Key result
Metabolically healthy obesity was associated with a significantly increased risk of incident erosive esophagitis compared to normal weight (HR 1.29).
Why the study?
Although obesity and metabolic unhealthiness are linked to erosive esophagitis, the risk among metabolically healthy obese individuals remained unclear.
Does metabolically healthy obesity increase the risk of erosive esophagitis in asymptomatic adults?
Cohort (n=14,725)
No
Does metabolically healthy obesity increase the risk of erosive esophagitis in asymptomatic adults?
Hazard Ratio: 1.29 (95% CI 1.14–1.47)
Absolute Event Rate: 34.2% vs 19%
p-value: p=0.001
In metabolically healthy individuals, overweight and obesity are associated with an increased risk of incident erosive esophagitis compared to normal weight, indicating that the metabolically healthy obese phenotype is not protective against gastroesophageal reflux disease.
May warrant caution in metabolically healthy obesity; leaves open causality and need for confirmatory trials.
OBJECTIVES: Obesity is an established risk factor of erosive esophagitis, and metabolic unhealthiness has been implicated in the pathogenesis of erosive esophagitis. Yet, the risk of erosive esophagitis among obese individuals without obesity-related metabolic unhealthiness, a condition referred to as "metabolically healthy obese (MHO)", remains unclear. We examined the association between body mass index (BMI) categories and the development of erosive esophagitis in a cohort of metabolically healthy individuals. METHODS: We conducted a cohort study of 14,725 asymptomatic adults free of erosive esophagitis and metabolic abnormalities, who underwent repeated health checkups including screening endoscopy. A metabolically healthy state was defined as having no metabolic syndrome components and a homeostasis model assessment of insulin resistance <2.5. The presence of erosive esophagitis was determined using endoscopy. RESULTS: During 81,385.2 person-years of follow-up, 1,865 participants developed erosive esophagitis (incidence rate, 22.9 per 1,000 person-years). The multivariable adjusted hazard ratios (95% confidence intervals) for incident erosive esophagitis comparing overweight (BMI 23.0-24.9) and obese (≥25) with normal-weight participants (18.5-22.9) were 1.12 (1.00-1.25) and 1.29 (1.14-1.47), respectively. In dose-response analyses, increasing BMI also showed positive association with overall and LA-B grade or higher. The association persisted in MHO individuals without central obesity. The association between waist circumference categories and the development of erosive esophagitis was also evident. DISCUSSION: In a large cohort of strictly defined metabolically healthy men and women, the MHO phenotype was associated with an increased incidence of erosive esophagitis, providing evidence that the MHO phenotype is not protective from gastroesophageal reflux disease.
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Kim et al. (2019) conducted a cohort in Metabolically healthy adults free of erosive esophagitis (n=14,725). Obesity (BMI ≥25 kg/m²) vs. Normal weight (BMI 18.5-22.9 kg/m²) was evaluated on Incident erosive esophagitis (HR 1.29, 95% CI 1.14-1.47, p=0.001). Metabolically healthy obesity was associated with a significantly increased risk of incident erosive esophagitis compared to normal weight (HR 1.29).
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