Exploring metabolically healthy obesity: prevalence, characteristics, and cardiovascular risk in the Iranian population based on the STEPS 2021

Ashkan Pourabhari Langroudi; Yosef Farzi; Masoud Masinaei; Zahra Shokri Varniab; Sarvenaz Shahin; Mohammad-Mahdi Rashidi; Sahar Saeedi Moghaddam; Shakiba Rahimi; Majid Khalili; Mohammad Keykhaei; Naser Ahmadi; Ameneh Kazemi; Erfan Ghasemi; Sina Azadnajafabad; Moein Yoosefi; Nima Fattahi; Maryam Nasserinejad; Nazila Rezaei; Rosa Haghshenas; Arezou Dilmaghani-Marand; Elham Abdolhamidi; Shirin Djalalinia; Negar Rezaei; Bagher Larijani; Farshad Farzadfar

doi:10.1007/s40200-023-01364-5

Exploring metabolically healthy obesity: prevalence, characteristics, and cardiovascular risk in the Iranian population based on the STEPS 2021

J Diabetes Metab Disord. 2023 Dec 30;23(1):881-893. doi: 10.1007/s40200-023-01364-5. eCollection 2024 Jun.

Authors

Ashkan Pourabhari Langroudi^#¹, Yosef Farzi^#¹, Masoud Masinaei^{1

2}, Zahra Shokri Varniab¹, Sarvenaz Shahin^{1

3}, Mohammad-Mahdi Rashidi¹, Sahar Saeedi Moghaddam^{1

4}, Shakiba Rahimi¹, Majid Khalili¹, Mohammad Keykhaei^{1

5}, Naser Ahmadi¹, Ameneh Kazemi¹, Erfan Ghasemi¹, Sina Azadnajafabad¹, Moein Yoosefi^{1

6}, Nima Fattahi^{1

7}, Maryam Nasserinejad^{1

8}, Nazila Rezaei¹, Rosa Haghshenas¹, Arezou Dilmaghani-Marand¹, Elham Abdolhamidi¹, Shirin Djalalinia⁹, Negar Rezaei¹, Bagher Larijani¹⁰, Farshad Farzadfar^{1

10}

Affiliations

¹ Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
² Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran.
³ Department of Pediatrics, New York University Grossman School of Medicine, New York, NY USA.
⁴ Kiel Institute for the World Economy, Kiel, Germany.
⁵ Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD USA.
⁶ Department of Mathematics and Statistics, Memorial University of Newfoundland, St. John's, NL Canada.
⁷ Department of Internal Medicine, Yale School of Medicine, New Haven, CT USA.
⁸ Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.
⁹ Development of Research and Technology Center, Deputy of Research and Technology Ministry of Health and Medical Education, Tehran, Iran.
¹⁰ Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

^# Contributed equally.

Abstract

Background: Regarding the rapidly increasing prevalence of obesity throughout the globe, it remains a serious public health concern. A subgroup of obesity that does not meet metabolic syndrome criteria is called metabolically healthy obesity (MHO). However, whether the MHO phenotype increases cardiovascular disease (CVD) risk is controversial. This study aimed to evaluate the prevalence of MHO and its 10-year CVD risk in Iranian populations.

Methods: Based on the STEPS 2021 project in Iran, we collected data on 18119 Iranians 25 years and older from all 31 provinces after applying many statistical factors. Using the Framingham score, we evaluated the 10-year cardiovascular risk associated with the various MHO definition criteria for Iranian populations.

Results: The prevalence of MHO was 6.42% (5.93-6.91) at the national level according to the AHA-NHLBI definition, and 23.29% of obese women and 24.55% of obese men were classified as MHOs. Moreover, the MHO group was younger than the metabolically unhealthy obesity (MUO) group based on all definitions (p < 0.001). The odds ratio of MUO individuals being classified as high-risk individuals by the Framingham criteria for CVD was significantly higher than that of MHO individuals by all definitions, with a crude odds ratio of 3.55:1 based on AHA-NHLBI definition.

Conclusion: This study reveals a significant prevalence of MHO in the Iranian population, with approximately 25% of obese individuals classified as MHO. While MHO is associated with a lower risk of cardiovascular disease compared to MUO, MHO carries the potential for transitioning to an unhealthy state.

Supplementary information: The online version contains supplementary material available at 10.1007/s40200-023-01364-5.

Keywords: Cardiovascular diseases; Metabolic syndrome; Obesity; Public health; World Health Organization.

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