An Empirically Derived Definition of Metabolically Healthy Obesity Based on Risk of Cardiovascular and Total Mortality
IMPORTANCE: People classified by a priori definitions as having metabolically healthy obesity have frequently been found to be at increased risk of mortality, compared with individuals with metabolically healthy normal weight, suggesting these definitions may be insufficient. OBJECTIVES: To systemat...
Gespeichert in:
| Veröffentlicht in: | JAMA Network Open Jg. 4; H. 5; S. e218505 |
|---|---|
| Hauptverfasser: | , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
| Veröffentlicht: |
United States
American Medical Association
03.05.2021
|
| Schlagworte: | |
| ISSN: | 2574-3805, 2574-3805 |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| Abstract | IMPORTANCE: People classified by a priori definitions as having metabolically healthy obesity have frequently been found to be at increased risk of mortality, compared with individuals with metabolically healthy normal weight, suggesting these definitions may be insufficient. OBJECTIVES: To systematically derive a new definition of metabolic health (MH) and investigate its association with cardiovascular disease (CVD) mortality and total mortality. DESIGN, SETTING, AND PARTICIPANTS: In a cohort study using data from the third National Health and Nutrition Examination Survey (NHANES-III), a representative survey using complex multistage probability sampling, anthropometric factors, biomarkers, and blood pressure (BP) associated with total and CVD mortality among participants with obesity were identified with Cox proportional hazards regression. Area under the receiver operating characteristic was calculated to identify predictive factors for mortality to be used to define MH, cutoff levels were determined by the Youden index, and the findings were validated through comparison with the independent UK Biobank cohort, a population-based prospective study. All nonpregnant participants in the databases aged 18 to 75 years with no history of CVD, body mass index greater than or equal to 18.5, and who fasted 6 or more hours before examination in NHANES-III were included; participants in the UK Biobank cohort who did not have blood measurements were excluded. The study was conducted from 2015 to 2020. EXPOSURES: Body mass index and MH were defined by the new definition and compared with 3 a priori definitions. MAIN OUTCOMES AND MEASURES: Cardiovascular disease mortality and total mortality. RESULTS: Within the NHANES-III (n = 12 341) cohort, mean (SD) age was 41.6 (29.2) years, 50.7% were women, and mean follow-up was 14.5 (2.7) years. Within the UK Biobank (n = 374 079) cohort, mean (SD) age was 56.2 (8.1) years, 55.1% were women, and mean follow-up was 7.8 (1.0) years. Use of blood pressure (BP)-lowering medication (hazard ratio [HR] for CVD mortality, 2.41; 95% CI, 1.50-3.87 and total mortality, 2.05; 95% CI, 1.47-2.84), diabetes, and several continuous factors were associated with mortality. Of all significant continuous factors, the combination of systolic BP and waist-to-hip ratio showed the highest area under the receiver operating characteristic (CVD mortality: 0.775; 95% CI, 0.770-0.781; total mortality: 0.696; 95% CI, 0.694-0.699). Thus, MH was defined as systolic BP less than 130 mm Hg, no BP-lowering medication, waist-to-hip ratio less than 0.95 for women and less than 1.03 for men, and no self-reported (ie, prevalent) diabetes. In both cohorts, metabolically healthy obesity was not associated with CVD and total mortality compared with metabolically healthy normal weight. For NHANES-III, the hazard ratio was 0.68 (95% CI, 0.30-1.54) for CVD mortality and 1.03 (95% CI, 0.70-1.51) for total mortality. For UK Biobank, the hazard ratio was 1.17 (95% CI, 0.81-1.69) for CVD mortality and 0.98 (95% CI, 0.87-1.10) for total mortality. Regardless of body mass index, all metabolically unhealthy groups displayed increased risks. CONCLUSIONS AND RELEVANCE: This newly proposed definition of MH may identify a subgroup of people with obesity without increased risk of mortality and stratify risks in people who are overweight or normal weight. |
|---|---|
| AbstractList | Importance People classified by a priori definitions as having metabolically healthy obesity have frequently been found to be at increased risk of mortality, compared with individuals with metabolically healthy normal weight, suggesting these definitions may be insufficient. Objectives To systematically derive a new definition of metabolic health (MH) and investigate its association with cardiovascular disease (CVD) mortality and total mortality. Design, Setting, and Participants In a cohort study using data from the third National Health and Nutrition Examination Survey (NHANES-III), a representative survey using complex multistage probability sampling, anthropometric factors, biomarkers, and blood pressure (BP) associated with total and CVD mortality among participants with obesity were identified with Cox proportional hazards regression. Area under the receiver operating characteristic was calculated to identify predictive factors for mortality to be used to define MH, cutoff levels were determined by the Youden index, and the findings were validated through comparison with the independent UK Biobank cohort, a population-based prospective study. All nonpregnant participants in the databases aged 18 to 75 years with no history of CVD, body mass index greater than or equal to 18.5, and who fasted 6 or more hours before examination in NHANES-III were included; participants in the UK Biobank cohort who did not have blood measurements were excluded. The study was conducted from 2015 to 2020. Exposures Body mass index and MH were defined by the new definition and compared with 3 a priori definitions. Main Outcomes and Measures Cardiovascular disease mortality and total mortality. Results Within the NHANES-III (n = 12 341) cohort, mean (SD) age was 41.6 (29.2) years, 50.7% were women, and mean follow-up was 14.5 (2.7) years. Within the UK Biobank (n = 374 079) cohort, mean (SD) age was 56.2 (8.1) years, 55.1% were women, and mean follow-up was 7.8 (1.0) years. Use of blood pressure (BP)-lowering medication (hazard ratio [HR] for CVD mortality, 2.41; 95% CI, 1.50-3.87 and total mortality, 2.05; 95% CI, 1.47-2.84), diabetes, and several continuous factors were associated with mortality. Of all significant continuous factors, the combination of systolic BP and waist-to-hip ratio showed the highest area under the receiver operating characteristic (CVD mortality: 0.775; 95% CI, 0.770-0.781; total mortality: 0.696; 95% CI, 0.694-0.699). Thus, MH was defined as systolic BP less than 130 mm Hg, no BP-lowering medication, waist-to-hip ratio less than 0.95 for women and less than 1.03 for men, and no self-reported (ie, prevalent) diabetes. In both cohorts, metabolically healthy obesity was not associated with CVD and total mortality compared with metabolically healthy normal weight. For NHANES-III, the hazard ratio was 0.68 (95% CI, 0.30-1.54) for CVD mortality and 1.03 (95% CI, 0.70-1.51) for total mortality. For UK Biobank, the hazard ratio was 1.17 (95% CI, 0.81-1.69) for CVD mortality and 0.98 (95% CI, 0.87-1.10) for total mortality. Regardless of body mass index, all metabolically unhealthy groups displayed increased risks. Conclusions and Relevance This newly proposed definition of MH may identify a subgroup of people with obesity without increased risk of mortality and stratify risks in people who are overweight or normal weight. People classified by a priori definitions as having metabolically healthy obesity have frequently been found to be at increased risk of mortality, compared with individuals with metabolically healthy normal weight, suggesting these definitions may be insufficient. To systematically derive a new definition of metabolic health (MH) and investigate its association with cardiovascular disease (CVD) mortality and total mortality. In a cohort study using data from the third National Health and Nutrition Examination Survey (NHANES-III), a representative survey using complex multistage probability sampling, anthropometric factors, biomarkers, and blood pressure (BP) associated with total and CVD mortality among participants with obesity were identified with Cox proportional hazards regression. Area under the receiver operating characteristic was calculated to identify predictive factors for mortality to be used to define MH, cutoff levels were determined by the Youden index, and the findings were validated through comparison with the independent UK Biobank cohort, a population-based prospective study. All nonpregnant participants in the databases aged 18 to 75 years with no history of CVD, body mass index greater than or equal to 18.5, and who fasted 6 or more hours before examination in NHANES-III were included; participants in the UK Biobank cohort who did not have blood measurements were excluded. The study was conducted from 2015 to 2020. Body mass index and MH were defined by the new definition and compared with 3 a priori definitions. Cardiovascular disease mortality and total mortality. Within the NHANES-III (n = 12 341) cohort, mean (SD) age was 41.6 (29.2) years, 50.7% were women, and mean follow-up was 14.5 (2.7) years. Within the UK Biobank (n = 374 079) cohort, mean (SD) age was 56.2 (8.1) years, 55.1% were women, and mean follow-up was 7.8 (1.0) years. Use of blood pressure (BP)-lowering medication (hazard ratio [HR] for CVD mortality, 2.41; 95% CI, 1.50-3.87 and total mortality, 2.05; 95% CI, 1.47-2.84), diabetes, and several continuous factors were associated with mortality. Of all significant continuous factors, the combination of systolic BP and waist-to-hip ratio showed the highest area under the receiver operating characteristic (CVD mortality: 0.775; 95% CI, 0.770-0.781; total mortality: 0.696; 95% CI, 0.694-0.699). Thus, MH was defined as systolic BP less than 130 mm Hg, no BP-lowering medication, waist-to-hip ratio less than 0.95 for women and less than 1.03 for men, and no self-reported (ie, prevalent) diabetes. In both cohorts, metabolically healthy obesity was not associated with CVD and total mortality compared with metabolically healthy normal weight. For NHANES-III, the hazard ratio was 0.68 (95% CI, 0.30-1.54) for CVD mortality and 1.03 (95% CI, 0.70-1.51) for total mortality. For UK Biobank, the hazard ratio was 1.17 (95% CI, 0.81-1.69) for CVD mortality and 0.98 (95% CI, 0.87-1.10) for total mortality. Regardless of body mass index, all metabolically unhealthy groups displayed increased risks. This newly proposed definition of MH may identify a subgroup of people with obesity without increased risk of mortality and stratify risks in people who are overweight or normal weight. This cohort study formulates a new definition of metabolically healthy obesity and examines its use in estimation of cardiovascular disease mortality and total mortality. People classified by a priori definitions as having metabolically healthy obesity have frequently been found to be at increased risk of mortality, compared with individuals with metabolically healthy normal weight, suggesting these definitions may be insufficient.ImportancePeople classified by a priori definitions as having metabolically healthy obesity have frequently been found to be at increased risk of mortality, compared with individuals with metabolically healthy normal weight, suggesting these definitions may be insufficient.To systematically derive a new definition of metabolic health (MH) and investigate its association with cardiovascular disease (CVD) mortality and total mortality.ObjectivesTo systematically derive a new definition of metabolic health (MH) and investigate its association with cardiovascular disease (CVD) mortality and total mortality.In a cohort study using data from the third National Health and Nutrition Examination Survey (NHANES-III), a representative survey using complex multistage probability sampling, anthropometric factors, biomarkers, and blood pressure (BP) associated with total and CVD mortality among participants with obesity were identified with Cox proportional hazards regression. Area under the receiver operating characteristic was calculated to identify predictive factors for mortality to be used to define MH, cutoff levels were determined by the Youden index, and the findings were validated through comparison with the independent UK Biobank cohort, a population-based prospective study. All nonpregnant participants in the databases aged 18 to 75 years with no history of CVD, body mass index greater than or equal to 18.5, and who fasted 6 or more hours before examination in NHANES-III were included; participants in the UK Biobank cohort who did not have blood measurements were excluded. The study was conducted from 2015 to 2020.Design, Setting, and ParticipantsIn a cohort study using data from the third National Health and Nutrition Examination Survey (NHANES-III), a representative survey using complex multistage probability sampling, anthropometric factors, biomarkers, and blood pressure (BP) associated with total and CVD mortality among participants with obesity were identified with Cox proportional hazards regression. Area under the receiver operating characteristic was calculated to identify predictive factors for mortality to be used to define MH, cutoff levels were determined by the Youden index, and the findings were validated through comparison with the independent UK Biobank cohort, a population-based prospective study. All nonpregnant participants in the databases aged 18 to 75 years with no history of CVD, body mass index greater than or equal to 18.5, and who fasted 6 or more hours before examination in NHANES-III were included; participants in the UK Biobank cohort who did not have blood measurements were excluded. The study was conducted from 2015 to 2020.Body mass index and MH were defined by the new definition and compared with 3 a priori definitions.ExposuresBody mass index and MH were defined by the new definition and compared with 3 a priori definitions.Cardiovascular disease mortality and total mortality.Main Outcomes and MeasuresCardiovascular disease mortality and total mortality.Within the NHANES-III (n = 12 341) cohort, mean (SD) age was 41.6 (29.2) years, 50.7% were women, and mean follow-up was 14.5 (2.7) years. Within the UK Biobank (n = 374 079) cohort, mean (SD) age was 56.2 (8.1) years, 55.1% were women, and mean follow-up was 7.8 (1.0) years. Use of blood pressure (BP)-lowering medication (hazard ratio [HR] for CVD mortality, 2.41; 95% CI, 1.50-3.87 and total mortality, 2.05; 95% CI, 1.47-2.84), diabetes, and several continuous factors were associated with mortality. Of all significant continuous factors, the combination of systolic BP and waist-to-hip ratio showed the highest area under the receiver operating characteristic (CVD mortality: 0.775; 95% CI, 0.770-0.781; total mortality: 0.696; 95% CI, 0.694-0.699). Thus, MH was defined as systolic BP less than 130 mm Hg, no BP-lowering medication, waist-to-hip ratio less than 0.95 for women and less than 1.03 for men, and no self-reported (ie, prevalent) diabetes. In both cohorts, metabolically healthy obesity was not associated with CVD and total mortality compared with metabolically healthy normal weight. For NHANES-III, the hazard ratio was 0.68 (95% CI, 0.30-1.54) for CVD mortality and 1.03 (95% CI, 0.70-1.51) for total mortality. For UK Biobank, the hazard ratio was 1.17 (95% CI, 0.81-1.69) for CVD mortality and 0.98 (95% CI, 0.87-1.10) for total mortality. Regardless of body mass index, all metabolically unhealthy groups displayed increased risks.ResultsWithin the NHANES-III (n = 12 341) cohort, mean (SD) age was 41.6 (29.2) years, 50.7% were women, and mean follow-up was 14.5 (2.7) years. Within the UK Biobank (n = 374 079) cohort, mean (SD) age was 56.2 (8.1) years, 55.1% were women, and mean follow-up was 7.8 (1.0) years. Use of blood pressure (BP)-lowering medication (hazard ratio [HR] for CVD mortality, 2.41; 95% CI, 1.50-3.87 and total mortality, 2.05; 95% CI, 1.47-2.84), diabetes, and several continuous factors were associated with mortality. Of all significant continuous factors, the combination of systolic BP and waist-to-hip ratio showed the highest area under the receiver operating characteristic (CVD mortality: 0.775; 95% CI, 0.770-0.781; total mortality: 0.696; 95% CI, 0.694-0.699). Thus, MH was defined as systolic BP less than 130 mm Hg, no BP-lowering medication, waist-to-hip ratio less than 0.95 for women and less than 1.03 for men, and no self-reported (ie, prevalent) diabetes. In both cohorts, metabolically healthy obesity was not associated with CVD and total mortality compared with metabolically healthy normal weight. For NHANES-III, the hazard ratio was 0.68 (95% CI, 0.30-1.54) for CVD mortality and 1.03 (95% CI, 0.70-1.51) for total mortality. For UK Biobank, the hazard ratio was 1.17 (95% CI, 0.81-1.69) for CVD mortality and 0.98 (95% CI, 0.87-1.10) for total mortality. Regardless of body mass index, all metabolically unhealthy groups displayed increased risks.This newly proposed definition of MH may identify a subgroup of people with obesity without increased risk of mortality and stratify risks in people who are overweight or normal weight.Conclusions and RelevanceThis newly proposed definition of MH may identify a subgroup of people with obesity without increased risk of mortality and stratify risks in people who are overweight or normal weight. |
| Author | Schulze, Matthias B Zembic, Anika Eckel, Nathalie Baudry, Julia Stefan, Norbert |
| AuthorAffiliation | 3 Institute of Nutritional Science, University of Potsdam, Potsdam, Germany 5 Department of Internal Medicine IV, University Hospital of Tübingen, Tübingen, Germany 2 German Center for Diabetes Research, Neuherberg, Germany 1 Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany 4 Institute of Diabetes Research and Metabolic Diseases of the Helmholtz Center München, University of Tübingen, Tübingen, Germany 6 Sorbonne Paris North University, the National Institute for Health and Medical Research, the National Research Institute for Agriculture, Food and Environment, the National Conservatory of Arts and Crafts and the Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Centre, University of Paris, Bobigny, France |
| AuthorAffiliation_xml | – name: 1 Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany – name: 5 Department of Internal Medicine IV, University Hospital of Tübingen, Tübingen, Germany – name: 4 Institute of Diabetes Research and Metabolic Diseases of the Helmholtz Center München, University of Tübingen, Tübingen, Germany – name: 6 Sorbonne Paris North University, the National Institute for Health and Medical Research, the National Research Institute for Agriculture, Food and Environment, the National Conservatory of Arts and Crafts and the Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Centre, University of Paris, Bobigny, France – name: 2 German Center for Diabetes Research, Neuherberg, Germany – name: 3 Institute of Nutritional Science, University of Potsdam, Potsdam, Germany |
| Author_xml | – sequence: 1 givenname: Anika surname: Zembic fullname: Zembic, Anika – sequence: 2 givenname: Nathalie surname: Eckel fullname: Eckel, Nathalie – sequence: 3 givenname: Norbert surname: Stefan fullname: Stefan, Norbert – sequence: 4 givenname: Julia surname: Baudry fullname: Baudry, Julia – sequence: 5 givenname: Matthias B surname: Schulze fullname: Schulze, Matthias B |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33961036$$D View this record in MEDLINE/PubMed https://hal.inrae.fr/hal-04065651$$DView record in HAL |
| BookMark | eNqNkl9v0zAUxSM0xP6wL8ADCuJlPLRc27GdvAyVMihSp0loPFtOYlN3rl3sJKjfHkftptEnnq5l_865tu85z06cdyrL3iGYIgD0cS030qnujw8PfqvcFANG05ICfZGdYcqLCSmBnjxbn2aXMa4BAAMiFaOvslOSKgLCzrJh5vKbzdYE00hrd_kXFcyg2lS1caYz3uVe57eqk7W3B2ahpO1Wu_yuVtF0u_yzjEmRyB8mPoz4XIbW-EHGprcy5NK1-b3vpM1vfUglaV5nL7W0UV0e6kX28-vN_XwxWd59-z6fLSeScugmXBNSMl0yxVlNalW1rKlphRiuiE4P1GVTVVXDS65Y4qQmDIpaIigw0ZxLcpFd7323fb1RbaNcF6QV22A2MuyEl0b8e-LMSvzygygRUE4hGXzYG6yOZIvZUox7UACjjKIBJfbq0Cz4372KndiY2Chr07x8HwWmuCC0AlYk9P0RuvZ9cOkrBGaMlwRIQRL19vntn_o_ji8Bn_ZAE3yMQWnRmE6OU0uPMVYgEGNmxFFmxJgZMWYmOVRHDo9N_kf7Zq9NxJMMc16xkpK_OaXWKg |
| CitedBy_id | crossref_primary_10_1007_s11883_023_01182_3 crossref_primary_10_1186_s12933_023_01807_6 crossref_primary_10_1186_s12872_023_03452_z crossref_primary_10_3389_fendo_2023_1228300 crossref_primary_10_3390_nu14214601 crossref_primary_10_1136_bmjopen_2024_087307 crossref_primary_10_1007_s00592_023_02230_9 crossref_primary_10_1111_echo_70283 crossref_primary_10_3390_nu17081345 crossref_primary_10_1111_dom_15329 crossref_primary_10_1001_jamanetworkopen_2023_2145 crossref_primary_10_1186_s12889_022_14062_3 crossref_primary_10_3390_jpm13101452 crossref_primary_10_1002_cam4_5896 crossref_primary_10_1002_oby_24238 crossref_primary_10_1007_s11739_023_03263_2 crossref_primary_10_1016_j_numecd_2022_06_010 crossref_primary_10_3389_fneur_2024_1476863 crossref_primary_10_1016_j_numecd_2022_12_008 crossref_primary_10_1161_ATVBAHA_122_317526 crossref_primary_10_1016_j_obmed_2021_100361 crossref_primary_10_1111_eci_14161 crossref_primary_10_3389_fendo_2022_886957 crossref_primary_10_3390_biom15091278 crossref_primary_10_1016_j_heliyon_2024_e37875 crossref_primary_10_3389_fendo_2023_1140472 crossref_primary_10_1186_s12933_023_01815_6 crossref_primary_10_1038_s41366_025_01800_x crossref_primary_10_1371_journal_pone_0269550 crossref_primary_10_1371_journal_pone_0305592 crossref_primary_10_1016_j_critrevonc_2022_103796 crossref_primary_10_1186_s12944_023_01921_0 crossref_primary_10_1016_j_puhe_2024_09_021 crossref_primary_10_1016_j_cjca_2025_02_025 crossref_primary_10_1002_clc_24118 crossref_primary_10_1186_s12933_022_01567_9 crossref_primary_10_1016_j_diabres_2022_109213 crossref_primary_10_1007_s13679_025_00637_9 crossref_primary_10_4330_wjc_v17_i9_110228 crossref_primary_10_1001_jamanetworkopen_2023_4989 crossref_primary_10_1080_19390211_2023_2301383 crossref_primary_10_1016_j_ypmed_2024_108100 crossref_primary_10_1111_ijcp_14727 crossref_primary_10_3389_fpubh_2024_1371359 crossref_primary_10_1186_s12967_023_04244_x crossref_primary_10_1002_dmrr_3725 crossref_primary_10_3390_ijms23179614 crossref_primary_10_1177_00031348241241621 crossref_primary_10_1038_s41366_025_01723_7 crossref_primary_10_3389_fcvm_2022_1032633 crossref_primary_10_1016_j_jot_2025_02_004 crossref_primary_10_1016_j_orcp_2022_10_009 crossref_primary_10_3390_ijms24065209 crossref_primary_10_1002_oby_24218 crossref_primary_10_1016_j_orcp_2024_01_006 crossref_primary_10_1007_s13679_023_00494_4 crossref_primary_10_1111_eci_70059 crossref_primary_10_1016_S2213_8587_23_00086_4 crossref_primary_10_3390_biomedicines10102416 crossref_primary_10_1016_j_fertnstert_2024_01_030 crossref_primary_10_1001_jamanetworkopen_2021_8860 crossref_primary_10_3390_nu14224939 crossref_primary_10_3389_fnut_2022_958753 crossref_primary_10_1186_s12889_022_13082_3 crossref_primary_10_1038_s41574_024_01008_5 crossref_primary_10_1038_s41598_024_84104_w crossref_primary_10_1159_000531421 crossref_primary_10_1016_j_numecd_2022_01_019 crossref_primary_10_1002_oby_24122 crossref_primary_10_1016_j_orcp_2021_10_002 crossref_primary_10_1111_ceo_14467 crossref_primary_10_1038_s41574_021_00537_7 crossref_primary_10_1016_j_numecd_2022_12_017 crossref_primary_10_1111_dom_16004 crossref_primary_10_1016_j_jprot_2022_104556 crossref_primary_10_1186_s13098_025_01836_z crossref_primary_10_3233_THC_241472 crossref_primary_10_3390_jcm11092440 crossref_primary_10_1016_j_orcp_2024_08_001 crossref_primary_10_1016_j_numecd_2022_12_019 crossref_primary_10_1007_s00394_025_03642_9 crossref_primary_10_3389_fnut_2025_1608603 crossref_primary_10_1007_s13669_023_00361_y crossref_primary_10_1210_clinem_dgac091 crossref_primary_10_3389_fendo_2022_860799 crossref_primary_10_1007_s13679_023_00518_z crossref_primary_10_1111_acel_14435 crossref_primary_10_1186_s41043_025_01003_0 crossref_primary_10_3390_metabo12050419 |
| Cites_doi | 10.1016/S2213-8587(20)30110-8 10.1093/aje/kwq341 10.1177/2047487315623884 10.1001/jama.1997.03550040069040 10.1371/journal.pmed.1001779 10.1002/(ISSN)1097-0258 10.1007/s00125-014-3285-x 10.1186/1476-511X-12-159 10.1016/S2213-8587(13)70062-7 10.1038/ejcn.2009.70 10.1093/eurheartj/ehx448 10.1056/NEJMoa0801891 10.7326/0003-4819-159-11-201312030-00008 10.1038/sj.ijo.0802060 10.1038/oby.2007.92 10.1161/01.CIR.0000111245.75752.C6 10.1093/aje/kwx246 10.1161/CIRCULATIONAHA.117.029617 10.1016/S0140-6736(11)60105-0 10.1016/S0140-6736(07)61778-4 10.1001/jama.2018.19329 10.1016/j.amjcard.2007.06.073 10.1016/S2213-8587(17)30292-9 10.1016/S2213-8587(18)30288-2 10.1016/S2213-8587(18)30137-2 10.1002/9780470316696 10.1111/obr.2014.15.issue-10 10.1007/s00125-018-4787-8 10.1155/2012/460321 |
| ContentType | Journal Article |
| Copyright | 2021. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. Attribution Copyright 2021 Zembic A et al. . |
| Copyright_xml | – notice: 2021. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. – notice: Attribution – notice: Copyright 2021 Zembic A et al. . |
| DBID | ZGVWO AAYXX CITATION CGR CUY CVF ECM EIF NPM 3V. 7X7 7XB 8FI 8FJ 8FK ABUWG AFKRA AZQEC BENPR CCPQU DWQXO FYUFA GHDGH K9. M0S PHGZM PHGZT PIMPY PJZUB PKEHL PPXIY PQEST PQQKQ PQUKI PRINS 7X8 1XC VOOES 5PM |
| DOI | 10.1001/jamanetworkopen.2021.8505 |
| DatabaseName | JAMA Network (Open Access) CrossRef Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed ProQuest Central (Corporate) ProQuest Health & Medical Collection ProQuest Central (purchase pre-March 2016) Hospital Premium Collection Hospital Premium Collection (Alumni Edition) ProQuest Central (Alumni) (purchase pre-March 2016) ProQuest Central (Alumni Edition) ProQuest Central UK/Ireland ProQuest Central Essentials ProQuest Central ProQuest One Community College ProQuest Central Korea Health Research Premium Collection Health Research Premium Collection (Alumni) ProQuest Health & Medical Complete (Alumni) Health & Medical Collection (Alumni Edition) ProQuest Central Premium ProQuest One Academic (New) Publicly Available Content Database ProQuest Health & Medical Research Collection ProQuest One Academic Middle East (New) ProQuest One Health & Nursing ProQuest One Academic Eastern Edition (DO NOT USE) ProQuest One Academic (retired) ProQuest One Academic UKI Edition ProQuest Central China MEDLINE - Academic Hyper Article en Ligne (HAL) Hyper Article en Ligne (HAL) (Open Access) PubMed Central (Full Participant titles) |
| DatabaseTitle | CrossRef MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) Publicly Available Content Database ProQuest One Academic Middle East (New) ProQuest Central Essentials ProQuest One Academic Eastern Edition ProQuest Health & Medical Complete (Alumni) ProQuest Central (Alumni Edition) ProQuest One Community College ProQuest Hospital Collection Health Research Premium Collection (Alumni) ProQuest One Health & Nursing ProQuest Central China ProQuest Hospital Collection (Alumni) ProQuest Central ProQuest Health & Medical Complete ProQuest Health & Medical Research Collection Health Research Premium Collection ProQuest One Academic UKI Edition Health and Medicine Complete (Alumni Edition) ProQuest Central Korea ProQuest Central (New) ProQuest One Academic ProQuest One Academic (New) ProQuest Central (Alumni) MEDLINE - Academic |
| DatabaseTitleList | Publicly Available Content Database MEDLINE MEDLINE - Academic |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: ZGVWO name: JAMA Network (Open Access) url: https://jamanetwork.com sourceTypes: Publisher – sequence: 3 dbid: PIMPY name: Publicly Available Content Database url: http://search.proquest.com/publiccontent sourceTypes: Aggregation Database |
| DeliveryMethod | fulltext_linktorsrc |
| DocumentTitleAlternate | An Empirically Derived Definition of Metabolically Healthy Obesity Based on Risk of Mortality |
| EISSN | 2574-3805 |
| ExternalDocumentID | PMC8105750 oai:HAL:hal-04065651v1 33961036 10_1001_jamanetworkopen_2021_8505 2779685 |
| Genre | Research Support, Non-U.S. Gov't Journal Article |
| GeographicLocations | United Kingdom United Kingdom--UK |
| GeographicLocations_xml | – name: United Kingdom – name: United Kingdom--UK |
| GrantInformation_xml | – fundername: British Heart Foundation grantid: CH/1996001/9454 – fundername: Medical Research Council grantid: MC_PC_17228 – fundername: Medical Research Council grantid: MC_QA137853 |
| GroupedDBID | ZGVWO 0R~ 53G 7X7 8FI 8FJ AAYXX ABUWG ADBBV ADPDF AFFHD AFKRA ALMA_UNASSIGNED_HOLDINGS AMJDE BCNDV BENPR CCPQU CITATION EBS EMOBN FYUFA GROUPED_DOAJ H13 HMCUK OK1 OVD OVEED PHGZM PHGZT PIMPY RAJ TEORI UKHRP W2D ALIPV CGR CUY CVF ECM EIF M~E NPM 3V. 7XB 8FK AZQEC DWQXO K9. PJZUB PKEHL PPXIY PQEST PQQKQ PQUKI PRINS 7X8 PUEGO 1XC VOOES 5PM |
| ID | FETCH-LOGICAL-a570t-7f3386f86e76b3be9d6cb5916293f257f8c999c787e686faf3604ba10423f77a3 |
| IEDL.DBID | BENPR |
| ISICitedReferencesCount | 99 |
| ISICitedReferencesURI | http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=000647827400005&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| ISSN | 2574-3805 |
| IngestDate | Tue Nov 04 02:00:42 EST 2025 Tue Oct 14 21:07:22 EDT 2025 Fri Sep 05 11:36:02 EDT 2025 Tue Oct 07 07:16:02 EDT 2025 Mon Jul 21 06:00:13 EDT 2025 Tue Nov 18 22:41:04 EST 2025 Sat Nov 29 06:31:35 EST 2025 Fri Jul 05 01:57:43 EDT 2024 |
| IsDoiOpenAccess | true |
| IsOpenAccess | true |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 5 |
| Language | English |
| License | Attribution: http://creativecommons.org/licenses/by This is an open access article distributed under the terms of the CC-BY License. |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-a570t-7f3386f86e76b3be9d6cb5916293f257f8c999c787e686faf3604ba10423f77a3 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 |
| ORCID | 0000-0002-7919-6039 |
| OpenAccessLink | https://www.proquest.com/docview/2667830343?pq-origsite=%requestingapplication% |
| PMID | 33961036 |
| PQID | 2667830343 |
| PQPubID | 5319538 |
| ParticipantIDs | pubmedcentral_primary_oai_pubmedcentral_nih_gov_8105750 hal_primary_oai_HAL_hal_04065651v1 proquest_miscellaneous_2524359064 proquest_journals_2667830343 pubmed_primary_33961036 crossref_citationtrail_10_1001_jamanetworkopen_2021_8505 crossref_primary_10_1001_jamanetworkopen_2021_8505 ama_primary_2779685 |
| PublicationCentury | 2000 |
| PublicationDate | 2021-05-03 |
| PublicationDateYYYYMMDD | 2021-05-03 |
| PublicationDate_xml | – month: 05 year: 2021 text: 2021-05-03 day: 03 |
| PublicationDecade | 2020 |
| PublicationPlace | United States |
| PublicationPlace_xml | – name: United States – name: Chicago |
| PublicationTitle | JAMA Network Open |
| PublicationTitleAlternate | JAMA Netw Open |
| PublicationYear | 2021 |
| Publisher | American Medical Association |
| Publisher_xml | – name: American Medical Association |
| References | Schulze (zoi210274r3) 2019; 62 Kramer (zoi210274r5) 2013; 159 Lassale (zoi210274r7) 2018; 39 Wormser (zoi210274r22) 2011; 377 Flegal (zoi210274r19) 2011; 173 Rey-López (zoi210274r20) 2014; 15 Otten (zoi210274r14) 2014; 57 Durward (zoi210274r31) 2012; 2012 Carroll (zoi210274r33) 2008; 16 Song (zoi210274r29) 2007; 100 Hebert (zoi210274r26) 1997; 278 Jonsson (zoi210274r30) 2002; 26 Lear (zoi210274r32) 2010; 64 Bhaskaran (zoi210274r1) 2018; 6 Eckel (zoi210274r6) 2016; 23 zoi210274r10 Pischon (zoi210274r21) 2008; 359 Neeland (zoi210274r25) 2018; 137 Stefan (zoi210274r2) 2018; 6 Fry (zoi210274r34) 2017; 186 Stefan (zoi210274r23) 2020; 8 zoi210274r15 Rubin (zoi210274r17) 1987 Sudlow (zoi210274r11) 2015; 12 zoi210274r13 zoi210274r12 Harel (zoi210274r16) 2007; 26 Lotta (zoi210274r24) 2018; 320 Lewington (zoi210274r28) 2007; 370 Liu (zoi210274r27) 2013; 12 Grundy (zoi210274r18) 2004; 109 Stefan (zoi210274r4) 2013; 1 National Center for Health Statistics (zoi210274r9) 1994 Eckel (zoi210274r8) 2018; 6 33961041 - JAMA Netw Open. 2021 May 3;4(5):e218860. doi: 10.1001/jamanetworkopen.2021.8860. |
| References_xml | – volume: 8 start-page: 616 issue: 7 year: 2020 ident: zoi210274r23 article-title: Causes, consequences, and treatment of metabolically unhealthy fat distribution. publication-title: Lancet Diabetes Endocrinol doi: 10.1016/S2213-8587(20)30110-8 – ident: zoi210274r13 – ident: zoi210274r15 – volume: 173 start-page: 1 issue: 1 year: 2011 ident: zoi210274r19 article-title: Reverse causation and illness-related weight loss in observational studies of body weight and mortality. publication-title: Am J Epidemiol doi: 10.1093/aje/kwq341 – volume: 23 start-page: 956 issue: 9 year: 2016 ident: zoi210274r6 article-title: Metabolically healthy obesity and cardiovascular events: a systematic review and meta-analysis. publication-title: Eur J Prev Cardiol doi: 10.1177/2047487315623884 – volume: 278 start-page: 313 issue: 4 year: 1997 ident: zoi210274r26 article-title: Cholesterol lowering with statin drugs, risk of stroke, and total mortality. an overview of randomized trials. publication-title: JAMA doi: 10.1001/jama.1997.03550040069040 – volume: 12 issue: 3 year: 2015 ident: zoi210274r11 article-title: UK Biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age. publication-title: PLoS Med doi: 10.1371/journal.pmed.1001779 – volume: 26 start-page: 3057 issue: 16 year: 2007 ident: zoi210274r16 article-title: Multiple imputation: review of theory, implementation and software. publication-title: Stat Med doi: 10.1002/(ISSN)1097-0258 – volume: 57 start-page: 1781 issue: 9 year: 2014 ident: zoi210274r14 article-title: Surrogate measures of insulin sensitivity vs the hyperinsulinaemic-euglycaemic clamp: a meta-analysis. publication-title: Diabetologia doi: 10.1007/s00125-014-3285-x – volume: 12 start-page: 159 issue: 1 year: 2013 ident: zoi210274r27 article-title: Effects of blood triglycerides on cardiovascular and all-cause mortality: a systematic review and meta-analysis of 61 prospective studies. publication-title: Lipids Health Dis doi: 10.1186/1476-511X-12-159 – volume: 1 start-page: 152 issue: 2 year: 2013 ident: zoi210274r4 article-title: Metabolically healthy obesity: epidemiology, mechanisms, and clinical implications. publication-title: Lancet Diabetes Endocrinol doi: 10.1016/S2213-8587(13)70062-7 – volume: 64 start-page: 42 issue: 1 year: 2010 ident: zoi210274r32 article-title: Appropriateness of waist circumference and waist-to-hip ratio cutoffs for different ethnic groups. publication-title: Eur J Clin Nutr doi: 10.1038/ejcn.2009.70 – volume: 39 start-page: 397 issue: 5 year: 2018 ident: zoi210274r7 article-title: Separate and combined associations of obesity and metabolic health with coronary heart disease: a pan-European case-cohort analysis. publication-title: Eur Heart J doi: 10.1093/eurheartj/ehx448 – volume: 359 start-page: 2105 issue: 20 year: 2008 ident: zoi210274r21 article-title: General and abdominal adiposity and risk of death in Europe. publication-title: N Engl J Med doi: 10.1056/NEJMoa0801891 – volume: 159 start-page: 758 issue: 11 year: 2013 ident: zoi210274r5 article-title: Are metabolically healthy overweight and obesity benign conditions? a systematic review and meta-analysis. publication-title: Ann Intern Med doi: 10.7326/0003-4819-159-11-201312030-00008 – volume: 26 start-page: 1046 issue: 8 year: 2002 ident: zoi210274r30 article-title: Influence of obesity on cardiovascular risk: twenty-three-year follow-up of 22,025 men from an urban Swedish population. publication-title: Int J Obes Relat Metab Disord doi: 10.1038/sj.ijo.0802060 – volume: 16 start-page: 600 issue: 3 year: 2008 ident: zoi210274r33 article-title: Visceral fat, waist circumference, and BMI: impact of race/ethnicity. publication-title: Obesity (Silver Spring) doi: 10.1038/oby.2007.92 – start-page: 1 issue: 32 year: 1994 ident: zoi210274r9 article-title: Plan and operation of the Third National Health and Nutrition Examination Survey, 1988-94—series 1: programs and collection procedures. publication-title: Vital Health Stat 1 – volume: 109 start-page: 433 issue: 3 year: 2004 ident: zoi210274r18 article-title: Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. publication-title: Circulation doi: 10.1161/01.CIR.0000111245.75752.C6 – volume: 186 start-page: 1026 issue: 9 year: 2017 ident: zoi210274r34 article-title: Comparison of sociodemographic and health-related characteristics of UK Biobank participants with those of the general population. publication-title: Am J Epidemiol doi: 10.1093/aje/kwx246 – ident: zoi210274r12 – ident: zoi210274r10 – volume: 137 start-page: 1391 issue: 13 year: 2018 ident: zoi210274r25 article-title: Cardiovascular and metabolic heterogeneity of obesity: clinical challenges and implications for management. publication-title: Circulation doi: 10.1161/CIRCULATIONAHA.117.029617 – volume: 377 start-page: 1085 issue: 9771 year: 2011 ident: zoi210274r22 article-title: Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies. publication-title: Lancet doi: 10.1016/S0140-6736(11)60105-0 – volume: 370 start-page: 1829 issue: 9602 year: 2007 ident: zoi210274r28 article-title: Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. publication-title: Lancet doi: 10.1016/S0140-6736(07)61778-4 – volume: 320 start-page: 2553 issue: 24 year: 2018 ident: zoi210274r24 article-title: Association of genetic variants related to gluteofemoral vs abdominal fat distribution with type 2 diabetes, coronary disease, and cardiovascular risk factors. publication-title: JAMA doi: 10.1001/jama.2018.19329 – volume: 100 start-page: 1654 issue: 11 year: 2007 ident: zoi210274r29 article-title: Comparison of usefulness of body mass index versus metabolic risk factors in predicting 10-year risk of cardiovascular events in women. publication-title: Am J Cardiol doi: 10.1016/j.amjcard.2007.06.073 – volume: 6 start-page: 249 issue: 3 year: 2018 ident: zoi210274r2 article-title: Metabolically healthy obesity: the low-hanging fruit in obesity treatment? publication-title: Lancet Diabetes Endocrinol doi: 10.1016/S2213-8587(17)30292-9 – volume: 6 start-page: 944 issue: 12 year: 2018 ident: zoi210274r1 article-title: Association of BMI with overall and cause-specific mortality: a population-based cohort study of 3·6 million adults in the UK. publication-title: Lancet Diabetes Endocrinol doi: 10.1016/S2213-8587(18)30288-2 – volume: 6 start-page: 714 issue: 9 year: 2018 ident: zoi210274r8 article-title: Transition from metabolic healthy to unhealthy phenotypes and association with cardiovascular disease risk across BMI categories in 90?257 women (the Nurses’ Health Study): 30 year follow-up from a prospective cohort study. publication-title: Lancet Diabetes Endocrinol doi: 10.1016/S2213-8587(18)30137-2 – volume-title: Multiple Imputation for Nonresponse in Surveys year: 1987 ident: zoi210274r17 doi: 10.1002/9780470316696 – volume: 15 start-page: 781 issue: 10 year: 2014 ident: zoi210274r20 article-title: The prevalence of metabolically healthy obesity: a systematic review and critical evaluation of the definitions used. publication-title: Obes Rev doi: 10.1111/obr.2014.15.issue-10 – volume: 62 start-page: 558 issue: 4 year: 2019 ident: zoi210274r3 article-title: Metabolic health in normal-weight and obese individuals. publication-title: Diabetologia. doi: 10.1007/s00125-018-4787-8 – volume: 2012 year: 2012 ident: zoi210274r31 article-title: All-cause mortality risk of metabolically healthy obese individuals in NHANES III. publication-title: J Obes doi: 10.1155/2012/460321 – reference: 33961041 - JAMA Netw Open. 2021 May 3;4(5):e218860. doi: 10.1001/jamanetworkopen.2021.8860. |
| SSID | ssj0002013965 |
| Score | 2.495802 |
| Snippet | IMPORTANCE: People classified by a priori definitions as having metabolically healthy obesity have frequently been found to be at increased risk of mortality,... People classified by a priori definitions as having metabolically healthy obesity have frequently been found to be at increased risk of mortality, compared... Importance People classified by a priori definitions as having metabolically healthy obesity have frequently been found to be at increased risk of mortality,... IMPORTANCE People classified by a priori definitions as having metabolically healthy obesity have frequently been found to be at increased risk of mortality,... This cohort study formulates a new definition of metabolically healthy obesity and examines its use in estimation of cardiovascular disease mortality and total... |
| SourceID | pubmedcentral hal proquest pubmed crossref ama |
| SourceType | Open Access Repository Aggregation Database Index Database Enrichment Source Publisher |
| StartPage | e218505 |
| SubjectTerms | Adolescent Adult Aged Biobanks Blood pressure Body mass index Cardiovascular disease Cohort Studies Diabetes Female Heart Diseases - mortality Human health and pathology Humans Life Sciences Male Middle Aged Mortality Mortality - trends Nutrition Surveys Nutrition, Obesity, and Exercise Obesity Obesity, Metabolically Benign Online Only Original Investigation Risk Factors United Kingdom - epidemiology Womens health Young Adult |
| SummonAdditionalLinks | – databaseName: JAMA Network (Open Access) dbid: ZGVWO link: http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1LT9wwEB7BUiEulJYCobQyVa-pNnb8yHF5lQPQqqKAuFhOYouIJYvYZSX-PeMkuxBAAnGKlMzEzngm_iyPvwH4aTLEqSYWIRcZDWMTudDgsIfUKqdo6vJulW1xciCPjtTZWfL34Rz3sx38mh-orFOifUEpXNLR6Jfinrd0jkrOeQfmzn-fnP6Zh81XdR7zqTZz0OyFz4B8Di-fZkk-mnb2Pr6rw0uw2KBM0qvd4hPM2HIZxr2S7F5dFxUpSP-O7KDzjW2OV1eUVeYWGThyaEfoF_1Gpj6ldEea-gFkCye9nKDkv2J46cW3W_msxJQ5OR4goCeHFa5HnS_wf2_3eHs_bMouhIbL7iiUDpetwilhpUhZapNcZClHGInIwGGEO5Uhqsww0q1AOeOY6MapiXyGjZPSsBXolIPSrgFhVHquUucodbEyzEQ5E8KoandVGBvAZzSWvq6JNTRKJ0LxANRkeHTWMJX7ghl9XXMs44qlbWLtTay9iQOgU9XJW9-g9AN9YCrvCbf3ewfa38NfHAJeHo2jADYmLqKbMB9qRDdSIQiIWQCb08cYoH7XBRsb3KIMpwhJE4R-AazWHjVtirEE4SsTAciWr7X60n5SFhcVCbjyBZp5d_1FC36FBf91VWIm24DO6ObWfoMP2XhUDG--N_FyDx9EG8Q priority: 102 providerName: American Medical Association |
| Title | An Empirically Derived Definition of Metabolically Healthy Obesity Based on Risk of Cardiovascular and Total Mortality |
| URI | http://dx.doi.org/10.1001/jamanetworkopen.2021.8505 https://www.ncbi.nlm.nih.gov/pubmed/33961036 https://www.proquest.com/docview/2667830343 https://www.proquest.com/docview/2524359064 https://hal.inrae.fr/hal-04065651 https://pubmed.ncbi.nlm.nih.gov/PMC8105750 |
| Volume | 4 |
| WOSCitedRecordID | wos000647827400005&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| hasFullText | 1 |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| journalDatabaseRights | – providerCode: PRVAON databaseName: DOAJ Directory of Open Access Journals customDbUrl: eissn: 2574-3805 dateEnd: 99991231 omitProxy: false ssIdentifier: ssj0002013965 issn: 2574-3805 databaseCode: DOA dateStart: 20180101 isFulltext: true titleUrlDefault: https://www.doaj.org/ providerName: Directory of Open Access Journals – providerCode: PRVPQU databaseName: Health & Medical Collection customDbUrl: eissn: 2574-3805 dateEnd: 99991231 omitProxy: false ssIdentifier: ssj0002013965 issn: 2574-3805 databaseCode: 7X7 dateStart: 20180101 isFulltext: true titleUrlDefault: https://search.proquest.com/healthcomplete providerName: ProQuest – providerCode: PRVPQU databaseName: ProQuest Central customDbUrl: eissn: 2574-3805 dateEnd: 99991231 omitProxy: false ssIdentifier: ssj0002013965 issn: 2574-3805 databaseCode: BENPR dateStart: 20180101 isFulltext: true titleUrlDefault: https://www.proquest.com/central providerName: ProQuest – providerCode: PRVPQU databaseName: Publicly Available Content Database customDbUrl: eissn: 2574-3805 dateEnd: 99991231 omitProxy: false ssIdentifier: ssj0002013965 issn: 2574-3805 databaseCode: PIMPY dateStart: 20180101 isFulltext: true titleUrlDefault: http://search.proquest.com/publiccontent providerName: ProQuest |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV3fb9MwED7RDiFe-A0LjMpDvAYaJ7HdJ9SNjiGtpZrGKHuJnMTWIrqkrF2l_fecHTdbQEJIvCRKc84P3eX82f76HcBbmSFOlRHzY5ZRP5KB9iW63adKaEFTnfct2-L0iE8mYjYbTN2E29LRKjc50SbqvMrMHPl77Ei4wHwbhR8WP31TNcqsrroSGh3YMkplURe29kaT6XEzy0INwmHxPdi9LTdU1gxrU58KR4g0eCdiU77uRmrVdU-dc0OO_BN5_k6gvNUjHTz833d5BA8cFiXDOngewx1VPoX1sCSji0VhpUPm1-Qjhuha5bjXRWn5XaTSZKxWGD1zZ1P_l-mauCoDZA-7xpyg5XGx_GHM91usVyLLnJxUCPvJ2KJ_bPMMvh6MTvYPfVecwZcx7698rnFwy7RgirM0TNUgZ1kaI9hE_KAxD2iRIfbMMB8ohnZSh6wfpTIwPBzNuQyfQ7esSrUNJKTcKJpqTamOhAxlkIeMSWHXYJlUHjxBzySLWn4jQesBE7EHYuOpJHN65qasxjyplZhxXNN2dWJcnRhXe0Cbppur_kOjNxgOjb2R5T4cHiXmN0yECIvjYB14sLPxeOKSwTK5cbcHu81p_IzN2gzerLpCm5gicB0gQPTgRR1cza1CDOEAkYYHvBV2rWdpnymLcysVLkwZ57j_8u-P9Qrum9e0PM5wB7qryyv1Gu5m61WxvOxBh8-43Yqe-756duoCj6afx9PvuD_7dPrtyy_TrjTE |
| linkProvider | ProQuest |
| linkToHtml | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMw1V1Lb9NAEB61KaJcWl4FlwJbBEdDvLbXmwNC6UuJmkQRCqg9LWt7V7UIdmjSoPwpfiOzfrUGCXHpgZMle9Ze29_MfOMdzwC8lhHyVOkx22cRtT3paFvia7ep4prTUMftPNvi8yAYjfjZWWe8Bj-rf2FMWmVlE3NDHWeR-Ub-Dh1JwNHeeu6H2XfbdI0yq6tVC40CFqdq9QNDtvn7_hG-3zeUnhxPDnt22VXAln7QXtiBxqiMac5UwEI3VJ2YRaGPLAkdn0YAax4haYoQyIqhnNQua3uhdEwCiQ4C6eJ512HDQ7DzFmyM-8Pxef1VhxpGxfy7sH-zvFFaZHSbflgYkVLnLfdNu7zr0q6lO1y_MMmYfzLd3xM2b3jAk-3_7dndh62Sa5NuoRwPYE2lj2DZTcnxt1mSl0aZrsgRquBSxbjVSZrnr5FMk6FaoHZMS5niX60VKbsokAN0_TFByY_J_KsRP2xk9RKZxmSSYVhDhnl0g2Mew6dbudUdaKVZqp4CcWlgKrZqTan2uHSlE7uMSZ6vMTOpLHiISBCzoryIQOkO474FvEKGiMp67aZtyFQUlaYxbmtCSxhoCQMtC2g9tDrrPwx6hfCr5U3Z8V53IMw-NPRI-31n6ViwVyFMlMZuLq7hZcF-fRjNlFl7wotlVyjjUyTmHSTAFjwpwFxfykWVcZBJWRA0YN6YS_NImlzkpdC5aVPtt3f_Pq2XsNmbDAdi0B-dPoN75pbznFV3D1qLyyv1HO5Ey0Uyv3xR6jOBL7etBr8A_PaKTA |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=An+Empirically+Derived+Definition+of+Metabolically+Healthy+Obesity+Based+on+Risk+of+Cardiovascular+and+Total+Mortality&rft.jtitle=JAMA+network+open&rft.au=Zembic%2C+Anika&rft.au=Eckel%2C+Nathalie&rft.au=Stefan%2C+Norbert&rft.au=Baudry%2C+Julia&rft.date=2021-05-03&rft.pub=American+Medical+Association&rft.eissn=2574-3805&rft.volume=4&rft.issue=5&rft_id=info:doi/10.1001%2Fjamanetworkopen.2021.8505&rft_id=info%3Apmid%2F33961036&rft.externalDBID=HAS_PDF_LINK&rft.externalDocID=oai%3AHAL%3Ahal-04065651v1 |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=2574-3805&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=2574-3805&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=2574-3805&client=summon |