University of Oulu

Käräjämäki, A. J., Korkiakoski, A., Hukkanen, J., Kesäniemi, Y. A., & Ukkola, O. (2022). Long-term metabolic fate and mortality in obesity without metabolic syndrome. Annals of Medicine, 54(1), 1432–1443.

Long-term metabolic fate and mortality in obesity without metabolic syndrome

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Author: Käräjämäki, Aki Juhani1,2; Korkiakoski, Arto2,3; Hukkanen, Janne2;
Organizations: 1Department of Internal Medicine, Vaasa Central Hospital, Vaasa, Finland
2Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
3Department of Internal Medicine, Central Ostrobothnia Central Hospital, Kokkola, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 2 MB)
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Language: English
Published: Informa, 2022
Publish Date: 2022-11-16


Background: Obesity and metabolic syndrome (MetS) are known to expose to atrial fibrillation (AF), cardiovascular diseases (CVD) and mortality. Metabolically healthy obesity refers to obesity without MetS. This study aimed to investigate how obesity and MetS modify the risk of CVD, AF and mortality in very long-time follow-up.

Methods: Finnish middle-aged subjects (n = 1045) were grouped into four subgroups according to the presence of obesity and MetS. CVD events and AF were followed for 24 years and total mortality for 30 years. Moreover, 600 available patients had a follow-up visit for metabolic examinations after approximately 22 years.

Results: One-hundred and sixty-two (30%) subjects without obesity or MetS died during the follow-up. Ninety-two (17%) of the patients in this group had a CVD event and 58 (11%) were diagnosed with AF. As compared to them, obese subjects without MetS had similar metabolic fate and mortality (mortality 26 (38%), p = .143; CVD event 12 (18%), p = .858 and AF 7 (10%), p = .912, respectively), whereas subjects with obesity and MetS had greater mortality (102 (49%), p < .001), more CVD (71 (34%), p < .001) and AF (49 (23%), p < .001). Non-obese individuals with MetS had greater rates of mortality (96 (44%), p < .001) and CVD (80 (37%), p < .001), but not of AF (26 (12%), p = .606). Of the 40 subjects with obesity but without MetS at baseline and available for the follow-up visit, 15 (38%) were metabolically healthy at the follow-up visit.

Conclusions: In the present long-term follow-up study, the presence of MetS, but not obesity only, implies a greater risk of mortality and CVD. The risk of AF is increased only in subjects with both obesity and MetS. However, obesity without MetS tends to progress eventually to obesity with MetS.

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Series: Annals of medicine
ISSN: 0785-3890
ISSN-E: 1365-2060
ISSN-L: 0785-3890
Volume: 54
Issue: 1
Pages: 1432 - 1443
DOI: 10.1080/07853890.2022.2075915
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: This work was supported by the Medical Foundation of Vaasa, Vaasa, Finland and the State Research Funding of Vaasa Hospital District.
Copyright information: © 2022 The Author(s). This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.