{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T02:54:51Z","timestamp":1792292091052,"version":"4.4.0"},"reference-count":67,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,4,2]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Metabolic syndrome is associated with high risk of cardiovascular disease, although risk may differ according to the specific conditions present and variability in those conditions.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We defined obesity (body mass index [BMI] \u226530\u00a0kg\/m\n              <jats:sup>2<\/jats:sup>\n              ) and metabolic health (&lt;2 nonobesity National Cholesterol Education Program Adult Treatment Panel\u00a0III conditions) among 3632 Framingham Heart Study offspring cohort participants (mean age, 50.8\u00a0years; 53.8% women) who were followed up from 1987 to 2014. We defined participants whose variance independent of the mean for a metabolic syndrome\u2013associated measure was in the top quintile as being \u201cvariable\u201d for that measure. Variable metabolic health was defined as \u22652 variable nonobesity metabolic syndrome components. We investigated the interaction between obesity and metabolic health in their associations with cardiometabolic disease and cardiovascular disease using Cox proportional hazards regression. In addition, we estimated the associations of BMI variability and variable metabolic health with study outcomes within categories of obesity and metabolic health status, respectively. We observed 567 incident obesity (41\u00a0439\u00a0person\u2010years), 771 incident metabolically unhealthy state (25\u00a0765\u00a0person\u2010years), 272 incident diabetes mellitus (56\u00a0233\u00a0person\u2010years), 503 incident hypertension (12\u00a0957\u00a0person\u2010years), 589 cardiovascular disease (60\u00a0300\u00a0person\u2010years), and 195 chronic kidney disease (47\u00a0370\u00a0person\u2010years) events on follow\u2010up. Obesity and being metabolically unhealthy were independently and positively associated with all outcomes. BMI variability, compared with stable BMI, was associated with 163%, 67%, 58%, and 74% higher risks of having obesity, becoming metabolically unhealthy, having diabetes mellitus, and having hypertension, respectively, among nonobese participants. Variable metabolic health, compared with stable metabolic health, was associated with a 28% higher risk of cardiovascular disease, among metabolically healthy participants.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">We did not observe evidence for a positive interaction between obesity and metabolic health status with regard to study outcomes. BMI and metabolic health variability are associated with adverse health outcomes.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.118.010793","type":"journal-article","created":{"date-parts":[[2019,3,22]],"date-time":"2019-03-22T09:00:22Z","timestamp":1553245222000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":38,"title":["Association of Variability in Body Mass Index and Metabolic Health With Cardiometabolic Disease Risk"],"prefix":"10.1161","volume":"8","author":[{"given":"Todd R.","family":"Sponholtz","sequence":"first","affiliation":[{"name":"The Whitaker Cardiovascular Institute Boston University School of Medicine Boston MA"},{"name":"Section of Preventive Medicine and Epidemiology, and Cardiovascular Medicine Department of Medicine Boston University School of Medicine Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwin R.","family":"van den Heuvel","sequence":"additional","affiliation":[{"name":"Department of Mathematics and Computer Science Eindhoven University of Technology Eindhoven The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Xanthakis","sequence":"additional","affiliation":[{"name":"National Heart, Lung, and Blood Institute Framingham Heart Study Framingham MA"},{"name":"Department of Biostatistics Boston University School of Public Health Boston MA"},{"name":"Section of Preventive Medicine and Epidemiology, and Cardiovascular Medicine Department of Medicine Boston University School of Medicine Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramachandran S.","family":"Vasan","sequence":"additional","affiliation":[{"name":"National Heart, Lung, and Blood Institute Framingham Heart Study Framingham MA"},{"name":"Department of Epidemiology Boston University School of Public Health Boston MA"},{"name":"Section of Preventive Medicine and Epidemiology, and Cardiovascular Medicine Department of Medicine Boston University School of Medicine Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(88)90402-0"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.4065\/81.12.1615"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.HYP.0000251934.55488.ae"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/83.6.1237"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/34.8.1617"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mam.2012.10.004"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/2047487315623884"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.13230"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.09.077"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-15-0449"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0176665"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-14-1033"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0039461"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/obr.12251"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacl.2017.12.003"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11906-015-0537-1"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/obr.12250"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1038\/hr.2014.89"},{"key":"e_1_3_3_20_2","first-page":"694","article-title":"Obesity is associated with visit\u2010to\u2010visit systolic blood pressure variability in the US adults","volume":"37","author":"Faramawi MF","year":"2015","unstructured":"Faramawi MF, Fischbach L, Delongchamp R, Cardenas V, Abouelenien S, Chedjieu IP, Taha N. 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