Firstly, Johan compared patterns and prognosis for cardiovascular disease and mortality of middle-aged people, who are obese but NOT hospitalized (healthy obese), to the same age-class people, who are obese AND hospitalized (unhealthy obese) and lastly to people who are NOT obese (not obese). During 20 years of follow-up in the MDCS, healthy obese individuals showed lower prospective risk of total mortality and cardiovascular morbidity than unhealthy obese. Interestingly, Johan did not observe differences between healthy obese and not obese people. Secondly, Johan further explored the metabolic profiles of healthy obese people and found that compared to unhealthy obese people, there is a downregulation of potentially harmful proteomic biomarkers. To go into details, Johan further elucidated in his third study the role of anti-phosphorylcholine (anti-PC, anti-inflammatory antibodies) in hospitalized and non-hospitalized subjects with obesity. His findings show that low levels of anti-PCs were associated with higher risk of being hospitalized.
Finally, Johan used a multiplex proteomic panel of 92 proteins associated with cardiovascular diseases, metabolism and inflammation and found that increased Galectin-4 levels were also associated with higher probability of being hospitalized. Although, the results were limited to subjects with diabetes, this still further implies the role of Galectin-4 in diabetes and the resulting effects of it.