Introduction
Evidence for an MHO phenotype
Author/Study | Definition of metabolic health | Outcome measure | MHO RR (95% CI)a | MUHNW RR (95% CI)a |
---|---|---|---|---|
Meta-analyses | ||||
Kramer et al, 2013 (8 cohorts) [10] | Absence of the metabolic syndrome | CVD and total mortality | 1.19 (0.98, 1.38) | 3.14 (2.36, 3.93) |
Fan et al, 2013 (8 cohorts) [9] | Absence of the metabolic syndrome or insulin resistance | CVD | 1.56 (1.40, 1.92) | 1.81 (1.56, 2.10) |
Eckel et al, 2016 (13 cohorts) [8] | Absence of the metabolic syndrome | CVD | 1.45 (1.20, 1.75) | 2.07 (1.62, 2.65) |
Eckel et al, 2016 (5 cohorts) [8] | Absence of insulin resistance | CVD | 1.39 (1.14, 1.69) | 1.41 (0.79, 2.53) |
Zheng et al, 2016 (18 cohorts) [11] | Various definitions, predominantly related to absence of the metabolic syndrome | CVD | 1.60 (1.38, 1.84) | ND |
Individual cohort studies | ||||
EPIC-CVD [14] | Absence of the metabolic syndrome | Coronary heart disease | 1.28 (1.03, 1.58) | 2.15 (1.79, 2.57) |
THIN [12] | Absence of diabetes, hypertension and lipid-lowering drugs | Coronary heart disease | 1.49 (1.45, 1.54) | Increasing with number of metabolic abnormalities |
Cerebrovascular disease | 1.07 (1.04, 1.11) | Increasing with number of metabolic abnormalities | ||
Nurses’ Health Study [13] | Absence of diabetes, hypertension and hypercholesterolaemia | CVD | 1.39 (1.15, 1.68) | 2.43 (2.19, 2.68) |
Myocardial infarction | 1.44 (1.11, 1.86) | 2.60 (2.26, 2.99) | ||
Stroke | 1.37 (1.04, 1.81) | 2.22 (1.92, 2.57) |
The MUHNW phenotype
Relevance of body-fat distribution in the MHO and MUHNW phenotypes
Long-term trajectories of metabolic health
Author | Study | Definition of metabolic health | Follow-up time | Findings for the MHO phenotype | Findings for the MHNW phenotype |
---|---|---|---|---|---|
Appleton et al, 2013 [29] | North West Adelaide Health Study | Absence of the metabolic syndrome | ~8 years | Transition to MUHO: 31% | Remaining MHNW: 59% |
Soriguer et al, 2013 [37] | Pizarra Study | Absence of the metabolic syndrome and/or insulin resistance | 6 years | Transition to MUHO: 37% | ND |
Achilike et al, 2015 [28] | San Antonio Heart Study | Absence of the metabolic syndrome, including insulin resistance | ~8 years | Transition to MUHO: 48% | ND |
Bell et al, 2015 [30] | Whitehall II Study | Absence of the metabolic syndrome, including insulin resistance | 5, 10, 15 and 20 years | Transition to MUHO: 32% at 5 years; 41% at 10 years; 35% at 15 years; 52% at 20 years | ND |
Lee et al, 2015 [33] | Chungju Metabolic Disease Cohort | In the lower 3 quartiles for fasting glucose and triacylglycerol indexes | 4 years | Transition to MUHO: 15% | ND |
Hamer et al, 2015 [34] | English Longitudinal Study of Ageing | Absence of the metabolic syndrome, including inflammation | 8 years | Transition to MUHO: 45% | ND |
Hwang et al, 2015 [39] | Japanese American Community Diabetes Study | Absence of the metabolic syndrome | 10 years | Transition to MUHOa: 65% | ND |
Kim et al, 2016 [32] | Korean Genome Epidemiology Study | Absence of the metabolic syndrome | 10 years | Transition to MUHOa: 45% | Remaining MHNW: 60% |
Kabat et al, 2017 [31] | Women’s Health Initiative | Absence of the metabolic syndrome | 6 years | Transition to metabolically unhealthy phenotypes: 34% | ND |
Eckel et al, 2018 [13] | Nurses’ Health Study | Absence of diabetes, hypertension and hypercholesterolaemia | 10, 20 and 30 years | Transition to metabolically unhealthy phenotypes: 57% at 10 years; 84% at 20 years; 94% at 30 years | Remaining metabolically healthy: 63% at 10 years; 32% at 20 years; 15% at 30 years |
Mongraw-Chaffin et al, 2018 [35] | Multi-Ethnic Study of Atherosclerosis | Absence of the metabolic syndrome | 10 years | Transition to MUHO: 48% | ND |
Moussa et al, 2018 [36] | UK Clinical Practice Research Datalink | Absence of diabetes, hypertension, hyperlipidaemia, CVD, cerebrovascular disease, liver disease, renal disease and obstructive sleep apnoea | ~9 years | Transition to metabolically unhealthy phenotypesb: 44% | ND |