5.4 (4.3–6.9) |
|
|
Non-Hispanic White |
73.9 (71.7–75.9) |
67.6 (64.7–70.3) |
73.4 (70.3–76.3) |
71.9 (69.1–74.6) |
|
|
Non-Hispanic Black |
8.4 (7.4–9.6) |
13.2 (11.6–15) |
7.5 (6.4–8.9) |
10.2 (8.9–11.7) |
|
|
Other race |
7.2 (6.2–8.3) |
4 (3.3–4.8) |
10 (8.3–12.1) |
4.3 (3.6–5.1) |
|
CVD eventsa, % |
2.3 (1.8–2.9) |
4 (3.5–4.6) |
12.3 (10.9–13.9) |
12.5 (11.7–13.4) |
|
Smoking, % |
45.4 (43.3–47.6) |
43.8 (42.1–45.7) |
55.5 (53–58.1) |
51.3 (49.9–52.7) |
|
BMI, kg/m2
|
22 (22–22.1) |
30.2 (30–30.3) |
22.6 (22.5–22.7) |
32 (31.8–32.1) |
<0.001 |
Waist circumference, cm |
80.7 (80.4–81) |
100.3 (99.9–100.8) |
85.5 (85.1–85.9) |
107.3 (106.8–107.7) |
<0.001 |
ABSI |
0.0791 (0.0789–0.0793) |
0.0798 (0.0796–0.0800) |
0.0826 (0.0823–0.0828) |
0.0823 (0.0821–0.0824) |
<0.001 |
ASMIa, kg/m2
|
6.55 (6.49 – 6.62) |
8.16 (8.10 – 8.22) |
6.45 (6.37 – 6.54) |
8.30 (8.24 – 8.36) |
<0.001 |
Sarcopenia, % |
27.0 (24.4–29.8) |
1.4 (1.0–1.9) |
38.8 (35.9–41.8) |
2.1 (1.7–2.7) |
<0.001 |
Systolic BP, mm Hg |
112 (111.5–112.5) |
115.6 (115.2–116) |
131 (129.8–132.2) |
129.1 (128.5–129.6) |
<0.001 |
Diastolic BP, mm Hg |
67.9 (67.5–68.4) |
69.7 (69.3–70.1) |
72.5 (71.8–73.2) |
73.9 (73.5–74.4) |
<0.001 |
FBG level, mg/dL |
90.8 (90.4–91.2) |
93.5 (93–94.1) |
105.9 (104.4–107.5) |
114.1 (112.8–115.4) |
<0.001 |
HbA1c, % |
5.2 (5.2–5.2) |
5.3 (5.3–5.3) |
5.6 (5.6–5.7) |
5.9 (5.8–5.9) |
<0.001 |
Total cholesterol, mg/dL |
185.7 (184.3–187.2) |
193.4 (192.2–194.6) |
209.2 (206.9–211.4) |
208.5 (207.1–209.8) |
<0.001 |
HDL-C, mg/dL |
61.4 (60.8–62) |
54.9 (54.4–55.3) |
56.4 (55.3–57.5) |
46.5 (46.1–46.9) |
<0.001 |
TG, mg/dL |
89.5 (86.7–92.3) |
107.9 (105.4–110.5) |
141.8 (131.7–151.8) |
183.3 (177.6–189.1) |
<0.001 |
Metabolic state, % |
|
|
|
|
|
|
High BP |
5.2 (4.5–6) |
6.8 (6–7.7) |
59.8 (57.2–62.4) |
51.4 (49.9–52.8) |
<0.001 |
|
Hyperglycemia |
4.1 (3.5–4.7) |
5.9 (5.2–6.6) |
44.4 (41.7–47.1) |
55.6 (54–57.2) |
<0.001 |
|
Low HDL-C level |
9.3 (8.2–10.4) |
13.1 (12–14.2) |
34 (31.4–36.8) |
52.5 (51.2–53.9) |
<0.001 |
|
High TG level |
37.5 (35.9–39.2) |
48.3 (46.5–50) |
91.9 (90.4–93.2) |
91.8 (91–92.5) |
<0.001 |
Table 2.Weighted odds ratios for cardiovascular disease events according to obesity phenotypes
Variable |
OR (95% CI) |
P value |
MHNW |
1 (reference) |
|
MHO |
1.543 (1.158–2.056) |
0.003 |
MUNW |
2.026 (1.539–2.667) |
<0.001 |
MUO |
2.725 (2.186–3.398) |
<0.001 |
Table 3.Correlation between ABSI and ASMI, BMI, and waist circumference
Group |
Correlation coefficients
|
ASMI |
BMI |
Waist circumference |
MHNW |
|
|
|
Men |
–0.586b
|
0.039 |
0.695b
|
Women |
–0.332b
|
–0.039a
|
0.660b
|
MHO |
|
|
|
Men |
–0.400b
|
0.082b
|
0.552b
|
Women |
–0.285b
|
–0.132b
|
0.403b
|
MUNW |
|
|
|
Men |
–0.596b
|
0.036 |
0.711b
|
Women |
–0.283b
|
–0.043 |
0.694b
|
MUO |
|
|
|
Men |
–0.433b
|
–0.024 |
0.399b
|
Women |
–0.351b
|
–0.249b
|
0.251b
|
Table 4.Area under the receiver operating characteristics curve of ABSI for sarcopenia
|
Men
|
Women
|
AUC (95% CI) |
P value |
AUC (95% CI) |
P value |
MHNW |
0.755 (0.722–0.787) |
0.017 |
0.677 (0.646–0.708) |
0.016 |
MHO |
0.884 (0.802–0.966) |
0.042 |
0.722 (0.644–0.800) |
0.040 |
MUNW |
0.776 (0.737–0.815) |
0.020 |
0.635 (0.589–0.681) |
0.023 |
MUO |
0.854 (0.818–0.889) |
0.018 |
0.672 (0.613–0.732) |
0.030 |