{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T16:33:29Z","timestamp":1789576409459,"version":"build-2803163510"},"reference-count":30,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Center for Chronic and Noncommunicable Disease Control and Prevention","award":["2023ZD0508404"],"award-info":[{"award-number":["2023ZD0508404"]}]},{"award":["2023ZD0508404"],"award-info":[{"award-number":["2023ZD0508404"]}],"id":[{"id":"https:\/\/ror.org\/01r58sr54","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Metabolites"],"abstract":"<jats:p>Background\/Objectives: Metabolic-obesity phenotypes are dynamic, yet little is known about how their longitudinal transitions affect cardiovascular disease (CVD) risk. We aimed to characterize these transitions and examine their associations with incident CVD in middle-aged and older Chinese adults. Methods: We included 4516 participants from the China Health and Retirement Longitudinal Study (CHARLS) who were free of CVD at the follow-up baseline (wave 3). Metabolic-obesity phenotypes (metabolically healthy non-obese [MHNO], metabolically unhealthy non-obese [MUNO], metabolically healthy obese [MHO], and metabolically unhealthy obese [MUO]) were assessed in 2011 and 2015, and six trajectory patterns were defined. Incident CVD (heart disease or stroke) was ascertained from 2015 to 2020. Cox proportional hazards models estimated associations between trajectory groups and incident CVD, and Kaplan\u2013Meier curves compared cumulative incidence across groups. Results: Stable MHNO accounted for 35.96% of the cohort, whereas the stable non-MHNO group accounted for 28.06%. After multivariable adjustment, the small obesity recovery group (n = 89) showed an elevated CVD risk estimate compared with the stable MHNO (HR 2.32, 95% CI 1.33\u20134.05), while stable non-MHNO group were associated with higher CVD risk (HR 1.72, 95% CI 1.36\u20132.18). Incident obesity showed elevated but non-significant risk (HR 1.71, 95% CI 0.94\u20133.10), and metabolic decline showed borderline significance (HR 1.36, 95% CI 1.00\u20131.85). Sex-stratified analyses showed heterogeneous risk patterns. Conclusions: Metabolic-obesity phenotypes are dynamic, but unfavorable phenotypes often persist. The obesity recovery group, defined using BMI, may represent a heterogeneous group and does not necessarily indicate true cardiometabolic recovery; the observed association should not be interpreted as evidence that weight loss itself increases CVD risk. These findings highlight the importance of jointly considering longitudinal changes in metabolic health and obesity when examining their associations with incident CVD.<\/jats:p>","DOI":"10.3390\/metabo16070510","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T16:16:39Z","timestamp":1784650599000},"page":"510","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Longitudinal Transitions of Metabolic-Obesity Phenotypes and Subsequent Cardiovascular Disease Risk: A Prospective Analysis of the CHARLS Cohort"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-3162-5590","authenticated-orcid":false,"given":"Wenjing","family":"Yan","sequence":"first","affiliation":[{"name":"Department of Elderly Nutrition and Clinical Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaona","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Elderly Nutrition and Clinical Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingqing","family":"Man","sequence":"additional","affiliation":[{"name":"Department of Elderly Nutrition and Clinical Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China"},{"name":"NHC Key Laboratory of Public Health and Nutrition, Beijing 100050, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanshan","family":"Jia","sequence":"additional","affiliation":[{"name":"Department of Elderly Nutrition and Clinical Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjing","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Elderly Nutrition and Clinical Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Elderly Nutrition and Clinical Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rongzhen","family":"Li","sequence":"additional","affiliation":[{"name":"NHC Specialty Laboratory of Food Safety Risk Assessment and Standard Development, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6631-5254","authenticated-orcid":false,"given":"Lianlong","family":"Yu","sequence":"additional","affiliation":[{"name":"Shandong Center for Disease Control and Prevention, Shandong Provincial Academy of Preventive Medicine, Jinan 250014, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5227-4236","authenticated-orcid":false,"given":"Liangkai","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Food Hygiene, School of Public Health, Huazhong University of Science and Technology, Wuhan 430030, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Elderly Nutrition and Clinical Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China"},{"name":"NHC Key Laboratory of Public Health and Nutrition, Beijing 100050, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2332-7500","authenticated-orcid":false,"given":"Pengkun","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Elderly Nutrition and Clinical Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China"},{"name":"NHC Key Laboratory of Public Health and Nutrition, Beijing 100050, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1161\/CIRCULATIONAHA.118.033484","article-title":"Epidemic of cardiovascular disease in China: Current perspective and prospects for the 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