Predictors of the transition from metabolically healthy obesity to unhealthy obesity

  • Luisa GilardiniEmail author
  • Antonella Zambon
  • Davide Soranna
  • Marina Croci
  • Cecilia Invitti
Original Article
Part of the following topical collections:
  1. Obesity Paradox



Evidence that metabolically healthy obesity (MHO) is a stable benign condition is unclear. The aim of this study was to estimate the transition of MHO subjects to unhealthy obesity (occurrence of cardio-metabolic events and/or risk factors) and its predictors.


We conducted an explorative follow-up study in a subset of MHO patients > 40 years without any cardio-metabolic risk factors and with normal LDL cholesterol (LDLc) levels, identified among 1530 obese patients. Due to the low sample size, a bootstrap approach was applied to identify the variables to be included in the final multivariate discrete-time logit model.


The prevalence of MHO was 3.7%. During the follow-up (mean 6.1 years, SD 2.0), none of the MHO reported cardiovascular events, diabetes or prediabetes; 26 subjects developed risk factors (53% high LDLc and 50% hypertension). At the 6 and 12-year of follow-up, the cumulative incidence of transition to unhealthy obesity was 44% (95% CI 31–59%) and 62% (95% CI 45–79%), the incidence of high LDLc was 23% (95% CI 13–37%) and 40% (95% CI 25–59%) and that of hypertension was 20% (95% CI 11–33%) and 30% (95% CI 17–48%). LDLc and duration of follow-up were independent predictors of the transition from MHO to unhealthy obesity [OR 1.038 (1.005–1.072) and 1.360 (1.115–1.659)].


Results suggest that (a) MHO individuals do not move over time forward diabetes/prediabetes but develop risk factors, such as hypertension and higher LDL c that worsen the cardiovascular prognosis; (b) LDLc and the flow of time independently predict the transition to unhealthy status.

Level of evidence

Level III, cohort study.


Metabolically healthy obesity LDL cholesterol Hypertension Follow-up study 


Compliance with ethical standards

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The Ethics Committee of the IRCCS Istituto Auxologico Italiano approved the study.

Informed consent

All subjects gave their informed consent after we provided a full explanation of the study.


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Dipartimento di Scienza Mediche e RiabilitativeIstituto Auxologico Italiano, IRCCSMilanItaly
  2. 2.Dipartimento di Statistica e Metodi QuantitativiUniversità Milano-BicoccaMilanItaly
  3. 3.Istituto Auxologico Italiano, IRCCSMilanItaly

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