From healthy to unhealthy obesity: A longitudinal study of adults in ELSA-Brasil

Despite obesity being associated with negative metabolic and cardiovascular outcomes, there is a subgroup of individuals considered healthy. However, there are questions about the stability of the Metabolically Healthy Obesity phenotype. This is a longitudinal study using the ELSA-Brasil cohort, conducted from 2008/10-2017/19 aiming to describe the trajectory of metabolic status of individuals with obesity, as well as the factors associated with the transition into the unhealthy status. Metabolic status was determined using measures of blood pressure, fasting glucose/glycated hemoglobin, triglycerides, and HDL-cholesterol, no previous diagnosis of alteration in any of these parameters nor taking medication to control them. SPSS v.21.0 was used, considering p < 0.05 as significant. The sample consisted of 190 Metabolically Healthy Individuals with Obesity at baseline, of whom 75.8% transitioned to Metabolically Unhealthy status on the third wave of the study. The baseline data indicates that 8.6% of individuals with obesity were metabolically healthy, and in the follow-up, the prevalence was 5.5%. Alcohol use was a risk factor for metabolic status transition [RR: 1.359 (95%CI: 1.005-1.838)]. Also, each 1 cm increase in waist circumference contributed to a 1% increase in the risk of transitioning from healthy to unhealthy metabolic status [RR: 1.011 (95%CI: 1.004-1.018)]. Being a metabolically healthy individual with obesity is a transient state and alcohol consumption as well as increases in waist circumference are risk factors for the metabolic transition.