OBJECTIVES Obesity is an established risk factor of erosive esophagitis, and metabolic unhealthiness has been implicated in the pathogenesis of erosive esophagitis. Yet, the risk of erosive esophagitis among obese individuals without obesity-related metabolic unhealthiness, a condition referred to as "metabolically healthy obese (MHO)", remains unclear. We examined the association between body mass index (BMI) categories and the development of erosive esophagitis in a cohort of metabolically healthy individuals. METHODS We conducted a cohort study of 14,725 asymptomatic adults free of erosive esophagitis and metabolic abnormalities, who underwent repeated health checkups including screening endoscopy. A metabolically healthy state was defined as having no metabolic syndrome components and a homeostasis model assessment of insulin resistance <2.5. The presence of erosive esophagitis was determined using endoscopy. RESULTS During 81,385.2 person-years of follow-up, 1,865 participants developed erosive esophagitis (incidence rate, 22.9 per 1,000 person-years). The multivariable adjusted hazard ratios (95% confidence intervals) for incident erosive esophagitis comparing overweight (BMI 23.0-24.9) and obese (≥25) with normal-weight participants (18.5-22.9) were 1.12 (1.00-1.25) and 1.29 (1.14-1.47), respectively. In dose-response analyses, increasing BMI also showed positive association with overall and LA-B grade or higher. The association persisted in MHO individuals without central obesity. The association between waist circumference categories and the development of erosive esophagitis was also evident. DISCUSSION In a large cohort of strictly defined metabolically healthy men and women, the MHO phenotype was associated with an increased incidence of erosive esophagitis, providing evidence that the MHO phenotype is not protective from gastroesophageal reflux disease.

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代谢性健康肥胖与糜烂性食管炎的风险：一项队列研究。

目的肥胖是糜烂性食管炎的既定危险因素，代谢不健康与糜烂性食管炎的发病机理有关。然而，尚不清楚在没有与肥胖相关的代谢性不健康（称为“代谢健康的肥胖（MHO）”）的肥胖个体中发生侵蚀性食管炎的风险。我们研究了一组代谢健康个体的体重指数（BMI）类别与糜烂性食管炎的发展之间的关联。方法我们进行了一项队列研究，研究了14,725名无症状的无糜烂性食管炎和代谢异常的成年人，他们接受了包括筛查内窥镜检查在内的反复健康检查。代谢健康状态定义为没有代谢综合征成分，且胰岛素抵抗的动态平衡模型评估<2.5。使用内窥镜检查确定糜烂性食管炎的存在。结果在81,385.2人年的随访中，有1,865名参与者患了糜烂性食管炎（发生率，每2 000人年22.​​9）。相对于正常体重参与者（18.5-22.9）的超重（BMI 23.0-24.9）和肥胖（≥25），肥胖者（70％置信区间）的多变量校正风险比为1.12（1.00-1.25）和1.29（1.14） -1.47）。在剂量反应分析中，BMI升高也与总体和LA-B级或更高呈正相关。该协会在没有中枢性肥胖的MHO患者中持续存在。腰围类别与糜烂性食管炎的发展之间的关联也很明显。讨论在一组严格定义的代谢健康的男性和女性中，MHO表型与糜烂性食管炎的发生率增加相关，提供了证据表明MHO表型对胃食管反流疾病没有保护作用。