Diabetes, Heart and Cardiovascular Diseases News Chronicle.  Diabetes, Cardiovascular and Heart Diseases
 Article 332
    Published on July 1, 2018


"Fat But Fit" people are at higher risk of heart disease

Earlier studies have suggested "obesity paradox", a medical hypothesis, which says overweight or obesity might offer a heart-protective effect and greater survival chances to some elderly individuals or to people with certain chronic diseases. Another study has suggested that middle-aged people with higher body mass index (BMI) may live longer compared to the people with normal body mass index (BMI).


Authors of the current study say earlier study findings are conflicting on the association between body mass index (BMI) and the risk to the development of cardiovascular diseases (CVD), especially among middle-aged people with low categories of body mass index (BMI). Earlier studies did not account for other body composition measures such fat distribution pattern throughout the body, fat-free mass (or lean body mass), body fat percentage etc. This study shows that the obesity paradox is due to the confusion in the body fat calculation.

A large study conducted by the UK researchers shows an increase in the heart disease and stroke events and negative health benefits such as blood pressure with an increase in the body weight. In this study, researchers used five different measures to assess the body composition of healthy people and their associated cardiovascular disease (CVD) risks. The measures used by the researchers to assess the body composition are

  • Body mass index (BMI).
  • Waist circumference.
  • Waist-to-hip ratio (WHR).
  • Waist-to-height ratio (WHtR).
  • Percentage body fat (BFP).

Researchers have conducted a five-year follow-up study on more than 296,535 European middle-aged people, both men, and women but without heart and cardiovascular diseases (CVD). About 57.8 percent of them are women. Many of them are overweight or obese. They used the UK biobank for the study purpose.


The increased heart disease risks associated with the increased body adiposity are irrespective of other conventional heart disease risk factors such as inactivity or socioeconomic status. There is an enhanced risk to the development of cardiovascular disease (CVD) with the increase in body fat percentage and waist-to-hip ratio. Incidents of heart attack, stroke or cardiovascular events were observed in 3.3 percent of the women and 5.7 percent of the men.

When compared with those people with a body mass index (BMI) of 22 kg/meter2, there was 13 percent increase in heart attack or stroke risks with 5.2 point increase in BMI for women and 4.3 point increase in BMI for men.

In women, there is a 16 percent enhanced risk of cardiovascular disease (CVD) with a 5-inch increase in waist circumference beyond 29 inches compared to women with normal body mass index (BMI) of 22 kg/meter2. Correspondingly in men, the study has found 10 percent enhanced risk of cardiovascular disease with a 4.5-inch increase in waist circumference beyond 33 inches compared to men with normal body mass index (BMI) of 22 kg/meter2.

The study provides the evidence linking the increase in the body weight to the increase in the heart and cardiovascular diseases. This study also says there is a need to assess other health parameters such as fat percentage, waist-to-hip ratio, waist circumference to calculate obesity of a person as body mass index (BMI) is an imperfect indicator for body weight and does not differentiate between lean muscle mass and body fat.

Authors say that the heart and cardiovascular disease risk associated with overweight or obesity may not be lowered by just maintaining healthy body mass index (BMI). It is important to do regular exercise (or workout) along with healthy body mass index (BMI) to lower heart and cardiovascular risks.

Authors say even though an overweight (or obese) person may be healthy, the person is at greater risk of heart attack, stroke or cardiovascular diseases compared with normal BMI person having exactly same risk factors.



A study shows that the obesity paradox is due to the confusion in the body fat calculation.

The lead author of the study was Dr. Stamatina Iliodromiti, a lecturer in obstetrics and gynecology and MRC Fellow, School of Medicine, the University of Glasgow. Co-author of the study was Dr. Naveed Sattar, Professor of Metabolic Medicine, the University of Glasgow. The study findings were published March 16, 2018, in the European Heart Journal. Title of the article was "The impact of confounding on the associations of different adiposity measures with the incidence of cardiovascular disease: a cohort study of 296,535 adults of white European descent." DOI : doi.org/10.1093/eurheartj/ehy057




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