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Background  Metabolic healthy obesity (MHO), a phenotype of obesity, seems to be associated with a lower risk of cardiovascular disease. However, MHO has a close relationship with a higher incidence of metabolic syndrome and diabetes. This study aimed to investigate the prevalence of MHO at baseline, the changes in the obese metabolic phenotype at follow-up and the relationship of this phenotype with the incidence of mildly reduced estimated glomerular filtration rate (eGFR) in rural Northeast Chinese.    Methods  The Chronic Kidney Disease Epidemiology (CKD-EPI) equation was used to calculate eGFR. A total of 4903 participants aged ≥35 years with eGFR > 90 ml/min/1.73 m 2  at baseline were enrolled and successfully followed. All participants completed the questionnaires, anthropometric measurements, and blood tests during baseline and follow-up. Mild renal dysfunction was defined as mildly reduced eGFR between 60 and 90 ml/min/1.73 m 2 .    Results  The prevalence of MHO was 20.0% at baseline (19.0% for women and 21.1% for men), which was secondary to metabolic abnormal obesity (MAO) (24.4, 27.2% for women and 21.5% for men). A total of 38.4% of women and 38.9% of men experienced phenotypic changes during follow-up. The cumulative incidence of mildly reduced eGFR in the MHO group was 20.1% (17.7% for women and 22.3% for men), which was also secondary to the incidence in the MAO group (20.8, 18.6% for women and 23.5% for men). After adjusting for age, current smoking, current drinking, chronic diseases, LDL-C, ALT, and AST, MHO was associated with a higher incidence of mildly reduced eGFR among women [OR (95% CI) =1.6 (1.2, 2.3)] and men [OR (95% CI) =1.6(1.2, 2.1)], whereas MAO was related to a higher incidence of mildly reduced eGFR among men only [OR (95% CI) =1.7 (1.3, 2.3)].    Conclusion  MHO was associated with a higher incidence of mildly reduced eGFR in both sexes; however, there was a specific relationship between MAO and mildly reduced eGFR in men only. Therefore, it is necessary to monitor kidney function among participants with both MHO and MAO.

Metabolic healthy obesity is associated with higher incidence of mild decrease estimate glomerular rate in rural northeast Chinese