Metabolically healthy obesity and health-related quality of life: A prospective cohort study

Bariatric Surgery: An Opportunity to Improve Quality of Life and Healthy Habits

Bariatric surgery therapy (BST) is an effective treatment for obesity; however, little is known about its impacts on health-related quality of life (HRQoL) and related factors. This study aimed to evaluate changes in HRQoL and its relationship with weight loss, depression status, physical activity (PA), and nutritional habits after BST. Data were obtained before and 18 months postprocedure from 56 obese patients who underwent BST. We administered four questionnaires: Short Form-36 health survey for HRQoL, 14-item MedDiet adherence questionnaire, Rapid Assessment of PA (RAPA) questionnaire, and Beck's Depression Inventory-II. Multivariable linear regression analysis was used to identify factors associated with improvement in HRQoL. After the surgery, MedDiet adherence and HRQoL improved significantly, especially in the physical component. No changes in PA were found. Patients without previous depression have better mental quality of life, and patients who lost more than 25% of %TBWL have better results in physical and mental quality of life. In the multivariable analysis, we found that %TBWL and initial PCS (inversely) were related to the improvement in PCS and initial MCS (inversely) with the MCS change. In conclusion, BST is an effective intervention for obesity, resulting in significant weight loss and improvements in HRQoL and nutritional habits.

Quality of life and psychosocial outcomes among children with metabolically healthy and unhealthy obesity

BACKGROUND

Obesity and obesity-related morbidities are associated with poor psychosocial adjustment and health-related quality of life (HRQoL). This study aims to examine HRQoL and psychosocial outcomes in children with metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO), and the effects of familial health on these outcomes.

METHODS

Four hundred and six children with BMI for age ≥ 97th percentile were classified as having MHO and MUO based on the absence or presence of metabolic abnormalities. HRQoL and psychosocial outcomes were assessed using validated questionnaires such as PedsQL and DASS-21.

RESULTS

There were no significant differences in HRQoL and psychosocial outcomes between children with MHO and children with MUO. Children with MUO and prior knowledge of existing metabolic conditions reported significantly lower total HRQoL (71.18 ± 17.42 vs. 75.34 ± 15.33), and higher depression (12.16 ± 11.80 vs. 8.95 ± 8.52) and stress (12.11 ± 8.21 vs. 10.04 ± 7.92) compared to children with MHO. Children with MUO who had fathers with metabolically unhealthy phenotype reported significantly lower total HRQoL (72.41 ± 15.67 vs. 76.82 ± 14.91) compared to children with MUO who had fathers with metabolically healthy phenotype.

CONCLUSION

Prior knowledge of existing metabolic abnormalities was associated with poorer HRQoL and mental health in children with obesity. Paternal metabolic health status influenced HRQoL in children with MUO.

IMPACT

First study that compared health-related quality of life (HRQoL) and psychosocial outcomes between children with metabolically healthy obesity (MHO) and children with metabolically unhealthy obesity (MUO). No significant differences in HRQoL and psychosocial outcomes between children with metabolically healthy obesity (MHO) and children with metabolically unhealthy obesity (MUO). Children with MUO who had prior knowledge of existing metabolic conditions reported lower HRQoL, higher depression and stress compared to children with MHO. Paternal metabolic health status was found to influence HRQoL in children with MUO. Mental health support intervention with paternal involvement should be provided for children with MUO.

The Mediating Role of Physical Activity and Physical Function in the Association between Body Mass Index and Health-Related Quality of Life: A Population-Based Study with Older Adults

This study aimed (1) to investigate the association between body mass index (BMI), physical activity (PA), and physical function (PF) with health-related quality of life (HRQoL), and (2) to examine in-depth whether PA and PF mediate the relationship between BMI and HRQoL in older adults. We investigated 802 individuals (mean age 69.8 ± 5.6 years), residents of the Autonomous Region of Madeira, Portugal. Harmol and PA were assessed using the SF-36 and Baecke questionnaires, respectively, and PF by the Senior Fitness Test. The prevalence of overweight was 71.3%, 26.5% for normal weight, and 2.1% for underweight. We verified a small correlation between age and sex with BMI, PA, PF, and medium borderline with HRQoL. After adjusting for covariates (i.e., sex, age, comorbidities), the multivariate regression analysis indicated a 93.1% chance of improvement in HRQoL for low BMI, while PA and PF revealed a chance of increasing HRQoL by 91.8% and 60.0%, respectively. According to the serial mediation pathway, PA and PF partially mediated the association between BMI and HRQoL by 32.3% and 81.5%, respectively. The total variance of the model was 90%. It was concluded that BMI can negatively affect HRQoL. On the other hand, PA and PF are able to increase HRQoL levels during the aging process.

Do lifestyle factors and quality of life differ in people with metabolically healthy and unhealthy obesity?

BACKGROUND AND OBJECTIVES

Although obesity is typically associated with metabolic co-morbidities, some people with obesity do not develop metabolic abnormalities. We evaluated whether modifiable lifestyle factors (i.e., physical activity, dietary composition, and sleep characteristics) can help explain why some people with obesity are metabolically healthy (MHO) and whether metabolically unhealthy obesity (MUO) affects quality of life (QOL).

SUBJECTS/METHODS

Physical activity and sleep characteristics were assessed by using tri-axial accelerometers and dietary intake, sleep quality, and QOL were evaluated by using validated questionnaires in people stratified into three groups: (1) lean with normal glucose tolerance, plasma triglyceride (TG) concentration and intrahepatic TG (IHTG) content (metabolically healthy lean [MHL]; n = 20); (2) obesity and normal glucose tolerance, plasma TG concentration and IHTG content (MHO; n = 36); and (3) obesity with abnormal glucose metabolism and hepatic steatosis (MUO; n = 43).

RESULTS

People with MHO performed ~45-min more light-intensity physical activity/day than the MHL and MUO groups (P < 0.05). QOL, particularly the physical function domain, was higher in the MHO than the MUO group (P < 0.05). Although self-reported intake of starch, dairy, and cured meats were higher in the MUO than the MHO group (P < 0.02), the absolute differences were small and unlikely to have metabolic effects. No differences were found in sleep duration or quality between groups.

CONCLUSIONS

These data suggest physical activity, but not sleep or dietary intake, contribute to better metabolic health in people with MHO than those with MUO, and that QOL is lower in people with MUO than those with MHO.

The Association of Obesity and Cardiorespiratory Fitness in Relation to Cognitive Flexibility: An Event-Related Potential Study

This study investigates an association between obesity and cardiorespiratory fitness concerning their potential effects on cognitive flexibility in young adults from behavioral and neuroelectrical perspectives. Eligible young adults (N = 140, 18–25 years) were assigned into one of four groups, according to their status of obesity (i.e., body mass index) and cardiorespiratory fitness levels (i.e., estimated maximal oxygen uptake), namely, normal weight with high cardiorespiratory fitness (NH), obese with high cardiorespiratory fitness (OH), normal weight with low cardiorespiratory fitness (NL), and obese with low cardiorespiratory fitness (OL). The task-switching test was utilized, and its induced endogenous (P3) and exogenous (N1) event-related potential components were recorded. Concerning behavioral indices, the NH demonstrated superior behavioral performance across global switching and local switching of the task-switching test compared to individuals with lower cardiorespiratory fitness and obesity (i.e., NL, OH, and OL). Additionally, the OH demonstrated better performance than the OL during the heterogeneous condition. For neuroelectrical indices, the NH had larger mean P3 amplitudes during global and local switching than the other three groups. A larger N1 amplitude was also observed in the NH during local switching than in the OH group. The findings suggest that cardiorespiratory fitness has beneficial effects on cognitive flexibility, attentional resource allocation, and sensory evaluation in young adults. Furthermore, our research provided novel evidence showing that cardiorespiratory fitness might potentially alleviate the adverse effects of obesity on cognitive flexibility in young adults.

Mental health and quality of life in different obesity phenotypes: a systematic review

Objectives

It has been suggested that obesity phenotypes are related to mental health problems and health-related quality of life (HRQoL). However, there is no certain consensus. This systematic review aimed to evaluate the association between different obesity phenotypes with common psychiatric symptoms and HRQoL.

Methods

Electronic databases i.e. PubMed, Scopus, EMBASE, and google scholar were searched until September 2021, to identify studies that investigated associations between the obesity phenotypes with psychiatric symptoms and/or mental and physical HRQoL. Two researchers independently checked titles and abstracts, evaluated full-text studies, extracted data, and appraised their quality using the Newcastle–Ottawa Scale.

Results

Eighteen studies, with a total of 3,929,203 participants, were included. Of the studies included in this systematic review, 10 articles evaluated the association between obesity phenotypes and psychiatric symptoms, while six papers investigated the association between HRQoL and obesity phenotypes, and two studies assessed both. As a whole, the findings of these studies suggest that obese individuals with a favorable metabolic profile have a slightly higher risk of mental health problems and poor quality of life, however, the risk becomes larger when obesity is combined with an adverse metabolic profile. So, metabolically healthy obesity may not be a completely benign condition in relation to mental disorders and poor quality of life.

Conclusion

According to published research, obesity is likely to increase the risk of mental health problems and poor quality of life when metabolic disturbances are present.

Metabolic Phenotypes—The Game Changer in Quality of Life of Obese Patients?

Background: The present study aimed to investigate the association of obesity phenotypes and quality of life (QoL) scales and their relationship with fat mass (FM) parameters. Methods: This study categorized 104 subjects into 4 obesity phenotypes based on BMI and metabolic syndrome status: metabolically healthy obese (MHO), metabolically unhealthy obese (MUO), metabolically healthy non-obese (MHNO), and metabolically unhealthy non-obese (MUNO). Body composition was measured by dual-energy X-ray absorptiometry (DEXA) and metabolic profile was characterized by blood samples. All subjects completed the SF-36 item Short Form Health Survey Questionnaire. Results: Comparing the four obesity phenotypes, significant results were reported for Bodily Pain between MHNO/MUNO (p = 0.034), for Vitality between MHO/MUO (p = 0.024), and for Mental Component Score between MHO/MUO (p = 0.026) and MUO/MUNO (p = 0.003). A more thorough inside-groups analysis yielded a positive and moderate to high correlation between FM parameters and QoL scales in MHO and MHNO, while a negative and weak to moderate correlation was observed in MUO and MUNO. Conclusion: This study reported an inverse U-shaped relationship between FM and QoL in obesity phenotypes, suggesting that metabolic status is a key factor involved in modulating QoL and therefore challenging the idea of obesity as a main driver of low QoL. We recommend the inclusion of FM percentage in the definition of obesity phenotypes in future research, to better evaluate QoL of obesity phenotypes.

Obesity, metabolic risk and adherence to healthy lifestyle behaviours: prospective cohort study in the UK Biobank

BACKGROUND

Contested evidence suggests that obesity confers no risk to health in people who have a healthy lifestyle, particularly if there are no metabolic complications of obesity. The aim was to examine the association between adherence to lifestyle recommendations and the absence of metabolic complications on the incident or fatal cardiovascular disease and all-cause mortality across different categories of body mass index (BMI).

METHODS

This contemporary prospective cohort study included 339,902 adults without cardiovascular disease at baseline, recruited between 2006 and 2010 from the UK Biobank and followed until 2018-2020. The main exposures were four healthy lifestyle behaviours: never smoker, alcohol intake ≤ 112g/ week, 150 min moderate physical activity or 75 min vigorous activity/week, ≥ 5 servings of fruit or vegetables/day, and we assessed these overall and across the BMI groups. Metabolic complications of excess adiposity were hypertension, diabetes and hyperlipidaemia, and we examined whether obesity was associated with increased risk in the absence of these complications. The outcomes were all-cause mortality, death from, and incident cardiovascular disease (CVD).

RESULTS

Individuals who met four lifestyle recommendations but had excess weight had higher all-cause mortality; for BMI 30-34.9 kg/m², the hazard ratio (HR) was 1.42 (95% confidence interval 1.20 to 1.68), and for BMI ≥ 35 kg/m², HR was 2.17 (95% CI 1.71 to 2.76). The risk was lower, but still increased for people with no metabolic complications; for all-cause mortality, BMI 30-34.9 kg/m² had an HR of 1.09 (95% CI 0.99 to 1.21), and BMI ≥ 35 kg/m² had an HR of 1.44 (95% CI 1.19 to 1.74) for all-cause mortality. Similar patterns were found for incident and fatal CVD.

CONCLUSIONS

Meeting healthy lifestyle recommendations, or the absence of metabolic complications of obesity offsets some, but not all, of the risk of subsequent CVD, and premature mortality in people with overweight or obesity. Offering support to achieve and maintain a healthy weight and to adopt healthy behaviours are likely to be important components in effective preventative healthcare.

Do Metabolically Healthy People with Obesity Have a Lower Health-Related Quality of Life? A Prospective Cohort Study in Taiwan

The association between metabolically healthy obesity (MHO) and health-related quality of life (HRQOL) has not been thoroughly evaluated. This study enrolled 906 adult participants aged 35–55 years between 2009 and 2010 in Northern Taiwan; 427 participants were followed up after eight years. Normal weight, overweight, and obesity were evaluated via body mass index. Metabolic health was defined as the absence of cardiometabolic diseases and having ≤1 metabolic risk factor. HRQOL was evaluated using the 36-Item Short Form Health Survey (SF-36), Taiwan version. Generalized linear mixed-effects models were used to analyze the repeated, measured data with adjustment for important covariates. Compared with metabolically healthy normal weight individuals, participants with metabolically unhealthy normal weight and obesity had a significantly poorer physical component summary score (β (95% CI) = −2.17 (−3.38–−0.97) and −2.29 (−3.70–−0.87), respectively). There were no significant differences in physical and mental component summary scores among participants with metabolically healthy normal weight, overweight, and obesity. This study showed that metabolically healthy individuals with obesity and normal weight had similar HRQOL in physical and mental component summary scores. Maintaining metabolic health is an ongoing goal for people with obesity.

Changes in metabolic syndrome affect the health-related quality of life of community-dwelling adults

Metabolic syndrome (MetS) is associated with cardiovascular diseases, type 2 diabetes, chronic renal diseases, and all-cause mortality. Furthermore, MetS is associated with poor health-related quality of life (HRQOL). However, the impact of dynamic changes in MetS on changes in the HRQOL was not previously explored. This was an eight-year, prospective cohort study in which 906 middle-aged adults from Shipai, Taipei in northern Taiwan were enrolled during 2009–2010 (baseline). Of those sampled, 427 participants completed the follow-up investigation after 8 years. The HRQOL was measured using the Short Form Health Survey (SF-36). Other variables including age, sex, marital status, level of education, smoking, alcohol consumption, baseline body mass index, and changes in physical activity were adjusted. Compared with adults who never experienced MetS, adults with persistent MetS had a negative change in mental HRQOL (β − 4.20, 95% CI − 7.54 to − 0.86, p = 0.01). The negative changes of persistent MetS on the HRQOL were in the domains of vitality and mental health (β − 4.42, 95% CI − 8.10 to − 0.73 and β − 3.47, 95% CI − 6.90 to − 0.04, respectively). Women and overweight adults were vulnerable to the detrimental effects of persistent MetS. For better HRQOL, more resources should be devoted to reversing MetS in public health.

The Effect of Physical Activity and High Body Mass Index on Health-Related Quality of Life in Individuals with Metabolic Syndrome

The main objective of this study was to examine the relationship between the level of physical activity (PA) and the degree of obesity with health-related quality of life (HRQoL) in individuals with metabolic syndrome (MetS) who participated in the Predimed-Plus study. A total of 6875 subjects between 55 and 75 years of age with MetS were selected and randomized in 23 Spanish centers. Subjects were classified according to categories of body mass index (BMI). PA was measured with the validated Registre Gironí del Cor (REGICOR) questionnaire and subjects were classified according to their PA level (light, moderate, vigorous) and the HRQoL was measured with the validated short-form 36 (SF-36) questionnaire. By using the ANOVA model, we found a positive and statistically significant association between the level of PA and the HRQoL (aggregated physical and mental dimensions p < 0.001), but a negative association with higher BMI in aggregated physical dimensions p < 0.001. Furthermore, women obtained lower scores compared with men, more five points in all fields of SF-36. Therefore, it is essential to promote PA and body weight control from primary care consultations to improve HRQoL, paying special attention to the differences that sex incurs.

Associations Between Mental Health, Quality of Life, and Obesity/Metabolic Risk Phenotypes

Background: Obesity is a risk factor for many health issues, as are metabolic abnormalities; all may affect mental health and one's health-related quality of life. Therefore, we investigated the association between obesity subtypes, considering both body weight and metabolic abnormalities, and the mental health and quality of life of a Korean population. Methods: We used data from the 2016 Korean National Health and Nutrition Examination Survey, a cross-sectional survey of Korean civilians, and data on a total of 6057 participants were analyzed. Obesity subtypes were classified as metabolically healthy but obese (MHO); metabolically abnormal but of normal weight (MANW); and metabolically abnormal and obese (MAO). Results: MHO was positively associated with mobility problems, pain/discomfort, and stress compared with metabolically healthy and of normal weight (MHNW) control. MAO was positively associated with problems in terms of not only mobility problems, pain/discomfort, and stress but also self-care and usual activity problems, and improper sleep duration, compared with the MHNW control. MANW showed no associations with the mental health problems or quality of life. Conclusions: With or without metabolic abnormalities, obesity is associated with mental health problems and decreased quality of life.

The effect of weight loss and exercise on Health-Related Quality of Life (HRQOL) following Endoscopic Bariatric Therapies (EBT) for obesity

Introduction

Endoscopic bariatric therapies (EBT) have demonstrated to induce weight loss and improve comorbidities in obese patients. However, little is known about its impact on health-related quality of life (HRQOL) outcomes and physical activity status. This study aimed to evaluate the change in HRQOL and physical activity following EBT induced weight loss in obese patients.

Methods

We approached 181 patients who underwent EBT in a standardized multidisciplinary follow-up program to participate in the study. We provided them two questionnaires-a) Short Form-36 health survey with the physical (PSC) and mental (MSC) summary component scores to capture generic HRQOL, and b) international physical activity questionnaire (IPAQ) for physical activity (PA). We administered the survey at baseline and at 9 months post-procedure. We expressed the procedure outcome as percentage total body weight loss (%TBWL). We expressed continuous variables as mean (SD) or median and categorical variables as percentages. We used non-parametric tests for comparison and performed multivariable linear regression analysis to identify factors associated with improvement in HRQOL.

Results

The mean age was 42.2 (11.3) years, and the mean BMI was 38 (5.9)kg/m². A majority of them were female (n-132, 73%). The EBT included intragastric balloons (n-136, 75%) and endoscopic sleeve gastroplasty (n-24, 25%). The mean %TBWL achieved after the intervention was 16.9 (9.7)%. We noticed a significant improvement in the median PSC (77.8 vs. 90.4, p < 0.001) and MSC (67 vs. 80.2, p < 0.001) scores after EBT. Similarly, we observed a significant positive change in physical activity compared to baseline (1606.2 vs. 2749 MET-minutes/week, p = < 0.001). Linear regression analysis showed an increase in %TBWL was associated with significant improvement in PSC (β = 0.193, p = 0.003) and MSC (β = 0.166, p = 0.02) scores of HRQOL, and likewise, increase in PA was independently associated with improvement in MSC (β = 0.192, p = 0.01). We did not find any difference in outcome based on gender or the type of intervention.

Conclusion

EBT improves HRQOL in obese patients regardless of the type of intervention. The weight loss induced by EBT and the improvement in PA positively influence the health outcomes and quality of life.

Impact of Self-Rated Health on Progression to a Metabolically Unhealthy Phenotype in Metabolically Healthy Obese and Non-Obese Individuals

We examined the association between self-rated health (SRH), a subjective measure of an individual’s health status, and the incidence of metabolic abnormalities, as well as the effect of obesity on this association in metabolically healthy individuals. The cohort study included 85,377 metabolically healthy men and women who were followed annually or biennially for a median of 3.0 years (interquartile range, 1.9–4.1 years). A parametric proportional hazard model was used to assess hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between SRH and the incidence of metabolic abnormalities. During 258,689.03 person-years, 40,858 participants developed metabolic abnormalities. Poorer SRH was significantly associated with increased risk of developing any metabolic abnormality including hypertriglyceridemia, high homeostasis model assessment of insulin resistance (HOMA-IR), and fatty liver in a dose-dependent manner (p for trend <0.05). The association between SRH and progression to metabolically unhealthy status was much stronger in individuals with obesity than those without, especially in relation to any metabolic abnormality, fatty liver, and high C-reactive protein (all p for interaction by obesity <0.05). The multivariable-adjusted HR (95% CI) for any metabolic abnormality comparing the “poor or very poor” vs. the “very good” self-rated health category was 0.97 (0.90–1.05) among non-obese subjects, whereas the corresponding HR (95% CI) among obese subjects was 1.25 (1.02–1.52). Low SRH, as assessed by a single question, was independently associated with increased risk of progression to metabolically unhealthy status in metabolically healthy individuals, especially metabolically healthy individuals with obesity. SRH may help identify individuals at high risk for progression to metabolically unhealthy status.

Which obesity phenotypes predict poor health-related quality of life in adult men and women? Tehran Lipid and Glucose Study

Purpose

This study aimed to explore the association between different obesity phenotypes and health-related quality of life (HRQoL) among Tehranian men and women.

Methods

The participants of this study were 2880 healthy adults (aged>19 years) who participated in Tehran Lipid and Glucose Study (TLGS). To obtain socio-demographic and HRQoL information, participants were interviewed by trained interviewers and were stratified by body mass index categories and metabolic status. Dysmetabolic status was defined as having either metabolic syndrome or diabetes according to the Joint Interim Statement definition and American Diabetes Association. Poor HRQoL was defined as the first quartile of HRQoL scores and logistic regression analysis was used to compare sex-specific odds ratios.

Results

Mean age of participants was 47.7±15.6 and 47.8±14.2 years in men and women respectively. The most and the least common obesity phenotypes were overweight-normal metabolic status and normal weight-dysmetabolic status, respectively. Only mean scores for physical HRQoL were significantly different among obesity phenotypes in both men and women (p<0.05). In addition, after adjusting for age, marital status, level of education, job status and physical activity, the odds of reporting poor physical HRQoL was significantly higher in men (OR: 1.960, 95% CI: 1.037–3.704; p<0.05) and women (OR: 2.887, 95% CI: 1.674–4.977; p<0.001) with obese-dysmetabolic status, compared to their counterparts with normal weight-normal metabolic status. However, except for overweight-normal metabolic women, who were less likely to report poor mental HRQoL (OR: 0.638, 95% CI: 0.415–0.981; p<0.05), none of the phenotypes were associated with poor mental HRQoL in either gender.

Conclusions

Compared to those with normal weight normal metabolic status, only obese dysmetabolic individuals were more likely to report poor physical HRQoL in both genders.

Evaluation of the physical activity level, nutrition quality, and depression in patients with metabolic syndrome: Comparative study

Metabolic syndrome (MetS) is a complex problem that contains risk factors related with obesity, cardiovascular diseases, and type-II diabetes. The incidence of MetS is increasing every year throughout the world.The aim of this study was to evaluate and compare physical activity levels, nutrition quality, and depression status of the individuals who are diagnosed with and without MetS.International Physical Activity Questionnaire (IPAQ), Mediterranean Diet Adherence Screener (MEDAS), Beck Depression Inventory (BDI) was used. In addition, biochemical analysis and anthropometric measurements were also taken.According to IPAQ, 81.1% of the MetS group is inactive, 6.8% is active, and 5.1% is highly active, whereas 22.3% of the non-MetS group is inactive, 46.2% is active, and 31.5% is highly active. MEDAS was found to be lower in the MetS group. BDI levels were also determined high in the MetS group.Sedentary lifestyle, depression, and unhealthy nutrition habits are among the significant factors for the development of MetS. The knowledge levels of the people should be increased by developing national physical activity and nutrition guidelines.

Effect of multimorbidity on quality of life in adult with cardiovascular disease: a cross-sectional study

BACKGROUND

The aim of present study was to describe the effect of multimorbidity on Health-Related Quality of Life (HRQoL) in patients with coronary artery disease (CAD).

METHODS

A cross-sectional study with a simple sampling method of 296 patients undergoing coronary artery bypass surgery in a referral hospital of the northern part of Iran was conducted between April, 2015 and September, 2016. Multimorbidity was defined as the presence of at least two chronic diseases based on self-reporting and medical records. HRQoL was measured using the 36-item short form (SF-36) health status survey. We used analysis of variance (ANOVA) to assess the effect of multimorbidity on mental and physical component of HRQoL.

RESULTS

Approximately, 69% of CAD patients had at least one other disease like diabetes or hypertension. Patients without multimorbidity compared with patients with multimorbidity were significantly older (p = 0.012) and more educated (p = 0.002). Both physical and mental component score of HRQoL was better in patients without any morbidity (48.82 vs. 43.93 with 95%CI of mean difference: 3.37-6.42 and 54.85 vs. 50.44 with 95% CI of mean difference: 1.68-7.15, respectively). Both physical and mental component score was significantly lower in female and lower educated patients (physical mean score 43.07 vs. 46.54 with P = .001 and 42.53 vs. 46.82 with P < .001 and mental mean score 49.98 vs. 52.65 with P = .055 and 49.80 vs. 52.75 with P = .022 for sex and education, respectively). Also, two-way ANOVA showed that regards to morbidity, physical component score was grater in patients with lower education level than higher education level (P < .001).

CONCLUSION

The findings of this study suggest that women, lower education level and overweight reported lower quality of life. HRQoL is affected by multimorbidity among CAD patients specially in less educated.

The prevalence, metabolic risk and effects of lifestyle intervention for metabolically healthy obesity: a systematic review and meta-analysis: A PRISMA-compliant article

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.

Physical health-related quality of life in relation to metabolic health and obesity among men and women in Germany

Background

This study examined sex-specific differences in physical health-related quality of life (HRQoL) across subgroups of metabolic health and obesity. We specifically asked whether (1) obesity is related to lower HRQoL independent of metabolic health status and potential confounders, and (2) whether associations are similar in men and women.

Methods

We used cross-sectional data from the German Health Interview and Examination Survey 2008–11. Physical HRQoL was measured using the Short Form-36 version 2 physical component summary (PCS) score. Based on harmonized ATPIII criteria for the definition of the metabolic health and a body mass index ≥ 30 kg/m² to define obesity, individuals were classified as metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO). Sex-specific analyses including multivariable linear regression analyses were based on PCS as the dependent variable, metabolic health and obesity category as the independent variable with three categories and MHNO as the reference, and age, education, lifestyle and comorbidities as confounders.

Results

This study included 6860 participants (3298 men, 3562 women). Compared to MHNO, all other metabolic health and obesity categories had significantly lower PCS in both sexes. As reflected by the beta coefficients [95% confidence interval] from bivariable linear regression models, a significant inverse association with PCS was strongest for MUO (men: −7.0 [−8.2; −5.8]; women: −9.0 [−10.2; −7.9]), intermediate for MUNO (men: −4.2 [−5.3; −3.1]; women: −5.6 [−6.8; −4.4]) and least pronounced for MHO (men: −2.2 [−3.6; −0.8]; women −3.9 [−5.4; −2.5]). Differences in relation to MHNO remained statistically significant for all groups after adjusting for confounders, but decreased in particular for MUNO (men:–1.3 [−2.3; −0.3]; women: −1.5 [−2.7; −0.3].

Conclusions

Obesity was significantly related to lower physical HRQoL, independent of metabolic health status. Potential confounders including age, educational status, health-related behaviors, and comorbidities explained parts of the inverse relationship. Associations were evident in both sexes and consistently more pronounced among women than men.

Electronic supplementary material

The online version of this article (doi:10.1186/s12955-017-0688-7) contains supplementary material, which is available to authorized users.

Prevalence of metabolic syndrome and health-related quality of life in war-related bilateral lower limb amputees

BACKGROUND

Lower limb amputation is correlated with considerable impairments in health-related quality of life (HRQOL) in veterans. The aim of this study is to determine the prevalence of metabolic syndrome (MetS) in veterans with bilateral lower limb amputation and to identify its association with HRQOL.

METHODS

This cross-sectional study was conducted on 235 Iranian male veterans with bilateral lower limb amputation. Demographics, anthropometrics, and biochemical measurements were assessed and MetS was defined by National Cholesterol Education Program Adult Treatment Panel III definition. HRQOL was assessed using the 36-item Short Form Health Survey (SF-36) questionnaire which measures eight health-related domains. The scores were compared between two groups of bilateral lower limb Amputees who have diagnosed with and without MetS.

RESULTS

The response rate was 40.7% and the mean age of the amputees was 52.05 years. 62.1% of participants were suffering from MetS (95% CI: 55.9%-68.4%). Patients with MetS were observed to have higher weight, waist and hip circumferences, FBS, TG, LDL and liver enzymes concentrations (P < 0.05). Although scores on all 8 subscales of SF-36 were low, no significant difference was observed in HRQOL scores between amputees with and without MetS. Moreover, the risk of MetS was not significantly different across subjects in the highest compared to the lowest quartile category of HRQOL scores.

CONCLUSIONS

Prevalence of MetS in veterans with bilateral lower limb amputation was higher and their HRQOL was lower compared to general population. Some strategies are needed to reduce the risk of cardiovascular diseases among this susceptible population.

Metabolically Healthy Overweight and Obesity Is Associated with Higher Adherence to a Traditional Dietary Pattern: A Cross-Sectional Study among Adults in Lebanon

This study aimed to examine the proportion and socio-demographic correlates of Metabolically Healthy Overweight and Obesity (MHOv/O) among Lebanese adults and to investigate the independent effect of previously identified dietary patterns on odds of MHOv/O. Data were drawn from the National Nutrition and Non-Communicable Disease Risk Factor Survey (Lebanon 2008-2009). Out of the 337 adult participants who had complete socio-demographic, lifestyle, dietary as well as anthropometric and biochemical data, 196 had a BMI ≥ 25 kg/m² and their data were included in this study. MHOv/O was identified using the Adult Treatment Panel criteria. Dietary patterns previously derived in this study population were: Fast Food/Dessert, Traditional-Lebanese and High-Protein. The proportion of MHOv/O in the study sample was 37.2%. Females, higher education and high level of physical activity were positively associated with odds of MHOv/O. Subjects with higher adherence to the Traditional-Lebanese pattern had higher odds of MHOv/O (OR: 1.83, 95% CI: 1.09-3.91). No significant associations were observed between the Fast Food/Dessert and the high-protein patterns with MHOv/O. Follow-up studies are needed to confirm those findings and understand the mechanisms by which the Traditional-Lebanese pattern may exert a protective effect in this subgroup of overweight and obese adults.