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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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Mauriège P, Karelis AD, Taleb N, Clément AA, Joanisse DR. Comparing an adiposopathy approach with four popular classifications schemes to categorize the metabolic profile of postmenopausal women. J Physiol Biochem 2020; 76:609-622. [PMID: 32970306 DOI: 10.1007/s13105-020-00766-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 09/07/2020] [Indexed: 01/04/2023]
Abstract
Numerous classifications are used to discern metabolically healthy obese (MHO) from metabolically abnormal obese (MAO) individuals. The goal of this study was to compare a single phenotype approach, adiposopathy (i.e., the plasma adiponectin/leptin ratio), with four commonly used classifications (International Diabetes Federation (IDF), Karelis, Lynch, Wildman), all based on obesity with other risk factors), for their ability to discern phenotypic differences between MAO and MHO postmenopausal women. Anthropometry, body composition, blood pressure, cardiorespiratory fitness (CRF), lipid-lipoprotein, hepatic, inflammatory, and adipokine profiles, as well as glucose-insulin homeostasis, were assessed in 79 obese sedentary postmenopausal women (60 ± 5 years; body mass index, BMI, 34.0 ± 3.7 kg/m2). Abdominal subcutaneous adipose tissue (SCAT) expression of selected genes involved in fatty acid metabolism and inflammation was used as markers of tissue state (n = 48). Beyond their intrinsic criteria, adiposopathy was almost as effective as the Karelis definition in discerning differences in MHO for adiposity (reduced body weight, BMI, waist circumference, and fat mass), lipid-lipoprotein (lower triacylglycerol and higher HDL-cholesterol levels, reduced atherogenic ratios) and adipokine (higher adiponectin and lower leptin levels) profiles, and glucose-insulin homeostasis (lower insulin resistance) as well as for some SCAT gene expression related to lipolysis and lipogenesis, but was the only one able to distinguish these subjects for greater CRF. The other classifications revealed fewer differences between MAO and MHO women. These data suggest that considering a marker of AT dysfunction such as adiposopathy either alone or in addition to other criteria could be potentially interesting in discerning the MHO phenotype.
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Affiliation(s)
- Pascale Mauriège
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada. .,Département de Kinésiologie, Faculté de Médecine, Université Laval, Québec, Canada.
| | - Antony D Karelis
- Département des Sciences de l'activité physique, Université du Québec à Montréal, Montréal, Canada.,Institut de Recherches Cliniques de Montréal, Université de Montréal, Montréal, Canada
| | - Nadine Taleb
- Institut de Recherches Cliniques de Montréal, Université de Montréal, Montréal, Canada
| | - Andrée-Anne Clément
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada.,Département de Kinésiologie, Faculté de Médecine, Université Laval, Québec, Canada
| | - Denis R Joanisse
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada.,Département de Kinésiologie, Faculté de Médecine, Université Laval, Québec, Canada
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Viticchi G, Falsetti L, Plutino A, Bartolini M, Buratti L, Silvestrini M. Sex influence in ischemic stroke severity and outcome among metabolically unhealthy overweight patients. J Neurol Sci 2020; 416:116955. [PMID: 32540509 DOI: 10.1016/j.jns.2020.116955] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The role of metabolically unhealthy (MU) overweight in influencing stroke prognosis has not been fully assessed and conclusive data about the impact of sex are lacking. Aim of this study was to evaluate the possible correlations among MU overweight, sex and ischemic stroke severity and outcome. METHODS All consecutive patients with acute non-lacunar ischemic stroke observed over a one-year period were considered. MU subjects were selected and classified according to the body mass index (BMI) values. The relationships among sex, BMI and National Institutes of Health Stroke Scale (NIHSS) score at admission and modified Rankin scale (mRS) score at discharge were analysed with multivariate models. RESULTS 180 patients were included. A significantly increasing trend in the NIHSS (p = .030) and in the mRS (p = .001) scores along with the increase of the BMI category was detected in women. Men showed a significantly decreasing trend in the NIHSS (p = .040) and a non-significant decreasing trend in the mRS (p = .290) scores with increasing BMI category. CONCLUSIONS Our findings show that sex can influence stroke severity and outcome among MU patients. The worse outcome observed in women suggest the need of considering differential sex-based clinical approaches in stroke overweight patients.
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Affiliation(s)
- Giovanna Viticchi
- Neurological Clinic, Marche Polytechnic University, via Conca 1, 60020 Ancona, Italy.
| | - Lorenzo Falsetti
- Internal and Subintensive Medicine, Ospedali Riuniti Ancona, via Conca 1, 60020 Ancona, Italy
| | - Andrea Plutino
- Neurological Clinic, Marche Polytechnic University, via Conca 1, 60020 Ancona, Italy
| | - Marco Bartolini
- Neurological Clinic, Marche Polytechnic University, via Conca 1, 60020 Ancona, Italy.
| | - Laura Buratti
- Neurological Clinic, Marche Polytechnic University, via Conca 1, 60020 Ancona, Italy
| | - Mauro Silvestrini
- Neurological Clinic, Marche Polytechnic University, via Conca 1, 60020 Ancona, Italy.
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Abstract
A peculiar category of persons with obesity lacking common metabolic disturbances has been depicted and termed as metabolically healthy obesity (MHO). Yet, although MHO patients are free of obesity-associated complications, they might not be entirely precluded from developing cardio-metabolic disorders. Among patients with morbid obesity (MO) who are referred to bariatric surgery, a subset of metabolically healthy MO (MHMO) has been identified and the question arises if these patients would benefit from surgery in terms of mitigating the peril of cardio-metabolic complications. We revisited the pathophysiological mechanisms that define MHO, the currently available data on the cardio-metabolic risk of these patients and finally we reviewed the benefits of bariatric surgery and the urge to better characterize MHMO before submission to surgery.
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Affiliation(s)
- Adriana Florinela Cătoi
- Pathophysiology Department, Faculty of Medicine, 'Iuliu Hațieganu', University of Medicine and Pharmacy Cluj-Napoca Romania, Cluj-Napoca, Romania.
| | - Luca Busetto
- Department of Medicine, University of Padova, Padua, Italy
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Narankiewicz D, Ruiz-Nava J, Buonaiuto V, Ruiz-Moreno MI, López-Carmona MD, Pérez-Belmonte LM, Gómez-Huelgas R, Bernal-López MR. Utility of Liver Function Tests and Fatty Liver Index to Categorize Metabolic Phenotypes in a Mediterranean Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103518. [PMID: 32443453 PMCID: PMC7277926 DOI: 10.3390/ijerph17103518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 12/21/2022]
Abstract
The aim of this study was to analyze the utility of liver function tests (LFT) and fatty liver index (FLI), a surrogate marker of non-alcoholic fatty liver disease, in the categorization of metabolic phenotypes in a Mediterranean population. A cross-sectional study was performed on a random representative sample of 2233 adults assigned to a health center in Málaga, Spain. The metabolic phenotypes were determined based on body mass index (BMI) categorization and the presence or absence of two or more cardiometabolic abnormalities (high blood pressure, low high-density lipoprotein (HDL) cholesterol, hypertriglyceridemia, pre-diabetes) or type 2 diabetes. No difference was observed between metabolically healthy and metabolically abnormal phenotypes on LFT. The mean FLI of the population was 41.1 ± 28.6. FLI was significantly higher (p < 0.001) in the metabolically abnormal phenotypes in all BMI categories. The proportion of individuals with pathological FLI (≥60) was significantly higher in the metabolically abnormal overweight and obese phenotypes (p < 0.001). On a multivariate model adjusted for sex, age, and waist circumference, a significant correlation was found between pathological FLI and metabolically abnormal phenotypes in the overweight and obese BMI categories. Area under the curve (AUC) of FLI as a biomarker was 0.76, 0.74, and 0.72 for the metabolically abnormal normal-weight, overweight, and obese groups, respectively. Liver biochemistry is poorly correlated with metabolic phenotypes. Conversely, a good correlation between FLI, as a marker of non-alcoholic fatty liver disease (NAFLD), and metabolically abnormal phenotypes in all BMI ranges was found. Our study suggests that FLI may be a useful marker for characterizing metabolically abnormal phenotypes in individuals who are overweight or obese.
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Affiliation(s)
- Dariusz Narankiewicz
- Preventive Medicine Department, Virgen de la Victoria University Hospital, 29010 Malaga, Spain;
| | - Josefina Ruiz-Nava
- Internal Medicine Department, Regional University Hospital of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (J.R.-N.); (V.B.); (M.I.R.-M.); (M.D.L.-C.); (L.M.P.-B.)
| | - Veronica Buonaiuto
- Internal Medicine Department, Regional University Hospital of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (J.R.-N.); (V.B.); (M.I.R.-M.); (M.D.L.-C.); (L.M.P.-B.)
| | - María Isabel Ruiz-Moreno
- Internal Medicine Department, Regional University Hospital of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (J.R.-N.); (V.B.); (M.I.R.-M.); (M.D.L.-C.); (L.M.P.-B.)
| | - María Dolores López-Carmona
- Internal Medicine Department, Regional University Hospital of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (J.R.-N.); (V.B.); (M.I.R.-M.); (M.D.L.-C.); (L.M.P.-B.)
| | - Luis Miguel Pérez-Belmonte
- Internal Medicine Department, Regional University Hospital of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (J.R.-N.); (V.B.); (M.I.R.-M.); (M.D.L.-C.); (L.M.P.-B.)
| | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (J.R.-N.); (V.B.); (M.I.R.-M.); (M.D.L.-C.); (L.M.P.-B.)
- Ciber Fisiopatología de la Obesidad y Nutrición. Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: (R.G.-H.); (M.R.B.-L.); Tel.: +34-951-291-169 (R.G.-H.); 34-951-290-346 (M.R.B.-L.); Fax: +34-951-290-006 (R.G.-H.); +34-951-290-302 (M.R.B.-L.)
| | - María Rosa Bernal-López
- Internal Medicine Department, Regional University Hospital of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain; (J.R.-N.); (V.B.); (M.I.R.-M.); (M.D.L.-C.); (L.M.P.-B.)
- Ciber Fisiopatología de la Obesidad y Nutrición. Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: (R.G.-H.); (M.R.B.-L.); Tel.: +34-951-291-169 (R.G.-H.); 34-951-290-346 (M.R.B.-L.); Fax: +34-951-290-006 (R.G.-H.); +34-951-290-302 (M.R.B.-L.)
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Nijhawans P, Behl T, Bhardwaj S. Angiogenesis in obesity. Biomed Pharmacother 2020; 126:110103. [PMID: 32200253 DOI: 10.1016/j.biopha.2020.110103] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Angiogenesis is considered as a major progenitor in the progression of obesity. The current manuscript enumerates the extrinsic role of angiogenesis in obesity. RESULT High caloric diet and lack of physical exercise are the most common causes of obesity and related metabolic conditions. A grossly elevated levels of fat in adipose tissue escalate certain complications which further worsen the state of obesity. Enlargement of white adipose tissue (WAT), deposition of fat mass, proliferation of endothelial cells, production of inflammatory cytokines induces the formation of denovo capillaries from parent microvasculature. Also, several intracellular signaling pathways precipitate obesity. Though, angiostatic molecules (endostatin, angiostatin and TNP-470) have been designed to combat obesity and associated complications. CONCLUSION Adipose tissue trigger growth of blood capillaries, and in turn adipose tissue endothelial cells promote pre-adipocyte proliferation. Modulation of angiogenesis and treatment with angiostatic substances may have the potential to impair the progression of obesity.
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Affiliation(s)
- Priya Nijhawans
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Tapan Behl
- Chitkara College of Pharmacy, Chitkara University, Punjab, India.
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Different Patterns of Left Ventricular Hypertrophy in Metabolically Healthy and Insulin-Resistant Obese Subjects. Nutrients 2020; 12:nu12020412. [PMID: 32033349 PMCID: PMC7071187 DOI: 10.3390/nu12020412] [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] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/26/2020] [Accepted: 02/03/2020] [Indexed: 12/16/2022] Open
Abstract
Obese subjects showed different cardiovascular risk depending by different insulin sensitivity status. We investigated the difference in left ventricular mass and geometry between metabolically healthy (MHO) and unhealthy (MUHO) obese subjects. From a cohort of 876 obese subjects (48.3 ± 14.1 years) without cardio-metabolic disease and stratified according to increasing values of Matsuda index after 75 g oral glucose tolerance test, we defined MHO (n = 292) those in the upper tertile and MUHO (n = 292) those in the lower tertile. All participants underwent echocardiographic measurements. Left ventricular mass was calculated by Devereux equation and normalized by height2,7 and left ventricular hypertrophy (LVH) was defined by values >44 g/m2.7 for females and >48 g/m2.7 for males. Left ventricular geometric pattern was defined as concentric or eccentric if relative wall thickness was higher or lower than 0.42, respectively. MHO developed more commonly a concentric remodeling (19.9 vs. 9.9%; p = 0.001) and had a reduced risk for LVH (OR 0.46; p < 0.0001) than MUHO, in which the eccentric type was more prevalent (40.4 vs. 5.1%; p < 0.0001). We demonstrated that obese subjects-matched for age, gender and BMI-have different left ventricular mass and geometry due to different insulin sensitivity status, suggesting that diverse metabolic phenotypes lead to alternative myocardial adaptation.
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Camhi SM, Must A, Gona PN, Hankinson A, Odegaard A, Reis J, Gunderson EP, Jacobs DR, Carnethon MR. Duration and stability of metabolically healthy obesity over 30 years. Int J Obes (Lond) 2019; 43:1803-1810. [PMID: 30158567 PMCID: PMC6395568 DOI: 10.1038/s41366-018-0197-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/19/2018] [Accepted: 07/30/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Obese adults who are free from metabolic risk factors may develop risk factors over time. Our objective was to characterize development of obesity and duration of metabolically healthy obese (MHO) over 30 years. METHODS Participants in CARDIA who developed obesity (BMI ≥ 30 kg/m2) at follow-up exams during years 7, 10, 15, 20, 25, and 30 were analyzed. MHO was defined as obese and having 0 or 1 risk factor: ≥SBP/DBP 130/85 mmHg; fasting glucose ≥100 mg/dL/5.55 mmol/L; fasting triglycerides (≥150 mg/dL/1.69 mmol/L); and HDL-C (men <40 mg/dL/1.036 mmol/L, women <50 mg/dL/1.295 mmol/L) or on any medication(s) for these conditions. MHO duration (years) and obesity duration (years) were estimated for each subsequent time-point; and an overall cumulative duration was also calculated over available follow-up. MHO duration (%) was approximated as MHO duration ÷ obesity duration. Stable MHO was defined as 100% MHO duration over follow-up, while transient MHO was defined as <1-99%. Chi-squared tests were used to compare proportions by sex and race across obesity phenotypes. Multivariable-adjusted ANCOVA, adjusting for baseline BMI, age, race, and sex, was used to analyze obesity duration in all individuals who developed obesity, and also compare MHO duration (%) across race and sex in transient MHO individuals. RESULTS Of the 987 eligible participants who developed obesity, 51% were African American (AA), 56% were women. Higher percentages of AA were classified as transient MHO, and higher proportions of females were MHO (both p < 0.0001). Obesity duration (years) was higher in transient MHO compared with stable MHO (mean difference: 6.2 ± 0.5 years, p < 0.0001). Of those with transient MHO, African Americans (51.4 ± 1.6%) were more likely to have longer MHO duration compared to Caucasians (44.4 ± 1.9%, p = 0.005). CONCLUSION MHO status can be a transient phenotype which differs by sex and race. Future studies are needed to explore modifiable lifestyle/behavioral predictors associated with longer MHO duration.
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Affiliation(s)
| | | | | | | | | | - Jared Reis
- National Heart, Lung, and Blood Institute at the National Institutes of Health, Bethesda, MD, USA
| | - Erica P Gunderson
- Cardiovascular and Metabolic Conditions Section, Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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Bae YS, Choi S, Lee K, Son JS, Lee H, Cho MH, Koo HY, Cho IY, Chang J, Kim K, Kim SM, Park SM. Association of Concurrent Changes in Metabolic Health and Weight on Cardiovascular Disease Risk: A Nationally Representative Cohort Study. J Am Heart Assoc 2019; 8:e011825. [PMID: 31451053 PMCID: PMC6755827 DOI: 10.1161/jaha.118.011825] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background The combined effect of transitions of metabolic health and weight on cardiovascular disease (CVD) remains unclear. We aimed to examine the association of concurrent changes of metabolic health and weight on CVD over time. Methods and Results The study population consisted of 205 394 from the Korean National Health Insurance Service. Metabolic health was determined by fasting serum glucose, total cholesterol, and blood pressure levels, while obesity was determined by body mass index. All participants were divided into either metabolically healthy nonobese (MHNO), metabolically healthy obese, metabolically unhealthy nonobese, or metabolically unhealthy obese for each of the first (2002–2003) and second (2004–2005) health screening periods, after which participants were followed‐up for CVD from 2006 to 2015. Cox proportional hazards regression was used to determine adjusted hazard ratios (aHRs) and 95% CIs. Among initial MHNO participants, those who became metabolically healthy obese (aHR, 1.25; 95% CI, 1.10–1.41), metabolically unhealthy nonobese (aHR, 1.23; 95% CI, 1.15–1.31), and metabolically unhealthy obese (aHR, 1.34; 95% CI, 1.12–1.61) had elevated risk for CVD compared with those who remained MHNO. Conversely, improving metabolic health and obesity were associated with reduced CVD risk among initially metabolically unhealthy nonobese to secondary MHNO (aHR, 0.79; 95% CI, 0.73–0.84), metabolically unhealthy obese to MHNO (aHR, 0.68; 95% CI, 0.58–0.81), and metabolically unhealthy obese to metabolically healthy obese (aHR, 0.73; 95% CI, 0.66–0.80) participants. Conclusions Changes toward metabolically unhealthy or obese states resulted in increased CVD risk. Improving metabolic health along with reducing weight may lead to decreased risk of CVD.
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Affiliation(s)
- Ye Seul Bae
- Department of Family Medicine Seoul National University Hospital Seoul Republic of Korea.,Office of Hospital Information Seoul National University Hospital Seoul Republic of Korea
| | - Seulggie Choi
- Department of Biomedical Sciences Seoul National University Graduate School Seoul Republic of Korea
| | - Kiheon Lee
- Department of Family Medicine Seoul National University Bundang Hospital Seongnam Republic of Korea
| | - Joung Sik Son
- Department of Family Medicine Seoul National University Hospital Seoul Republic of Korea
| | - Hyejin Lee
- Department of Family Medicine Seoul National University Bundang Hospital Seongnam Republic of Korea
| | - Mi Hee Cho
- Samsung C&T Medical Clinic Kangbuk Samsung Hospital Seoul Republic of Korea
| | - Hye-Yeon Koo
- Department of Family Medicine Seoul National University Bundang Hospital Seongnam Republic of Korea
| | - In Young Cho
- Department of Family Medicine Samsung Medical Center Seoul Republic of Korea
| | - Jooyoung Chang
- Department of Biomedical Sciences Seoul National University Graduate School Seoul Republic of Korea
| | - Kyuwoong Kim
- Department of Biomedical Sciences Seoul National University Graduate School Seoul Republic of Korea
| | - Sung Min Kim
- Department of Biomedical Sciences Seoul National University Graduate School Seoul Republic of Korea
| | - Sang Min Park
- Department of Family Medicine Seoul National University Hospital Seoul Republic of Korea.,Department of Biomedical Sciences Seoul National University Graduate School Seoul Republic of Korea
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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: 226] [Impact Index Per Article: 45.2] [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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Lassale C, Tzoulaki I, Moons KG, Sweeting M, Boer J, Johnson L, Huerta JM, Agnoli C, Freisling H, Weiderpass E, Wennberg P, van der A D, Arriola L, Benetou V, Boeing H, Bonnet F, Colorado-Yohar SM, Engström G, Eriksen AK, Ferrari P, Grioni S, Johansson M, Kaaks R, Katsoulis M, Katzke V, Key TJ, Matullo G, Melander O, Molina-Portillo E, Moreno-Iribas C, Norberg M, Overvad K, Panico S, Quirós JR, Saieva C, Skeie G, Steffen A, Stepien M, Tjønneland A, Trichopoulou A, Tumino R, van der Schouw YT, Verschuren W, Langenberg C, Di Angelantonio E, Riboli E, Wareham NJ, Danesh J, Butterworth AS. Separate and combined associations of obesity and metabolic health with coronary heart disease: a pan-European case-cohort analysis. Eur Heart J 2018; 39:397-406. [PMID: 29020414 PMCID: PMC6198928 DOI: 10.1093/eurheartj/ehx448] [Citation(s) in RCA: 173] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 07/18/2017] [Indexed: 12/13/2022] Open
Abstract
Aims The hypothesis of 'metabolically healthy obesity' implies that, in the absence of metabolic dysfunction, individuals with excess adiposity are not at greater cardiovascular risk. We tested this hypothesis in a large pan-European prospective study. Methods and results We conducted a case-cohort analysis in the 520 000-person European Prospective Investigation into Cancer and Nutrition study ('EPIC-CVD'). During a median follow-up of 12.2 years, we recorded 7637 incident coronary heart disease (CHD) cases. Using cut-offs recommended by guidelines, we defined obesity and overweight using body mass index (BMI), and metabolic dysfunction ('unhealthy') as ≥ 3 of elevated blood pressure, hypertriglyceridaemia, low HDL-cholesterol, hyperglycaemia, and elevated waist circumference. We calculated hazard ratios (HRs) and 95% confidence intervals (95% CI) within each country using Prentice-weighted Cox proportional hazard regressions, accounting for age, sex, centre, education, smoking, diet, and physical activity. Compared with metabolically healthy normal weight people (reference), HRs were 2.15 (95% CI: 1.79; 2.57) for unhealthy normal weight, 2.33 (1.97; 2.76) for unhealthy overweight, and 2.54 (2.21; 2.92) for unhealthy obese people. Compared with the reference group, HRs were 1.26 (1.14; 1.40) and 1.28 (1.03; 1.58) for metabolically healthy overweight and obese people, respectively. These results were robust to various sensitivity analyses. Conclusion Irrespective of BMI, metabolically unhealthy individuals had higher CHD risk than their healthy counterparts. Conversely, irrespective of metabolic health, overweight and obese people had higher CHD risk than lean people. These findings challenge the concept of 'metabolically healthy obesity', encouraging population-wide strategies to tackle obesity.
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Affiliation(s)
- Camille Lassale
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Karel G.M. Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michael Sweeting
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Jolanda Boer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Laura Johnson
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - José María Huerta
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Heinz Freisling
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Family medicine, Umeå University, Umeå, Sweden
| | - Daphne van der A
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Larraitz Arriola
- Public Health Division of Gipuzkoa, Instituto Bio-Donostia, Basque Government
| | - Vassiliki Benetou
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Dept. of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece
- Hellenic Health Foundation, Athens, Greece
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbrücke, Germany
| | - Fabrice Bonnet
- Université de Rennes 1, CHU de Rennes, Rennes, France
- Inserm (Institut National De La Santé Et De La Recherche Médical), Centre for Research in Epidemiology and Population Health (CESP), U1018, Villejuif, France
| | - Sandra M. Colorado-Yohar
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- National School of Public Health, Research Group on Demography and Health, University of Antioquia, Medellín, Colombia
| | - Gunnar Engström
- Dept Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Anne K Eriksen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Pietro Ferrari
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Sara Grioni
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Matthias Johansson
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Rudolf Kaaks
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | | | - Verena Katzke
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - Timothy J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health University of Oxford, Oxford, United Kingdom
| | - Giuseppe Matullo
- Human Genetics Foundation, Turin, Italy
- Department of Medical Sciences, University of Turin, Italy
| | - Olle Melander
- Dept Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Elena Molina-Portillo
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria ibs.GRANADA. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | | | - Margareta Norberg
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Kim Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | | | - Calogero Saieva
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Florence, Italy
| | - Guri Skeie
- Department of community medicine, University of Tromsø – the Arctic University of Norway, Tromsø, Norway
| | - Annika Steffen
- Department of Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbrücke, Germany
| | - Magdalena Stepien
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Antonia Trichopoulou
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Dept. of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece
- Hellenic Health Foundation, Athens, Greece
| | - Rosario Tumino
- Cancer Registry and Histopathology Unit, Civic - M.P. Arezzo Hospital, ASP Ragusa, Italy
| | - Yvonne T. van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W.M.Monique Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Claudia Langenberg
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Emanuele Di Angelantonio
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Elio Riboli
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Nicholas J Wareham
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - John Danesh
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Dept of Human Genetics, Wellcome Trust Sanger Institute, Hinxton, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
| | - Adam S Butterworth
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
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Yoon DY, Lee YA, Lee J, Kim JH, Shin CH, Yang SW. Prevalence and Clinical Characteristics of Metabolically Healthy Obesity in Korean Children and Adolescents: Data from the Korea National Health and Nutrition Examination Survey. J Korean Med Sci 2017; 32:1840-1847. [PMID: 28960038 PMCID: PMC5639066 DOI: 10.3346/jkms.2017.32.11.1840] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 07/29/2017] [Indexed: 12/21/2022] Open
Abstract
Metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) are differentiated by the presence of cardiometabolic risk factors (CMRFs) and insulin resistance (IR). This study aimed to evaluate the prevalence and clinical characteristics of MHO in Korean children and adolescents and to investigate the anthropometric, laboratory, and lifestyle predictors of MHO. This study included data from 530 obese subjects, aged 10-19 years, obtained from the Fourth Korea National Health and Nutrition Examination Survey. Subjects were classified into MHO and MUO groups according to the presence of CMRF (MHO(CMRF)/MUO(CMRF)) and degree of IR (MHO(IR)/MUO(IR)). Demographic, anthropometric, cardiometabolic, and lifestyle factors were compared between the groups. Logistic regression analysis and receiver operating characteristic curve analysis were performed to identify factors that predicted MHO. The prevalence of MHO(CMRF) and MHO(IR) in obese Korean youth was 36.8% (n = 197) and 68.8% (n = 356), respectively. CMRF profiles were significantly less favorable in MUO children. Longer and more vigorous physical activity and less protein intake were associated with MHO(CMRF) phenotype. The best predictors of MHO(CMRF) and MHO(IR) were waist circumference (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.77-0.88; P < 0.001) and body mass index (BMI) standard deviation score (OR, 0.24; 95% CI, 0.15-0.39; P < 0.001), respectively. The prevalence of MHO differed depending on how it was defined. To adequately manage obesity in youth, the approach to individuals with MHO and MUO should be personalized due to variation in clinical characteristics. Longitudinal studies are needed to evaluate long-term consequences of MHO.
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Affiliation(s)
- Da Young Yoon
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jieun Lee
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jae Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Sei Won Yang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Engin A. The Definition and Prevalence of Obesity and Metabolic Syndrome. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 960:1-17. [PMID: 28585193 DOI: 10.1007/978-3-319-48382-5_1] [Citation(s) in RCA: 622] [Impact Index Per Article: 88.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Increase in prevalence of obesity has become a worldwide major health problem in adults, as well as among children and adolescents. Furthermore, total adiposity and truncal subcutaneous fat accumulation during adolescence are positively and independently associated with atherosclerosis at adult ages. Centrally accumulation of body fat is associated with insulin resistance, whereas distribution of body fat in a peripheral pattern is metabolically less important. Obesity is associated with a large decrease in life expectancy. The effect of extreme obesity on mortality is greater among younger than older adults. In this respect, obesity is also associated with increased risk of several cancer types. However, up to 30% of obese patients are metabolically healthy with insulin sensitivity similar to healthy normal weight individuals, lower visceral fat content, and lower intima media thickness of the carotid artery than the majority of metabolically "unhealthy" obese patients.Abdominal obesity is the most frequently observed component of metabolic syndrome. The metabolic syndrome; clustering of abdominal obesity, dyslipidemia, hyperglycemia and hypertension, is a major public health challenge. The average prevalence of metabolic syndrome is 31%, and is associated with a two-fold increase in the risk of coronary heart disease, cerebrovascular disease, and a 1.5-fold increase in the risk of all-cause mortality.
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Affiliation(s)
- Atilla Engin
- Faculty of Medicine, Department of General Surgery, Gazi University, Besevler, Ankara, Turkey. .,, Mustafa Kemal Mah. 2137. Sok. 8/14, 06520, Cankaya, Ankara, Turkey.
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14
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Aldhoon-Hainerová I, Hainer V, Zamrazilová H. Impact of dietary intake, lifestyle and biochemical factors on metabolic health in obese adolescents. Nutr Metab Cardiovasc Dis 2017; 27:703-710. [PMID: 28693964 DOI: 10.1016/j.numecd.2017.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/09/2017] [Accepted: 05/08/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Obesity devoid of metabolic abnormalities is known as metabolically healthy obesity (MHO). The aim of the study was to examine determinants of MHO during adolescence. METHODS AND RESULTS From among 710 obese adolescents, 43 girls and 57 boys were classified as metabolically unhealthy (abdominal obesity and ≥2 risk components of metabolic syndrome). MHO (absence of any cardiometabolic risk factor) was found in 211 girls and 131 boys (regardless of waist circumference) and in 33 girls and 27 boys (without abdominal obesity). Laboratory and anthropometric parameters, dietary records and various lifestyle factors were compared between MHO vs. those unhealthy. The prevalence of MHO regardless of waist circumference was higher in girls than in boys (53.1 vs. 41.9%) but comparable when abdominal obesity was excluded (8.3 vs. 8.6%). Anthropometric variables, levels of gamma-glutamyl transferase, total and low-density lipoprotein cholesterol in both genders, hs-C-reactive protein in girls and alanine aminotransferase in boys differentiated the two metabolic phenotypes. Uric acid was related to metabolic health only in the analysis of MHO without abdominal obesity. Total hours of sleep, bedtime, time of the last daily meal, regular meal consumption and protein intake in boys and screen time, the score of disinhibition and diet composition in girls were found to impact cardiometabolic health. CONCLUSIONS In obese adolescents, metabolic health was related to anthropometric and biochemical parameters and only weak associations were found with most of the lifestyle factors studied. Uric acid concentration associated with metabolic health when abdominal obesity was excluded.
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Affiliation(s)
- I Aldhoon-Hainerová
- Institute of Endocrinology, Prague, Czech Republic; Department of Pediatrics, Third Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - V Hainer
- Institute of Endocrinology, Prague, Czech Republic
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15
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McElroy JA, Gilbert T, Hair EC, Mathews KJ, Redman SD, Williams A. Obese But Fit: The Relationship of Fitness to Metabolically Healthy But Obese Status among Sexual Minority Women. Womens Health Issues 2017; 26 Suppl 1:S81-6. [PMID: 27397921 DOI: 10.1016/j.whi.2015.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/15/2015] [Accepted: 09/24/2015] [Indexed: 01/03/2023]
Abstract
PURPOSE The purpose of this study was to describe fitness characteristics of metabolically healthy sexual minority women who are obese. METHODS As part of the Healthy Weight in Lesbian and Bisexual Women Initiative funded by the U.S. Office on Women's Health, one site enrolled self-identified lesbian or bisexual women age 40 and older in a randomized controlled trial that evaluated interventions to improve health. Women with waist-to-height ratio of 0.5 or greater were classified as obese. Women without diabetes or cardiovascular disease and with normal range fasting blood level measurements of glucose, triglycerides, high-density cholesterol, and blood pressure were classified as metabolically healthy but obese (MHO). Otherwise, women were classified as metabolically unhealthy obese (MUHO). Fitness measurements included predicted VO2 maximum, 1-minute heart rate recovery, and strength (single maximal leg lift and chest press). Self-reported demographic and physical activity level data were obtained by standardized questionnaires. RESULTS Of the 53 participants who completed the eligibility screener in Columbia, Missouri, 47 were enrolled in the study (89% participation proportion) with 45 categorized as obese. Approximately one-third (38%) were MHO. The majority of MHO and MUHO participants ranked poor or very poor on a composite fitness score that included measures of strength, flexibility, and aerobic fitness (75.0% and 77.8%, respectively). In the logistic regression models, better 1-minute heart rate recovery after peak exercise performance was significantly associated with MHO individuals (odds ratio, 2.92; 95% CI, 1.13-9.10) compared with MUHO. No other fitness measure was significantly different between the two groups. CONCLUSION Consistent with other studies, we identified more than one-third of our obese sexual minority women as MHO. Fitness measures may be potential predictors of MHO status because one measure, heart rate recovery, was significantly associated with MHO status. With the population prevalence of obesity high and even higher among lesbian or bisexual women, sexual minority women are an ideal population for a longitudinal study to better understand MHO characteristics.
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Affiliation(s)
- Jane A McElroy
- Department of Family & Community Medicine, University of Missouri, Columbia, Missouri.
| | - Tess Gilbert
- NORC at the University of Chicago, Bethesda, Maryland
| | - Elizabeth C Hair
- Evaluation Science and Research, Truth Initiative, Washington, DC
| | - Katherine J Mathews
- Department of Obstetrics, Gynecology, and Women's Health, Saint Louis University, St. Louis, Missouri
| | | | - Amy Williams
- Department of Family & Community Medicine, University of Missouri, Columbia, Missouri
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Oliva-Olivera W, Lhamyani S, Coín-Aragüez L, Castellano-Castillo D, Alcaide-Torres J, Yubero-Serrano EM, El Bekay R, Tinahones FJ. Neovascular deterioration, impaired NADPH oxidase and inflammatory cytokine expression in adipose-derived multipotent cells from subjects with metabolic syndrome. Metabolism 2017; 71:132-143. [PMID: 28521866 DOI: 10.1016/j.metabol.2017.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/24/2017] [Accepted: 03/23/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Expansion of adipose tissue depends on the growth of its vascular network and it has been shown that adipose tissue dysfunction in obese subjects with the metabolic syndrome is associated with decreased angiogenesis. However, some subjects with a high body mass index do not develop metabolic abnormalities associated with obesity. In this study we examined the neovascular properties, expression levels of proteins involved in cellular redox balance and inflammatory cytokines in adipose-derived multipotent mesenchymal cells (ASCs) of subjects with different metabolic profiles. MATERIALS/METHODS We applied cell culture, flow cytometry, RT-qPCR and ELISA techniques to characterize the ASCs isolated from paired biopsies of visceral (visASCs) and subcutaneous (subASCs) adipose tissue from 39 subjects grouped into normal weight (Nw), obese without metabolic syndrome (NonMS) and with metabolic syndrome (MS). RESULTS VisASCs and subASCs from MS subjects showed a decrease in tubules formation capacity compared to ASCs from NonMS subjects as well as changes in the expression levels of proteins involved in cell redox balance and secretion levels of proteins linked to the senescence-associated secretory phenotype. Deterioration in the neovascular properties of subASCs from the MS subjects was also evident in the decreased levels of VEGF secretion during adipogenesis and in the effects of the conditioned medium on endothelial cell tubule formation. CONCLUSIONS Our findings suggest a redox imbalance status in ASCs from subjects with metabolic syndrome and decreased their neovascular function that probably contributes to the vascular insufficiency of adipose depots.
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Affiliation(s)
- Wilfredo Oliva-Olivera
- Department of Clinical Endocrinology and Nutrition, Institute of Biomedical Research of Málaga (IBIMA), Hospital of Málaga (Virgen de la Victoria), University of Málaga (UMA), Málaga, Spain; CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III, Spain.
| | - Said Lhamyani
- Research Laboratory, Science School, University of Málaga (UMA), Campus Teatinos s/n, 29010 Málaga, Spain
| | - Leticia Coín-Aragüez
- Department of Clinical Endocrinology and Nutrition, Institute of Biomedical Research of Málaga (IBIMA), Hospital of Málaga (Virgen de la Victoria), University of Málaga (UMA), Málaga, Spain; CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III, Spain
| | - Daniel Castellano-Castillo
- Department of Clinical Endocrinology and Nutrition, Institute of Biomedical Research of Málaga (IBIMA), Hospital of Málaga (Virgen de la Victoria), University of Málaga (UMA), Málaga, Spain; CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III, Spain
| | - Juan Alcaide-Torres
- Department of Clinical Endocrinology and Nutrition, Institute of Biomedical Research of Málaga (IBIMA), Hospital of Málaga (Virgen de la Victoria), University of Málaga (UMA), Málaga, Spain; CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III, Spain
| | - Elena María Yubero-Serrano
- Department of Clinical Endocrinology and Nutrition, Institute of Biomedical Research of Málaga (IBIMA), Hospital of Málaga (Virgen de la Victoria), University of Málaga (UMA), Málaga, Spain; Lipids and Atherosclerosis Unit, Maimonides Institute of Biomedical Research of Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Rajaa El Bekay
- Department of Clinical Endocrinology and Nutrition, Institute of Biomedical Research of Málaga (IBIMA), Hospital of Málaga (Virgen de la Victoria), University of Málaga (UMA), Málaga, Spain; CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III, Spain.
| | - Francisco José Tinahones
- Department of Clinical Endocrinology and Nutrition, Institute of Biomedical Research of Málaga (IBIMA), Hospital of Málaga (Virgen de la Victoria), University of Málaga (UMA), Málaga, Spain; CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III, Spain.
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Pahwa R, Adams-Huet B, Jialal I. The effect of increasing body mass index on cardio-metabolic risk and biomarkers of oxidative stress and inflammation in nascent metabolic syndrome. J Diabetes Complications 2017; 31:810-813. [PMID: 28285929 DOI: 10.1016/j.jdiacomp.2017.02.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 01/31/2017] [Accepted: 02/16/2017] [Indexed: 12/22/2022]
Abstract
The effect of BMI defined obesity on cardio-metabolic features and biomarkers of oxidative stress and inflammation in patients with nascent metabolic Syndrome (MetS) is poorly defined. Hence the aim of this study was to examine the effect of increasing obesity on the cardio metabolic risk profile, pro-oxidant state and pro-inflammatory features in nascent MetS patients without Diabetes or CVD. MetS was diagnosed by ATPIII criteria using waist circumference (WC) as the measure of adiposity. Patients (n=58) were stratified into overweight, obese and extreme obesity groups using BMI cut offs of 25-29.9, 30-39.9kg/m2 and ≥40kg/m2 and cardio-metabolic features, circulating and cellular biomarkers of oxidative stress and inflammation were determined and correlated with BMI. None of the main cardio-metabolic features including blood pressure, blood glucose, HDL-cholesterol, triglycerides, HOMA-IR, free fatty acids were increased with increasing BMI. Also none of the biomarkers of oxidative stress (ox-LDL, nitrotyrosine and monocyte superoxide anion release) were increased with increasing BMI. However, significant increase in hsCRP, the soluble TNFR1 and sTNFR2 and leptin, were observed with increasing adiposity. Other inflammatory bio-mediators (IL-1β, IL-6, IL-8, MCP-1, Toll-like receptors 2-4), endotoxin, LBP, sCD14 and HMGB1, adiponectin, and chemerin did not show significant increases with increasing BMI. Leptin, hsCRP, sTNFR1, and sTNFR2 correlated significantly with BMI. In conclusion, capturing the cardio-metabolic cluster of MetS that predisposed to both increased risk of diabetes and CVD, using waist circumference, as one of the 5 diagnostic criteria is sufficient and BMI does not appear to afford any major incremental benefit on the cardio-metabolic risk factors, increased oxidative stress and the majority of both cellular and circulating biomarkers of inflammation.
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Affiliation(s)
- Roma Pahwa
- California North-state University College of Medicine, Elk Grove, Sacramento, CA, USA
| | - Beverley Adams-Huet
- Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ishwarlal Jialal
- California North-state University College of Medicine, Elk Grove, Sacramento, CA, USA.
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Kanagasabai T, Dhanoa R, Kuk JL, Ardern CI. Association between Sleep Habits and Metabolically Healthy Obesity in Adults: A Cross-Sectional Study. J Obes 2017; 2017:5272984. [PMID: 28367325 PMCID: PMC5358440 DOI: 10.1155/2017/5272984] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 02/15/2017] [Indexed: 02/06/2023] Open
Abstract
Higher body mass index (BMI) increases the risk of cardiometabolic diseases, but nearly a third of the people living with obesity (BMI: ≥30 kg/m2) are metabolically healthy (MHO). Extreme sleep durations and poor sleep quality are associated with higher bodyweight and cardiometabolic dysfunction, but the full extent to which sleep habits may help differentiate those with MHO versus metabolically abnormal obesity (MAO) is not yet known. Data from the U.S. National Health and Nutritional Examination Survey 2005-08 was used (BMI: ≥30 kg/m2; ≥20 y; N = 1,777). The absence of metabolic syndrome was used to define MHO. Those with MHO tended to be younger, female, Non-Hispanic Black, never smokers, more physically active, and with less physician diagnosed sleep disorders than MAO. Neither sleep duration nor overall sleep quality was related to MHO in crude or multivariable adjusted analyses; however, reporting "almost always" to having trouble falling asleep (OR (95% CI): 0.40 (0.20-0.78)), waking up during the night (0.38 (0.17-0.85)), feeling unrested during the day (0.35 (0.18-0.70)), and feeling overly sleepy during the day (0.35 (0.17-0.75)) was related to lower odds of MHO. Selected sleep quality factors, but not sleep quantity or overall sleep quality, are associated with the MHO phenotype.
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Affiliation(s)
| | - Ramandeep Dhanoa
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Jennifer L. Kuk
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Chris I. Ardern
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
- *Chris I. Ardern:
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Dusanov S, Heggen E, Tonstad S. Characteristics of Metabolic Syndrome in Morbidly Obese Subjects. Metab Syndr Relat Disord 2016; 14:500-506. [DOI: 10.1089/met.2016.0062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Sasa Dusanov
- Section for Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Eli Heggen
- Section for Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Serena Tonstad
- Section for Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
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Truthmann J, Mensink GBM, Bosy-Westphal A, Scheidt-Nave C, Schienkiewitz A. Metabolic Health in Relation to Body Size: Changes in Prevalence over Time between 1997-99 and 2008-11 in Germany. PLoS One 2016; 11:e0167159. [PMID: 27880828 PMCID: PMC5120858 DOI: 10.1371/journal.pone.0167159] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/09/2016] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE The study examined potential changes in the proportion of metabolic health according to body size categories over time and across strata of sex and age, varying definitions of metabolic health. METHODS We analysed data from national health interview and examination surveys 1997-99 and 2008-11 for adults aged 18-79 years (GNHIES98: N = 6,565; DEGS1: 6,860). Metabolic health as defined by ATPIII criteria was examined across body mass index categories. The Plourde and Karelis criteria were applied in relation to abdominal obesity. RESULTS Proportions of adults with metabolic health by body size categories were largely stable over time, except for an increasing proportion of metabolically healthy persons with pre-obesity and metabolically healthy women without abdominal obesity. In both surveys proportions of adults meeting ATPIII criteria ranged from approximately 30% among men and women with obesity, to about two thirds of those with pre-obesity to about 93% among those with normal weight. According to Plourde and Karelis criteria proportions ranged from almost 30% among men and women without abdominal obesity to less than 10% among those with abdominal obesity. Proportions were consistently higher among younger than older age groups and less consistently higher among women than men. CONCLUSIONS Proportions of adults with metabolic health by body size categories were largely stable over time, except for an increasing proportion of metabolically healthy women without abdominal obesity. There is no evidence that metabolic health among adults with obesity increased in Germany over a period of ten years.
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Affiliation(s)
- Julia Truthmann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
- * E-mail:
| | - Gert B. M. Mensink
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Anja Bosy-Westphal
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Anja Schienkiewitz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
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Yoo HJ, Hwang SY, Choi KM, Baik SH, Lee EM, Kim EJ, Rha SW, Park CG, Oh DJ, Seo HS. Clinical implication of body size phenotype on heart rate variability. Metabolism 2016; 65:1589-1596. [PMID: 27733246 DOI: 10.1016/j.metabol.2016.08.002] [Citation(s) in RCA: 11] [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: 04/14/2016] [Revised: 07/11/2016] [Accepted: 08/02/2016] [Indexed: 11/25/2022]
Abstract
We compared heart rate variability (HRV) values according to the following body size phenotypes: metabolically healthy normal weight (MHNW), metabolically unhealthy but normal weight (MUNW), metabolically healthy but obese (MHO), and metabolically unhealthy obese (MUO). We retrospectively analyzed a dataset from 1200 participants who had visited the Cardiovascular Center at Korea University Guro Hospital between March 2009 and February 2014 and underwent Holter monitoring for 24h. HRV was calculated from standard deviation of normal-to-normal R-R intervals (SDNN), standard deviation of the average normal-to-normal intervals (SDANN), and root mean square of successive differences (rMSSD) measurements, and study subjects were classified according to body mass index (BMI) and presence or absence of metabolic syndrome. Various HRV indices, including SDNN, SDANN, and rMSSD, were significantly lower in MUNW subjects than in MHNW or MHO subjects, while there were no significant differences between MUNW and MUO subjects. Although BMI had no significant correlation with any HRV indices, SDNN, SDANN, and rMSSD values had significant negative correlations with waist circumference and levels of C-reactive proteins, AST, ALT, fasting glucose, and HOMA-IR. A significant positive correlation was observed between HRV index and HDL level. Furthermore, the SDNN value significantly decreased with an increase in the number of metabolic syndrome components after adjusting for other covariates. Compared to MHNW or MHO subjects, Korean men and women with the MUNW phenotype exhibited decreased HRV, suggesting that low HRV is related to adverse cardiovascular outcomes in MUNW individuals.
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Affiliation(s)
- Hye Jin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Soon Young Hwang
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eun Mi Lee
- Department of Internal Medicine, Division of Cardiology, Wonkwang University Sanbon Hospital, Gyeonggi-do, Republic of Korea
| | - Eung Joo Kim
- Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chang Gyu Park
- Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Dong Joo Oh
- Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hong Seog Seo
- Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea; KU-KIST Graduate School Converging Science and Technology, Seoul, Republic of Korea.
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22
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Mediterranean diet and mortality risk in metabolically healthy obese and metabolically unhealthy obese phenotypes. Int J Obes (Lond) 2016; 40:1541-1549. [DOI: 10.1038/ijo.2016.114] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 06/04/2016] [Accepted: 06/12/2016] [Indexed: 12/15/2022]
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23
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Byun AR, Kwon S, Lee SW, Shim KW, Lee HS. Metabolic health is more closely associated with prevalence of cardiovascular diseases or stroke than obesity: A cross-sectional study in Korean populations. Medicine (Baltimore) 2016; 95:e3902. [PMID: 27310991 PMCID: PMC4998477 DOI: 10.1097/md.0000000000003902] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mounting evidence suggests that not all obese subjects are at increased cardiovascular risk. However, the relationship between the metabolically healthy obese (MHO) phenotype and cardiovascular diseases (CVDs) or stroke remains unclear. Therefore, we retrospectively investigated the prevalence of CVDs or stroke according to metabolic health with obese.We studied 3695 subjects (40-85 years) from the Fifth Korean National Health and Nutrition Examination Survey. Participants were divided into 2 groups and 6 subgroups based on the body mass index (BMI) and metabolic syndrome (MetS) components: healthy (exhibiting none of the 5 MetS components) with the followings: healthy-normal weight (BMI < 23 kg/m), healthy-overweight (BMI = 23-24.9 kg/m), and healthy-obese (BMI ≥ 25 kg/m); and unhealthy (exhibiting 2 or more MetS components) with the followings: unhealthy-normal weight, unhealthy-overweight, and unhealthy-obese.In the healthy group (n = 1726), there were 76 CVDs or stroke patients (4.4%), whereas in the unhealthy group (n = 1969), there were 170 (8.6%). The prevalence was significantly different between the 2 groups (P < 0.001). However, the prevalence was not significantly different among healthy subgroups (P = 0.4072). The prevalence in unhealthy subgroups also demonstrated no statistically significant difference (P = 0.3798).We suggest that the prevalence of CVDs or stroke is different between metabolically healthy and unhealthy phenotype. Furthermore, MHO did not reveal higher CVDs or stroke prevalence rather than metabolically healthy other groups. Additional cohort studies are needed to explain causality between CVDs or stroke incidence and subjects exhibiting the MHO phenotype.
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Affiliation(s)
- A Ri Byun
- Department of Family Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Seungwon Kwon
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, Korea
| | - Sang Wha Lee
- Department of Family Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Kyung Won Shim
- Department of Family Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Hong Soo Lee
- Department of Family Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
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24
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Doumatey AP, Zhou J, Zhou M, Prieto D, Rotimi CN, Adeyemo A. Proinflammatory and lipid biomarkers mediate metabolically healthy obesity: A proteomics study. Obesity (Silver Spring) 2016; 24:1257-65. [PMID: 27106679 PMCID: PMC4882259 DOI: 10.1002/oby.21482] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/11/2016] [Accepted: 01/11/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The metabolically healthy obesity (MHO) phenotype is an important obesity subtype in which obesity is not accompanied by any metabolic comorbidity. However, the underlying molecular mechanisms remain elusive. In this study, a shotgun proteomics approach to identify circulating biomolecules and pathways associated with MHO was used. METHODS The subjects were 20 African-American women: 10 MHO cases and 10 metabolically abnormal individuals with obesity (MAO) controls. Serum proteins were detected and quantified using label-free proteomics. Differential expression of proteins between the two groups was analyzed, and the list of differentially expressed proteins was analyzed to determine enriched biological pathways. RESULTS Twenty proteins were differentially expressed between MHO and controls. These proteins included: hemoglobin subunits (HBA1, P = 6.00 × 10(-18) ), haptoglobin-related protein (HPR, P = 1.2 × 10(-15) ), apolipoproteins (APOB-100, P = 1.50 × 10(-40) ; APOA4, P = 1.1 × 10(-14) ), retinol-binding protein 4 (RBP4, P = 7.1 × 10(-08) ), and CRP (P = 2.0 × 10(-04) ). MHO was associated with lower levels of proinflammatory and higher levels of anti-inflammatory biomarkers when compared with MAO. Pathway analysis showed enrichment of lipids and inflammatory pathways, including LXR/RXR and FXR/RXR activation, and acute phase response signaling. CONCLUSIONS These findings suggested that protection from dysregulated inflammatory and lipid processes were primary molecular hallmarks of MHO. The candidate biomarkers (AHSG, RBP4, and APOA4) identified in this study are potential prognostic markers for MHO.
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Affiliation(s)
- Ayo Priscille Doumatey
- Center for Research on Genomics and Global HealthNational Human Genome Research Institute, National Institutes of HealthBethesdaMarylandUSA
| | - Jie Zhou
- Center for Research on Genomics and Global HealthNational Human Genome Research Institute, National Institutes of HealthBethesdaMarylandUSA
| | - Ming Zhou
- Laboratory of Proteomics and Analytical Technologies (LPAT) Leidos Biomedical Research IncNational Cancer Institute, National Institutes of HealthFrederickMarylandUSA
| | - DaRue Prieto
- Laboratory of Proteomics and Analytical Technologies (LPAT) Leidos Biomedical Research IncNational Cancer Institute, National Institutes of HealthFrederickMarylandUSA
| | - Charles N. Rotimi
- Center for Research on Genomics and Global HealthNational Human Genome Research Institute, National Institutes of HealthBethesdaMarylandUSA
| | - Adebowale Adeyemo
- Center for Research on Genomics and Global HealthNational Human Genome Research Institute, National Institutes of HealthBethesdaMarylandUSA
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25
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Ortega FB, Lavie CJ, Blair SN. Obesity and Cardiovascular Disease. Circ Res 2016; 118:1752-70. [DOI: 10.1161/circresaha.115.306883] [Citation(s) in RCA: 578] [Impact Index Per Article: 72.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/11/2016] [Indexed: 12/20/2022]
Abstract
The prevalence of obesity has increased worldwide over the past few decades. In 2013, the prevalence of obesity exceeded the 50% of the adult population in some countries from Oceania, North Africa, and Middle East. Lower but still alarmingly high prevalence was observed in North America (≈30%) and in Western Europe (≈20%). These figures are of serious concern because of the strong link between obesity and disease. In the present review, we summarize the current evidence on the relationship of obesity with cardiovascular disease (CVD), discussing how both the degree and the duration of obesity affect CVD. Although in the general population, obesity and, especially, severe obesity are consistently and strongly related with higher risk of CVD incidence and mortality, the one-size-fits-all approach should not be used with obesity. There are relevant factors largely affecting the CVD prognosis of obese individuals. In this context, we thoroughly discuss important concepts such as the fat-but-fit paradigm, the metabolically healthy but obese (MHO) phenotype and the obesity paradox in patients with CVD. About the MHO phenotype and its CVD prognosis, available data have provided mixed findings, what could be partially because of the adjustment or not for key confounders such as cardiorespiratory fitness, and to the lack of consensus on the MHO definition. In the present review, we propose a scientifically based harmonized definition of MHO, which will hopefully contribute to more comparable data in the future and a better understanding on the MHO subgroup and its CVD prognosis.
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Affiliation(s)
- Francisco B. Ortega
- From the PROFITH “PROmoting FITness and Health through physical activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain (F.B.O.); Department of Biosciences and Nutrition at NOVUM, Karolinska Institutet, Huddinge, Sweden (F.B.O.); Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA (C.J.L.); and
| | - Carl J. Lavie
- From the PROFITH “PROmoting FITness and Health through physical activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain (F.B.O.); Department of Biosciences and Nutrition at NOVUM, Karolinska Institutet, Huddinge, Sweden (F.B.O.); Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA (C.J.L.); and
| | - Steven N. Blair
- From the PROFITH “PROmoting FITness and Health through physical activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain (F.B.O.); Department of Biosciences and Nutrition at NOVUM, Karolinska Institutet, Huddinge, Sweden (F.B.O.); Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA (C.J.L.); and
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26
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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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27
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Oliva-Olivera W, Leiva Gea A, Lhamyani S, Coín-Aragüez L, Alcaide Torres J, Bernal-López MR, García-Luna PP, Morales Conde S, Fernández-Veledo S, El Bekay R, Tinahones FJ. Differences in the Osteogenic Differentiation Capacity of Omental Adipose-Derived Stem Cells in Obese Patients With and Without Metabolic Syndrome. Endocrinology 2015; 156:4492-501. [PMID: 26372179 PMCID: PMC4655209 DOI: 10.1210/en.2015-1413] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Multiple studies have suggested that the reduced differentiation capacity of multipotent adipose tissue-derived mesenchymal stem cells (ASCs) in obese subjects could compromise their use in cell therapy. Our aim was to assess the osteogenic potential of omental ASCs and to examine the status of the isolated CD34(negative)-enriched fraction of omental-derived ASCs from subjects with different metabolic profiles. Omental ASCs from normal-weight subjects and subjects with or without metabolic syndrome were isolated, and the osteogenic potential of omental ASCs was evaluated. Additionally, osteogenic and clonogenic potential, proliferation rate, mRNA expression levels of proteins involved in redox balance, and fibrotic proteins were examined in the CD34(negative)-enriched fraction of omental-derived ASCs. Both the omental ASCs and the CD34(negative)-enriched fraction of omental ASCs from subjects without metabolic syndrome have a greater osteogenic potential than those from subjects with metabolic syndrome. The alkaline phosphatase and osteonectin mRNA were negatively correlated with nicotinamide adenine dinucleotide phosphate oxidase-2 mRNA and the mRNA expression levels of the fibrotic proteins correlated positively with nicotinamide adenine dinucleotide phosphate oxidase-5 mRNA and the homeostasis model assessment. Although the population doubling time was significantly higher in subjects with a body mass index of 25 kg/m(2) or greater, only the CD34(negative)-enriched omental ASC fraction in the subjects with metabolic syndrome had a higher population doubling time than the normal-weight subjects. The osteogenic, clonogenic, fibrotic potential, and proliferation rate observed in vitro suggest that omental ASCs from subjects without metabolic syndrome are more suitable for therapeutic osteogenic applications than those from subjects with metabolic syndrome.
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Affiliation(s)
- Wilfredo Oliva-Olivera
- Department of Clinical Endocrinology and Nutrition (W.O.-O., S.L., L.C.-A., J.A.T., R.E.B., F.J.T.), Institute of Biomedical Research of Malaga, Hospital Complex of Malaga (Virgen de la Victoria), University of Malaga, and Department of Orthopedic Surgery and Traumatology (A.L.G.), Virgen de la Victoria University Hospital and University of Malaga, and Department of Internal Medicine (M.R.B.-L.), Regional University Hospital of Malaga, Institute of Biomedical Research of Malaga, 29010 Malaga, Spain; Centro de Investigación Biomédica en Red of Obesity Physiopathology and Nutrition (W.O.-O., S.L., L..C.-A., J.A.T., M.R.B.-L., R.E.B., F.J.T.), and Centro de Investigación Biomédica en Red of Diabetes and Associated Metabolic Disorders (S.F.-V.), Institute of Health Salud Carlos III, 28029 Madrid, Spain; Department of Endocrinology and Nutrition (P.P.G.L.) and Unit of Innovation in Minimally Invasive Surgery (S.M.C.), Department of Surgery, Virgen del Rocío University Hospital, 41013 Seville, Spain; and University Hospital of Tarragona Joan XXIII Institut d'Investigació (S.F.-V.), Sanitaria Pere Virgili, Universitat Rovirai Virgili, 43003 Tarragona, Spain
| | - Antonio Leiva Gea
- Department of Clinical Endocrinology and Nutrition (W.O.-O., S.L., L.C.-A., J.A.T., R.E.B., F.J.T.), Institute of Biomedical Research of Malaga, Hospital Complex of Malaga (Virgen de la Victoria), University of Malaga, and Department of Orthopedic Surgery and Traumatology (A.L.G.), Virgen de la Victoria University Hospital and University of Malaga, and Department of Internal Medicine (M.R.B.-L.), Regional University Hospital of Malaga, Institute of Biomedical Research of Malaga, 29010 Malaga, Spain; Centro de Investigación Biomédica en Red of Obesity Physiopathology and Nutrition (W.O.-O., S.L., L..C.-A., J.A.T., M.R.B.-L., R.E.B., F.J.T.), and Centro de Investigación Biomédica en Red of Diabetes and Associated Metabolic Disorders (S.F.-V.), Institute of Health Salud Carlos III, 28029 Madrid, Spain; Department of Endocrinology and Nutrition (P.P.G.L.) and Unit of Innovation in Minimally Invasive Surgery (S.M.C.), Department of Surgery, Virgen del Rocío University Hospital, 41013 Seville, Spain; and University Hospital of Tarragona Joan XXIII Institut d'Investigació (S.F.-V.), Sanitaria Pere Virgili, Universitat Rovirai Virgili, 43003 Tarragona, Spain
| | - Said Lhamyani
- Department of Clinical Endocrinology and Nutrition (W.O.-O., S.L., L.C.-A., J.A.T., R.E.B., F.J.T.), Institute of Biomedical Research of Malaga, Hospital Complex of Malaga (Virgen de la Victoria), University of Malaga, and Department of Orthopedic Surgery and Traumatology (A.L.G.), Virgen de la Victoria University Hospital and University of Malaga, and Department of Internal Medicine (M.R.B.-L.), Regional University Hospital of Malaga, Institute of Biomedical Research of Malaga, 29010 Malaga, Spain; Centro de Investigación Biomédica en Red of Obesity Physiopathology and Nutrition (W.O.-O., S.L., L..C.-A., J.A.T., M.R.B.-L., R.E.B., F.J.T.), and Centro de Investigación Biomédica en Red of Diabetes and Associated Metabolic Disorders (S.F.-V.), Institute of Health Salud Carlos III, 28029 Madrid, Spain; Department of Endocrinology and Nutrition (P.P.G.L.) and Unit of Innovation in Minimally Invasive Surgery (S.M.C.), Department of Surgery, Virgen del Rocío University Hospital, 41013 Seville, Spain; and University Hospital of Tarragona Joan XXIII Institut d'Investigació (S.F.-V.), Sanitaria Pere Virgili, Universitat Rovirai Virgili, 43003 Tarragona, Spain
| | - Leticia Coín-Aragüez
- Department of Clinical Endocrinology and Nutrition (W.O.-O., S.L., L.C.-A., J.A.T., R.E.B., F.J.T.), Institute of Biomedical Research of Malaga, Hospital Complex of Malaga (Virgen de la Victoria), University of Malaga, and Department of Orthopedic Surgery and Traumatology (A.L.G.), Virgen de la Victoria University Hospital and University of Malaga, and Department of Internal Medicine (M.R.B.-L.), Regional University Hospital of Malaga, Institute of Biomedical Research of Malaga, 29010 Malaga, Spain; Centro de Investigación Biomédica en Red of Obesity Physiopathology and Nutrition (W.O.-O., S.L., L..C.-A., J.A.T., M.R.B.-L., R.E.B., F.J.T.), and Centro de Investigación Biomédica en Red of Diabetes and Associated Metabolic Disorders (S.F.-V.), Institute of Health Salud Carlos III, 28029 Madrid, Spain; Department of Endocrinology and Nutrition (P.P.G.L.) and Unit of Innovation in Minimally Invasive Surgery (S.M.C.), Department of Surgery, Virgen del Rocío University Hospital, 41013 Seville, Spain; and University Hospital of Tarragona Joan XXIII Institut d'Investigació (S.F.-V.), Sanitaria Pere Virgili, Universitat Rovirai Virgili, 43003 Tarragona, Spain
| | - Juan Alcaide Torres
- Department of Clinical Endocrinology and Nutrition (W.O.-O., S.L., L.C.-A., J.A.T., R.E.B., F.J.T.), Institute of Biomedical Research of Malaga, Hospital Complex of Malaga (Virgen de la Victoria), University of Malaga, and Department of Orthopedic Surgery and Traumatology (A.L.G.), Virgen de la Victoria University Hospital and University of Malaga, and Department of Internal Medicine (M.R.B.-L.), Regional University Hospital of Malaga, Institute of Biomedical Research of Malaga, 29010 Malaga, Spain; Centro de Investigación Biomédica en Red of Obesity Physiopathology and Nutrition (W.O.-O., S.L., L..C.-A., J.A.T., M.R.B.-L., R.E.B., F.J.T.), and Centro de Investigación Biomédica en Red of Diabetes and Associated Metabolic Disorders (S.F.-V.), Institute of Health Salud Carlos III, 28029 Madrid, Spain; Department of Endocrinology and Nutrition (P.P.G.L.) and Unit of Innovation in Minimally Invasive Surgery (S.M.C.), Department of Surgery, Virgen del Rocío University Hospital, 41013 Seville, Spain; and University Hospital of Tarragona Joan XXIII Institut d'Investigació (S.F.-V.), Sanitaria Pere Virgili, Universitat Rovirai Virgili, 43003 Tarragona, Spain
| | - Maria Rosa Bernal-López
- Department of Clinical Endocrinology and Nutrition (W.O.-O., S.L., L.C.-A., J.A.T., R.E.B., F.J.T.), Institute of Biomedical Research of Malaga, Hospital Complex of Malaga (Virgen de la Victoria), University of Malaga, and Department of Orthopedic Surgery and Traumatology (A.L.G.), Virgen de la Victoria University Hospital and University of Malaga, and Department of Internal Medicine (M.R.B.-L.), Regional University Hospital of Malaga, Institute of Biomedical Research of Malaga, 29010 Malaga, Spain; Centro de Investigación Biomédica en Red of Obesity Physiopathology and Nutrition (W.O.-O., S.L., L..C.-A., J.A.T., M.R.B.-L., R.E.B., F.J.T.), and Centro de Investigación Biomédica en Red of Diabetes and Associated Metabolic Disorders (S.F.-V.), Institute of Health Salud Carlos III, 28029 Madrid, Spain; Department of Endocrinology and Nutrition (P.P.G.L.) and Unit of Innovation in Minimally Invasive Surgery (S.M.C.), Department of Surgery, Virgen del Rocío University Hospital, 41013 Seville, Spain; and University Hospital of Tarragona Joan XXIII Institut d'Investigació (S.F.-V.), Sanitaria Pere Virgili, Universitat Rovirai Virgili, 43003 Tarragona, Spain
| | - Pedro Pablo García-Luna
- Department of Clinical Endocrinology and Nutrition (W.O.-O., S.L., L.C.-A., J.A.T., R.E.B., F.J.T.), Institute of Biomedical Research of Malaga, Hospital Complex of Malaga (Virgen de la Victoria), University of Malaga, and Department of Orthopedic Surgery and Traumatology (A.L.G.), Virgen de la Victoria University Hospital and University of Malaga, and Department of Internal Medicine (M.R.B.-L.), Regional University Hospital of Malaga, Institute of Biomedical Research of Malaga, 29010 Malaga, Spain; Centro de Investigación Biomédica en Red of Obesity Physiopathology and Nutrition (W.O.-O., S.L., L..C.-A., J.A.T., M.R.B.-L., R.E.B., F.J.T.), and Centro de Investigación Biomédica en Red of Diabetes and Associated Metabolic Disorders (S.F.-V.), Institute of Health Salud Carlos III, 28029 Madrid, Spain; Department of Endocrinology and Nutrition (P.P.G.L.) and Unit of Innovation in Minimally Invasive Surgery (S.M.C.), Department of Surgery, Virgen del Rocío University Hospital, 41013 Seville, Spain; and University Hospital of Tarragona Joan XXIII Institut d'Investigació (S.F.-V.), Sanitaria Pere Virgili, Universitat Rovirai Virgili, 43003 Tarragona, Spain
| | - Salvador Morales Conde
- Department of Clinical Endocrinology and Nutrition (W.O.-O., S.L., L.C.-A., J.A.T., R.E.B., F.J.T.), Institute of Biomedical Research of Malaga, Hospital Complex of Malaga (Virgen de la Victoria), University of Malaga, and Department of Orthopedic Surgery and Traumatology (A.L.G.), Virgen de la Victoria University Hospital and University of Malaga, and Department of Internal Medicine (M.R.B.-L.), Regional University Hospital of Malaga, Institute of Biomedical Research of Malaga, 29010 Malaga, Spain; Centro de Investigación Biomédica en Red of Obesity Physiopathology and Nutrition (W.O.-O., S.L., L..C.-A., J.A.T., M.R.B.-L., R.E.B., F.J.T.), and Centro de Investigación Biomédica en Red of Diabetes and Associated Metabolic Disorders (S.F.-V.), Institute of Health Salud Carlos III, 28029 Madrid, Spain; Department of Endocrinology and Nutrition (P.P.G.L.) and Unit of Innovation in Minimally Invasive Surgery (S.M.C.), Department of Surgery, Virgen del Rocío University Hospital, 41013 Seville, Spain; and University Hospital of Tarragona Joan XXIII Institut d'Investigació (S.F.-V.), Sanitaria Pere Virgili, Universitat Rovirai Virgili, 43003 Tarragona, Spain
| | - Sonia Fernández-Veledo
- Department of Clinical Endocrinology and Nutrition (W.O.-O., S.L., L.C.-A., J.A.T., R.E.B., F.J.T.), Institute of Biomedical Research of Malaga, Hospital Complex of Malaga (Virgen de la Victoria), University of Malaga, and Department of Orthopedic Surgery and Traumatology (A.L.G.), Virgen de la Victoria University Hospital and University of Malaga, and Department of Internal Medicine (M.R.B.-L.), Regional University Hospital of Malaga, Institute of Biomedical Research of Malaga, 29010 Malaga, Spain; Centro de Investigación Biomédica en Red of Obesity Physiopathology and Nutrition (W.O.-O., S.L., L..C.-A., J.A.T., M.R.B.-L., R.E.B., F.J.T.), and Centro de Investigación Biomédica en Red of Diabetes and Associated Metabolic Disorders (S.F.-V.), Institute of Health Salud Carlos III, 28029 Madrid, Spain; Department of Endocrinology and Nutrition (P.P.G.L.) and Unit of Innovation in Minimally Invasive Surgery (S.M.C.), Department of Surgery, Virgen del Rocío University Hospital, 41013 Seville, Spain; and University Hospital of Tarragona Joan XXIII Institut d'Investigació (S.F.-V.), Sanitaria Pere Virgili, Universitat Rovirai Virgili, 43003 Tarragona, Spain
| | - Rajaa El Bekay
- Department of Clinical Endocrinology and Nutrition (W.O.-O., S.L., L.C.-A., J.A.T., R.E.B., F.J.T.), Institute of Biomedical Research of Malaga, Hospital Complex of Malaga (Virgen de la Victoria), University of Malaga, and Department of Orthopedic Surgery and Traumatology (A.L.G.), Virgen de la Victoria University Hospital and University of Malaga, and Department of Internal Medicine (M.R.B.-L.), Regional University Hospital of Malaga, Institute of Biomedical Research of Malaga, 29010 Malaga, Spain; Centro de Investigación Biomédica en Red of Obesity Physiopathology and Nutrition (W.O.-O., S.L., L..C.-A., J.A.T., M.R.B.-L., R.E.B., F.J.T.), and Centro de Investigación Biomédica en Red of Diabetes and Associated Metabolic Disorders (S.F.-V.), Institute of Health Salud Carlos III, 28029 Madrid, Spain; Department of Endocrinology and Nutrition (P.P.G.L.) and Unit of Innovation in Minimally Invasive Surgery (S.M.C.), Department of Surgery, Virgen del Rocío University Hospital, 41013 Seville, Spain; and University Hospital of Tarragona Joan XXIII Institut d'Investigació (S.F.-V.), Sanitaria Pere Virgili, Universitat Rovirai Virgili, 43003 Tarragona, Spain
| | - Francisco José Tinahones
- Department of Clinical Endocrinology and Nutrition (W.O.-O., S.L., L.C.-A., J.A.T., R.E.B., F.J.T.), Institute of Biomedical Research of Malaga, Hospital Complex of Malaga (Virgen de la Victoria), University of Malaga, and Department of Orthopedic Surgery and Traumatology (A.L.G.), Virgen de la Victoria University Hospital and University of Malaga, and Department of Internal Medicine (M.R.B.-L.), Regional University Hospital of Malaga, Institute of Biomedical Research of Malaga, 29010 Malaga, Spain; Centro de Investigación Biomédica en Red of Obesity Physiopathology and Nutrition (W.O.-O., S.L., L..C.-A., J.A.T., M.R.B.-L., R.E.B., F.J.T.), and Centro de Investigación Biomédica en Red of Diabetes and Associated Metabolic Disorders (S.F.-V.), Institute of Health Salud Carlos III, 28029 Madrid, Spain; Department of Endocrinology and Nutrition (P.P.G.L.) and Unit of Innovation in Minimally Invasive Surgery (S.M.C.), Department of Surgery, Virgen del Rocío University Hospital, 41013 Seville, Spain; and University Hospital of Tarragona Joan XXIII Institut d'Investigació (S.F.-V.), Sanitaria Pere Virgili, Universitat Rovirai Virgili, 43003 Tarragona, Spain
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Obesity, metabolic abnormality, and health-related quality of life by gender: a cross-sectional study in Korean adults. Qual Life Res 2015; 25:1537-48. [PMID: 26615614 DOI: 10.1007/s11136-015-1193-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE This study sought to compare the association between health-related quality of life (HRQoL) and four body health types by gender. METHODS The study included 6217 men and 8243 women over 30 years of age chosen from a population-based survey. Participants were grouped by body mass index and metabolic abnormality into four types: metabolically healthy normal weight, metabolically abnormal but normal weight (MANW), metabolically healthy obesity (MHO), and metabolically abnormal obesity (MAO). HRQoL was measured using the EQ-5D health questionnaire. The outcomes encompassed five dimensions (mobility, self-care, usual activity, pain/discomfort, and anxiety/depression), and the impaired HRQoL dichotomized by the EQ-5D preference score. Complex sample multivariate binary logistic regression analyses were conducted to adjust for sociodemographic variables, lifestyle factors, and disease comorbidity. RESULTS Among men, those in the MANW group presented worse conditions on all dimensions and the impaired HRQoL compared to other men. However, no significant effect remained after adjusting for relevant covariates. For women, those in the MAO group had the most adversely affected HRQoL followed by those females in the MHO group. The domain of mobility and impaired HRQoL variable of the MAO and MHO groups remained significant when controlling for all covariates in the model. CONCLUSIONS The MANW is the least favorable condition of HRQoL for men, suggesting that metabolic health may associate with HRQoL more than obesity for males. In women, the MAO and MHO groups had the most adversely affected HRQoL, implying that MHO is not a favorable health condition and that obesity, in general, may be strongly associated with HRQoL in women.
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Rey-López JP, de Rezende LF, de Sá TH, Stamatakis E. Is the metabolically healthy obesity phenotype an irrelevant artifact for public health? Am J Epidemiol 2015; 182:737-41. [PMID: 26363513 DOI: 10.1093/aje/kwv177] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/08/2015] [Indexed: 01/29/2023] Open
Abstract
Some obese persons do not develop (at least in the short term) the metabolic complications of obesity that are thought to be causally linked to cardiovascular events or premature mortality. This phenomenon has been termed "metabolically healthy obesity" (MHO), and it has received much attention recently, to the extent that some authors argue that "new metrics" must be developed to estimate the risk associated with obesity beyond body mass index. In this commentary, we argue that the MHO phenotype is not benign and as such has very limited relevance as a public health target. More efforts must be allocated to reducing the distal and actual causal agents that lead to weight gain, instead of the current disproportionate scientific interest in the biological processes that explain the heterogeneity of obesity.
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Ayça B, Kafadar D, Avsar M, Avci İİ, Akın F, Okuyan E, Dinckal MH. Lower Muscle Strength and Increased Visceral Fat Associated With No-reflow and High Gensini Score in STEMI. Clin Appl Thromb Hemost 2015; 23:367-373. [DOI: 10.1177/1076029615613159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The impact of fat distribution, muscle mass, and muscle strength on no-reflow and severity of coronary artery disease in patients with ST-segment elevation myocardial infarction (STEMI) remains unclear. Objective: To investigate association between muscle strength and fat and muscle mass and severity of coronary atherosclerosis. Methods: We included 218 patients with STEMI who had undergone primary percutaneous coronary intervention. We evaluated the no-reflow phenomenon in infarct-related artery and calculated Gensini scores from initial angiograms as indicative of coronary atherosclerosis severity. The patients were divided into 2 groups as patients with no-reflow and with thrombolysis in myocardial infarction grade 3 flow and patients with low (<55) Gensini and with high (≥55) Gensini. Patients’ total fat, muscle mass, visceral fat mass, and muscle strength were measured via body composition analyzer and handgrip dynamometer. Results: High Gensini patients had a greater body mass index (BMI) and lower handgrip strength and more visceral fat ( P = .05, P = .017, and P < .001, respectively). The patients with no-reflow had significantly lower handgrip strength and more visceral fat (both, P < .001). In multivariate regression analysis, visceral fat and handgrip strength were associated with high no-reflow rate and high Gensini scores in patients with STEMI ( P = .001, P = .014, P = .022, and P = .010; respectively). Conclusion: Increased visceral fat and lower handgrip strength may be related to increased no-reflow rate and coronary plaque burden in STEMI. Visceral fat and muscle strength may be better prognostic markers than weight, BMI, total fat, and muscle mass in coronary artery disease.
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Affiliation(s)
- Burak Ayça
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - Didem Kafadar
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - Murat Avsar
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - İ. İlker Avci
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - Fatih Akın
- Department of Cardiology, Muğla Sıtkı Koçman University, Medical School, Muğla, Turkey
| | - Ertugrul Okuyan
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - M. Hakan Dinckal
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
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Berg C, Strandhagen E, Mehlig K, Subramoney S, Lissner L, Björck L. Normal weight adiposity in a Swedish population: how well is cardiovascular risk associated with excess body fat captured by BMI? Obes Sci Pract 2015; 1:50-58. [PMID: 27721982 PMCID: PMC5049492 DOI: 10.1002/osp4.4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 04/14/2015] [Accepted: 05/11/2015] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The aim of this study was to examine how well body mass index (BMI) reflects cardiovascular risk associated with excess adiposity in a Swedish population by examining the association between body fat, BMI and cardiovascular risk factors. METHODS A total of 3,010 adults participated. Normal weight adiposity was defined as the combination of BMI < 25 kg/m2 and percentage body fat ≥35% for women and ≥25% for men. Associations with blood pressure, blood lipids, apolipoproteins and C-reactive protein were analysed in age-adjusted regression models. RESULTS The majority of the individuals with overweight and obesity were correctly classified to adiposity, while a wide range of body fat was observed among the normal weight subjects. In total, 9% of the participants were categorised as normal weight with adiposity. Compared with the normal weight leanness group, participants with normal weight adiposity had higher levels of serum triglycerides, low-density lipoprotein cholesterol, C-reactive protein, apolipoptotein B and the apolipoprotein B/A-I ratio. In normal weight men, adiposity was also associated with higher blood pressure and lower high-density lipoprotein cholesterol. CONCLUSIONS Higher percentage of body fat was associated with less favourable risk factor profile even in subjects who were normal weight. Thus, it might be relevant to screen for metabolic risk factors in the upper end of the normal weight category.
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Affiliation(s)
- Christina Berg
- Department of Food and Nutrition, and Sport ScienceUniversity of GothenburgGothenburgSweden
| | - Elisabeth Strandhagen
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Kirsten Mehlig
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Sreevidya Subramoney
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Nordic School of Public HealthGothenburgSweden
| | - Lauren Lissner
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Lena Björck
- Department of Molecular and Clinical Medicine and Institute of Health and Care SciencesUniversity of GothenburgGothenburgSweden
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Bleau C, Karelis AD, St-Pierre DH, Lamontagne L. Crosstalk between intestinal microbiota, adipose tissue and skeletal muscle as an early event in systemic low-grade inflammation and the development of obesity and diabetes. Diabetes Metab Res Rev 2015; 31:545-61. [PMID: 25352002 DOI: 10.1002/dmrr.2617] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 10/01/2014] [Accepted: 10/13/2014] [Indexed: 02/06/2023]
Abstract
Obesity is associated with a systemic chronic low-grade inflammation that contributes to the development of metabolic disorders such as cardiovascular diseases and type 2 diabetes. However, the etiology of this obesity-related pro-inflammatory process remains unclear. Most studies have focused on adipose tissue dysfunctions and/or insulin resistance in skeletal muscle cells as well as changes in adipokine profile and macrophage recruitment as potential sources of inflammation. However, low-grade systemic inflammation probably involves a complex network of signals interconnecting several organs. Recent evidences have suggested that disturbances in the composition of the gut microbial flora and alterations in levels of gut peptides following the ingestion of a high-fat diet may be a cause of low-grade systemic inflammation that may even precede and predispose to obesity, metabolic disorders or type 2 diabetes. This hypothesis is appealing because the gastrointestinal system is first exposed to nutrients and may thereby represent the first link in the chain of events leading to the development of obesity-associated systemic inflammation. Therefore, the present review will summarize the latest advances interconnecting intestinal mucosal bacteria-mediated inflammation, adipose tissue and skeletal muscle in a coordinated circuitry favouring the onset of a high-fat diet-related systemic low-grade inflammation preceding obesity and predisposing to metabolic disorders and/or type 2 diabetes. A particular emphasis will be given to high-fat diet-induced alterations of gut homeostasis as an early initiator event of mucosal inflammation and adverse consequences contributing to the promotion of extended systemic inflammation, especially in adipose and muscular tissues.
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MESH Headings
- Adipose Tissue, White/immunology
- Adipose Tissue, White/metabolism
- Animals
- Diabetes Mellitus, Type 2/etiology
- Diabetes Mellitus, Type 2/immunology
- Diabetes Mellitus, Type 2/metabolism
- Diabetes Mellitus, Type 2/microbiology
- Diet, High-Fat/adverse effects
- Enteritis/etiology
- Enteritis/immunology
- Enteritis/microbiology
- Enteritis/physiopathology
- Gastrointestinal Hormones/metabolism
- Gastrointestinal Microbiome
- Humans
- Immunity, Mucosal
- Intestinal Mucosa/immunology
- Intestinal Mucosa/metabolism
- Intestinal Mucosa/microbiology
- Models, Biological
- Muscle, Skeletal/immunology
- Muscle, Skeletal/metabolism
- Myositis/etiology
- Myositis/immunology
- Myositis/microbiology
- Myositis/physiopathology
- Obesity/etiology
- Obesity/immunology
- Obesity/metabolism
- Obesity/microbiology
- Panniculitis/etiology
- Panniculitis/immunology
- Panniculitis/microbiology
- Panniculitis/physiopathology
- Systemic Vasculitis/etiology
- Systemic Vasculitis/immunology
- Systemic Vasculitis/microbiology
- Systemic Vasculitis/physiopathology
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Affiliation(s)
- Christian Bleau
- Department of Biological Sciences, Université du Québec à Montréal, Montreal, Canada, H3C 3P8
| | - Antony D Karelis
- Department of Kinanthropology, Université du Québec à Montréal, Montreal, Canada, H3C 3P8
| | - David H St-Pierre
- Department of Kinanthropology, Université du Québec à Montréal, Montreal, Canada, H3C 3P8
| | - Lucie Lamontagne
- Department of Biological Sciences, Université du Québec à Montréal, Montreal, Canada, H3C 3P8
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Kanagasabai T, Thakkar NA, Kuk JL, Churilla JR, Ardern CI. Differences in physical activity domains, guideline adherence, and weight history between metabolically healthy and metabolically abnormal obese adults: a cross-sectional study. Int J Behav Nutr Phys Act 2015; 12:64. [PMID: 25982079 PMCID: PMC4490726 DOI: 10.1186/s12966-015-0227-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 05/11/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Despite the accepted health consequences of obesity, emerging research suggests that a significant segment of adults with obesity are metabolically healthy (MHO). To date, MHO individuals have been shown to have higher levels of physical activity (PA), but little is known about the importance of PA domains or the influence of weight history compared to their metabolically abnormal (MAO) counterpart. OBJECTIVE To evaluate the relationship between PA domains, PA guideline adherence, and weight history on MHO. METHODS Pooled cycles of the National Health and Nutritional Examination Survey (NHANES) 1999-2006 (≥20 y; BMI ≥ 30 kg/m(2); N = 2,753) and harmonized criteria for metabolic syndrome (MetS) were used. Participants were categorized as "inactive" (no reported PA), "somewhat active" (>0 to < 500 metabolic equivalent (MET) min/week), and "active" (PA guideline adherence, ≥ 500 MET min/week) according to each domain of PA (total, recreational, transportation and household). Logistic and multinomial regressions were modelled for MHO and analyses were adjusted for age, sex, education, ethnicity, income, smoking and alcohol intake. RESULTS Compared to MAO, MHO participants were younger, had lower BMI, and were more likely to be classified as active according to their total and recreational PA level. Based on total PA levels, individuals who were active had a 70% greater likelihood of having the MHO phenotype (OR = 1.70, 95% CI: 1.19-2.43); however, once stratified by age (20-44 y; 45-59 y; and; ≥60 y), the association remained significant only amongst those aged 45-59 y. Although moderate and vigorous PA were inconsistently related to MHO following adjustment for covariates, losing ≥30 kg in the last 10 y and not gaining ≥10 kg since age 25 y were significant predictors of MHO phenotype for all PA domains, even if adherence to the PA guidelines were not met. CONCLUSION Although PA is associated with MHO, the beneficial effects of PA may be moderated by longer-term changes in weight. Longitudinal analysis of physical activity and weight change trajectories are necessary to isolate the contribution of duration of obesity, PA behaviours, and longer-term outcomes amongst MHO individuals.
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Affiliation(s)
- Thirumagal Kanagasabai
- School of Kinesiology and Health Science, 352 Norman Bethune College, York University, 4700 Keele Street, Toronto, ON, M3J1P3, Canada.
| | - Niels A Thakkar
- School of Kinesiology and Health Science, 352 Norman Bethune College, York University, 4700 Keele Street, Toronto, ON, M3J1P3, Canada.
| | - Jennifer L Kuk
- School of Kinesiology and Health Science, 352 Norman Bethune College, York University, 4700 Keele Street, Toronto, ON, M3J1P3, Canada.
| | - James R Churilla
- Brooks College of Health, University of North Florida, Jacksonville, FL, USA.
| | - Chris I Ardern
- School of Kinesiology and Health Science, 352 Norman Bethune College, York University, 4700 Keele Street, Toronto, ON, M3J1P3, Canada.
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Ortega FB, Cadenas-Sánchez C, Sui X, Blair SN, Lavie CJ. Role of Fitness in the Metabolically Healthy but Obese Phenotype: A Review and Update. Prog Cardiovasc Dis 2015; 58:76-86. [PMID: 25959452 DOI: 10.1016/j.pcad.2015.05.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Despite the strong and consistent evidence supporting that a high physical fitness (PF) level at any age is a major predictor of a healthier metabolic profile, major studies focused on the metabolically healthy but obese (MHO) phenotype have ignored the role of PF when examining this phenotype and its prognosis. Particularly, the role of its main health-related components such as higher cardiorespiratory fitness (CRF) and muscular fitness in the MHO phenotype needs to be reviewed in depth. The present review aimed to: 1) contribute to the characterization of the MHO phenotype by examining whether MHO individuals are fitter than metabolically abnormal obese (MAO) individuals in terms of CRF and other PF components; 2) review the role of CRF and other PF components in the prognosis of MHO. The studies reviewed suggest that a higher CRF level should be considered a characteristic of the MHO phenotype. Likewise, CRF seems to play a key role in the prognosis of the MHO individuals, yet this statement is based on a single study and future studies need to confirm or contrast these findings. Comparability of studies is difficult due to the different definitions used for MHO; consequently, the present review makes a proposal for harmonizing this definition in adults and in youth. Obesity is still related to an important number of comorbidities; therefore, the public health message remains to fight against both obesity and low CRF in both adult and pediatric populations.
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Affiliation(s)
- Francisco B Ortega
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, School of Sport Sciences, University of Granada, Spain; Department of Biosciences and Nutrition at NOVUM, Karolinska Institutet, Huddinge, Sweden.
| | - Cristina Cadenas-Sánchez
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, School of Sport Sciences, University of Granada, Spain
| | - Xuemei Sui
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA
| | - Steven N Blair
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA; Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, USA
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Song YM, Sung J, Lee K. Genetic and Environmental Relationships of Metabolic and Weight Phenotypes to Metabolic Syndrome and Diabetes: The Healthy Twin Study. Metab Syndr Relat Disord 2015; 13:36-44. [DOI: 10.1089/met.2014.0087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Yun-Mi Song
- Department of Family Medicine, Samsung Medical Center and Center for Clinical Research, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joohon Sung
- Department of Epidemiology, School of Public Health, Seoul National University, Seoul, South Korea
- Institute of Health and Environment, Seoul National University, Seoul, South Korea
| | - Kayoung Lee
- Department of Family Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
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36
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Karelis A, Rabasa-Lhoret R. Characterization of metabolically healthy but obese individuals: Should we add vitamin D to the puzzle? DIABETES & METABOLISM 2014; 40:319-21. [DOI: 10.1016/j.diabet.2014.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 03/17/2014] [Indexed: 11/29/2022]
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Gómez-Ambrosi J, Catalán V, Rodríguez A, Andrada P, Ramírez B, Ibáñez P, Vila N, Romero S, Margall MA, Gil MJ, Moncada R, Valentí V, Silva C, Salvador J, Frühbeck G. Increased cardiometabolic risk factors and inflammation in adipose tissue in obese subjects classified as metabolically healthy. Diabetes Care 2014; 37:2813-21. [PMID: 25011950 DOI: 10.2337/dc14-0937] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE It has been suggested that individuals with the condition known as metabolically healthy obesity (MHO) may not have the same increased risk for the development of metabolic abnormalities as their non-metabolically healthy counterparts. However, the validity of this concept has recently been challenged, since it may not translate into lower morbidity and mortality. The aim of the current study was to compare the cardiometabolic/inflammatory profile and the prevalence of impaired glucose tolerance (IGT) and type 2 diabetes (T2D) in patients categorized as having MHO or metabolically abnormal obesity (MAO). RESEARCH DESIGN AND METHODS We performed a cross-sectional analysis to compare the cardiometabolic/inflammatory profile of 222 MHO and 222 MAO patients (62% women) matched by age, including 255 lean subjects as reference (cohort 1). In a second cohort, we analyzed the adipokine profile and the expression of genes involved in inflammation and extracellular matrix remodeling in visceral adipose tissue (VAT; n = 82) and liver (n = 55). RESULTS The cardiometabolic and inflammatory profiles (CRP, fibrinogen, uric acid, leukocyte count, and hepatic enzymes) were similarly increased in MHO and MAO in both cohorts. Moreover, above 30%of patients classified as MHO according to fasting plasma glucose exhibited IGT or T2D [corrected]. The profile of classic (leptin, adiponectin, resistin) as well as novel (serum amyloid A and matrix metallopeptidase 9) adipokines was almost identical in MHO and MAO groups in cohort 2. Expression of genes involved in inflammation and tissue remodeling in VAT and liver showed a similar alteration pattern in MHO and MAO individuals. CONCLUSIONS The current study provides evidence for the existence of a comparable adverse cardiometabolic profile in MHO and MAO patients; thus the MHO concept should be applied with caution. A better identification of the obesity phenotypes and a more precise diagnosis are needed for improving the management of obese individuals.
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Affiliation(s)
- Javier Gómez-Ambrosi
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Pamplona, Spain
| | - Victoria Catalán
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Pamplona, Spain
| | - Amaia Rodríguez
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Pamplona, Spain
| | - Patricia Andrada
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
| | - Beatriz Ramírez
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Pamplona, Spain
| | - Patricia Ibáñez
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Pamplona, Spain Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
| | - Neus Vila
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
| | - Sonia Romero
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
| | - María A Margall
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
| | - María J Gil
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Pamplona, Spain Department of Biochemistry, Clínica Universidad de Navarra, Pamplona, Spain
| | - Rafael Moncada
- Department of Anesthesiology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Víctor Valentí
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Pamplona, Spain Department of Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - Camilo Silva
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Pamplona, Spain Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
| | - Javier Salvador
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Pamplona, Spain Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
| | - Gema Frühbeck
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Pamplona, Spain Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
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Akbas EM, Hamur H, Demirtas L, Bakirci EM, Ozcicek A, Ozcicek F, Kuyrukluyildiz U, Turkmen K. Predictors of epicardial adipose tissue in patients with type 2 diabetes mellitus. Diabetol Metab Syndr 2014; 6:55. [PMID: 24822086 PMCID: PMC4018267 DOI: 10.1186/1758-5996-6-55] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 05/02/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Epicardial adipose tissue (EAT), visceral fat depot of the heart, was found to be associated with coronary artery disease in cardiac and non-cardiac patients. Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) were introduced as potential markers to determine inflammation in various disorders. Recently, atherogenic index of plasma (AIP) was found to be closely associated with atherosclerosis in general population. Waist circumference is commonly used to assess the risk factors in various metabolic disorders. There has been a well known relation between inflammation and peripheral adipose tissue in diabetes mellitus. However, the data regarding EAT and inflammation is scant in this population. Hence, we aimed to determine the relationship between PLR, NLR, AIP, waist circumference and EAT in diabetic patients. METHODS This was a cross-sectional study involving 156 patients with type 2 diabetes mellitus (87 females, 69 males; mean age, 53.62 ± 9.33 years) and 50 control subjects (35 females, 15 males; mean age, 51.06 ± 8.74 years). EAT was measured by using a trans-thoracic echocardiogram. Atherogenic index of plasma was calculated as the logarithmically transformed ratio of the serum triglyceride to high density lipoprotein (HDL)cholesterol. NLR and PLR were calculated as the ratio of the neutrophils and platelets to lymphocytes, respectively. RESULTS Waist circumference, PLR, NLR, AIP and EAT measurements were significantly higher in diabetic patients when compared to control subjects. When diabetic patients were separated into two groups according to their median value of EAT (Group 1, EAT < 4.53 (n = 78) and group 2, EAT ≥4.53 (n = 78)), group 2 patients had significantly higher Body mass index (BMI), waist circumference, AIP, NLR and PLR levels. In the bivariate correlation analysis, EAT was positively correlated with PLR, NLR, AIP, BMI and waist circumference (r = 0.197, p = 0.014; r = 0.229, p = 0.004; r = 0.161, p = 0.044; r = 0.248, p = 0.002; r = 0.306, p < 0.001, respectively). Waist circumference was found to be independent variables of EAT. CONCLUSIONS Simple calculation of PLR and measurement of waist circumference were found to be associated with increased EAT in diabetic patients.
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Affiliation(s)
- Emin M Akbas
- Department of Endocrinology, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Hikmet Hamur
- Department of Cardiology, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Levent Demirtas
- Department of Internal Medicine, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Eftal M Bakirci
- Department of Cardiology, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Adalet Ozcicek
- Department of Internal Medicine, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Fatih Ozcicek
- Department of Internal Medicine, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Ufuk Kuyrukluyildiz
- Department of Anesthesiology and Reanimation, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Kultigin Turkmen
- Department of Nephrology, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
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