Metabolically-healthy obesity and coronary artery calcification

Prevalence and characteristics of individuals without diabetes and hypertension who underwent bariatric surgery: lessons learned about metabolically healthy obese

BACKGROUND

Recent studies describe a unique subset of obese individuals with normal metabolic profiles despite having excess weight called "metabolically healthy but obese (MHO)". Our aim was to determine the prevalence of individuals without diabetes and hypertension and risk factors associated with the MHO phenotype among bariatric surgery patients.

METHODS

We conducted a retrospective study of 710 adults who underwent bariatric surgery at Johns Hopkins between 2008 and 2010. In the first analysis of 523 individuals, we identified 150 individuals without diabetes and hypertension; in the second analysis of 260 individuals, we identified 44 individuals without diabetes, hypertension and hypertriglyceridemia. We used multivariable logistic regression to examine the association between each group and potential risk factors including age, sex, race, body mass index, and presence of liver disease on liver biopsy.

RESULTS

The prevalence of individuals without diabetes and hypertension was 28.7%; among these individuals 88.7% had liver steatosis, 7.3% nonalcoholic steatohepatitis (NASH), and 19.3% liver fibrosis. These individuals were significantly more likely to be white OR=1.9 (95% CI: 1.1-3.1), younger OR=4.1 (95% CI=2.6-6.3), and female OR=2.1, (95% CI=1.2-3.6) and less likely to have liver steatosis OR=0.4 (95% CI=0.2-0.9) or NASH OR=0.3 (95% CI=0.2-0.6).

CONCLUSION

Among bariatric surgery patients, almost a third of patients do not have diabetes and hypertension and could be probably considered "MHO" and were more likely to be white, young, female, and have less liver injury. The high prevalence of liver steatosis in MHO individuals among bariatric surgery patients challenges the notion of MHO as a truly metabolically healthy entity.

Is there an increased cardiovascular risk in metabolically healthy obese individuals? Lessons from the HUNT (Nord-Trøndelag Health) study

Obesity and metabolic syndrome frequently co-exist and are major health problems worldwide. Prior research has questioned whether obesity without cardiometabolic abnormalities “metabolically healthy obesity” (MHO), has adverse effects on overall cardiovascular disease risk (CVD). The association between MHO and the first development of acute myocardial infarction and heart failure (HF) was evaluated in the second HUNT (Nord-Trøndelag Health).