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Schulze MB, Stefan N. Metabolically healthy obesity: from epidemiology and mechanisms to clinical implications. Nat Rev Endocrinol 2024; 20:633-646. [PMID: 38937638 DOI: 10.1038/s41574-024-01008-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 06/29/2024]
Abstract
The concept of metabolic health, particularly in obesity, has attracted a lot of attention in the scientific community, and is being increasingly used to determine the risk of cardiovascular diseases and diabetes mellitus-related complications. This Review assesses the current understanding of metabolically healthy obesity (MHO). First, we present the historical evolution of the concept. Second, we discuss the evidence for and against its existence, the usage of different definitions of MHO over the years and the efforts made to provide novel definitions of MHO. Third, we highlight epidemiological data with regard to cardiovascular risk in MHO, which is estimated to be moderately elevated using widely used definitions of MHO when compared with individuals with metabolically healthy normal weight, but potentially not elevated using a novel definition of MHO. Fourth, we discuss novel findings about the physiological mechanisms involved in MHO and how such knowledge helps to identify and characterize both people with MHO and those with metabolically unhealthy normal weight. Finally, we address how the concept of MHO can be used for risk stratification and treatment in clinical practice.
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Affiliation(s)
- Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
- German Center for Diabetes Research, Neuherberg, Germany.
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany.
| | - Norbert Stefan
- German Center for Diabetes Research, Neuherberg, Germany
- Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Centre Munich, Tübingen, Germany
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2
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Junker D, Wu M, Reik A, Raspe J, Rupp S, Han J, Näbauer SM, Wiechert M, Somasundaram A, Burian E, Waschulzik B, Makowski MR, Hauner H, Holzapfel C, Karampinos DC. Impact of baseline adipose tissue characteristics on change in adipose tissue volume during a low calorie diet in people with obesity-results from the LION study. Int J Obes (Lond) 2024; 48:1332-1341. [PMID: 38926461 PMCID: PMC11347377 DOI: 10.1038/s41366-024-01568-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND/OBJECTIVES Weight loss outcomes vary individually. Magnetic resonance imaging (MRI)-based evaluation of adipose tissue (AT) might help to identify AT characteristics that predict AT loss. This study aimed to assess the impact of an 8-week low-calorie diet (LCD) on different AT depots and to identify predictors of short-term AT loss using MRI in adults with obesity. METHODS Eighty-one adults with obesity (mean BMI 34.08 ± 2.75 kg/m², mean age 46.3 ± 10.97 years, 49 females) prospectively underwent baseline MRI (liver dome to femoral head) and anthropometric measurements (BMI, waist-to-hip-ratio, body fat), followed by a post-LCD-examination. Visceral and subcutaneous AT (VAT and SAT) volumes and AT fat fraction were extracted from the MRI data. Apparent lipid volumes based on MRI were calculated as approximation for the lipid contained in the AT. SAT and VAT volumes were subdivided into equidistant thirds along the craniocaudal axis and normalized by length of the segmentation. T-tests compared baseline and follow-up measurements and sex differences. Effect sizes on subdivided AT volumes were compared. Spearman Rank correlation explored associations between baseline parameters and AT loss. Multiple regression analysis identified baseline predictors for AT loss. RESULTS Following the LCD, participants exhibited significant weight loss (11.61 ± 3.07 kg, p < 0.01) and reductions in all MRI-based AT parameters (p < 0.01). Absolute SAT loss exceeded VAT loss, while relative apparent lipid loss was higher in VAT (both p < 0.01). The lower abdominopelvic third showed the most significant SAT and VAT reduction. The predictor of most AT and apparent lipid losses was the normalized baseline SAT volume in the lower abdominopelvic third, with smaller volumes favoring greater AT loss (p < 0.01 for SAT and VAT loss and SAT apparent lipid volume loss). CONCLUSIONS The LCD primarily reduces lower abdominopelvic SAT and VAT. Furthermore, lower abdominopelvic SAT volume was detected as a potential predictor for short-term AT loss in persons with obesity.
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Affiliation(s)
- Daniela Junker
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Technical University of Munich, Munich, Germany.
| | - Mingming Wu
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Anna Reik
- Institute for Nutritional Medicine, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Johannes Raspe
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Selina Rupp
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Jessie Han
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Stella M Näbauer
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Meike Wiechert
- Institute for Nutritional Medicine, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Arun Somasundaram
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Egon Burian
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Birgit Waschulzik
- Institute of AI and Informatics in Medicine, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Marcus R Makowski
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Hans Hauner
- Institute for Nutritional Medicine, School of Medicine and Health, Technical University of Munich, Munich, Germany
- Else Kroener-Fresenius-Center of Nutritional Medicine, School of Life Sciences, Technical University of Munich, Freising, Germany
| | - Christina Holzapfel
- Institute for Nutritional Medicine, School of Medicine and Health, Technical University of Munich, Munich, Germany
- Department of Nutritional, Food and Consumer Sciences, Fulda University of Applied Sciences, Fulda, Germany
| | - Dimitrios C Karampinos
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Technical University of Munich, Munich, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, Garching, Germany
- Munich Data Science Institute, Technical University of Munich, Garching, Germany
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3
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Tremblay EJ, Peyrel P, Karelis AD, Rabasa-Lhoret R, Tchernof A, Joanisse DR, Mauriège P. Resistance training and cardiometabolic risk in women with metabolically healthy and unhealthy obesity. Appl Physiol Nutr Metab 2024; 49:1068-1082. [PMID: 38648673 DOI: 10.1139/apnm-2023-0279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Despite some reported benefits, there is a low quality of evidence for resistance training (RT) improving metabolic health of individuals with overweight or obesity. We evaluated the impact of RT on body composition, cardiorespiratory fitness (CRF) and physical performance, lipid-lipoprotein profile, inflammation, and glucose-insulin homeostasis in 51 postmenopausal women versus 29 controls matched for age, obesity, and physical activity. Exercised women were further subdivided for comparison of RT effects into those presenting metabolically healthy obesity (MHO) and those with metabolically unhealthy obesity (MUHO) classified according to Karelis and Rabasa-Lhoret or an approach based on adipose tissue secretory dysfunction using the plasma adiponectin(A)/leptin (L) ratio. Participants followed a 4-month weekly RT program targeting major muscle groups (3 × 10 repetitions at 80% one repetition maximum (1-RM)). Percent fat marginally decreased and lean body mass increased (0.01 < p < 0.05) while CRF and muscular strength improved in all women, after RT (effect size (ES): 0.11-1.21 (trivial to large effects), p ˂ 0.01). Fasting plasma triacylglycerol and high-density lipoprotein-cholesterol levels slightly increased and decreased, respectively, in participants with MHO using the A/L ratio approach (ES: -0.47 to 1.07 (small to large effects), p ˂ 0.05). Circulating interleukin-6 soluble receptor decreased in both groups and soluble tumor necrosis factor receptor-1/soluble tumor necrosis factor receptor-2 in women with MUHO only, irrespective of definition (ES: -0.42 to -0.84 (small to large effects), p ˂ 0.05). Glucose-insulin homeostasis was unchanged regardless of group or definition. RT improved physical performance and body composition but had a lesser impact on cardiometabolic risk in women with obesity, irrespective of their metabolic phenotype.
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Affiliation(s)
- Eve-Julie Tremblay
- École de nutrition, Université Laval, Québec, QC, Canada
- Centre de recherche de l'institut de cardiologie et pneumologie de Québec (CRIUCPQ), Université Laval, Québec, QC, Canada
| | - Paul Peyrel
- Centre de recherche de l'institut de cardiologie et pneumologie de Québec (CRIUCPQ), Université Laval, Québec, QC, Canada
- Département de kinésiologie, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Antony D Karelis
- Département des sciences de l'activité physique, Université du Québec à Montréal, Montréal, QC, Canada
| | - Rémi Rabasa-Lhoret
- Département de nutrition, Université de Montréal, Montréal, QC, Canada
- Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - André Tchernof
- École de nutrition, Université Laval, Québec, QC, Canada
- Centre de recherche de l'institut de cardiologie et pneumologie de Québec (CRIUCPQ), Université Laval, Québec, QC, Canada
| | - Denis R Joanisse
- Centre de recherche de l'institut de cardiologie et pneumologie de Québec (CRIUCPQ), Université Laval, Québec, QC, Canada
- Département de kinésiologie, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Pascale Mauriège
- Centre de recherche de l'institut de cardiologie et pneumologie de Québec (CRIUCPQ), Université Laval, Québec, QC, Canada
- Département de kinésiologie, Faculté de médecine, Université Laval, Québec, QC, Canada
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Kawai S, Yamakage H, Kotani K, Noda M, Satoh-Asahara N, Hashimoto K. Differences in metabolic characteristics between Metabolically Healthy Obesity (MHO) and Metabolically Unhealthy Obesity (MUO) in weight reduction therapy. Endocr J 2023; 70:1175-1186. [PMID: 37793817 DOI: 10.1507/endocrj.ej23-0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
Metabolically Healthy Obesity (MHO) is generally recognized as the absence of any metabolic disorders and cardiovascular diseases, including type 2 diabetes, dyslipidemia, and hypertension, in obese individuals; however, it is not clearly defined. Therefore, the present study investigated differences in metabolic characteristics between individuals with MHO and Metabolically Unhealthy Obesity (MUO) during weight reduction therapy. The key factors defining MHO and the importance of weight reduction therapy for MHO were also examined. Cohort data from the Japan Obesity and Metabolic Syndrome (JOMS) study were analyzed. Subjects were divided into the MHO (n = 25) and MUO (n = 120) groups. Prior to weight reduction therapy, serum adiponectin levels were significantly higher in the MHO group than in the MUO group. Serum adiponectin levels also negatively correlated with the area of subcutaneous adipose tissue (SAT) and Homeostasis model assessment (HOMA)-R in the MHO group, but not in the MUO group. Collectively, the present results suggest the importance of adiponectin for maintaining metabolic homeostasis in the MHO group. On the other hand, no significant differences were observed in inflammatory markers between the MHO and MUO groups, suggesting the presence of chronic inflammation in both groups. Furthermore, a positive correlation was noted between changes in serum cystatin C levels and waist circumference in the MHO group, which indicated that despite the absence of metabolic disorders, the MHO group exhibited anti-inflammatory responses during weight reduction therapy. These results underscore the significance of weight reduction even for individuals with MHO.
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Affiliation(s)
- Shiori Kawai
- Department of Diabetes, Endocrinology and Hematology, Dokkyo Medical University Saitama Medical Center, Saitama 343-8555, Japan
- Department of Diabetes Mellitus, Saitama Cooperative Hospital, Saitama 333-0831, Japan
| | - Hajime Yamakage
- Division of Diabetic Research, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Jichi Medical University, Tochigi 329-0498, Japan
| | - Mitsuhiko Noda
- Department of Diabetes, Metabolism and Endocrinology, Ichikawa Hospital, International University of Health and Welfare, Chiba 272-0827, Japan
- Department of Endocrinology and Diabetes, Saitama Medical University, Saitama 350-0495, Japan
| | - Noriko Satoh-Asahara
- Division of Diabetic Research, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
- Department of Metabolic Syndrome and Nutritional Science, Research Institute of Environmental Medicine, Nagoya University, Aichi 464-8601, Japan
| | - Koshi Hashimoto
- Department of Diabetes, Endocrinology and Hematology, Dokkyo Medical University Saitama Medical Center, Saitama 343-8555, Japan
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Blaak EE, Goossens GH. Metabolic phenotyping in people living with obesity: Implications for dietary prevention. Rev Endocr Metab Disord 2023; 24:825-838. [PMID: 37581871 PMCID: PMC10492670 DOI: 10.1007/s11154-023-09830-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 08/16/2023]
Abstract
Given the increasing number of people living with obesity and related chronic metabolic disease, precision nutrition approaches are required to increase the effectiveness of prevention strategies. This review addresses these approaches in different metabolic phenotypes (metabotypes) in obesity. Although obesity is typically associated with an increased cardiometabolic disease risk, some people with obesity are relatively protected against the detrimental effects of excess adiposity on cardiometabolic health, also referred to as 'metabolically healthy obesity' (MHO). Underlying mechanisms, the extent to which MHO is a transient state as well as lifestyle strategies to counteract the transition from MHO to metabolically unhealthy obesity (MUO) are discussed. Based on the limited resources that are available for dietary lifestyle interventions, it may be reasonable to prioritize interventions for people with MUO, since targeting high-risk patients for specific nutritional, lifestyle or weight-loss strategies may enhance the cost-effectiveness of these interventions. Additionally, the concept of tissue insulin resistant (IR) metabotypes is discussed, representing distinct etiologies towards type 2 diabetes (T2D) as well as cardiovascular disease (CVD). Recent evidence indicates that these tissue IR metabotypes, already present in individuals with obesity with a normal glucose homeostasis, respond differentially to diet. Modulation of dietary macronutrient composition according to these metabotypes may considerably improve cardiometabolic health benefits. Thus, nutritional or lifestyle intervention may improve cardiometabolic health, even with only minor or no weight loss, which stresses the importance of focusing on a healthy lifestyle and not on weight loss only. Targeting different metabotypes towards T2D and cardiometabolic diseases may lead to more effective lifestyle prevention and treatment strategies. Age and sex-related differences in tissue metabotypes and related microbial composition and functionality (fermentation), as important drivers and/or mediators of dietary intervention response, have to be taken into account. For the implementation of these approaches, more prospective trials are required to provide the knowledge base for precision nutrition in the prevention of chronic metabolic diseases.
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Affiliation(s)
- Ellen E Blaak
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Gijs H Goossens
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Zhu R, Huttunen-Lenz M, Stratton G, Handjieva-Darlenska T, Handjiev S, Sundvall J, Silvestre MP, Jalo E, Pietiläinen KH, Adam TC, Drummen M, Simpson EJ, Taylor MA, Poppitt SD, Navas-Carretero S, Martinez JA, Schlicht W, Fogelholm M, Brand-Miller J, Raben A. Associations of obesity phenotypes with weight change, cardiometabolic benefits, and type 2 diabetes incidence during a lifestyle intervention: results from the PREVIEW study. Int J Obes (Lond) 2023; 47:833-840. [PMID: 37420008 DOI: 10.1038/s41366-023-01328-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/15/2023] [Accepted: 06/01/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND/OBJECTIVES Some individuals with overweight/obesity may be relatively metabolically healthy (MHO) and have a lower risk of cardiovascular disease than those with metabolically unhealthy overweight/obesity (MUO). We aimed to compare changes in body weight and cardiometabolic risk factors and type 2 diabetes incidence during a lifestyle intervention between individuals with MHO vs MUO. METHODS This post-hoc analysis included 1012 participants with MHO and 1153 participants with MUO at baseline in the randomized trial PREVIEW. Participants underwent an eight-week low-energy diet phase followed by a 148-week lifestyle-based weight-maintenance intervention. Adjusted linear mixed models and Cox proportional hazards regression models were used. RESULTS There were no statistically significant differences in weight loss (%) between participants with MHO vs MUO over 156 weeks. At the end of the study, weight loss was 2.7% (95% CI, 1.7%-3.6%) in participants with MHO and 3.0% (2.1%-4.0%) in those with MUO. After the low-energy diet phase, participants with MHO had smaller decreases in triglyceride (mean difference between MHO vs MUO 0.08 mmol·L-1 [95% CI, 0.04-0.12]; P < 0.001) but similar reductions in fasting glucose and HOMA-IR than those with MUO. However, at the end of weight maintenance, those with MHO had greater reductions in triglyceride (mean difference -0.08 mmol·L-1 [-0.12--0.04]; P < 0.001), fasting glucose, 2-hour glucose (difference -0.28 mmol·L-1 [-0.41--0.16]; P < 0.001), and HOMA-IR than those with MUO. Participants with MHO had smaller decreases in diastolic blood pressure and HbA1c and greater decreases in HDL cholesterol after weight loss than those with MUO, whereas the statistically significant differences disappeared at the end of weight maintenance. Participants with MHO had lower 3-year type 2 diabetes incidence than those with MUO (adjusted hazard ratio 0.37 [0.20-0.66]; P < 0.001). CONCLUSIONS Individuals with MUO had greater improvements in some cardiometabolic risk factors during the low-energy diet phase, but had smaller improvements during long-term lifestyle intervention than those with MHO.
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Affiliation(s)
- Ruixin Zhu
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Maija Huttunen-Lenz
- Institute for Nursing Science, University of Education Schwäbisch Gmünd, Schwäbisch Gmünd, Germany
| | - Gareth Stratton
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, UK
| | | | - Svetoslav Handjiev
- Department of Pharmacology and Toxicology, Medical University of Sofia, Sofia, Bulgaria
| | - Jouko Sundvall
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Marta P Silvestre
- Human Nutrition Unit, School of Biological Sciences, Department of Medicine, University of Auckland, Auckland, New Zealand
- CINTESIS, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Elli Jalo
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Kirsi H Pietiläinen
- Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Abdominal Center, Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tanja C Adam
- Department of Nutrition and Movement Sciences, NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Mathijs Drummen
- Department of Nutrition and Movement Sciences, NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Elizabeth J Simpson
- MRC/ARUK Centre for Musculoskeletal Ageing Research, ARUK Centre for Sport, Exercise and Osteoarthritis, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
| | - Moira A Taylor
- MRC/ARUK Centre for Musculoskeletal Ageing Research, ARUK Centre for Sport, Exercise and Osteoarthritis, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Queen's Medical Centre, Nottingham, UK
| | - Sally D Poppitt
- Human Nutrition Unit, School of Biological Sciences, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Santiago Navas-Carretero
- Centre for Nutrition Research, University of Navarra, Pamplona, Spain
- Centro de Investigacion Biomedica en Red Area de Fisiologia de la Obesidad y la Nutricion (CIBEROBN), Madrid, Spain
- IdisNA Instituto for Health Research, Pamplona, Spain
| | - J Alfredo Martinez
- Centro de Investigacion Biomedica en Red Area de Fisiologia de la Obesidad y la Nutricion (CIBEROBN), Madrid, Spain
- Precision Nutrition and Cardiometabolic Health Program, IMDEA-Food Institute (Madrid Institute for Advanced Studies), CEI UAM+CSIC, Madrid, Spain
- Department of Nutrition and Physiology, University of Navarra, Pamplona, Spain
| | - Wolfgang Schlicht
- Department of Exercise and Health Sciences, University of Stuttgart, Stuttgart, Germany
| | - Mikael Fogelholm
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Jennie Brand-Miller
- School of Life and Environmental Sciences and Charles Perkins Centre, the University of Sydney, Sydney, NSW, Australia
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark.
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Tanriover C, Copur S, Gaipov A, Ozlusen B, Akcan RE, Kuwabara M, Hornum M, Van Raalte DH, Kanbay M. Metabolically healthy obesity: Misleading phrase or healthy phenotype? Eur J Intern Med 2023; 111:5-20. [PMID: 36890010 DOI: 10.1016/j.ejim.2023.02.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/16/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023]
Abstract
Obesity is a heterogenous condition with multiple different phenotypes. Among these a particular subtype exists named as metabolically healthy obesity (MHO). MHO has multiple definitions and its prevalence varies according to study. The potential mechanisms underlying the pathophysiology of MHO include the different types of adipose tissue and their distribution, the role of hormones, inflammation, diet, the intestinal microbiota and genetic factors. In contrast to the negative metabolic profile associated with metabolically unhealthy obesity (MUO), MHO has relatively favorable metabolic characteristics. Nevertheless, MHO is still associated with many important chronic diseases including cardiovascular disease, hypertension, type 2 diabetes, chronic kidney disease as well as certain types of cancer and has the risk of progression into the unhealthy phenotype. Therefore, it should not be considered as a benign condition. The major therapeutic alternatives include dietary modifications, exercise, bariatric surgery and certain medications including glucagon-like peptide-1 (GLP-1) analogs, sodium-glucose cotransporter-2 (SGLT-2) inhibitors and tirzepatide. In this review, we discuss the significance of MHO while comparing this phenotype with MUO.
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Affiliation(s)
- Cem Tanriover
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Abduzhappar Gaipov
- Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan; Clinical Academic Department of Internal Medicine, CF "University Medical Center", Astana, Kazakhstan
| | - Batu Ozlusen
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Rustu E Akcan
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | | | - Mads Hornum
- Department of Nephrology, Rigshospitalet, Inge Lehmanns Vej 7, Copenhagen 2100, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Daniel H Van Raalte
- Diabetes Center, Department of Internal Medicine, Amsterdam University Medical Center, Loaction VUMC, Amsterdam, the Netherlands
| | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul 34010, Turkey.
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8
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Le Jemtel TH, Samson R, Oparil S. Integrated Care Model of Adiposity-Related Chronic Diseases. Curr Hypertens Rep 2022; 24:563-570. [PMID: 36083439 DOI: 10.1007/s11906-022-01223-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Although obesity is a disease, most patients with obesity do not undergo effective treatment nor adhere to long-term care. We examine the barriers that patients with obesity confront when searching for effective treatment and propose an integrated care model of adiposity-related chronic diseases in a cardio-renal metabolic unit. RECENT FINDINGS The current care of obesity is fragmented between primary care providers, medical specialists and metabolic bariatric surgeons with little or no coordination of care between these providers. The current care of obesity heavily focuses on weight loss as the primary aim of treatment thereby reenforcing the weight stigma and turning patients away from effective therapy like metabolic bariatric surgery. An interdisciplinary cardio-renal metabolic unit that, besides weight loss, emphasizes prevention/remission of adiposity-related chronic diseases may deliver thorough and rewarding care to most patients with obesity.
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Affiliation(s)
- Thierry H Le Jemtel
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA.
| | - Rohan Samson
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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9
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Yang Q, Wang K, Tian Q, Zhang J, Qi L, Chen T. Effect of Diet and Exercise-Induced Weight Loss among Metabolically Healthy and Metabolically Unhealthy Obese Children and Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106120. [PMID: 35627657 PMCID: PMC9141466 DOI: 10.3390/ijerph19106120] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 12/17/2022]
Abstract
Objective: To study the effect of diet- and exercise-based lifestyle intervention on weight loss (WL) and cardiovascular risk among metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO) children and adolescents. Methods: The sample included 282 obese individuals (54% males, age (±SD) 12.9 (±2.3) years) who completed a 3- to 4-week WL camp program between 2017 and 2019. MUO was defined according to the consensus-based definition of pediatric MHO in 2018. Results: The intervention exhibited significantly benefits in improving body weight, body mass index, body fat ratio, waist circumference, systolic blood pressure (SBP), diastolic blood pressure (DBP), resting heart rate (RHR), triglycerides (TG), total cholesterol, and low-density lipoprotein−cholesterol levels in both MHO and MUO groups (for all comparisons, p < 0.01). However, the beneficial high-density lipoprotein−cholesterol (HDL-C) level (both p < 0.01) decreased evidently in both groups after intervention. In addition, percent changes in SBP (p < 0.001), DBP (p < 0.001), RHR (p = 0.025), fasting blood glucose (p = 0.011), and TG (p < 0.001) were more profound in MUO group than that in MHO group. Conclusion: Metabolical health is a mutable and transient state during childhood. Although both groups gained comparable WL benefits from diet- and exercise-based lifestyle intervention, the MUO group may benefit more than the MHO group. Strategies aiming at lowering blood pressure and preventing the decrease of HDL-C level should be considered for the precise treatment of childhood obesity in clinical practice, with the goal of improving metabolically healthy state.
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Affiliation(s)
- Qin Yang
- International College of Football, Tongji University, Shanghai 200092, China; (Q.Y.); (J.Z.); (L.Q.)
| | - Kun Wang
- Shanghai Dianfeng Sports Management Co., Ltd., Shanghai 200441, China
- Correspondence: (K.W.); (T.C.)
| | - Qianqian Tian
- Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;
- China Hospital Management Institute, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Jian Zhang
- International College of Football, Tongji University, Shanghai 200092, China; (Q.Y.); (J.Z.); (L.Q.)
| | - Linyu Qi
- International College of Football, Tongji University, Shanghai 200092, China; (Q.Y.); (J.Z.); (L.Q.)
| | - Tao Chen
- Sports and Health Research Center, Department of Physical Education, Tongji University, Shanghai 200092, China
- Correspondence: (K.W.); (T.C.)
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10
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The Role of Intermittent Energy Restriction Diet on Metabolic Profile and Weight Loss among Obese Adults. Nutrients 2022; 14:nu14071509. [PMID: 35406122 PMCID: PMC9002823 DOI: 10.3390/nu14071509] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/02/2022] [Accepted: 04/03/2022] [Indexed: 02/01/2023] Open
Abstract
Obesity is a disease defined by an elevated body mass index (BMI), which is the result of excessive or abnormal accumulation of fat. Dietary intervention is fundamental and essential as the first-line treatment for obese patients, and the main rule of every dietary modification is calorie restriction and consequent weight loss. Intermittent energy restriction (IER) is a special type of diet consisting of intermittent pauses in eating. There are many variations of IER diets such as alternate-day fasting (ADF) and time-restricted feeding (TRF). In the literature, the IER diet is known as an effective method for bodyweight reduction. Furthermore, IER diets have a beneficial effect on systolic or diastolic pressure, lipid profile, and glucose homeostasis. In addition, IER diets are presented as being as efficient as a continuous energy restriction diet (CER) in losing weight and improving metabolic parameters. Thus, the IER diet could present an alternative option for those who cannot accept a constant food regimen.
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11
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Soll D, Gawron J, Pletsch-Borba L, Spranger J, Mai K. Long-term impact of the metabolic status on weight loss-induced health benefits. Nutr Metab (Lond) 2022; 19:25. [PMID: 35346256 PMCID: PMC8962471 DOI: 10.1186/s12986-022-00660-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/16/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND While short-term effects of weight loss on quality of life and metabolic aspects appear to be different in metabolically healthy (MHO) and metabolically unhealthy obese (MUO), respective long-term data is still missing. Given the high relevance of long-term changes, we aimed to address these in this post-hoc analysis of the MAINTAIN trial. METHODS We analyzed 143 overweight/obese subjects (BMI ≥ 27 kg/m2, age ≥ 18 years) before and after a 3-month weight loss program (≥ 8% weight loss), after a 12-month period of a randomized weight maintenance intervention (n = 121), and after another 6 months without intervention (n = 112). Subjects were retrospectively grouped into MHO and MUO by the presence of metabolic syndrome and secondarily by estimates of insulin sensitivity (HOMA-IR and ISIClamp). Quality of life (QoL), blood pressure, lipids, HOMA-IR, and ISIClamp were assessed and evaluated using mixed model analyses. RESULTS Despite similar short- and long-term weight loss, weight loss-induced improvement of HOMA-IR was more pronounced in MUO than MHO after 3 months (MHO: 2.4[95%-CI: 1.9-2.9] vs. 1.6[1.1-2.1], p = 0.004; MUO: 3.6[3.2-4.0] vs. 2.0[1.6-2.4], p < 0.001; p = 0.03 for inter-group comparison). After 21 months, the beneficial effect was no longer seen in MHO (2.0[1.5-2.6], p = 1.0), while it remained partially preserved in MUO (2.9[2.4-3.3], p = 0.002). QueryShort-term improvements of lipid parameters were similar in both groups. However, long-term improvements of HDL-cholesterol and triglycerides were only seen in MUO (44.4[41.5-47.4] vs. 49.3[46.2, 52.3] mg/dl, p < 0.001; 176.8[158.9-194.8] vs. 138.8[119.4-158.3] mg/dl, p < 0.001, respectively) but not in MHO. Weight loss-induced improvements in the QoL and particularly the physical health status were maintained in MUO until the end of the trial, while benefits disappeared over time in MHO. Group allocation by HOMA-IR and ISIClamp revealed higher benefits for MUO mainly in parameters of the glucose metabolism and QoL. CONCLUSIONS Our data demonstrates stronger and longer-lasting improvements of metabolism and QoL in MUO after weight loss. Trial registration (ClinicalTrials.gov): NCT00850629. Registered 25 February 2009, https://clinicaltrials.gov/ct2/show/NCT00850629 .
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Affiliation(s)
- Dominik Soll
- Department of Endocrinology and Metabolism, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Chariteplatz 1, 10117, Berlin, Germany
| | - Julia Gawron
- Department of Endocrinology and Metabolism, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Chariteplatz 1, 10117, Berlin, Germany
| | - Laura Pletsch-Borba
- Department of Endocrinology and Metabolism, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Chariteplatz 1, 10117, Berlin, Germany
- NutriAct-Competence Cluster Nutrition Research Berlin-Potsdam, Nuthetal, Germany
| | - Joachim Spranger
- Department of Endocrinology and Metabolism, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Chariteplatz 1, 10117, Berlin, Germany
- Charité Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, 10117, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
- NutriAct-Competence Cluster Nutrition Research Berlin-Potsdam, Nuthetal, Germany
| | - Knut Mai
- Department of Endocrinology and Metabolism, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Chariteplatz 1, 10117, Berlin, Germany.
- Charité Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, 10117, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.
- NutriAct-Competence Cluster Nutrition Research Berlin-Potsdam, Nuthetal, Germany.
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12
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Vilela DLS, Fonseca PG, Pinto SL, Bressan J. Influence of dietary patterns on the metabolically healthy obesity phenotype: A systematic review. Nutr Metab Cardiovasc Dis 2021; 31:2779-2791. [PMID: 34340900 DOI: 10.1016/j.numecd.2021.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 11/26/2022]
Abstract
AIMS In many individuals (35%) obesity is not accompanied by cardiometabolic disorders, a condition referred to as metabolically healthy obesity. Since the effectiveness of dietary interventions for this condition is not well established, this study reviews the influence of dietary patterns on the phenotype of metabolically healthy obesity in adults and elderly. DATA SYNTHESIS The review was carried out following the PRISMA guidelines and registered in the PROSPERO. The search was conducted in the MEDLINE, SCOPUS, Web of Science, Science Direct, LILACS, and SciELO databases. A total of 236 articles were identified, seven of which were selected for synthesis after application of the eligibility criteria. CONCLUSIONS The overall result found out in this synthesis was that the greater adherence to healthy eating patterns was considered a preventive to the transition from metabolically healthy obesity to metabolic unhealthy obese phenotypes, by improving metabolic health, and reducing the risk of cardiovascular disease and mortality from all causes. In contrast, unhealthy eating patterns resulted in increased inflammation and risks of developing noncommunicable diseases. This review indicates that adherence to healthy eating patterns may interfere with metabolic phenotypes of obesity and positively affect metabolically healthy obesity. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42020159783.
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Affiliation(s)
- Darlene L S Vilela
- Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
| | - Pâmela G Fonseca
- Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
| | - Sônia L Pinto
- Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil; Department of Nutrition, Universidade Federal de Tocantins, Palmas, Tocantins, Brazil
| | - Josefina Bressan
- Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil.
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13
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Goday A, Julià H, de Vargas-Machuca A, Pedro-Botet J, Benavente S, Ramon JM, Pera M, Casajoana A, Villatoro M, Fontané L, Bisbe M, Climent E, Castañer O, Flores Le Roux JA, Benaiges D. Bariatric surgery improves metabolic and nonalcoholic fatty liver disease markers in metabolically healthy patients with morbid obesity at 5 years. Surg Obes Relat Dis 2021; 17:2047-2053. [PMID: 34509375 DOI: 10.1016/j.soard.2021.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/22/2021] [Accepted: 07/31/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND No studies have evaluated the effect of metabolic and bariatric surgery (MBS) on nonalcoholic fatty liver disease (NAFLD) and cardiometabolic markers in metabolically healthy patients with morbid obesity (MHMO) at midterm. OBJECTIVES To assess the effect of MBS on NAFLD and cardiometabolic markers in MHMO patients and ascertain whether metabolically unhealthy patients with morbid obesity (MUMO) remain metabolically healthy at 5 years after MBS. SETTING University hospital. METHODS A total of 191 patients with a body mass index >40 kg/m2 and at least 5 years of follow-up were retrospectively analyzed. Lost to follow-up were 37.6% (151 of 401 patients). Patients were classified as MHMO if 1 or 0 of the cardiometabolic markers were present using the Wildman criteria. The degree of liver fibrosis was assessed using the NAFLD fibrosis score (NFS). RESULTS Forty-one patients (21.5%) fulfilled the criteria for MHMO. They showed significant improvements in blood pressure (from 135.1 ± 22.1 and 84.2 ± 14.3 mm Hg to 117.7 ± 19.2 and 73.0 ± 10.9 mm Hg), plasma glucose (from 91.0 ± 5.6 mg/dL to 87.2 ± 5.2 mg/dL), homeostatic model assessment for insulin resistance (from 2.2 ± .9 to 1.0 ± .8), triglycerides (from 88.0 [range, 79.5-103.5] mg/dL to 61.0 [range, 2.0-76.5] mg/dL), alanine aminotransferase, gamma-glutamyl transpeptidase NFS (from -1.0 ± 1.0 to -1.9 ± 1.2), and high-density lipoprotein cholesterol (from 56.9 ± 10.5 mg/dL to 77.9 ± 17.4 mg/dL) at 5 years after surgery. A total of 108 MUMO patients (84.4%) who became metabolically healthy after 1 year stayed healthy at 5 years. CONCLUSIONS MBS induced a midterm improvement in cardiometabolic and NAFLD markers in MHMO patients. Seventy-six percent of MUMO patients became metabolically healthy at 5 years after MBS.
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Affiliation(s)
- Alberto Goday
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain; Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona Biomedical Research Park, Barcelona, Spain; Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain; Centro de Investigaciones Biomédicas en Red de Obesidad y Nutrición, Madrid, Spain
| | - Helena Julià
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain; Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
| | | | - Juan Pedro-Botet
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain; Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
| | - Sergi Benavente
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Jose M Ramon
- Unit of Gastrointestinal Surgery, Hospital del Mar, Institut de Recerca Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Manuel Pera
- Unit of Gastrointestinal Surgery, Hospital del Mar, Institut de Recerca Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Anna Casajoana
- Unit of Gastrointestinal Surgery, Hospital del Mar, Institut de Recerca Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | | | - Laia Fontané
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
| | - Maria Bisbe
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Elisenda Climent
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain; Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona Biomedical Research Park, Barcelona, Spain; Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
| | - Olga Castañer
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona Biomedical Research Park, Barcelona, Spain; Centro de Investigaciones Biomédicas en Red de Obesidad y Nutrición, Madrid, Spain
| | - Juana A Flores Le Roux
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain; Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona Biomedical Research Park, Barcelona, Spain; Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
| | - David Benaiges
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain; Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona Biomedical Research Park, Barcelona, Spain; Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain; Consorci Sanitari de l'Alt Penedès i Garraf, Vilafranca del Penedès, Spain.
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14
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Barzin M, Aryannezhad S, Khalaj A, Mahdavi M, Valizadeh M, Ghareh S, Azizi F, Hosseinpanah F. Effects of bariatric surgery in different obesity phenotypes: Tehran Obesity Treatment Study (TOTS). Obes Surg 2021; 30:461-469. [PMID: 31650407 DOI: 10.1007/s11695-019-04182-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Not all morbid obese patients suffer from metabolic co-morbidities; thus, a sub-group of metabolically healthy morbid obese (MHMO) individuals are identified. However, the role of bariatric surgery is not well understood in this subgroup. METHODS A total of 2244 morbid obese individuals aged 18-65 years undergoing bariatric surgery were selected. Patients were considered MHMO according to the joint interim statement (JIS) definition, as having two or less abnormalities in these five parameters: waist circumference (WC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), systolic or diastolic blood pressure (SBP or DBP), and fasting plasma glucose (FPG). Otherwise, they were considered metabolically unhealthy morbid obese (MUMO). Follow-up data were collected at 6, 12, and 24 months post-surgery. RESULTS Prior to surgery, 36.2% of participants were MHMO and had significantly lower BMI, WC, TG, FPG, SBP, and DBP and higher HDL-C compared to MUMO. Both MHMO and MUMO participants showed a significant decrease in BMI, WC, TG, SBP, DBP, and FPG and increase in HDL-C and the percentage of excess weight loss (%EWL). Two-year post-operative changes (from baseline) of BMI, WC, and %EWL were greater in MHMO subjects and changes of TG, HDL-C, DBP, SBP, and FPG were greater in MUMO subjects. Further multivariate regression analysis for delta (∆) change in these characteristics revealed that only the delta (∆) changes of WC and %EWL were statistically different between the two phenotypes and were greater in MHMO subjects, 2 years after the surgery (- 3.077 cm decrease in WC and + 3.612% higher %EWL compared to MUMO subjects). CONCLUSION Bariatric surgery is an effective method for reduction of metabolic abnormalities and weight loss in both MUMO and MHMO phenotypes. Benefits of this intervention are comparable between patients with these two obesity phenotypes.
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Affiliation(s)
- Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shayan Aryannezhad
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Khalaj
- Tehran Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Maryam Mahdavi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Ghareh
- Mashhad Medical Branch, Faculty of Medicine, Islamic Azad University, Mashhad, Islamic Republic of Iran
| | - Feridoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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15
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Ono H, Akahoshi K, Kai M. The Trends of Medical Care Expenditure with Adjustment of Lifestyle Habits and Medication; 10-Year Retrospective Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9546. [PMID: 33419363 PMCID: PMC7767014 DOI: 10.3390/ijerph17249546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023]
Abstract
In Japan, the prevention of lifestyle-related diseases is the most important issue for the optimization of medical expenditure. This study aimed to analyze the impact of lifestyle and medication status on medical expenditure. Health checkup data and medical expenditure records of a retrospective cohort of 1463 people aged between 40 and 65 years old who underwent specific health checks at least three times between 2008 and 2017 were analyzed. Regression analysis was performed with medical expenditure as the dependent variable and age, gender, waist ratio, medication status, and lifestyle habits as independent variables using a Tobit model. Focusing on the factors that increase medical expenditure, the regression coefficients of age, medication status, weight gain of 10 kg or more since the age of 20, and walking more than 1 h per day were 0.048 (95% CI 0.04 to 0.06), 1.020 (95% CI 0.88 to 1.16), 0.210 (95% CI 0.06 to 0.36), and -0.208 (95% CI -0.35 to -0.07), respectively. The estimate of 5-year cumulative medical expenditure showed that those with walking habits without medication had the lowest medical expenditure. The result of this study suggests that walking more than 1 h a day may lower health expenditure in the general population.
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Affiliation(s)
- Haruko Ono
- Department of Community Health Nursing, Oita University of Nursing and Health Science, Oita 870-1201, Japan;
| | - Kotomi Akahoshi
- Department of Community Health Nursing, Oita University of Nursing and Health Science, Oita 870-1201, Japan;
| | - Michiaki Kai
- Department of Environmental Health Science, Oita University of Nursing and Health Science, Oita 870-1201, Japan;
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16
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Ostrovskaya ЕV, Romantsova ТI, Gerasimov AN, Novoselova ТЕ. Metabolically healthy obesity: prevalence, phenotype characteristic, effectiveness of weight loss. RUSSIAN OPEN MEDICAL JOURNAL 2020. [DOI: 10.15275/rusomj.2020.0301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The goal was to study the prevalence of metabolically healthy obesity (MHO), the features of this phenotype compared with metabolically unhealthy obesity (MUHO), and the effect of weight loss on cardiometabolic risk factors in patients with MHO. Material and Methods — To assess the prevalence of MHO, 389 case histories of obese patients aged 18-60 were analyzed. Three types of MHO criteria were used: 1) the definitions of metabolic syndrome (MS) according to International Diabetes Federation (IDF), 2005; 2) the HOMA-IR index (<2.7); 3) Biobank Standardisation and Harmonisation for Research Excellence in the European Union (BioSHaRE-EU) criteria, 2013. The study included comparative analysis of the medical history, anthropometry, basic metabolic parameters, and adipocytokine levels in 44 patients with MHO (taking into account the MS definitions) and 33 women with MUHO initially and with a decrease in body mass (BM) by ≥5% after 6 months. Results — The MHO prevalence was: according to the definitions of MS – 38.6%, according to HOMA-IR index – 34.5%, in BioSHaRE-EU – 9.6%. All indicators of anthropometry, carbohydrate and lipid metabolism, including the HOMA-IR index, interleukin-6, and chemerin, as well as the duration of obesity in the MHO and MUHO groups significantly differed (p<0.05). After 6 months, MHO-patients who lost ≥5% BM from the initial value (63.6%) showed an increase of adiponectin, a decrease in waist circumference, HOMA-IR index, C-reactive protein (CRP), retinol-binding protein 4 (RBP-4), and chemerin (p<0.05). Conclusion — The MHO prevalence was maximal according to the MS definitions and minimal with BioSHaRE-EU criteria. The BM decrease in MHO is accompanied by a decrease in the content of proinflammatory adipocytokines and the HOMA-IR index, which determines the need to treat obesity regardless of the phenotype.
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17
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Machann J, Stefan N, Wagner R, Fritsche A, Bell JD, Whitcher B, Häring HU, Birkenfeld AL, Nikolaou K, Schick F, Thomas EL. Normalized Indices Derived from Visceral Adipose Mass Assessed by Magnetic Resonance Imaging and Their Correlation with Markers for Insulin Resistance and Prediabetes. Nutrients 2020; 12:nu12072064. [PMID: 32664590 PMCID: PMC7400828 DOI: 10.3390/nu12072064] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/30/2022] Open
Abstract
Visceral adipose tissue (VAT) plays an important role in the pathogenesis of insulin resistance (IR), prediabetes and type 2 diabetes. However, VAT volume alone might not be the best marker for insulin resistance and prediabetes or diabetes, as a given VAT volume may impact differently on these metabolic traits based on body height, gender, age and ethnicity. In a cohort of 1295 subjects from the Tübingen Diabetes Family Study (TDFS) and in 9978 subjects from the UK Biobank (UKBB) undergoing magnetic resonance imaging for quantification of VAT volume, total adipose tissue (TAT) in the TDFS, total abdominal adipose tissue (TAAT) in the UKBB, and total lean tissue (TLT), VAT volume and several VAT-indices were investigated for their relationships with insulin resistance and glycemic traits. VAT-related indices were calculated by correcting for body height (VAT/m:VAT/body height; VAT/m2:VAT/(body height)2, and VAT/m3:VAT/(body height)3), TAT (%VAT), TLT (VAT/TLT) and weight (VAT/WEI), with closest equivalents used within the UKBB dataset. Prognostic values of VAT and VAT-related indices for insulin sensitivity, HbA1c levels and prediabetes/diabetes were analyzed for males and females. Males had higher VAT volume and VAT-related indices than females in both cohorts (p < 0.0001) and VAT volume has shown to be a stronger determinant for insulin sensitivity than anthropometric variables. Among the parameters uncorrected VAT and derived indices, VAT/m3 most strongly correlated negatively with insulin sensitivity and positively with HbA1c levels and prediabetes/diabetes in the TDFS (R2 = 0.375/0.305 for females/males for insulin sensitivity, 0.178/0.148 for HbA1c levels vs., e.g., 0.355/0.293 and 0.144/0.133 for VAT, respectively) and positively with HbA1c (R2 = 0.046/0.042) in the UKBB for females and males. Furthermore, VAT/m3 was found to be a significantly better determinant of insulin resistance or prediabetes than uncorrected VAT volume (p < 0.001/0.019 for females/males regarding insulin sensitivity, p < 0.001/< 0.001 for females/males regarding HbA1c). Evaluation of several indices derived from VAT volume identified VAT/m3 to correlate most strongly with insulin sensitivity and glucose metabolism. Thus, VAT/m3 appears to provide better indications of metabolic characteristics (insulin sensitivity and pre-diabetes/diabetes) than VAT volume alone.
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Affiliation(s)
- Jürgen Machann
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany; (N.S.); (R.W.); (A.F.); (A.L.B.); (F.S.)
- German Center for Diabetes Research (DZD), 72076 Tübingen, Germany;
- Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
- Correspondence:
| | - Norbert Stefan
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany; (N.S.); (R.W.); (A.F.); (A.L.B.); (F.S.)
- German Center for Diabetes Research (DZD), 72076 Tübingen, Germany;
- Department of Endocrinology, Diabetology and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Robert Wagner
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany; (N.S.); (R.W.); (A.F.); (A.L.B.); (F.S.)
- German Center for Diabetes Research (DZD), 72076 Tübingen, Germany;
- Department of Endocrinology, Diabetology and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Andreas Fritsche
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany; (N.S.); (R.W.); (A.F.); (A.L.B.); (F.S.)
- German Center for Diabetes Research (DZD), 72076 Tübingen, Germany;
- Department of Endocrinology, Diabetology and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Jimmy D. Bell
- Research Centre for Optimal Health, School of Life Sciences, University of Westminster, London W1W 6UW, UK; (J.D.B.); (B.W.); (E.L.T)
| | - Brandon Whitcher
- Research Centre for Optimal Health, School of Life Sciences, University of Westminster, London W1W 6UW, UK; (J.D.B.); (B.W.); (E.L.T)
| | | | - Andreas L. Birkenfeld
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany; (N.S.); (R.W.); (A.F.); (A.L.B.); (F.S.)
- German Center for Diabetes Research (DZD), 72076 Tübingen, Germany;
- Department of Endocrinology, Diabetology and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, 72076 Tübingen, Germany;
| | - Fritz Schick
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany; (N.S.); (R.W.); (A.F.); (A.L.B.); (F.S.)
- German Center for Diabetes Research (DZD), 72076 Tübingen, Germany;
- Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - E. Louise Thomas
- Research Centre for Optimal Health, School of Life Sciences, University of Westminster, London W1W 6UW, UK; (J.D.B.); (B.W.); (E.L.T)
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Abstract
Obesity contributes to reduced life expectancy, impaired quality of life, and disabilities, mainly in those individuals who develop cardiovascular diseases, type 2 diabetes, osteoarthritis, and cancer. However, there is a large variation in the individual risk to developing obesity-associated comorbid diseases that cannot simply be explained by the extent of adiposity. Observations that a proportion of individuals with obesity have a significantly lower risk for cardiometabolic abnormalities led to the concept of metabolically healthy obesity (MHO). Although there is no clear definition, normal glucose and lipid metabolism parameters-in addition to the absence of hypertension-usually serve as criteria to diagnose MHO. Biological mechanisms underlying MHO lower amounts of ectopic fat (visceral and liver), and higher leg fat deposition, expandability of subcutaneous adipose tissue, preserved insulin sensitivity, and beta-cell function as well as better cardiorespiratory fitness compared to unhealthy obesity. Whereas the absence of metabolic abnormalities may reduce the risk of type 2 diabetes and cardiovascular diseases in metabolically healthy individuals compared to unhealthy individuals with obesity, it is still higher in comparison with healthy lean individuals. In addition, MHO seems to be a transient phenotype further justifying therapeutic weight loss attempts-even in this subgroup-which might not benefit from reducing body weight to the same extent as patients with unhealthy obesity. Metabolically healthy obesity represents a model to study mechanisms linking obesity to cardiometabolic complications. Metabolically healthy obesity should not be considered a safe condition, which does not require obesity treatment, but may guide decision-making for a personalized and risk-stratified obesity treatment.
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Affiliation(s)
- Matthias Blüher
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig, Leipzig, Germany and Helmholtz Institute for Metabolic, Obesity and Vascular Research, Helmholtz Zentrum München, University Hospital Leipzig, Leipzig, Germany
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Abdelbasset WK, Elsayed SH, Nambi G, Alrawaili SM, Elnegamy TE, Khalil MA, Tantawy SA, Soliman GS, Ibrahim AA, Kamel DM. Effect of Moderate-Intensity Aerobic Exercise on Hepatic Fat Content and Visceral Lipids in Hepatic Patients with Diabesity: A Single-Blinded Randomised Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:1923575. [PMID: 32351591 PMCID: PMC7171632 DOI: 10.1155/2020/1923575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/04/2020] [Accepted: 03/09/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Limited studies have assessed the effect of moderate-intensity continuous aerobic exercise on hepatic fat content and visceral lipids in hepatic patients with diabesity. This study was designed to evaluate hepatic fat content and visceral lipids following moderate-intensity continuous aerobic exercise in hepatic patients with diabesity. DESIGN A single-blinded randomised controlled trial. METHODS Thirty-one diabetic obese patients with nonalcoholic fatty liver disease were recruited into this study. The patients were randomly classified into exercise and control groups, fifteen patients in the exercise group and sixteen patients in the control group. The exercise group received an 8-week moderate-intensity continuous aerobic exercise program with standard medical treatment, while the control group received standard medical treatment without any exercise program. Hepatic fat content and visceral lipids were assessed before and after intervention at the end of the study. RESULTS Baseline and clinical characteristics showed a nonsignificant difference between the two groups (p > 0.05). At the end of the intervention, the aerobic exercise showed significant improvements (serum triglycerides and low-density lipoproteins (LDLs), p ≤ 0.002, total cholesterol, p=0.004, visceral fats, p=0.016, glycated hemoglobin (HbA1C), p=0.022, high-density lipoproteins (HDLs), p=0.038, alanine transaminases (AL), p=0.044, intrahepatic triglyceride and HOMA-IR, p=0.046, and body mass index (BMI), p=0.047), while the control group showed a nonsignificant difference (p > 0.05). The postintervention analysis showed significant differences in favor of the aerobic exercise group (p < 0.05). CONCLUSIONS Moderate-intensity continuous aerobic exercise reduces the hepatic fat content and visceral lipids in hepatic patients with diabesity. Recommendations should be prescribed for encouraging moderate-intensity aerobic exercise training, particularly hepatic patients with diabesity.
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Affiliation(s)
- Walid Kamal Abdelbasset
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
- Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
| | - Shereen H. Elsayed
- Rehabilitation Sciences Department, Faculty of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
- Department of Physical Therapy for Cardiovascular/Respiratory Disorders and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Gopal Nambi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Saud M. Alrawaili
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Tamer E. Elnegamy
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Mona A. Khalil
- Department of Biochemistry, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Sayed A. Tantawy
- Department of Physiotherapy, College of Medical and Health Sciences, Ahlia University, Manama, Bahrain
- Department of Physiotherapy, Centre of Radiation, Oncology and Nuclear Medicine, Cairo University, Giza, Egypt
| | - Gaber S. Soliman
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences in Al-Qurayyat, Jouf University, Sakakah, Saudi Arabia
| | - Ahmed A. Ibrahim
- Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
- Department of Physical Therapy, College of Applied Medical Sciences, Hail University, Hail, Saudi Arabia
| | - Dalia M. Kamel
- Department of Physiotherapy, College of Medical and Health Sciences, Ahlia University, Manama, Bahrain
- Department of Physiotherapy for Women's Health, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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20
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Hsueh YW, Yeh TL, Lin CY, Tsai SY, Liu SJ, Lin CM, Chen HH. Association of metabolically healthy obesity and elevated risk of coronary artery calcification: a systematic review and meta-analysis. PeerJ 2020; 8:e8815. [PMID: 32257643 PMCID: PMC7103199 DOI: 10.7717/peerj.8815] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/27/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Metabolically healthy obesity (MHO) is defined as obesity with less than two parameters of metabolic abnormalities. Some studies report that MHO individuals show similar risk of cardiovascular disease (CVD) compared with metabolically healthy non-obese (MHNO) individuals, but the results are conflicting. Coronary artery calcium (CAC) reflects the extent of coronary atherosclerosis and is a useful tool to predict future risk of CVD. The objective of this meta-analysis was to investigate whether MHO is associated with elevated risk of CAC. METHOD We searched Cochrane, PubMed, and Embase up to April 19, 2019. Prospective cohort and cross-sectional studies examining the association between MHO subjects and CAC were included with MHNO as the reference. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using random-effect models. Subgroup analysis and meta-regression were applied to define possible sources of heterogeneity. We conducted this research following a pre-established protocol registered on PROSPERO (CRD 42019135006). RESULTS A total of nine studies were included in this review and six studies with 23,543 participants were eligible for the meta-analysis. Compared with MHNO subjects, MHO had a higher odds of CAC (OR 1.36, 95% CI [1.11 to 1.66]; I 2 = 39%). In the subgroup analysis, the risk associated with MHO participants was significant in cohort studies (OR = 1.47, 95% CI [1.15,1.87], I 2 = 0%), and borderline significant in cross-sectional studies. The risk of CAC was also significant in MHO participants defined by Adult Treatment Panel III (ATP III) (OR = 1.55, 95% CI [1.25,1.93], I 2 = 0%). The univariate meta-regression model showed that age and smoking status were possible effect modifiers for MHO and CAC risk. CONCLUSION Our meta-analysis showed that MHO phenotypes were associated with elevated risk of CAC compared with MHNO, which reflects the extent of coronary atherosclerosis. People with obesity should strive to achieve normal weight even when only one metabolic abnormality is present.
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Affiliation(s)
- Yu-wen Hsueh
- Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Tzu-Lin Yeh
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Yu Lin
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Szu-Ying Tsai
- Department of Family Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shu-Jung Liu
- Department of Medical Library, MacKay Memorial Hospital, Tamsui Branch, New Taipei City, Taiwan
| | - Chi-Min Lin
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Hsin-Hao Chen
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
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Abdelbasset WK, Tantawy SA, Kamel DM, Alqahtani BA, Elnegamy TE, Soliman GS, Ibrahim AA. Effects of high-intensity interval and moderate-intensity continuous aerobic exercise on diabetic obese patients with nonalcoholic fatty liver disease: A comparative randomized controlled trial. Medicine (Baltimore) 2020; 99:e19471. [PMID: 32150108 PMCID: PMC7478706 DOI: 10.1097/md.0000000000019471] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Some studies assessed the effect of aerobic exercise on diabetic obese patients with hepatic disease, while very limited studies compared high-intensity interval (HII) versus moderate-intensity continuous (MIC) on diabetic obese patients with non-alcoholic fatty liver disease (NAFLD). OBJECTIVES This study was designed to assess the effects of HII versus MIC on intrahepatic triglycerides (IHTG) and visceral lipids in diabetic obese patients with NAFLD. DESIGN Randomized controlled trial. METHODS Forty-seven diabetic obese individuals with NAFLD were enrolled in this study. The individuals were randomly divided into 16 in HII group, 15 in MIC group, and 16 in the controls. HII group received HII exercise, MIC group received 8-week MIC exercise while the control group did not receive any exercise intervention. IHTG and visceral lipids were assessed pre- and post-intervention. RESULTS Baseline and clinical characteristics showed nonsignificant difference among the 3 groups (P > .05). Both HII and MIC groups showed a significant reduction in hepatic fat and visceral lipids (P < .05), while the controls showed nonsignificant difference (P > .05) after completing the study intervention. Postintervention analysis showed nonsignificant changes between the HII and MIC groups (P > .05). CONCLUSIONS Exercise training wither HII or MIC aerobic exercise reduces IHGT and visceral lipids in diabetic obese patients with NAFLD. No differences were observed between the effects of both exercise programs on diabetic obese patients with NAFLD.
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Affiliation(s)
- Walid Kamal Abdelbasset
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
- Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
| | - Sayed A. Tantawy
- Department of Physiotherapy, College of Medical and Health Sciences, Ahlia University, Manama, Kingdom of Bahrain
- Department of Physiotherapy, Centre of Radiation, Oncology and Nuclear Medicine
| | - Dalia M. Kamel
- Department of Physiotherapy, College of Medical and Health Sciences, Ahlia University, Manama, Kingdom of Bahrain
- Department of Physiotherapy for Women's Health
| | - Bader A. Alqahtani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Tamer E. Elnegamy
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Gaber S. Soliman
- Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences in Al-Qurayyat, Jouf University
| | - Ahmed A. Ibrahim
- Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
- Department of Physical Therapy, College of Applied Medical Sciences, Hail University, Hail, Saudi Arabia
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22
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Chait A, den Hartigh LJ. Adipose Tissue Distribution, Inflammation and Its Metabolic Consequences, Including Diabetes and Cardiovascular Disease. Front Cardiovasc Med 2020; 7:22. [PMID: 32158768 PMCID: PMC7052117 DOI: 10.3389/fcvm.2020.00022] [Citation(s) in RCA: 622] [Impact Index Per Article: 155.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/10/2020] [Indexed: 12/13/2022] Open
Abstract
Adipose tissue plays essential roles in maintaining lipid and glucose homeostasis. To date several types of adipose tissue have been identified, namely white, brown, and beige, that reside in various specific anatomical locations throughout the body. The cellular composition, secretome, and location of these adipose depots define their function in health and metabolic disease. In obesity, adipose tissue becomes dysfunctional, promoting a pro-inflammatory, hyperlipidemic and insulin resistant environment that contributes to type 2 diabetes mellitus (T2DM). Concurrently, similar features that result from adipose tissue dysfunction also promote cardiovascular disease (CVD) by mechanisms that can be augmented by T2DM. The mechanisms by which dysfunctional adipose tissue simultaneously promote T2DM and CVD, focusing on adipose tissue depot-specific adipokines, inflammatory profiles, and metabolism, will be the focus of this review. The impact that various T2DM and CVD treatment strategies have on adipose tissue function and body weight also will be discussed.
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Affiliation(s)
- Alan Chait
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Laura J den Hartigh
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA, United States
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Karczewska-Kupczewska M, Nikołajuk A, Majewski R, Filarski R, Stefanowicz M, Matulewicz N, Strączkowski M. Changes in adipose tissue lipolysis gene expression and insulin sensitivity after weight loss. Endocr Connect 2020; 9:90-100. [PMID: 31905163 PMCID: PMC6993275 DOI: 10.1530/ec-19-0507] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 12/22/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Insulin resistance is a major pathophysiological link between obesity and its metabolic complications. Weight loss (WL) is an effective tool to prevent obesity-related diseases; however, the mechanisms of an improvement in insulin sensitivity (IS) after weight-reducing interventions are not completely understood. The aim of the present study was to analyze the relationships between IS and adipose tissue (AT) expression of the genes involved in the regulation of lipolysis in obese subjects after WL. METHODS Fifty-two obese subjects underwent weight-reducing dietary intervention program. The control group comprised 20 normal-weight subjects, examined at baseline only. Hyperinsulinemic-euglycemic clamp and s.c. AT biopsy with subsequent gene expression analysis were performed before and after the program. RESULTS AT expression of genes encoding lipases (PNPLA2, LIPE and MGLL) and lipid-droplet proteins enhancing (ABHD5) and inhibiting lipolysis (PLIN1 and CIDEA) were decreased in obese individuals in comparison with normal-weight individuals. The group of 38 obese participants completed dietary intervention program and clamp studies, which resulted in a significant WL and an improvement in mean IS. However, in nine subjects from this group IS did not improve in response to WL. AT expression of PNPLA2, LIPE and PLIN1 increased only in the group without IS improvement. CONCLUSIONS Excessive lipolysis may prevent an improvement in IS during WL. The change in AT PNPLA2 and LIPE expression was a negative predictor of the change in IS after WL.
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Affiliation(s)
- Monika Karczewska-Kupczewska
- Department of Internal Medicine and Metabolic Diseases, Medical University of Białystok, Białystok, Poland
- Correspondence should be addressed to M Karczewska-Kupczewska:
| | - Agnieszka Nikołajuk
- Department of Prophylaxis of Metabolic Diseases, Institute of Animal Reproduction and Food Research Polish Academy of Sciences, Olsztyn, Poland
| | - Radosław Majewski
- Department of Prophylaxis of Metabolic Diseases, Institute of Animal Reproduction and Food Research Polish Academy of Sciences, Olsztyn, Poland
| | - Remigiusz Filarski
- Department of Prophylaxis of Metabolic Diseases, Institute of Animal Reproduction and Food Research Polish Academy of Sciences, Olsztyn, Poland
| | - Magdalena Stefanowicz
- Department of Metabolic Diseases, Medical University of Białystok, Białystok, Poland
| | - Natalia Matulewicz
- Department of Metabolic Diseases, Medical University of Białystok, Białystok, Poland
| | - Marek Strączkowski
- Department of Prophylaxis of Metabolic Diseases, Institute of Animal Reproduction and Food Research Polish Academy of Sciences, Olsztyn, Poland
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Kim JM, Kim BH, Lee H, Kim EH, Kim M, Kim JH, Jeon YK, Kim SS, Kim IJ, Kim YK. The Relationship between Thyroid Function and Different Obesity Phenotypes in Korean Euthyroid Adults. Diabetes Metab J 2019; 43:867-878. [PMID: 30968620 PMCID: PMC6943265 DOI: 10.4093/dmj.2018.0130] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 01/10/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Thyroid disease and metabolic syndrome are both associated with cardiovascular disease. The aim of this study was to investigate the correlation between thyroid hormones and obesity sub-phenotypes using nationwide data from Korea, a country known to be iodine replete. METHODS This study was based on data obtained from the sixth Korea National Health and Nutrition Examination Survey, administered from 2013 to 2015. A total of 13,873 participants aged ≥19 years were included, and classified into four groups: metabolically healthy non-obesity (MHNO), metabolically healthy obesity (MHO), metabolically unhealthy non-obesity (MUNO), and metabolically unhealthy obesity (MUO) by body fat on the basis of body mass index and metabolic health. RESULTS At baseline, serum free thyroxine (fT4) values were significantly higher in the MHNO phenotype (MHNO, 1.27±0.01 ng/dL; MHO, 1.25±0.01 ng/dL; MUNO, 1.24±0.01 ng/dL; MUO, 1.24±0.01 ng/dL, P<0.001) in total study population. However, this significant association no longer remained after adjustment for age, urine iodine concentration, and smoking (P=0.085). After adjustment for confounders, statistically significant association was observed between lower thyroid stimulating hormone (TSH) and MHNO phenotype (P=0.044). In men participants (not women), higher fT4 values were significantly associated with MHNO phenotype (P<0.001). However, no significant association was observed between thyroid function (TSH or fT4) and obesity phenotypes in groups classified by age (cutoff age of 55 years). CONCLUSION Although there was a difference by age and sex, we found that the decrease of TSH and the increase of fT4 values were associated with MHNO.
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Affiliation(s)
- Jeong Mi Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Bo Hyun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
| | - Hyungi Lee
- ARO, Clinical Trial Center, Pusan National University Hospital, Busan, Korea
| | - Eun Heui Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Mijin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jong Ho Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Yun Kyung Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Sang Soo Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - In Joo Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Yong Ki Kim
- Kim Yong Ki Internal Medicine Clinic, Busan, Korea
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Magkos F. Metabolically healthy obesity: what's in a name? Am J Clin Nutr 2019; 110:533-539. [PMID: 31240297 DOI: 10.1093/ajcn/nqz133] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/06/2019] [Indexed: 02/07/2023] Open
Abstract
Metabolically healthy obesity refers to an obesity phenotype with no or little evidence of metabolic dysfunction. Lower liver fat content and visceral adipose tissue, greater insulin sensitivity and secretion, greater cardiorespiratory fitness, and a predominantly lower body (i.e., leg) fat deposition are key physiological traits of a metabolically healthy phenotype. About 35% of all subjects with obesity are metabolically healthy. These individuals have approximately half the risk of developing type 2 diabetes and cardiovascular disease compared with metabolically unhealthy subjects with obesity, but they still have a significantly greater risk (by 50-300%) compared with metabolically healthy lean subjects. Therefore, absence of metabolic risk factors in people with obesity should not be a contraindication for weight-loss treatment. Metabolically healthy obesity needs to be treated, and this need is reinforced by the fact that this phenotype is not stable over time, as ∼50% of these subjects will cease being metabolically healthy within ∼10 y. Intervening early is therefore important. Weight loss dose-dependently decreases visceral adipose tissue and liver fat content, and it improves multiorgan insulin sensitivity and β-cell function (i.e., it beneficially affects many of the physiological traits of a metabolically healthy phenotype); however, weight loss is very difficult to maintain. This typically results in disappointment among patients and hinders adherence, which is likely critical for the limited success of most weight-loss treatments in the long term. On the other hand, using ≥1 metabolic health targets in a non-weight-loss-centered treatment paradigm that includes prudent dietary changes and increased physical activity can serve as an appropriate first goal that can help motivate patients toward the long-term goals of obesity treatment.
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Affiliation(s)
- Faidon Magkos
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
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Genetic predisposition to higher body fat yet lower cardiometabolic risk in children and adolescents. Int J Obes (Lond) 2019; 43:2007-2016. [PMID: 31332278 DOI: 10.1038/s41366-019-0414-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 06/06/2019] [Accepted: 06/08/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Most obese children show cardiometabolic impairments, such as insulin resistance, dyslipidemia, and hypertension. Yet some obese children retain a normal cardiometabolic profile. The mechanisms underlying this variability remain largely unknown. We examined whether genetic loci associated with increased insulin sensitivity and relatively higher fat storage on the hip than on the waist in adults are associated with a normal cardiometabolic profile despite higher adiposity in children. METHODS We constructed a genetic score using variants previously linked to increased insulin sensitivity and/or decreased waist-hip ratio adjusted for body mass index (BMI), and examined the associations of this genetic score with adiposity and cardiometabolic impairments in a meta-analysis of six cohorts, including 7391 European children aged 3-18 years. RESULTS The genetic score was significantly associated with increased degree of obesity (higher BMI-SDS beta = 0.009 SD/allele, SE = 0.003, P = 0.003; higher body fat mass beta = 0.009, SE = 0.004, P = 0.031), yet improved body fat distribution (lower WHRadjBMI beta = -0.014 SD/allele, SE = 0.006, P = 0.016), and favorable concentrations of blood lipids (higher HDL cholesterol: beta = 0.010 SD/allele, SE = 0.003, P = 0.002; lower triglycerides: beta = -0.011 SD/allele, SE = 0.003, P = 0.001) adjusted for age, sex, and puberty. No differences were detected between prepubertal and pubertal/postpubertal children. The genetic score predicted a normal cardiometabolic profile, defined by the presence of normal glucose and lipid concentrations, among obese children (OR = 1.07 CI 95% 1.01-1.13, P = 0.012, n = 536). CONCLUSIONS Genetic predisposition to higher body fat yet lower cardiometabolic risk exerts its influence before puberty.
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Haghighatdoost F, Amini M, Aminorroaya A, Abyar M, Feizi A. Different metabolic/obesity phenotypes are differentially associated with development of prediabetes in adults: Results from a 14-year cohort study. World J Diabetes 2019; 10:350-361. [PMID: 31231458 PMCID: PMC6571483 DOI: 10.4239/wjd.v10.i6.350] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/10/2019] [Accepted: 05/14/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The risk of developing prediabetes based on the metabolic/obesity phenotypes has been poorly investigated.
AIM To examine the association of baseline metabolic/obesity phenotypes and their changes over time with the risk of prediabetes development.
METHODS In a population-based cohort study, 1741 adults (aged > 19 years) with normal blood glucose were followed for 14 years. Anthropometric and biochemical measures were evaluated regularly during the follow-up period. According to body mass index and metabolic health status, participants were categorized into four groups: Metabolically healthy normal weight (MHNW), metabolically healthy obese (MHO), metabolically unhealthy normal weight (MUNW) and metabolically unhealthy obese (MUO). Multivariable Cox regression analysis was used to measure the risk of prediabetes according to the baseline metabolic/obesity phenotype and their changes during the follow-up.
RESULTS In the whole population with a mean (95CCI for mean) follow up duration of 12.7 years (12.6-12.9), all three MUNW, MHO, MUO groups were at higher risk for developing prediabetes compared to the MHNW group (P = 0.022). The MUNW group had the highest risk for developing prediabetes (hazard ratio (HR): 3.84, 95%CI: 1.20, 12.27). In stratified analysis by sex, no significant association was found in men, while women in the MUNW group were at the greatest risk for prediabetes (HR: 6.74, 95%CI: 1.53, 29.66). Transforming from each phenotype to MHNW or MHO was not related to the risk of prediabetes development, whereas transforming from each phenotype to MUO was associated with an increased risk of prediabetes (HR > 1; P < 0.05).
CONCLUSION Our findings indicate that MHO is not a high risk, unless it transforms into MUO over time. However, people in the MUNW group have the greatest risk for developing prediabetes, and therefore, they should be screened and treated.
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Affiliation(s)
- Fahimeh Haghighatdoost
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Masoud Amini
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Ashraf Aminorroaya
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Majid Abyar
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Awat Feizi
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
- Biostatistics and Epidemiology Department, School of Health, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
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Konieczna J, Yañez A, Moñino M, Babio N, Toledo E, Martínez-González MA, Sorlí JV, Salas-Salvadó J, Estruch R, Ros E, Alonso-Gómez A, Schröder H, Lapetra J, Serra-Majem L, Pintó X, Gutiérrez-Bedmar M, Díaz-López A, González JI, Fitó M, Forga L, Fiol M, Romaguera D. Longitudinal changes in Mediterranean diet and transition between different obesity phenotypes. Clin Nutr 2019; 39:966-975. [PMID: 31053509 DOI: 10.1016/j.clnu.2019.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/19/2019] [Accepted: 04/03/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND & AIMS Little is known about the impact of specific dietary patterns on the development of obesity phenotypes. We aimed to determine the association of longitudinal changes in adherence to the traditional Mediterranean diet (MedDiet) with the transition between different obesity phenotypes. METHODS Data of 5801 older men and women at high cardiovascular risk from PREDIMED trial were used. Adherence to MedDiet was measured with the validated 14p-Mediterranean Diet Adherence Screener (MEDAS). Using the simultaneous combination of metabolic health- and body size-related parameters participants were categorized into one of four phenotypes: metabolically healthy and abnormal obese (MHO and MAO), metabolically healthy and abnormal non-obese (MHNO and MANO). Cox regression models with yearly repeated measures during 5-year of follow-up were built with use of Markov chain assumption. RESULTS Each 2-point increase in MEDAS was associated with the following transitions: in MAO participants, with a 16% (95% CI 3-31%) greater likelihood of becoming MHO; in MHO participants with a 14% (3-23%) lower risk of becoming MAO; in MHNO participants with a 18% (5-30%) lower risk of becoming MHO. In MANO women, but not in men, MEDAS was associated with 20% (5-38%) greater likely of becoming MHNO (p for interaction by gender 0.014). No other significant associations were observed. CONCLUSIONS Better adherence to the traditional MedDiet is associated with transitions to healthier phenotypes, promoting metabolic health improvement in MAO, MANO (only in women), and MHO, as well as protecting against obesity incidence in MHNO subjects.
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Affiliation(s)
- J Konieczna
- Instituto de Investigación Sanitaria Illes Balears (IdISBa), University Hospital Son Espases, Palma de Mallorca, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - A Yañez
- Instituto de Investigación Sanitaria Illes Balears (IdISBa), University Hospital Son Espases, Palma de Mallorca, Spain; Department of Nursing and Physiotheraphy, University of the Balearic Islands, Palma de Mallorca, Spain
| | - M Moñino
- Instituto de Investigación Sanitaria Illes Balears (IdISBa), University Hospital Son Espases, Palma de Mallorca, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - N Babio
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; Rovira i Virgili University Department of Biochemistry and Biotechnology, Human Nutrition Unit, IISPV, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - E Toledo
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; University of Navarra-Navarra Institute for Health Research, Department of Preventive Medicine and Public Health, Pamplona, Spain
| | - M A Martínez-González
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; University of Navarra-Navarra Institute for Health Research, Department of Preventive Medicine and Public Health, Pamplona, Spain; Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA
| | - J V Sorlí
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - J Salas-Salvadó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; Rovira i Virgili University Department of Biochemistry and Biotechnology, Human Nutrition Unit, IISPV, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - R Estruch
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; Department of Internal Medicine, August Pi i Sunyer Institute of Biomedical Research (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - E Ros
- Lipid Clinics. Department of Endocrinology, August Pi i Sunyer Institute of Biomedical Research (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - A Alonso-Gómez
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, University Hospital Araba, Vitoria, Spain
| | - H Schröder
- Cardiovascular Risk and Nutrition Research Group (CARIN), Institut Hospital del Mar d' Investigacions Mèdiques (IMIM), Barcelona Biomedical Research Park, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - J Lapetra
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; Department of Familiy Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, Sevilla, Spain
| | - Ll Serra-Majem
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria and Service of Preventive Medicine, Complejo Hospitalario Universitario Insular Materno Infantil (CHUIMI), Canary Health Service, Las Palmas de Gran Canaria, Spain
| | - X Pintó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; Department of Internal Medicine, Bellvitge Hospital, Barcelona, Spain
| | - M Gutiérrez-Bedmar
- Department of Preventive Medicine and Public Health, University of Malaga, Malaga, Spain
| | - A Díaz-López
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; Rovira i Virgili University Department of Biochemistry and Biotechnology, Human Nutrition Unit, IISPV, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - J I González
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - M Fitó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; Cardiovascular Risk and Nutrition Research Group (CARIN), Institut Hospital del Mar d' Investigacions Mèdiques (IMIM), Barcelona Biomedical Research Park, Barcelona, Spain
| | - L Forga
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - M Fiol
- Instituto de Investigación Sanitaria Illes Balears (IdISBa), University Hospital Son Espases, Palma de Mallorca, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - D Romaguera
- Instituto de Investigación Sanitaria Illes Balears (IdISBa), University Hospital Son Espases, Palma de Mallorca, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
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Iacobini C, Pugliese G, Blasetti Fantauzzi C, Federici M, Menini S. Metabolically healthy versus metabolically unhealthy obesity. Metabolism 2019; 92:51-60. [PMID: 30458177 DOI: 10.1016/j.metabol.2018.11.009] [Citation(s) in RCA: 237] [Impact Index Per Article: 47.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 11/10/2018] [Accepted: 11/15/2018] [Indexed: 12/22/2022]
Abstract
Obesity-related disease complications reduce life quality and expectancy and increase health-care costs. Some studies have suggested that obesity not always entails metabolic abnormalities and increased risk of cardiometabolic complications. Because of the lack of universally accepted criteria to identify metabolically healthy obesity (MHO), its prevalence varies widely among studies. Moreover, the prognostic value of MHO is hotly debated, mainly because it likely shifts gradually towards metabolically unhealthy obesity (MUO). In this review, we outline the differential factors contributing to the metabolic heterogeneity of obesity by discussing the behavioral, genetic, phenotypical, and biological aspects associated with each of the two metabolic phenotypes (MHO and MUO) of obesity and their clinical implications. Particular emphasis will be laid on the role of adipose tissue biology and function, including genetic determinants of body fat distribution, depot-specific fat metabolism, adipose tissue plasticity and, particularly, adipogenesis. Finally, the emerging role of gut microbiota in obesity and adipose tissue dysfunction as well as the search for novel biomarkers for the obesity-related metabolic traits and associated diseases will be briefly presented. A better understanding of the main determinants of a healthy metabolic status in obesity would allow promotion of this favorable condition by targeting the relevant pathways.
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Affiliation(s)
- Carla Iacobini
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy
| | | | - Massimo Federici
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Stefano Menini
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy.
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30
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Abdelbasset WK, Tantawy SA, Kamel DM, Alqahtani BA, Soliman GS. A randomized controlled trial on the effectiveness of 8-week high-intensity interval exercise on intrahepatic triglycerides, visceral lipids, and health-related quality of life in diabetic obese patients with nonalcoholic fatty liver disease. Medicine (Baltimore) 2019; 98:e14918. [PMID: 30896648 PMCID: PMC6708753 DOI: 10.1097/md.0000000000014918] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Medications are limited for patients with nonalcoholic fatty liver disease (NAFLD). It has been reported that aerobic exercise is effective in reducing the characteristics of NAFLD, although unclear data have ascertained the effects of high-intensity interval aerobic exercise on health-related quality of life (HRQoL) in diabetic obese patients with NAFLD. OBJECTIVES This a randomized controlled trial aimed to ascertain the effectiveness of 8-week high-intensity interval exercise on intrahepatic triglycerides (IHTG), visceral lipids and HRQoL in diabetic obese patients with NAFLD. STUDY DESIGN Between August and December 2017, 32 diabetic obese patients with NAFLD aged 45 to 60 years (21 men and 11 women) were enrolled in this study. They were randomly assigned to 2 groups, 16 patients in each group, high-intensity interval (HII) exercise and control groups. The HII group received a program of HII aerobic exercise for 8 weeks with medications of NAFLD and the control group received only medications without any type of exercise intervention. The test of IHTG, visceral lipids, and HRQoL were recorded at the initial assessment and at the end of the program after 8 weeks. RESULTS There were significant differences between the 2 groups at the end of the study. These study findings exhibited significant improvements in IHTG, VO2peak, visceral lipids, glycohemoglobin, plasma glucose, and all dimensions of HRQoL in the HII group (P <.05), But there was non-significant improvement in any measure in the control group (P >.05) after the 8-week intervention. CONCLUSION Eight-week high-intensity interval aerobic exercise has a beneficial effect on IHTG, visceral lipids, and HRQoL in diabetic obese patients with NAFLD. Effort and awareness should be dedicated to encouraging the active lifestyle among different population, especially diabetic obese patients with NAFLD.
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Affiliation(s)
- Walid Kamal Abdelbasset
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
- Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
| | - Sayed A. Tantawy
- Department of Physiotherapy, College of Medical and Health Sciences, Ahlia University, Manama, Kingdom of Bahrain
- Department of Physiotherapy, Centre of Radiation, Oncology and Nuclear Medicine
| | - Dalia M. Kamel
- Department of Physiotherapy, College of Medical and Health Sciences, Ahlia University, Manama, Kingdom of Bahrain
- Department of Physiotherapy for Women's Health, Faculty of Physical Therapy
| | - Bader A. Alqahtani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Gaber S. Soliman
- Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences in Al-Qurayyat, Jouf University, Saudi Arabia
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31
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Viallon M, Leporq B, Drinda S, Wilhelmi de Toledo F, Galusca B, Ratiney H, Croisille P. Chemical-Shift-Encoded Magnetic Resonance Imaging and Spectroscopy to Reveal Immediate and Long-Term Multi-Organs Composition Changes of a 14-Days Periodic Fasting Intervention: A Technological and Case Report. Front Nutr 2019; 6:5. [PMID: 30881957 PMCID: PMC6407435 DOI: 10.3389/fnut.2019.00005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 01/14/2019] [Indexed: 12/21/2022] Open
Abstract
Objectives: The aim of this study was to investigate the feasibility of measuring the effects of a 14-day Periodic Fasting (PF) intervention (<200 cal) on multi-organs of primary interest (liver, visceral/subcutaneous/bone marrow fat, muscle) using non-invasive advanced magnetic resonance spectroscopic (MRS) and imaging (MRI) methods. Methods: One subject participated in a 14-day PF under daily supervision of nurses and specialized physicians, ingesting a highly reduced intake: 200 Kcal/day coupled with active walking and drinking at least 3 L of liquids/day. The fasting was preceded by a 7-day pre-fasting vegetarian period and followed by 14 days of stepwise reintroduction of food. The longitudinal study collected imaging and biological data before the fast, at peak fasting, and 7 days, 1 month, and 4 months after re-feeding. Body fat mass in the trunk, abdomen, and thigh, liver and muscle mass, were respectively computed using advanced MRI and MRS signal modeling. Fat fraction, MRI relativity index T2* and susceptibility (Chi), as well as Fatty acid composition, were calculated at all-time points. Results: A decrease in body weight (BW: −9.5%), quadriceps muscle volume (−3.2%), Subcutaneous and Visceral Adipose Tissue (SAT −34.4%; VAT −20.8%), liver fat fraction (PDFF = 1.4 vs. 2.6 % at baseline) but increase in Spine Bone Marrow adipose tissue (BMAT) associated with a 10% increase in global adiposity fraction (PDFF: 54.4 vs. 50.9%) was observed. Femoral BMAT showed minimal changes compared to spinal level, with a slight decrease (−3.1%). Interestingly, fatty acid (FA) pattern changes differed depending on the AT locations. In muscle, all lipids increased after fasting, with a greater increase of intramyocellular lipid (IMCL: from 2.7 to 6.3 mmol/kg) after fasting compared to extramyocellular lipid (EMCL: from 6.2 to 9.5 mmol/kg) as well as Carnosine (6.9 to 8.1 mmol/kg). Heterogenous and reverse changes were also observed after re-feeding depending on the organ. Conclusion: These results suggest that investigating the effects of a 14-day PF intervention using advanced MRI and MRS is feasible. Quantitative MR indexes are a crucial adjunct to further understanding the effective changes in multiple crucial organs especially liver, spin, and muscle, differences between adipose tissue composition and the interplay that occurs during periodic fasting.
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Affiliation(s)
- Magalie Viallon
- Université de Lyon, Lyon, France.,Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France.,Université Jean Monnet, Saint-Étienne, France.,CNRS UMR 5520, INSERM U1206, CREATIS, Saint-Étienne, France.,Institut National des Sciences Appliquées de Lyon, Villeurbanne, France
| | - Benjamin Leporq
- Université de Lyon, Lyon, France.,Université Jean Monnet, Saint-Étienne, France.,CNRS UMR 5520, INSERM U1206, CREATIS, Saint-Étienne, France.,Institut National des Sciences Appliquées de Lyon, Villeurbanne, France
| | - Stephan Drinda
- Klinik St. Katharinental, Diessenhofen, Switzerland.,Buchinger Wilhelmi Clinic, Uberlingen, Germany
| | | | - Bogdan Galusca
- Université de Lyon, Lyon, France.,Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France.,Eating Disorders, Addictions & Extreme Bodyweight Research Group (TAPE) EA, Saint-Étienne, France
| | - Helene Ratiney
- Université de Lyon, Lyon, France.,Université Jean Monnet, Saint-Étienne, France.,CNRS UMR 5520, INSERM U1206, CREATIS, Saint-Étienne, France.,Institut National des Sciences Appliquées de Lyon, Villeurbanne, France
| | - Pierre Croisille
- Université de Lyon, Lyon, France.,Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France.,Université Jean Monnet, Saint-Étienne, France.,CNRS UMR 5520, INSERM U1206, CREATIS, Saint-Étienne, France.,Institut National des Sciences Appliquées de Lyon, Villeurbanne, France
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32
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Rodriguez-Garcia E, Ruiz-Nava J, Santamaria-Fernandez S, Fernandez-Garcia JC, Vargas-Candela A, Yahyaoui R, Tinahones FJ, Bernal-Lopez MR, Gomez-Huelgas R. Implications of the Mediterranean diet and physical exercise on the lipid profile of metabolically healthy obese women as measured by nuclear magnetic resonance spectroscopy ( 1 H NMR). Chem Phys Lipids 2018; 213:68-75. [DOI: 10.1016/j.chemphyslip.2018.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/08/2018] [Accepted: 03/22/2018] [Indexed: 01/28/2023]
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Gabel K, Hoddy KK, Haggerty N, Song J, Kroeger CM, Trepanowski JF, Panda S, Varady KA. Effects of 8-hour time restricted feeding on body weight and metabolic disease risk factors in obese adults: A pilot study. ACTA ACUST UNITED AC 2018; 4:345-353. [PMID: 29951594 PMCID: PMC6004924 DOI: 10.3233/nha-170036] [Citation(s) in RCA: 328] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND: Time restricted feeding decreases energy intake without calorie counting and may be a viable option for weight loss. However, the effect of this diet on body weight in obese subjects has never been examined. OBJECTIVE: This study investigated the effects of 8-h time restricted feeding on body weight and metabolic disease risk factors in obese adults. DESIGN: Obese subjects (n = 23) participated in an 8-h time restricted feeding intervention (ad libitum feeding between 10:00 to 18:00 h, water fasting between 18:00 to 10:00 h) for 12 weeks. Weight loss and other outcomes were compared to a matched historical control group (n = 23). RESULTS: Body weight and energy intake decreased in the time restricted group (–2.6% ± 0.5; –341 ± 53 kcal/d) relative to controls over 12 weeks (P < 0.05). Systolic blood pressure decreased in the time restricted feeding group (–7 ± 2 mm Hg) versus controls (P < 0.05). Fat mass, lean mass, visceral fat mass, diastolic blood pressure, LDL cholesterol, HDL cholesterol, triglycerides, fasting glucose, fasting insulin, HOMA-IR, and homocysteine were not significantly different from controls after 12 weeks (no group×time interaction). CONCLUSION: These findings suggest that 8-h time restricted feeding produces mild caloric restriction and weight loss, without calorie counting. It may also offer clinical benefits by reducing blood pressure.
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Affiliation(s)
- Kelsey Gabel
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Kristin K Hoddy
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Nicole Haggerty
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Jeehee Song
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Cynthia M Kroeger
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA.,School of Public Health, Indiana University, Bloomington, IN, USA
| | - John F Trepanowski
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Satchidananda Panda
- Regulatory Biology Lab, Salk Institute for Biological Studies, La Jolla, CA, USA
| | - Krista A Varady
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
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Park YMM, Choi MK, Lee SS, Shivappa N, Han K, Steck SE, Hébert JR, Merchant AT, Sandler DP. Dietary inflammatory potential and risk of mortality in metabolically healthy and unhealthy phenotypes among overweight and obese adults. Clin Nutr 2018; 38:682-688. [PMID: 29705061 DOI: 10.1016/j.clnu.2018.04.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 03/20/2018] [Accepted: 04/02/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND & AIMS This study was designed to investigate the association between the dietary inflammatory index (DII®) scores, metabolic phenotypes, and risk of mortality risk in overweight/obese individuals from a representative sample of the U.S. POPULATION METHODS Data from 3733 overweight/obese adults (BMI ≥ 25 kg/m2) aged 20-90 years from the National Health and Nutrition Examination Survey III, 1988-1994 were analyzed; these participants were followed for mortality through December 31, 2011. DII scores were computed based on baseline dietary intake using 24-h dietary recalls. Metabolically unhealthy status was defined as having 2 or more of these metabolic abnormalities: high glucose, insulin resistance, elevated blood pressure, triglycerides, C-reactive protein levels, or low high-density lipoprotein-cholesterol values. RESULTS In metabolically unhealthy overweight/obese (MUO) individuals, DII score was associated with increased risk of all-cause mortality (HRTertile 3 vs Tertile 1 1.44; 95% CI 1.11-1.86 Ptrend = 0.008; HR1SD increase 1.08; 95% CI 0.99-1.18). Additionally, a stronger association with cardiovascular mortality was observed (HRT3 vs T1 3.29; 95% CI 2.01-5.37 Ptrend < 0.001; HR1SD increase 1.40; 95% CI 1.18-1.66), after adjusting for potential confounders. Furthermore, when analyses were restricted to obese individuals (BMI ≥ 30 kg/m2), the association was more pronounced, especially for cardiovascular mortality (HRT3 vs T1 5.55; 95% CI 2.11-14.57 Ptrend = 0.006; HR1SD increase 1.74; 95% CI 1.21-2.50). No association was observed between DII score and risk of mortality in individuals with metabolically healthy overweight/obese (MHO) phenotype, or for cancer mortality in either MHO or MUO phenotype. CONCLUSIONS A pro-inflammatory diet appears to increase risk of all-cause and cardiovascular mortality in the MUO phenotype, but not among the MHO phenotype.
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Affiliation(s)
- Yong-Moon Mark Park
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, United States
| | - Moon Kyung Choi
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, United States
| | - Seong-Su Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Nitin Shivappa
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, United States; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States; Connecting Health Innovations, LLC, Columbia, SC, United States
| | - Kyungdo Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Susan E Steck
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, United States; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - James R Hébert
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, United States; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States; Connecting Health Innovations, LLC, Columbia, SC, United States
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, United States
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35
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Stefan N, Häring HU, Schulze MB. Metabolically healthy obesity: the low-hanging fruit in obesity treatment? Lancet Diabetes Endocrinol 2018; 6:249-258. [PMID: 28919065 DOI: 10.1016/s2213-8587(17)30292-9] [Citation(s) in RCA: 192] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 08/01/2017] [Accepted: 08/04/2017] [Indexed: 12/15/2022]
Abstract
Obesity increases the risk of several other chronic diseases and, because of its epidemic proportions, has become a major public health problem worldwide. Alarmingly, a lower proportion of adults have tried to lose weight during the past decade than during the mid-1980s to 1990s. The first-line treatment option for obesity is lifestyle intervention. Although this approach can decrease fat mass in the short term, these beneficial effects typically do not persist. If a large amount of weight loss is not an easily achievable goal, other goals that might motivate people with obesity to adopt a healthy lifestyle should be considered. In this setting, the concept of metabolically healthy obesity is useful. Accumulating evidence suggests that, although the risk of all-cause mortality and cardiovascular events might be higher in people with metabolically healthy obesity compared with metabolically healthy people of a normal weight, the risk is substantially lower than in individuals with metabolically unhealthy obesity. Therefore, every person with obesity should be motivated to achieve a normal weight in the long term, but more moderate weight loss sufficient for the transition from metabolically unhealthy obesity to metabolically healthy obesity might also lower the risk of adverse outcomes. However, how much weight needs to be lost for this transition to occur is under debate. This transition might be supported by lifestyle factors-such as the Mediterranean diet-that affect cardiovascular risk, independent of body fat. In this Series paper, we summarise available information about the concept of metabolically healthy obesity, highlight gaps in research, and discuss how this concept can be implemented in clinical care.
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Affiliation(s)
- Norbert Stefan
- Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany; Institute of Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich, Tübingen, Germany; German Center for Diabetes Research, Neuherberg, Germany.
| | - Hans-Ulrich Häring
- Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany; Institute of Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich, Tübingen, Germany; German Center for Diabetes Research, Neuherberg, Germany
| | - Matthias B Schulze
- German Center for Diabetes Research, Neuherberg, Germany; Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
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Schmid V, Wagner R, Sailer C, Fritsche L, Kantartzis K, Peter A, Heni M, Häring HU, Stefan N, Fritsche A. Non-alcoholic fatty liver disease and impaired proinsulin conversion as newly identified predictors of the long-term non-response to a lifestyle intervention for diabetes prevention: results from the TULIP study. Diabetologia 2017; 60:2341-2351. [PMID: 28840257 DOI: 10.1007/s00125-017-4407-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/11/2017] [Indexed: 02/08/2023]
Abstract
AIMS/HYPOTHESIS Lifestyle intervention is effective to prevent type 2 diabetes. However, a considerable long-term non-response occurs to a standard lifestyle intervention. We investigated which risk phenotypes at baseline and their changes during the lifestyle intervention predict long-term glycaemic non-response to the intervention. METHODS Of 300 participants at high risk for type 2 diabetes who participated in a 24 month lifestyle intervention with diet modification and increased physical activity, 190 participants could be re-examined after 8.7 ± 1.6 years. All individuals underwent a five-point 75 g OGTT and measurements of body fat compartments and liver fat content with MRI and spectroscopy at baseline, 9 and 24 months during the lifestyle intervention, and at long-term follow-up. Fasting proinsulin to insulin conversion (PI/I ratio) and insulin sensitivity and secretion were calculated from the OGTT. Non-response to lifestyle intervention was defined as no decrease in glycaemia, i.e. no decrease in AUC for glucose at 0-120 min during OGTT (AUCglucose0-120 min). RESULTS Before the lifestyle intervention, 56% of participants had normal glucose regulation and 44% individuals had impaired fasting glucose and/or impaired glucose tolerance. At long-term follow-up, 11% had developed diabetes. Multivariable regression analysis with adjustment for age, sex, BMI and change in BMI during the lifestyle intervention revealed that baseline insulin secretion and insulin sensitivity, as well as change in insulin sensitivity during the lifestyle intervention, predicted long-term glycaemic control after 9 years. In addition, increased hepatic lipid content as well as impaired fasting proinsulin conversion at baseline were newly detected phenotypes that independently predicted long-term glycaemic control. CONCLUSIONS/INTERPRETATION Increased hepatic lipid content and impaired proinsulin conversion are new predictors, independent of change in body weight, for non-response to lifestyle intervention in addition to the confirmed factors, impaired insulin secretion and insulin sensitivity.
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Affiliation(s)
- Vera Schmid
- Department of Internal Medicine IV, University Hospital of Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
- International Research Training Group 1302, University of Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
| | - Robert Wagner
- Department of Internal Medicine IV, University Hospital of Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany
- German Centre for Diabetes Research (DZD), Tübingen, Germany
| | - Corinna Sailer
- Department of Internal Medicine IV, University Hospital of Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany
- German Centre for Diabetes Research (DZD), Tübingen, Germany
| | - Louise Fritsche
- Department of Internal Medicine IV, University Hospital of Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany
- German Centre for Diabetes Research (DZD), Tübingen, Germany
| | - Konstantinos Kantartzis
- Department of Internal Medicine IV, University Hospital of Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany
- German Centre for Diabetes Research (DZD), Tübingen, Germany
| | - Andreas Peter
- Department of Internal Medicine IV, University Hospital of Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany
- German Centre for Diabetes Research (DZD), Tübingen, Germany
| | - Martin Heni
- Department of Internal Medicine IV, University Hospital of Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany
- German Centre for Diabetes Research (DZD), Tübingen, Germany
| | - Hans-Ulrich Häring
- Department of Internal Medicine IV, University Hospital of Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany
- German Centre for Diabetes Research (DZD), Tübingen, Germany
| | - Norbert Stefan
- Department of Internal Medicine IV, University Hospital of Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany
- German Centre for Diabetes Research (DZD), Tübingen, Germany
| | - Andreas Fritsche
- Department of Internal Medicine IV, University Hospital of Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany.
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany.
- German Centre for Diabetes Research (DZD), Tübingen, Germany.
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Lin H, Zhang L, Zheng R, Zheng Y. The prevalence, metabolic risk and effects of lifestyle intervention for metabolically healthy obesity: a systematic review and meta-analysis: A PRISMA-compliant article. Medicine (Baltimore) 2017; 96:e8838. [PMID: 29381992 PMCID: PMC5708991 DOI: 10.1097/md.0000000000008838] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND We conducted a systematic review and meta-analysis to firstly obtain a reliable estimation of the prevalence of metabolically healthy obese (MHO) individuals in obesity, then assessed the risk of developing metabolic abnormalities (MA) among MHO individuals. At last, we evaluated the effects of traditional lifestyle interventions on metabolic level for MHO subjects. METHODS A systematic review and meta-analysis (PRISMA) guideline were conducted, and original studies were searched up to December 31, 2016. The prevalence of MHO in obesity from each study was pooled using random effects models. The relative risks (RRs) were pooled to determine the risk of developing MA for MHO compared with metabolically healthy normal-weight (MHNW) subjects. For the meta-analysis of intervention studies, the mean difference and standardized mean differences were both estimated for each metabolic parameter within each study, and then pooled using a random-effects model. RESULTS Overall, 40 population-based studies reported the prevalence of MHO in obesity, 12 cohort studies and 7 intervention studies were included in the meta-analysis. About 35.0% obese individuals were metabolically healthy in the obese subjects. There were dramatic differences in the prevalence among different areas. However, 0.49 (95% confidence intervals [CI]: 0.38 to 0.60) of the MHO individuals would develop one or more MA within 10 years. Compared with MHNW subjects, the MHO subjects presented higher risk of incident MA (pooled RR = 1.80, 95%CI: 1.53-2.11). Following intervention, there was certain and significant improvement of metabolic state for metabolically abnormal obesity (MAO) subjects. Only diastolic blood pressure had reduced for MHO individuals after intervention. CONCLUSIONS Almost one-third of the obese individuals are in metabolic health. However, they are still at higher risk of advancing to unhealthy state. Therefore, it is still needed to advise MHO individuals to maintain or adopt a healthy lifestyle, so as to counterbalance the adverse effects of obesity.
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Affiliation(s)
| | - Liqun Zhang
- Department of Intensive Care Unit, Zhejiang Putuo Hospital, Zhoushan
| | - Ruizhi Zheng
- Department of Epidemiology and Statistic, Zhejiang University, Hangzhou, Zhejiang
| | - Yishan Zheng
- Department of Intensive Care Unit, The Second Hospital of Nanjing. Teaching Hospital of Medical School of Nanjing University, Nanjing, Jiangsu, China
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Machann J, Stefan N, Wagner R, Bongers M, Schleicher E, Fritsche A, Häring HU, Nikolaou K, Schick F. Intra- and interindividual variability of fatty acid unsaturation in six different human adipose tissue compartments assessed by 1 H-MRS in vivo at 3 T. NMR IN BIOMEDICINE 2017; 30:e3744. [PMID: 28543814 DOI: 10.1002/nbm.3744] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 03/30/2017] [Accepted: 04/10/2017] [Indexed: 05/18/2023]
Abstract
It is generally accepted that the amount and distribution of adipose tissue (AT) in the human body play an important role in the pathogenesis of metabolic diseases. In addition, metabolic effects of released saturated fatty acids (FAs) in blood are known to be more critical than those of unsaturated FAs. However, little is known about the variability in unsaturation of FAs in various AT compartments. The aim of this prospective study was the assessment of mono- and polyunsaturated FAs in various AT compartments by localized 1 H-MRS in order to obtain insight into the intra- and interindividual variability. Associations of FA unsaturation with intrahepatic lipids (IHLs), insulin sensitivity and related AT volumes were analyzed. Fifty healthy Caucasians (36 male, 14 female) participated in this study. Spectroscopic examinations were performed in subcutaneous adipose tissue in the neck (SCATneck ), abdominal deep subcutaneous adipose tissue (DSCAT), abdominal superficial subcutaneous adipose tissue (SSCAT), visceral adipose tissue (VAT), tibial bone marrow (BM) and subcutaneous adipose tissue of the lower leg (SCATcalf ) at 3 T. Unsaturated index (UI) was calculated by the ratio of olefinic and methyl resonances, polyunsaturated index (PUI) by the ratio of diallylic and methyl resonances. Volumes of AT compartments (by T1 -weighted MRI) and IHL (single-voxel STEAM) were assessed at 1.5 T, insulin sensitivity by an oral glucose tolerance test. UI was highest for SCATcalf (0.622) and lowest for BM (0.527). Highest PUI was observed for SSCAT (0.108), lowest for BM (0.093). Significant intraindividual differences between UIs-but not PUIs-are present for most compartments. There is a non-significant trend for higher UI in males but otherwise no correlation to anthropometric data (age, BMI). A significant negative correlation between UI and AT volume was observed for VAT but for none of the other compartments. Neither UIs nor PUIs show a relation with IHL; insulin sensitivity is significantly correlated to UI in BM (p < 0.01). Unsaturation indices in several distinct AT compartments are location dependent. Our cohort showed only moderate gender-related differences, with a trend towards less unsaturated FAs (mainly PUI) in females. In BM, insulin resistant subjects are characterized by a higher UI compared with the insulin sensitive ones. Further studies in larger cohorts are necessary to gain further insight into unsaturation of AT.
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Affiliation(s)
- Jürgen Machann
- Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Norbert Stefan
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Department of Endocrinology and Diabetology, Angiology, Nephrology and Clinical Chemistry, University Hospital Tübingen, Germany
| | - Robert Wagner
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Department of Endocrinology and Diabetology, Angiology, Nephrology and Clinical Chemistry, University Hospital Tübingen, Germany
| | - Malte Bongers
- Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Germany
| | - Erwin Schleicher
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Department of Endocrinology and Diabetology, Angiology, Nephrology and Clinical Chemistry, University Hospital Tübingen, Germany
| | - Andreas Fritsche
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Department of Endocrinology and Diabetology, Angiology, Nephrology and Clinical Chemistry, University Hospital Tübingen, Germany
| | - Hans-Ulrich Häring
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Department of Endocrinology and Diabetology, Angiology, Nephrology and Clinical Chemistry, University Hospital Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Germany
| | - Fritz Schick
- Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Germany
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Jung CH, Lee WJ, Song KH. Metabolically healthy obesity: a friend or foe? Korean J Intern Med 2017; 32:611-621. [PMID: 28602062 PMCID: PMC5511946 DOI: 10.3904/kjim.2016.259] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 04/27/2017] [Indexed: 12/11/2022] Open
Abstract
Obesity is associated with a reduced life expectancy, largely because obese individuals are at an increased risk of type 2 diabetes, cardiovascular disease, and several types of cancer. Much interest has recently focused on the concept of "all obesity is not created equally." Obese individuals without the metabolic abnormalities that commonly accompany excess adiposity, a condition known as metabolically healthy obesity (MHO), account for a substantial proportion of the obese adult population. Numerous possible mechanisms underlying MHO have been suggested, including adipose tissue distribution and inflammation. However, the prognostic value of MHO is controversial and considerably challenging. The lack of a standard definition for metabolic health and obesity as well as the dynamic properties of MHO may have contributed to these inconsistent results. This review aimed to present several current issues regarding MHO including its definition, epidemiology, natural course, suggested mechanisms, and clinical implications in the context of patient prognosis.
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Affiliation(s)
- Chang Hee Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Je Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee-Ho Song
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
- Correspondence to Kee-Ho Song, M.D. Department of Internal Medicine, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea Tel: +82-2-2030-753 Fax: +82-2-2030-7458 E-mail:
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40
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Trepanowski JF, Kroeger CM, Barnosky A, Klempel MC, Bhutani S, Hoddy KK, Gabel K, Freels S, Rigdon J, Rood J, Ravussin E, Varady KA. Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults: A Randomized Clinical Trial. JAMA Intern Med 2017; 177:930-938. [PMID: 28459931 PMCID: PMC5680777 DOI: 10.1001/jamainternmed.2017.0936] [Citation(s) in RCA: 370] [Impact Index Per Article: 52.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Alternate-day fasting has become increasingly popular, yet, to date, no long-term randomized clinical trials have evaluated its efficacy. OBJECTIVE To compare the effects of alternate-day fasting vs daily calorie restriction on weight loss, weight maintenance, and risk indicators for cardiovascular disease. DESIGN, SETTING, AND PARTICIPANTS A single-center randomized clinical trial of obese adults (18 to 64 years of age; mean body mass index, 34) was conducted between October 1, 2011, and January 15, 2015, at an academic institution in Chicago, Illinois. INTERVENTIONS Participants were randomized to 1 of 3 groups for 1 year: alternate-day fasting (25% of energy needs on fast days; 125% of energy needs on alternating "feast days"), calorie restriction (75% of energy needs every day), or a no-intervention control. The trial involved a 6-month weight-loss phase followed by a 6-month weight-maintenance phase. MAIN OUTCOMES AND MEASURES The primary outcome was change in body weight. Secondary outcomes were adherence to the dietary intervention and risk indicators for cardiovascular disease. RESULTS Among the 100 participants (86 women and 14 men; mean [SD] age, 44 [11] years), the dropout rate was highest in the alternate-day fasting group (13 of 34 [38%]), vs the daily calorie restriction group (10 of 35 [29%]) and control group (8 of 31 [26%]). Mean weight loss was similar for participants in the alternate-day fasting group and those in the daily calorie restriction group at month 6 (-6.8% [95% CI, -9.1% to -4.5%] vs -6.8% [95% CI, -9.1% to -4.6%]) and month 12 (-6.0% [95% CI, -8.5% to -3.6%] vs -5.3% [95% CI, -7.6% to -3.0%]) relative to those in the control group. Participants in the alternate-day fasting group ate more than prescribed on fast days, and less than prescribed on feast days, while those in the daily calorie restriction group generally met their prescribed energy goals. There were no significant differences between the intervention groups in blood pressure, heart rate, triglycerides, fasting glucose, fasting insulin, insulin resistance, C-reactive protein, or homocysteine concentrations at month 6 or 12. Mean high-density lipoprotein cholesterol levels at month 6 significantly increased among the participants in the alternate-day fasting group (6.2 mg/dL [95% CI, 0.1-12.4 mg/dL]), but not at month 12 (1.0 mg/dL [95% CI, -5.9 to 7.8 mg/dL]), relative to those in the daily calorie restriction group. Mean low-density lipoprotein cholesterol levels were significantly elevated by month 12 among the participants in the alternate-day fasting group (11.5 mg/dL [95% CI, 1.9-21.1 mg/dL]) compared with those in the daily calorie restriction group. CONCLUSIONS AND RELEVANCE Alternate-day fasting did not produce superior adherence, weight loss, weight maintenance, or cardioprotection vs daily calorie restriction. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00960505.
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Affiliation(s)
- John F Trepanowski
- Department of Kinesiology and Nutrition, University of Illinois at Chicago
| | - Cynthia M Kroeger
- Department of Kinesiology and Nutrition, University of Illinois at Chicago2Nutrition Obesity Research Center, University of Alabama at Birmingham
| | - Adrienne Barnosky
- Department of Kinesiology and Nutrition, University of Illinois at Chicago
| | - Monica C Klempel
- Department of Kinesiology and Nutrition, University of Illinois at Chicago
| | - Surabhi Bhutani
- Department of Kinesiology and Nutrition, University of Illinois at Chicago
| | - Kristin K Hoddy
- Department of Kinesiology and Nutrition, University of Illinois at Chicago
| | - Kelsey Gabel
- Department of Kinesiology and Nutrition, University of Illinois at Chicago
| | - Sally Freels
- Department of Epidemiology and Biostatistics, University of Illinois at Chicago
| | - Joseph Rigdon
- Quantitative Sciences Unit, Stanford University, Stanford, California
| | - Jennifer Rood
- Nutrition Obesity Research Center, Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Eric Ravussin
- Nutrition Obesity Research Center, Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Krista A Varady
- Department of Kinesiology and Nutrition, University of Illinois at Chicago
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Buscemi S, Chiarello P, Buscemi C, Corleo D, Massenti MF, Barile AM, Rosafio G, Maniaci V, Settipani V, Cosentino L, Giordano C. Characterization of Metabolically Healthy Obese People and Metabolically Unhealthy Normal-Weight People in a General Population Cohort of the ABCD Study. J Diabetes Res 2017; 2017:9294038. [PMID: 28840131 PMCID: PMC5559951 DOI: 10.1155/2017/9294038] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/13/2017] [Indexed: 12/22/2022] Open
Abstract
There is actually no consensus about the possibility that in some instances, obesity may be a benign metabolically healthy (MH) condition as opposed to a normal-weight but metabolically unhealthy (MUH) state. The aim of this study was to characterize MH condition and to investigate possible associations with metabolic and cardiovascular complications. One thousand nineteen people (range of age 18-90 years) of the cohort of the ABCD_2 study were investigated. Participants were classified as normal weight (BMI < 24.9 kg/m2) or overweight-obese (BMI ≥25 kg/m2); they were also classified as MH in the presence of 0-1 among the following conditions: (a) prediabetes/type 2 diabetes, (b) hypertension, (c) hypertriglyceridemia or low HDL cholesterolemia, and (d) hypercholesterolemia. MUH condition was diagnosed if ≥2 of the conditions listed were found. The prevalence of overweight/obese people was 71.1%, of whom 27.4% were found to be MH. In addition, 36.7% of the normal-weight participants were MUH. HOMA-IR, high sensitivity C-reactive protein, and the carotid intima-media thickness were significantly different in the 4 subgroups (P < 0.001), with higher values observed in the MUH normal-weight and obese groups. In conclusion, this study highlights the importance of identifying a MH condition in normal-weight and in obese people in order to offer better treatment.
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Affiliation(s)
- Silvio Buscemi
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), University of Palermo, Palermo, Italy
- Unit of Malattie Endocrine del Ricambio e della Nutrizione, AOU Policlinico “P. Giaccone”, Palermo, Italy
- *Silvio Buscemi:
| | - Pierfilippo Chiarello
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), University of Palermo, Palermo, Italy
- Unit of Malattie Endocrine del Ricambio e della Nutrizione, AOU Policlinico “P. Giaccone”, Palermo, Italy
| | - Carola Buscemi
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), University of Palermo, Palermo, Italy
- Unit of Malattie Endocrine del Ricambio e della Nutrizione, AOU Policlinico “P. Giaccone”, Palermo, Italy
| | - Davide Corleo
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), University of Palermo, Palermo, Italy
- Unit of Malattie Endocrine del Ricambio e della Nutrizione, AOU Policlinico “P. Giaccone”, Palermo, Italy
| | - Maria Fatima Massenti
- Dipartimento di Scienze per la Promozione della Salute e Materno Infantile, University of Palermo, Palermo, Italy
| | - Anna Maria Barile
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), University of Palermo, Palermo, Italy
- Unit of Malattie Endocrine del Ricambio e della Nutrizione, AOU Policlinico “P. Giaccone”, Palermo, Italy
| | - Giuseppe Rosafio
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), University of Palermo, Palermo, Italy
- Unit of Malattie Endocrine del Ricambio e della Nutrizione, AOU Policlinico “P. Giaccone”, Palermo, Italy
| | - Vincenza Maniaci
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), University of Palermo, Palermo, Italy
- Unit of Malattie Endocrine del Ricambio e della Nutrizione, AOU Policlinico “P. Giaccone”, Palermo, Italy
| | - Valentina Settipani
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), University of Palermo, Palermo, Italy
- Unit of Malattie Endocrine del Ricambio e della Nutrizione, AOU Policlinico “P. Giaccone”, Palermo, Italy
| | - Loretta Cosentino
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), University of Palermo, Palermo, Italy
- Unit of Malattie Endocrine del Ricambio e della Nutrizione, AOU Policlinico “P. Giaccone”, Palermo, Italy
| | - Carla Giordano
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), University of Palermo, Palermo, Italy
- Unit of Malattie Endocrine del Ricambio e della Nutrizione, AOU Policlinico “P. Giaccone”, Palermo, Italy
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Jamar G, Caranti DA, de Cassia Cesar H, Masquio DCL, Bandoni DH, Pisani LP. Leptin as a cardiovascular risk marker in metabolically healthy obese: Hyperleptinemia in metabolically healthy obese. Appetite 2016; 108:477-482. [PMID: 27838444 DOI: 10.1016/j.appet.2016.11.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 10/07/2016] [Accepted: 11/08/2016] [Indexed: 12/21/2022]
Abstract
Adipokines contribute to the inflammatory process which can lead to obesity-associated cardiometabolic complications. Metabolically healthy obese individuals seem to be protected or more resistant to develop these complications and it is intriguing why some individuals develop comorbidities and others do not. Thus, we questioned whether the differences between metabolically healthy and unhealthy obese relied on the alterations in metabolic profile, characterized by serum leptin and adiponectin. A total of 142 obese adults were divided into 2 groups - metabolically healthy obese (MHO) or unhealthy obese (MUO) - and they were evaluated for anthropometric measures, body composition, blood pressure, dietary intakes and plasma levels of leptin and adiponectin. Leptin/adiponectin ratio (L/A) was calculated. Age, BMI and blood pressure were higher in the MUO. No differences in anthropometric measurements, body composition, dietary intake and dietary quality were observed between groups. Leptin were significantly higher in the MUO (53.07 ± 34.56 versus 36.27 ± 24.02 ng/ml in the MHO, r < 0.04). The logistic regression analysis demonstrated that leptin was an important factor associated with not being healthy, independent of age, body weight and BMI. There were no differences between groups for adiponectin and L/A. Leptin correlated positively with body weight (r = 0.25, r < 0.05), BMI (r = 0.38, r < 0.05) and BF (r = 0.74, r < 0.05), and negatively with FFM (r = -0.74, r < 0.05). Our findings suggest that leptin is an important cardiovascular disease marker to obese population and can contribute to evaluate metabolic risks in these individuals.
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Affiliation(s)
- Giovana Jamar
- Programa de Pós-graduação Interdisciplinar em Ciências da Saúde, Universidade Federal de São Paulo - UNIFESP, Santos, SP, Brazil
| | - Danielle Arisa Caranti
- Programa de Pós-graduação Interdisciplinar em Ciências da Saúde, Universidade Federal de São Paulo - UNIFESP, Santos, SP, Brazil; Departamento de Biociências, Universidade Federal de São Paulo - UNIFESP, Santos, SP, Brazil
| | - Helena de Cassia Cesar
- Departamento de Biociências, Universidade Federal de São Paulo - UNIFESP, Santos, SP, Brazil
| | | | - Daniel Henrique Bandoni
- Programa de Pós-graduação Interdisciplinar em Ciências da Saúde, Universidade Federal de São Paulo - UNIFESP, Santos, SP, Brazil; Departamento de Saúde, Clínica e Instituições, Universidade Federal de São Paulo - UNIFESP, Santos SP, Brazil
| | - Luciana Pellegrini Pisani
- Programa de Pós-graduação Interdisciplinar em Ciências da Saúde, Universidade Federal de São Paulo - UNIFESP, Santos, SP, Brazil; Departamento de Biociências, Universidade Federal de São Paulo - UNIFESP, Santos, SP, Brazil.
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Phillips CM. Metabolically healthy obesity across the life course: epidemiology, determinants, and implications. Ann N Y Acad Sci 2016; 1391:85-100. [PMID: 27723940 DOI: 10.1111/nyas.13230] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/09/2016] [Accepted: 08/18/2016] [Indexed: 12/24/2022]
Abstract
In recent years, different subphenotypes of obesity have been described, including metabolically healthy obesity (MHO), in which a proportion of obese individuals, despite excess body fat, remain free of metabolic abnormalities and increased cardiometabolic risk. In the absence of a universally accepted set of criteria to classify MHO, the reported prevalence estimates vary widely. Our understanding of the determinants and stability of MHO over time and the associated cardiometabolic and mortality risks is improving, but many questions remain. For example, whether MHO is truly benign is debatable, and whether risk stratification of obese individuals on the basis of their metabolic health status may offer new opportunities for more personalized approaches in diagnosis, intervention, and treatment of diabetes remains speculative. Furthermore, as most of the research to date has focused on MHO in adults, little is known about childhood MHO. In this review, we focus on the epidemiology, determinants, stability, and health implications of MHO across the life course.
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Affiliation(s)
- Catherine M Phillips
- HRB Centre for Diet and Health Research, Department of Epidemiology and Public Health, University College Cork, Cork, Ireland; and HRB Centre for Diet and Health Research, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Abstract
This article describes phenotypes observed in a prediabetic population (i.e. a population with increased risk for type 2 diabetes) from data collected at the University hospital of Tübingen. We discuss the impact of genetic variation on insulin secretion, in particular the effect on compensatory hypersecretion, and the incretin-resistant phenotype of carriers of the gene variant TCF7L2 is described. Imaging studies used to characterise subphenotypes of fat distribution, metabolically healthy obesity and metabolically unhealthy obesity are described. Also discussed are ectopic fat stores in liver and pancreas that determine the phenotype of metabolically healthy and unhealthy fatty liver and the recently recognised phenotype of fatty pancreas. The metabolic impact of perivascular adipose tissue and pancreatic fat is discussed. The role of hepatokines, particularly that of fetuin-A, in the crosstalk between these organs is described. Finally, the role of brain insulin resistance in the development of the different prediabetes phenotypes is discussed.
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Affiliation(s)
- Hans-Ulrich Häring
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, University of Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany.
- Institute of Diabetes Research and Metabolic Diseases (IDM), University of Tübingen, Tübingen, Germany.
- German Center for Diabetes Research (DZD), Neuherberg, Germany.
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Abstract
Obesity is a top public health priority but interventions to reverse the condition have had limited success. About one-in-three obese adults are free of metabolic risk factor clustering and are considered 'healthy', and much attention has focused on the implications of this state for obesity management. Areas covered: We searched for individual studies, systematic reviews, and meta-analyses which examined correlates and outcomes of metabolically healthy obesity. We discuss the key roles of fat distribution and physical activity in determining healthy vs. unhealthy obesity and report a greatly increased risk of incident type 2 diabetes associated with healthy obesity vs. healthy normal weight, among other outcomes. We argue that despite inconsistencies in the definition, patterns across studies clearly show that healthy obesity is a state of intermediate disease risk. Expert commentary: Given the current state of population-level evidence, we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health. We recommend that weight loss through energy restriction be a stand-alone target in addition to increased physical activity for minimising risk of future disease.
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Affiliation(s)
- J A Bell
- a Department of Epidemiology & Public Health , University College London , London , UK
- b School of Sport, Exercise & Health Sciences, Loughborough University , Loughborough , UK
| | - M Hamer
- b School of Sport, Exercise & Health Sciences, Loughborough University , Loughborough , UK
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Stelmach-Mardas M, Walkowiak J. Dietary Interventions and Changes in Cardio-Metabolic Parameters in Metabolically Healthy Obese Subjects: A Systematic Review with Meta-Analysis. Nutrients 2016; 8:E455. [PMID: 27483307 PMCID: PMC4997370 DOI: 10.3390/nu8080455] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/14/2016] [Accepted: 07/25/2016] [Indexed: 11/27/2022] Open
Abstract
The aim of this systematic review was to assess the effect of diet on changes in parameters describing the body size phenotype of metabolically healthy obese subjects. The databases Medline, Scopus, Web of Knowledge and Embase were searched for clinical studies carried out between 1958 and June 2016 that reported the effect of dietary intervention on BMI, blood pressure, concentration of fasting triglyceride (TG), high density lipoprotein cholesterol (HDL-C), fasting glucose level, the homoeostatic model assessment of insulin resistance (HOMA-IR) and high sensitivity C-Reactive Protein (hsCRP) in metabolically healthy, obese subjects. Twelve clinical studies met inclusion criteria. The combined analyzed population consists of 1827 subjects aged 34.4 to 61.1 with a BMI > 30 kg/m². Time of intervention ranged from eight to 104 weeks. The baseline characteristics related to lipid profile were more favorable for metabolically healthy obese than for metabolically unhealthy obese. The meta-analyses revealed a significant associations between restricted energy diet and BMI (95% confidence interval (CI): -0.88, -0.19), blood pressure (systolic blood pressure (SBP): -4.73 mmHg; 95% CI: -7.12, -2.33; and diastolic blood pressure (DBP): -2.75 mmHg; 95% CI: -4.30, -1.21) and TG (-0.11 mmol/l; 95% CI: -0.16, -0.06). Changes in fasting glucose, HOMA-IR and hsCRP did not show significant changes. Sufficient evidence was not found to support the use of specific diets in metabolically healthy obese subjects. This analysis suggests that the effect of caloric restriction exerts its effects through a reduction in BMI, blood pressure and triglycerides in metabolically healthy obese (MHO) patients.
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Affiliation(s)
- Marta Stelmach-Mardas
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, Nuthetal 14558, Germany.
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Str 27/33, Poznan 60-572, Poland.
| | - Jarosław Walkowiak
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Str 27/33, Poznan 60-572, Poland.
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Natural Course of Metabolically Healthy Overweight/Obese Subjects and the Impact of Weight Change. Nutrients 2016; 8:nu8070430. [PMID: 27428997 PMCID: PMC4963906 DOI: 10.3390/nu8070430] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/08/2016] [Accepted: 07/11/2016] [Indexed: 02/03/2023] Open
Abstract
Few studies have described the characteristics of metabolically healthy individuals with excess fat in the Chinese population. This study aimed to prospectively investigate the natural course of metabolically healthy overweight/obese (MH-OW/OB) adults, and to assess the impact of weight change on developing metabolic abnormalities. During 2009–2010, 525 subjects without any metabolic abnormalities or other obesity-related diseases were evaluated and reevaluated after 5 years. The subjects were categorized into two groups of overweight/obese and normal weight based on the criteria of BMI by 24.0 at baseline. At follow-up, the MH-OW/OB subjects had a significantly increased risk of developing metabolically abnormalities compared with metabolically healthy normal-weight (MH-NW) individuals (risk ratio: 1.35, 95% confidence interval: 1.17–1.49, p value < 0.001). In the groups of weight gain and weight maintenance, the MH-OW/OB subjects was associated with a larger increase in fasting glucose, triglycerides, systolic blood pressure, diastolic blood pressure and decrease in high-density lipoprotein cholesterol comparing with MH-NW subjects. In the weight loss group, no significant difference of changes of metabolic parameters was observed between MH-OW/OB and MH-NW adults. This study verifies that MH-OW/OB are different from MH-NW subjects. Weight management is needed for all individuals since weight change has a significant effect on metabolic health without considering the impact of weight change according to weight status.
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Shen J, Baum T, Cordes C, Ott B, Skurk T, Kooijman H, Rummeny EJ, Hauner H, Menze BH, Karampinos DC. Automatic segmentation of abdominal organs and adipose tissue compartments in water-fat MRI: Application to weight-loss in obesity. Eur J Radiol 2016; 85:1613-21. [PMID: 27501897 DOI: 10.1016/j.ejrad.2016.06.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/26/2016] [Accepted: 06/06/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE To develop a fully automatic algorithm for abdominal organs and adipose tissue compartments segmentation and to assess organ and adipose tissue volume changes in longitudinal water-fat magnetic resonance imaging (MRI) data. MATERIALS AND METHODS Axial two-point Dixon images were acquired in 20 obese women (age range 24-65, BMI 34.9±3.8kg/m(2)) before and after a four-week calorie restriction. Abdominal organs, subcutaneous adipose tissue (SAT) compartments (abdominal, anterior, posterior), SAT regions along the feet-head direction and regional visceral adipose tissue (VAT) were assessed by a fully automatic algorithm using morphological operations and a multi-atlas-based segmentation method. RESULTS The accuracy of organ segmentation represented by Dice coefficients ranged from 0.672±0.155 for the pancreas to 0.943±0.023 for the liver. Abdominal SAT changes were significantly greater in the posterior than the anterior SAT compartment (-11.4%±5.1% versus -9.5%±6.3%, p<0.001). The loss of VAT that was not located around any organ (-16.1%±8.9%) was significantly greater than the loss of VAT 5cm around liver, left and right kidney, spleen, and pancreas (p<0.05). CONCLUSION The presented fully automatic algorithm showed good performance in abdominal adipose tissue and organ segmentation, and allowed the detection of SAT and VAT subcompartments changes during weight loss.
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Affiliation(s)
- Jun Shen
- Department of Computer Science, Technische Universität München, Munich, Germany; Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christian Cordes
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Beate Ott
- Else Kröner Fresenius Center for Nutritional Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Thomas Skurk
- Else Kröner Fresenius Center for Nutritional Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; ZIEL Research Center for Nutrition and Food Sciences, Technische Universität München, Germany
| | | | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Hans Hauner
- Else Kröner Fresenius Center for Nutritional Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; ZIEL Research Center for Nutrition and Food Sciences, Technische Universität München, Germany
| | - Bjoern H Menze
- Department of Computer Science, Technische Universität München, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
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49
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Does Metabolically Healthy Obesity Exist? Nutrients 2016; 8:nu8060320. [PMID: 27258304 PMCID: PMC4924161 DOI: 10.3390/nu8060320] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/04/2016] [Accepted: 05/17/2016] [Indexed: 02/07/2023] Open
Abstract
The relationship between obesity and other metabolic diseases have been deeply studied. However, there are clinical inconsistencies, exceptions to the paradigm of "more fat means more metabolic disease", and the subjects in this condition are referred to as metabolically healthy obese (MHO).They have long-standing obesity and morbid obesity but can be considered healthy despite their high degree of obesity. We describe the variable definitions of MHO, the underlying mechanisms that can explain the existence of this phenotype caused by greater adipose tissue inflammation or the different capacity for adipose tissue expansion and functionality apart from other unknown mechanisms. We analyze whether these subjects improve after an intervention (traditional lifestyle recommendations or bariatric surgery) or if they stay healthy as the years pass. MHO is common among the obese population and constitutes a unique subset of characteristics that reduce metabolic and cardiovascular risk factors despite the presence of excessive fat mass. The protective factors that grant a healthier profile to individuals with MHO are being elucidated.
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50
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Rial SA, Karelis AD, Bergeron KF, Mounier C. Gut Microbiota and Metabolic Health: The Potential Beneficial Effects of a Medium Chain Triglyceride Diet in Obese Individuals. Nutrients 2016; 8:nu8050281. [PMID: 27187452 PMCID: PMC4882694 DOI: 10.3390/nu8050281] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/05/2016] [Accepted: 05/09/2016] [Indexed: 02/07/2023] Open
Abstract
Obesity and associated metabolic complications, such as non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2D), are in constant increase around the world. While most obese patients show several metabolic and biometric abnormalities and comorbidities, a subgroup of patients representing 3% to 57% of obese adults, depending on the diagnosis criteria, remains metabolically healthy. Among many other factors, the gut microbiota is now identified as a determining factor in the pathogenesis of metabolically unhealthy obese (MUHO) individuals and in obesity-related diseases such as endotoxemia, intestinal and systemic inflammation, as well as insulin resistance. Interestingly, recent studies suggest that an optimal healthy-like gut microbiota structure may contribute to the metabolically healthy obese (MHO) phenotype. Here, we describe how dietary medium chain triglycerides (MCT), previously found to promote lipid catabolism, energy expenditure and weight loss, can ameliorate metabolic health via their capacity to improve both intestinal ecosystem and permeability. MCT-enriched diets could therefore be used to manage metabolic diseases through modification of gut microbiota.
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Affiliation(s)
- Sabri Ahmed Rial
- BioMed Research Center, Biological Sciences Department, University of Quebec at Montreal, Montreal, QC H2X 1Y4, Canada.
| | - Antony D Karelis
- Department of Exercise Science, University of Quebec at Montreal, Montreal, QC H2X 1Y4, Canada.
| | - Karl-F Bergeron
- BioMed Research Center, Biological Sciences Department, University of Quebec at Montreal, Montreal, QC H2X 1Y4, Canada.
| | - Catherine Mounier
- BioMed Research Center, Biological Sciences Department, University of Quebec at Montreal, Montreal, QC H2X 1Y4, Canada.
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