Endocr Pract. 2026 Oct 25:S1530-891X(26)01294-2. doi: 10.1016/j.eprac.2026.10.011. Online ahead of print.
ABSTRACT
OBJECTIVE: A new metabolic health definition has been developed for cardiovascular disease (CVD) risk stratification. This study aimed to assess the stability of this newly defined metabolic health status and evaluate the association of its transitions with CVD risk.
METHODS: This study included 7 395 UK Biobank participants. Metabolic health was defined using the new and the Adult Treatment Panel-III (ATP-III) definition. Participants were cross-classified based on their body mass index (BMI) (normal weight, overweight/obesity) and metabolic health (healthy, unhealthy) at baseline. The transitions of metabolic health status were assessed at the first repeat assessment. Cox proportional hazards models were used to examine the association between metabolic health transitions and CVD risks. Extreme gradient boosting and Shapley additive explanations were used to explore predictors of metabolic transition within the metabolically healthy overweight/obesity (MHOO) population.
RESULTS: Using the new and ATP-III definition respectively, 40.9% and 23.7% of participants with MHOO transitioned to metabolically unhealthy status. Under the new definition, baseline MHOO participants who became metabolically unhealthy exhibited an elevated CVD risk (HR = 1.71, 95% CI: 1.14-2.56), whereas maintaining metabolic health was not significantly associated with increased CVD risk, compared with normal-weight participants maintaining metabolic health. Systolic blood pressure, age, and BMI were the main predictors of metabolic transition.
CONCLUSIONS: The newly defined metabolic health yielded a higher reclassification rate over time and maintaining metabolic health was not significantly associated with increased CVD risk. These findings emphasize the importance of periodic health monitoring and preventing metabolic deterioration.
PMID:42927833 | DOI:10.1016/j.eprac.2026.10.011