Characterization of Metabolically Healthy Obese People and Metabolically Unhealthy Normal-Weight People in a General Population Cohort of the ABCD Study

Metabolically Unhealthy Normal Weight: Prevalence and Associated Factors in an Adult Population from Northwest Colombia

Background and Aim

Individuals with a normal weight may have metabolic alterations at risk for chronic non-communicable diseases. The prevalence of this condition and associated factors have not been reported in Latin American populations. We aimed to estimate the presence and associated factors of Metabolically Unhealthy Normal Weight (MUNW) in adults from a public program for the control and prevention of chronic diseases in Medellín, Colombia.

Methods

Cross-sectional study. Overweight and normal weight were characterized according to the absence or presence of one or more components of the metabolic syndrome, obtaining four phenotypes: Metabolically Healthy Normal Weight (MHNW), MUNW (phenotype of interest), Metabolically Healthy Overweight (MHO), and Metabolically Unhealthy Overweight (MUO). The association of these phenotypes with sociodemographic variables of lifestyles and increased waist circumference was conducted by using logistic regression.

Results

In 37,558 individuals (72.7% women), the prevalence of MUNW was 23.3%. Among the additional phenotypes, MUO was found to be more prevalent (71.6%), while MHNW and MHO were very slightly common, 2% and 3.1%, respectively. In a multiple model, the factors associated with MUNW were age over 60 years (trend [OR 1.56 95% CI 0.97-2.52] p-value = 0.066), living in a rural area ([OR 1.58 95% CI 1.09-2.29] p-value = 0.015), and increased waist circumference ([OR 1.68 95% CI 1.45-1.95] p-value < 0.001). Male gender was inversely associated with all phenotypes (P < 0.05).

Conclusion

Almost a quarter of the analyzed population presented MUNW. People living in a rural area and over 60 years old were more likely to present MUNW. Men were less likely to present the weight phenotypes studied, although they could have been underrepresented.

Anthropometric and Biochemical Correlations of Insulin Resistance in a Middle-Aged Maltese Caucasian Population

Background

Insulin resistance (IR) is associated with increased cardiovascular disease risk, and with increased all-cause, cardiovascular, and cancer mortality. A number of surrogate markers are used in clinical practice to diagnose IR. The aim of this study was to investigate the discriminatory power of a number of routinely available anthropometric and biochemical variables in predicting IR and to determine their optimal cutoffs.

Methods

We performed a cross-sectional study in a cohort of middle-aged individuals. We used receiver operator characteristics (ROC) analyses in order to determine the discriminatory power of parameters of interest in detecting IR, which was defined as homeostatic model assessment-insulin resistance ≥2.5.

Results

Both the lipid accumulation product (LAP) and visceral adiposity index (VAI) exhibited good discriminatory power to detect IR in both males and females. The optimal cutoffs were 42.5 and 1.44, respectively, in males and 36.2 and 1.41, respectively, in females. Serum triglycerides (TG) and waist circumference (WC) similarly demonstrated good discriminatory power in detecting IR in both sexes. The optimal cutoffs for serum TG and WC were 1.35 mmol/L and 96.5 cm, respectively, in men and 1.33 mmol/L and 82 cm, respectively, in women. On the other hand, systolic and diastolic blood pressure, liver transaminases, high-density lipoprotein cholesterol, serum uric acid, ferritin, waist-hip ratio, "A" body shape, thigh circumference, and weight-adjusted thigh circumference all had poor discriminatory power.

Conclusions

Our data show that LAP, VAI, TG, and WC all have good discriminatory power in detecting IR in both men and women. The optimal cutoffs for TG and WC were lower than those currently recommended in both sexes. Replication studies are required in different subpopulations and different ethnicities in order to be able to update the current cut points to ones which reflect the contemporary population as well as to evaluate their longitudinal relationship with longer-term cardiometabolic outcomes.

Differences in the levels of inflammatory markers between metabolically healthy obese and other obesity phenotypes in adults: A systematic review and meta-analysis

AIMS

The aim of this study was to systematically review and analyze differences in the levels of C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) comparing metabolically healthy but obese (MHO) with metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), and metabolically unhealthy obese (MUO) subjects.

DATA SYNTHESIS

We searched PubMed, Embase, Web of Science, and Scopus for studies that matched the relevant search terms. Differences in inflammatory marker levels between MHO and the other three phenotypes were pooled as standardized mean differences (SMD) or differences of medians (DM) using a random-effects model. We included 91 studies reporting data on 435,007 individuals. The CRP levels were higher in MHO than in MHNO subjects (SMD = 0.63, 95% CI: 0.49, 0.76; DM = 0.83 mg/L, 95% CI: 0.56, 1.11). The CRP levels were higher in MHO than in MUNO subjects (SMD = 0.16, 95% CI: 0.05, 0.28; DM = 0.39 mg/L, 95% CI: 0.09, 0.69). The CRP levels were lower in MHO than in MUO individuals (SMD = -0.43, 95% CI: -0.54, -0.31; DM = -0.82 mg/L, 95% CI: -1.16, -0.48). The IL-6 levels in MHO were higher than in MHNO while lower than in MUO subjects. The TNF-α levels in MHO were higher than in MHNO individuals.

CONCLUSIONS

This review provides evidence that CRP levels in MHO are higher than in MHNO and MUNO subjects but lower than in MUO individuals. Additionally, IL-6 levels in MHO are higher than in MHNO but lower than in MUO subjects, and TNF-α levels in MHO are higher than in MHNO individuals.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO number: CRD42021234948.

FAAH Pro129Thr Variant Is Associated with Increased Cholesterol Levels in Normal-Weight Metabolically Unhealthy Subjects

Introduction: The endocannabinoid system (ECS) plays an integral role in maintaining metabolic homeostasis, where an hyperactivation has been related with serum lipid alterations. The biological effects of ECS are limited by the activation of the endocannabinoid-degrading enzyme fatty acid amide hydrolase (FAAH) and by polyunsaturated fatty acid (PUFA) intake as precursors. The FAAH Pro129Thr variant has been associated with obesity in some populations. However, the association with metabolic phenotypes in the Mexican population has not been studied. This study aimed to analyze the association of the FAAH Pro129Thr variant with serum lipids and diet in Mexican adults with different metabolic phenotypes. Methods: This is a cross-sectional study with 306 subjects between 18 and 65 years of age. They were classified with normal weight (NW) or excess weight (EW) according to their body mass index (BMI). The EW group included individuals with overweight or obesity (BMI 25-39.9 kg/m2). The individuals were classified into two metabolic phenotypes, metabolically healthy and metabolically unhealthy (MUH), using the homeostatic model assessment of insulin resistance and the National Cholesterol Education Program-adenosine triphosphate III cutoff points for blood pressure, triglycerides, high-density lipoprotein cholesterol, and fasting glucose. Subjects with ≥2 of 5 altered parameters were classified as MUH. The FAAH Pro129Thr variant was determined by allelic discrimination with TaqMan® probes. Results: The total cholesterol and very low-density lipoprotein cholesterol levels were associated with the FAAH Pro129Thr variant in NW-MUH subjects. Moreover, a lower PUFA intake was found in EW-MUH subjects with the FAAH variant. Conclusions: FAAH Pro129Thr variant has an important role in lipid metabolism, especially in NW-MUH subjects. By contrast, a low dietary intake of endocannabinoid PUFA precursors may partly counteract the development of the altered lipid profile associated with overweight/obesity.

Metabolic syndrome is associated with similar long-term prognosis in those living with and without obesity: an analysis of 45 615 patients from the nationwide LIPIDOGRAM 2004-2015 studies

AIMS

We aimed to evaluate the association between metabolic syndrome (MetS) and long-term all-cause mortality.

METHODS AND RESULTS

The LIPIDOGRAM studies were carried out in the primary care in Poland in 2004, 2006, and 2015. MetS was diagnosed based on the National Cholesterol Education Program, Adult Treatment Panel III (NCEP/ATP III), and Joint Interim Statement (JIS) criteria. The cohort was divided into four groups: non-obese patients without MetS, obese patients without MetS, non-obese patients with MetS, and obese patients with MetS. Differences in all-cause mortality were analysed using Kaplan-Meier and Cox regression analyses. A total of 45 615 participants were enrolled (mean age 56.3, standard deviation: 11.8 years; 61.7% female). MetS was diagnosed in 14 202 (31%) by NCEP/ATP III criteria and 17 216 (37.7%) by JIS criteria. Follow-up was available for 44 620 (97.8%, median duration 15.3 years) patients. MetS was associated with increased mortality risk among the obese {hazard ratio, HR: 1.88 [95% confidence interval (CI) 1.79-1.99] and HR: 1.93 [95% CI 1.82-2.04], according to NCEP/ATP III and JIS criteria, respectively} and non-obese individuals [HR: 2.11 (95% CI 1.85-2.40) and 1.7 (95% CI 1.56-1.85) according to NCEP/ATP III and JIS criteria, respectively]. Obese patients without MetS had a higher mortality risk than non-obese patients without MetS [HR: 1.16 (95% CI 1.10-1.23) and HR: 1.22 (95% CI 1.15-1.30), respectively in subgroups with NCEP/ATP III and JIS criteria applied].

CONCLUSIONS

MetS is associated with increased all-cause mortality risk in non-obese and obese patients. In patients without MetS, obesity remains significantly associated with mortality. The concept of metabolically healthy obesity should be revised.

Is Metabolic Score for Visceral Fat (METS-VF) a Better Index Than Other Adiposity Indices for the Prediction of Visceral Adiposity

Background

Visceral adiposity is an important risk factor for cardiometabolic diseases.

Objective

To determine whether the Metabolic Score for Visceral Fat (METS-VF) is more effective than other adiposity indices in predicting visceral fat area (VFA).

Methods

In this single-center and cross-sectional study, we included patients aged 20-50 years, without diabetes and coronary artery disease, who underwent computed tomography (CT) including the third lumbar vertebra. Age, blood pressure, waist circumference (WC), hip circumference, fasting lipids, and glucose were assessed. VFA was measured by cross-sectional examination of CT. The correlation of WC, body mass index (BMI), waist-hip ratio (WHR), lipid accumulation product (LAP), visceral adiposity index (VAI), a body shape index (ABSI), body roundness index (BRI), and METS-VF with VFA was analyzed by correlation analysis. The cut-off values and area under the curve (AUC) for identifying increased VFA (>130 cm2) were determined.

Results

We included 185 individuals with mean age 38.2 ± 8 and female predominance (58.4%). There was a significant positive correlation between all indices and VFA (p<0.001). ROC analysis revealed that METS-VF and WC demonstrated the highest predictive value for identifying increased VFA. In both men (p=0.001) and women (p<0.001), METS-VF (AUC 0.922 and 0.939, respectively) showed a significant superiority over ABSI (AUC 0.702 and 0.658, respectively), and VAI (AUC 0.731 and 0.725, respectively). Additionally, in women, its superiority over WHR (AUC 0.807) was also statistically significant (p=0.003). We identified a METS-VF cut-off point >6.4 in males >6.5 in females and WC cut-off point >88 cm in males (AUC 0.922), >90.5 cm in females (AUC 0.938).

Conclusion

METS-VF is strongly associated with visceral adiposity and better to predict increased VFA. However, its superiority over WC, BMI, BRI, and LAP was not significant. The results emphasize that WC is more appealing as screening indicator for visceral adiposity considering its easy use.

Clinical Trial Registry Name

Clinicaltrials.gov (http://www.clinicaltrials.gov).

Clinical Trial Registry Url

https://clinicaltrials.gov/ct2/show/NCT05648409.

Clinical Trial Registry Number

NCT05648409.

The Prevalence of Metabolically Unhealthy Normal Weight and Its Influence on the Risk of Diabetes

CONTEXT

Diabetes is a major health problem and metabolically unhealthy is an important risk factor.

OBJECTIVE

To conduct the first nationally representative study on epidemiological data of metabolically unhealthy normal weight (MUNW) focused only on nondiabetic subjects and determine the predictive effect on diabetes in China.

METHODS

A longitudinal study was conducted using data from the Rich Healthcare Group in China. Metabolic status was determined by the revised National Cholesterol Education Program Adult Treatment Panel III criteria, and individuals with 2 or more criteria were categorized as MUNW and diagnosed with metabolic syndrome (MetS) if they met 3 or more.

RESULTS

Of a total of 63 830 nondiabetic normal-weight individuals, 8935 (14.0%) were classified as MUNW and 1916 (3.00%) were diagnosed with MetS. After adjusting for potential confounders, individuals with MUNW had a greater diabetes risk (4.234, 95% CI 3.089-5.803) than those without MUNW during an average of 3.10 years of follow-up. Also, the multivariable-adjusted hazard ratios for developing diabetes were 3.069 (95% CI 1.790-5.263), 7.990 (95% CI 4.668-13.677), and 11.950 (95% CI 6.618-21.579) for participants with 1, 2, and 3 or more components, respectively, compared with those without any components. Further analyses suggested that the number of MetS components present is associated with the risk of diabetes, especially in metabolically unhealthy normal-weight young male adults. Multivariable-adjusted hazard ratios (95% CI) for incident diabetes among individuals with 1, 2, and at least 3 components were 4.45 (1.45-13.72), 9.82 (3.05-31.64), and 15.13 (3.70-61.84) for participants aged ≤44 years, and 3.55 (1.81-6.97), 8.52 (4.34-16.73), and 13.69 (6.51-28.77) for male participants, respectively.

CONCLUSIONS

The prevalence of MUNW is 14% in Chinese normal-weight nondiabetic individuals, and active intervention is necessary for this category of people. The presence of MUNW significantly increases the risk of diabetes, and the risk of diabetes is associated with the number of MetS components present in the patient.

Obesity and metabolic state are associated with increased healthcare resource and medication use and costs: a Finnish population-based study

AIM

To characterize healthcare resource (HCRU) and medication use and associated costs in individuals with obesity compared with individuals with normal weight or overweight in a population-based cohort of Finnish adults. The association between metabolic state and direct costs was also assessed.

METHODS

The study cohort included 5587 randomly selected individuals who participated in the national FinHealth 2017 health examination survey. Data on healthcare visits and hospital stays, including diagnoses (ICD-10), and purchases and costs of prescription medicines were collected from the nationwide registers by the Finnish Institute for Health and Welfare and Social Insurance Institution of Finland. The healthcare costs were calculated based on standard unit costs reported by the Finnish Institute for Health and Welfare.

RESULTS

The total annual direct costs were €2665 (SD €5673) and €1799 (SD €3874) per person with obesity and with normal weight or overweight, respectively. Obesity was associated with significantly increased total direct (age- and sex-adjusted cost rate ratio, RR, 1.356; p < 0.001), HCRU-related (1.273; p = 0.002), and medication (1.669; p < 0.001) costs. A vast majority (90%) of individuals with obesity were classified as metabolically unhealthy based on clinical measurements. The metabolically unhealthy state was associated with increased costs in individuals with obesity but not in individuals with normal weight or overweight.

CONCLUSION

Obesity is associated with a significant and complex direct cost burden to society, arising primarily from increased comorbidity. Metabolically healthy obesity is uncommon and obesity prevention and timely treatment should be of high priority to tackle the increasing burden of obesity.

The Association between Cardio-metabolic and hepatic indices and anthropometric measures with metabolically obesity phenotypes: a cross-sectional study from the Hoveyzeh Cohort Study

BACKGROUND

This study aimed to compare the cardio-metabolic, anthropometric, and liver function indices among metabolic obesity phenotypes.

METHODS

In this cross-sectional study, which was carried out in Hoveyzeh, Khuzestan Province, Iran, a total of 7,464 individuals (male: 2859, female: 4605), were recruited and classified into four groups, based on Body Mass Index (obese, BMI ≥ 30 kg/m²; non-obese, BMI = 18.5-29.9 kg/m²) and the National Cholesterol Education Program and Adult Treatment Panel (NCEP ATP) III criteria (Healthy group, ≤ 1 of the criteria; Unhealthy group, ≥ 2 of the criteria), as follows: Metabolically Healthy Non-Obese (MHNO, 28.14%), Metabolically Unhealthy Non-Obese (MUNO, 33.06%), Metabolically Healthy Obese (MHO, 6.54%), and Metabolically Unhealthy Obese (MUO, 32.26%). Anthropometric indices (Waist/Hip Ratio (WHR), Waist/Height Ratio (WHtR), Body Adiposity Index (BAI), Visceral Adiposity Index (VAI), and Weight adjusted Waist Index (WWI)), cardio-metabolic indices (Atherogenic Index of Plasma (AIP), Lipid Accumulation Product (LAP), Cardio-Metabolic Index (CMI), Lipoprotein Combine Index (LCI), Triglyceride-Glucose (TyG), TyG-BMI, TyG-WC, and Thrombolysis In Myocardial Infarction (TIMI) risk index), and hepatic indices (Hepatic Steatosis Index (HSI) and ALD/NAFLD index (ANI)) were calculated and compared between the groups.

RESULTS

WHR,VAI, AIP, LAP, CMI, LCI, TyG, and TIMI risk index values were significantly higher in the MUNO phenotype compared to the MHO phenotype (WHR: 0.97 vs. 0.95; VAI: 3.16 vs. 1.33; AIP: 0.58 vs. 0.25; LAP: 78.87 vs. 55.79; CMI: 2.69 vs. 1.25; LCI: 27.91 vs. 12.11; TyG: 9.21 vs. 8.41; TIMI: 18.66 vs. 15.63; p < 0.001). The highest and lowest HSI and ANI values were detected in the MUO phenotype. After adjustment for age, sex, physical activity, and years of education, VAI showed the highest Odds Ratio for MUNO (OR: 5.65; 95% CI: 5.12, 6.24) and MUO (OR: 5.40; 95% CI: 5.89, 5.95) compared to the MHNO phenotypes (p < 0.001). The ANI indices was associated with a reduced risk of MUO (OR: 0.76; 95% CI: 0.75-0.78), MUNO (OR: 0.88; 95% CI: 0.87-0.90), and MHO (OR: 0.79; 95% CI: 0.77-0.81) phenotypes (p < 0.001).

CONCLUSION

MUNO phenotype was exposed to a higher risk of cardiovascular disease compared to the MHO phenotype. VAI was found to be the optimal index for cardiovascular risk assessment.

Role of physical activity and cardiorespiratory fitness in metabolically healthy obesity: a narrative review

Obesity has been associated with a multitude of metabolic disorders, often clustering with risk factors of cardiovascular disease and type 2 diabetes mellitus, hypertension, dyslipidaemia. Overall, obesity is a worldwide, growing health concern. However, a subgroup of obese individuals with a low burden of metabolic abnormalities have been identified and described as metabolically healthy obese (MHO). Whether the MHO phenotype is protective against obesity-related metabolic disorders in the long-term is presently unclear, and current research examining the potential transition has yielded inconsistent results. In this current narrative review, we aim to provide insights on the role of physical activity (PA) and cardiorespiratory fitness (CRF) in MHO. Lifestyle factors such as PA and CRF may influence the MHO phenotype. Limited studies have characterised energy expenditure and CRF in MHO and metabolically unhealthy obese. However, higher levels of PA, less sedentary behaviour and higher CRF have been observed in MHO individuals. Considering the multiple benefits of PA, it is high time to advocate this lifestyle change beyond its influence on energy balance in a weight loss programme to improve cardiovascular and metabolic risk factors irrespective of body weight and fat mass changes. Improved CRF via increased PA, especially exercise participation, while avoiding weight gain is not only a realistic goal, but should be the primary intervention for MHO populations to prevent the transition to an abnormal metabolic state.

Association between metabolic syndrome and uric acid: a systematic review and meta-analysis

This systematic review and meta-analysis aim to provide the best evidence on the association between metabolic syndrome (MetS) and uric acid (UA) by determining the size of the effect of this biomarker on MetS. The review protocol is registered with PROSPERO (CRD42021231124). The search covered the PubMed and Scopus databases. Methodological quality was assessed with the STROBE tool, overall risk of bias with RevMan (Cochrane Collaboration) and quality of evidence with Grade Pro. Initially, 1582 articles were identified. Then, after excluding duplicates and reviewing titles and abstracts, 1529 articles were excluded from applying the eligibility criteria. We included 43 papers (56 groups) comparing UA concentrations between subjects 91,845 with MetS and 259,931 controls. Subjects with MetS had a higher mean UA of 0.57 mg/dl (95% CI 0.54-0.61) (p < 0.00001). Given the heterogeneity of the included studies, the researchers decided to perform subgroups analysis. Men with MetS have a higher UA concentration mg/dl 0.53 (95% CI 0.45-0.62, p < 0.00001) and women with MetS 0.57 (95% CI 0.48-0.66, p < 0.00001) compared to subjects without MetS. Assessment of UA concentration could provide a new avenue for early diagnosis of MetS, as a new biomarker and the possibility of new therapeutic targets.

Prevalence and predictors of metabolically healthy obesity in severely obese Asian children

BACKGROUND

Obese individuals who have little or no metabolic syndrome components are proposed to be "metabolically healthy obese (MHO)". This study aim to evaluate the prevalence of MHO and examine the predictors associated with MHO in a multi-ethnic Asian cohort of severely obese children.

METHODS

This study included a cross-sectional cohort of 406 Chinese, Malay and Indian children aged 5-20 years old with BMI for age ≥ 97th percentile. Metabolic syndrome (MS) and metabolic health (MH) definitions based on the presence or absence of metabolic abnormalities (High triglycerides, low HDL cholesterol, elevated blood pressure and high glucose) were used to define MHO in the cohort.

RESULTS

The prevalence of MHO is 63.5% by MS definition and 22.4% by MH definition. Maternal healthy metabolic status (OR: 2.47), age (OR: 0.83, 0.80), paternal obesity (OR: 0.48, 0.53), Malay (OR: 1.97) and Indian ethnicity (OR: 6.38, 3.21) (compared to Chinese ethnicity) are independent predictors for MHO phenotype based on different MHO definitions.

CONCLUSIONS

Adiposity measures are not associated with MHO phenotype, but instead younger age, maternal healthy metabolic status, absence of paternal obesity, Malay and Indian ethnicity are independent predictors for MHO phenotype in a multi-ethnic Asian cohort of severely obese children.

IMPACT

The prevalence of metabolically healthy obese (MHO) in our multi-ethnic Asian cohort of severely obese children is 63.5% and 22.4%, respectively, based on different MHO definitions. Adiposity measures are not associated with the MHO phenotype. There are other factors that contribute to the metabolic phenotype in obese individuals. Younger age, maternal healthy metabolic status, absence of paternal obesity, Malay and Indian ethnicity are independent predictors for MHO phenotype. Parental influence is important in predicting metabolic health in obese individuals.

Body Composition and Anthropometric Indicators in Children and Adolescents 6-15 Years Old

The problem of overweight and obesity among children and adolescents has now become a major public health challenge worldwide. The aim of this study was to assess the effect of age and gender on body composition components and anthropometric indices of children and adolescents aged 6-15 years; in addition, the study aimed to assess body composition indices in relation to BMI (Body Mass Index) levels. The study was conducted at the end of 2019 and in the first quarter of 2020 among 181 pupils attending primary schools. Waist circumference, hip circumference, body weight, and body height were measured. The collected data were used to calculate and then to analyse BMI, WHR (Waist-Hip Ratio), and WHtR (Waist to Height Ratio) indices. Body composition was determined with the use of the Bioelectrical Impedance Analysis (BIA). The analyses' statistics were performed using IBM SPSS Statistics 24 and Excel. The statistical methods used included Chi² tests of independence, one-factor analysis of variance, and two-factor analysis of variance taking into account the level of α = 0.05. Based on the results, there were no statistically significant differences in the gender and age distributions of the BMI groups. However, the analysis of interaction effects confirmed that there were statistically significant differences according to pubertal age and gender in body fat, muscle mass, hydration, and WHR. Body composition in boys and girls before the age of 12 is similar while, after the age of 12, there are differences between boys and girls in terms of body composition so there is a need to deepen the assessment of body mass, especially in adolescents at the age of puberty, by body composition analysis using the BIA method.

Crossbred Sows Fed a Western Diet during Pre-Gestation, Gestation, Lactation, and Post-Lactation Periods Develop Signs of Lean Metabolic Syndrome That Are Partially Attenuated by Spirulina Supplementation

Excessive dietary intake of fats and sugars (“Western diet”, WD) is one of the leading causes of obesity. The consumption of the microalga Arthrospira platensis (spirulina, Sp) is increasing due to its presumed health benefits. Both WD and Sp are also consumed by pregnant and breastfeeding women. This study investigated if gestating and lactating domestic pigs are an appropriate model for WD-induced metabolic disturbances similar to those observed in humans and if Sp supplementation may attenuate any of these adverse effects. Pigs were fed a WD high in fat, sugars, and cholesterol or a control diet. Half of the animals per diet group were supplemented with 20 g Sp per day. The WD did not increase body weight or adipose tissue accumulation but led to metabolic impairments such as higher cholesterol concentration in plasma, lower IGF1 plasma levels, and signs of hepatic damage compared to the control group. Spirulina supplementation could not reduce all the metabolic impairments observed in WD-fed animals. These findings indicate limited suitability of gestating and lactating domestic pigs as a model for WD but a certain potential of low-dose Sp supplementation to partially attenuate negative WD effects.

Prevalence rates of metabolic health and body size phenotypes by different criteria and association with insulin resistance in a Maltese Caucasian population

INTRODUCTION

Hyperinsulinemia and insulin resistance are known to be associated with increased cardiovascular morbidity and mortality. A metabolically unhealthy phenotype is frequently used as a surrogate marker for insulin resistance. The aims of the current study were to compare the prevalence of the body size phenotypes using different definitions of metabolic health and to investigate which one of them is most strongly associated with insulin resistance in men and women.

METHODS

We conducted a cross-sectional study in a middle-aged cohort of Maltese Caucasian non-institutionalized population. Metabolic health was defined using the various currently used definitions.

RESULTS

There were significant differences in the prevalence of body size phenotypes according to the different definitions. We also found significant sex differences in the predictive value of the various definitions of the metabolically unhealthy phenotype to predict insulin resistance. The strongest association was for the definition of having >2 NCEP-ATPIII criteria to characterize the metabolic unhealthy phenotype in women (odds ratio of 19.7). On the other hand, the Aguilar-Salinas et al. definition had the strongest association in men (odds ratio of 18.7).

CONCLUSIONS

We found large differences in the prevalence of the various body size phenotypes when using different definitions, highlighting the need for having standard criteria. Our data also suggest the need for sex-specific definitions of metabolic health.

Prevalence and risk factors of hyperuricaemia in non-obese Chinese: a single-centre cross-sectional study

OBJECTIVES

Hyperuricaemia is closely related to metabolic diseases and is receiving increasing attention from all over the world. This study aimed to investigate the prevalence and factors associated with hyperuricaemia in non-obese Chinese population.

DESIGN

Retrospective cross-sectional study.

SETTING

A large general hospital that can provide health check-ups in Hangzhou, China.

PARTICIPANTS

A total of 5731 apparently healthy Chinese adults (2349 men and 3382 women) who took their health check-ups during the year of 2019.

EXCLUSION CRITERIA

(1) those with body mass index ≥24 kg/m2; (2) those with incomplete anthropometric and biochemical data; (3) those with a history of malignancy and (4) those under urate-lowering treatment.

PRIMARY AND SECONDARY OUTCOME MEASURES

The prevalence and factors associated with hyperuricaemia in non-obese Chinese adults.

RESULTS

Of the 5731 non-obese subjects enrolled, 538 (9.4%) were identified as having hyperuricaemia, specifically 16.3% in men and 4.6% in women. The prevalence of hyperuricaemia markedly increased in women aged above 50 years. The prevalence of hyperuricaemia was significantly higher in metabolically unhealthy participants with normal weight than in metabolically healthy participants with normal weight. Participants with hyperuricaemia showed a higher prevalence of metabolic syndrome and fatty liver disease than participants with normouraemia. Age, waist circumference, estimated glomerular filtration rate, blood urea nitrogen, excessive drinking and fatty liver were associated with hyperuricaemia in both genders.

CONCLUSION

The prevalence of hyperuricaemia was 9.4% in non-obese Chinese adults. Non-obese participants with hyperuricaemia also showed multiple metabolic disorders. We suggest that clinicians pay attention to serum uric acid level in non-obese patients.

Sex differences in cardiometabolic abnormalities in a middle-aged Maltese population

OBJECTIVES

There are sex differences in distribution of fat and in the prevalence of overweight and obesity. We therefore sought to explore sex differences in the prevalence of adiposity-metabolic health phenotypes, in anthropometric and cardio-metabolic parameters, and in the relationship between body mass index (BMI) categories and metabolic health.

METHODS

We conducted a cross-sectional study carried out between January 2018 and June 2019, of a nationally representative sample of the Maltese Caucasian population aged 41 ± 5 years. Metabolic health was defined as presence of ≤ 1 parameter of the metabolic syndrome as defined by the National Cholesterol Education Program-Adult Treatment Panel III criteria.

RESULTS

Males exhibited the unhealthy metabolic phenotype more frequently than women (41.3% vs 27.8%). In total, 10.3% of normal weight men and 6.3% of normal weight women were metabolically unhealthy. Males had a higher median BMI, but a lower proportion of males exhibited an abnormally high waist circumference as compared with females. A significant difference in sex distribution was noted for each body composition phenotype.

CONCLUSION

In a contemporary sample of middle-aged individuals, males were more metabolically unhealthy and more insulin resistant than their female counterparts in spite of exhibiting an abnormal waist circumference less frequently and having similar waist index. This suggests that the currently used cut-offs for normal waist circumference should be revised downwards in men. Since even normal weight men were more often metabolically unhealthy than normal weight women, BMI cut-offs may also need to be lowered in men.

Neural networks applied to 12-lead electrocardiograms predict body mass index, visceral adiposity and concurrent cardiometabolic ill-health

Background

Obesity is associated with electrophysiological remodeling, which manifests as detectable changes on the surface electrocardiogram (ECG).

Objective

To develop neural networks (NN) to predict body mass index (BMI) from ECGs and test the hypothesis that discrepancies between NN-predicted BMI and measured BMI are indicative of underlying adiposity and/or concurrent cardiometabolic ill-health.

Methods

NN models were developed using 36,856 12-lead resting ECGs from the UK Biobank. Two architectures were developed for continuous and categorical BMI estimation (normal weight [BMI <25 kg/m²] vs overweight/obese [BMI ≥25 kg/m²]). Models for male and female participants were trained and tested separately. For each sex, data were randomly divided into 4 folds, and models were evaluated in a leave-1-fold-out manner.

Results

ECGs were available for 17,807 male and 19,049 female participants (mean ages: 61 ± 7 and 63 ± 8 years; mean BMI 26 ± 5 kg/m² and 27 ± 4 kg/m², respectively). NN models detected overweight/obese individuals with average accuracies of 75% and 73% for male and female subjects, respectively. The magnitudes of difference between NN-predicted BMI and actual BMI were significantly correlated with visceral adipose tissue volumes. Concurrent hypertension, diabetes, dyslipidemia, and/or coronary heart disease explained false-positive classifications (ie, calculated BMI <25 kg/m² misclassified as ≥25 kg/m² by NN model, P < .001).

Conclusion

NN models applied to 12-lead ECGs predict BMI with a reasonable degree of accuracy. Discrepancies between NN-predicted and calculated BMI may be indicative of underlying visceral adiposity and concomitant cardiometabolic perturbation, which could be used to identify individuals at risk of cardiometabolic disease.

The Pancreatic ß-cell Response to Secretory Demands and Adaption to Stress

Pancreatic β cells dedicate much of their protein translation capacity to producing insulin to maintain glucose homeostasis. In response to increased secretory demand, β cells can compensate by increasing insulin production capability even in the face of protracted peripheral insulin resistance. The ability to amplify insulin secretion in response to hyperglycemia is a critical facet of β-cell function, and the exact mechanisms by which this occurs have been studied for decades. To adapt to the constant and fast-changing demands for insulin production, β cells use the unfolded protein response of the endoplasmic reticulum. Failure of these compensatory mechanisms contributes to both type 1 and 2 diabetes. Additionally, studies in which β cells are "rested" by reducing endogenous insulin demand have shown promise as a therapeutic strategy that could be applied more broadly. Here, we review recent findings in β cells pertaining to the metabolic amplifying pathway, the unfolded protein response, and potential advances in therapeutics based on β-cell rest.

Characterisation of body size phenotypes in a middle-aged Maltese population

Obesity is increasingly recognised as being a heterogeneous disease. Some obese individuals may present a metabolically healthy profile (metabolically healthy obese (MHO)), while some normal weight individuals exhibit an adverse cardiometabolic phenotype (metabolically unhealthy normal weight individuals (MUHNW)). The objectives of the present study were to examine the prevalence and associated characteristics of the different body composition phenotypes within a Maltese cohort. This was a cross-sectional analysis involving 521 individuals aged 41 ± 5 years. The metabolically unhealthy state was defined as the presence of ≥2 metabolic syndrome components (NCEP-ATPIII parameters), while individuals with ≤1 cardiometabolic abnormalities were classified as metabolically healthy. Overall, 70 % of the studied population was overweight or obese and 30⋅7 % had ≥2 cardiometabolic abnormalities. The prevalence of MHO and MUHNW was 10⋅7 and 2⋅1 %, respectively. Individuals with the healthy phenotype were more likely to consume alcohol, participate in regular physical activity and less likely to be smokers. While the MHO phenotype had similar values for waist, hip and neck circumferences, waist-hip ratio and insulin resistance when compared with MUHNW individuals, there was a lower proportion of MHO subjects having a high fasting plasma glucose, hypertriglyceridaemia or low HDL-C when compared with the unhealthy lean individuals. A high prevalence of the metabolically unhealthy phenotype was observed in this relatively young population which may result in significant future cardiovascular disease burden if timely assessment and management of modifiable risk factors are not implemented. Furthermore, the present study suggests that the MHO phenotype is not totally benign as previously thought.

Oxidative Stress in Association with Metabolic Health and Obesity in Young Adults

INTRODUCTION

Obesity is one of the most important public health problems in the world. Among obese people, there are those who, apart from excessive body weight, do not exhibit other metabolic dysfunctions, have a lower risk of developing cardiovascular diseases (CVDs), and show lower mortality. According to the theory, they are referred as metabolically healthy obese (MHO), in contrast to metabolically unhealthy obese (MUO). Metabolic disturbances occurring with obesity have been well established to be associated with oxidative stress.

AIM

The purpose of this study was to analyse the association between selected anthropometric and biochemical parameters with oxidative stress in MHO, MUO, and normal weight young adults. Material and Methods. Individuals with age between 18 and 36 years with no history of chronic diseases and use of medicaments, with or without obesity, participated in the study. Complete blood counts, biochemical measurements, and parameters of oxidative stress such as total antioxidant capacity (TAC), total oxidative status (TOS), oxidative stress index (OSI), serum concentration of malondialdehyde (MDA), ceruloplasmin, thiol groups and lipid hydroperoxides (LPH), concentration of lipofuscin (LPS) in erythrocytes, and the activity of superoxide dismutase (SOD) were measured.

RESULTS

422 patients who met the inclusion criteria were enrolled in the study. Among the study participants, 208 people (49.29%) were offspring of patients with angiographically confirmed coronary artery disease. Among the participants, 16 patients have been included in the group of metabolically healthy obese (MHO) people and 61 patients in the group of metabolically unhealthy obese (MUO) people and 345 patients had normal body weight. Significant differences between metabolically unhealthy obese and normal weight patients, as well as between women and men, have been found.

CONCLUSIONS

We showed significant differences in the selected parameters of oxidative stress between metabolically unhealthy obese (MUO) individuals and young volunteers with normal body weight as well as without significant medical history.

What Can We Change in Diet and Behaviour in Order to Decrease Carotid Intima-Media Thickness in Patients with Obesity?

Atherosclerosis-considered the major cause of cardiovascular diseases (CVDs)-is strongly associated with obesity, to which it strongly contributes. Moreover, atherosclerosis is characterised by a long asymptomatic phase, and its progression can lead to serious cardiovascular (CV) events. The carotid intima-media thickness (cIMT) has been determined as a predictor of CV events, as well as a marker of subclinical atherosclerosis, and has been used in clinical trials as an alternative assessment method or a surrogate endpoint. It should be noted that several behavioural approaches can directly influence the cIMT values, and decrease or increase the CV risk. In our paper, we aimed to summarize the current knowledge regarding IMT measurement among patients with obesity as a risk group-also in terms of the obesity paradox where the diagnosis of subclinical atherosclerosis is especially essential and implements the early therapeutic approach. We also summarized behavioural, modifiable factors, such as the Mediterranean diet, the Dietary Approach to Stop Hypertension Diets, body weight reduction or the intake of micro- and macronutrients, with a particular focus on the studies where the cIMT values were one of the outcomes. In order to collect the literature data related to the presented topic, the PubMed database was explored.

Metabolic disease and adverse events from immune checkpoint inhibitors

OBJECTIVE

Obese and overweight body mass index (BMI) categories have been associated with increased immune-related adverse events (irAEs) in patients with cancer receiving immune checkpoint inhibitors (ICIs); however, the impact of being overweight in conjunction with related metabolic syndrome-associated factors on irAEs have not been investigated. We aimed to evaluate the impact of overweight and obese BMI according to metabolic disease burden on the development of irAEs.

DESIGN AND METHODS

We conducted a retrospective observational study of patients receiving ICIs at a cancer center. Our main study outcome was development of ≥grade 2 (moderate) irAEs. Our main predictor was weight/metabolic disease risk category: (1) normal weight (BMI 18.5-24.9 kg/m²)/low metabolic risk (<2 metabolic diseases [diabetes, dyslipidemia, hypertension]), (2) normal weight/high metabolic risk (≥2 metabolic diseases), (3) overweight (BMI ≥25 kg/m²)/low metabolic risk, and (4) overweight/high metabolic risk.

RESULTS

Of 411 patients in our cohort, 374 were eligible for analysis. Overall, 111 (30%) patients developed ≥grade 2 irAEs. In Cox analysis, overweight/low metabolic risk was significantly associated with ≥grade 2 irAEs (hazard ratio [HR]: 2.0, 95% confidence interval [95% CI]: 1.2-3.4) when compared to normal weight/low metabolic risk, while overweight/high metabolic risk (HR: 1.3, 95% CI: 0.7-2.2) and normal weight/high metabolic risk (HR: 1.5, 95% CI: 0.7-3.0) were not.

CONCLUSIONS

Overweight patients with fewer metabolic comorbidities were at increased risk for irAEs. This study provides an important insight that BMI should be evaluated in the context of associated metabolic comorbidities in assessing risk of irAE development and ICI immune response.

Metabolically healthy obesity and physical fitness in military males in the CHIEF study

The metabolically healthy obese (MHO) characterized by the absence of metabolic syndrome have shown superior cardiorespiratory fitness (CRF) and similar muscular strength as compared with the metabolically unhealthy obese (MUO). However, this finding might be biased by the baseline sedentary behavior in the general population. This study utilized 3669 physically active military males aged 18-50 years in Taiwan. Obesity and metabolically unhealthy were respectively defined as body mass index ≥ 27.5 kg/m² and presence of at least two major components of the metabolic syndrome, according to the International Diabetes Federation criteria for Asian male adults. Four groups were accordingly classified as the metabolically healthy lean (MHL, n = 2510), metabolically unhealthy lean (MUL, n = 331), MHO (n = 181) and MUO (n = 647). CRF was evaluated by time for a 3-km run, and muscular strengths were separately assessed by numbers of push-up and sit-up within 2 min. Analysis of covariance was utilized to compare the difference in each exercise performance between groups adjusting for age, service specialty, smoking, alcohol intake and physical activity. The metabolic syndrome prevalence in MUL and MUO was 49.8% and 47.6%, respectively. The performance of CRF did not differ between MHO and MUO (892.3 ± 5.4 s and 892.6 ± 3.0 s, p = 0.97) which were both inferior to MUL and MHL (875.2 ± 4.0 s and 848.6 ± 1.3 s, all p values < 0.05). The performance of muscular strengths evaluated by 2-min push-ups did not differ between MUL and MUO (45.3 ± 0.6 and 45.2 ± 0.4, p = 0.78) which were both less than MHO and MHL (48.4 ± 0.8 and 50.6 ± 0.2, all p values < 0.05). However, the performance of 2-min sit-ups were only superior in MHL (48.1 ± 0.1) as compared with MUL, MHO and MUO (45.9 ± 0.4, 46.7 ± 0.5 and 46.1 ± 0.3, respectively, all p values < 0.05). Our findings suggested that in a physically active male cohort, the MHO might have greater muscle strengths, but have similar CRF level compared with the MUO.

Deciphering Biochemical and Molecular Signatures Associated with Obesity in Context of Metabolic Health

This study aims to identify the clinical and genetic markers related to the two uncommon nutritional statuses—metabolically unhealthy normal-weight (MUNW) and metabolically healthy overweight/obese (MHOW) individuals in the physically active individuals. Physically active male volunteers (n = 120) were recruited, and plasma samples were analyzed for the clinical parameters. Triglycerides, HDL-Cholesterol, LDL-cholesterol, total cholesterol, C-reactive protein, and insulin resistance were considered as markers of metabolic syndrome. The subjects were classified as ‘healthy’ (0 metabolic abnormalities) or ‘unhealthy’ (≥1 metabolic abnormalities) in their respective BMI group with a cut-off at 24.9 kg/m². Analysis of biochemical variables was done using enzyme linked immunosorbent assay (ELISA) kits with further confirmation using western blot analysis. The microarray was conducted, followed by quantitative real-time PCR to identify and analyze differentially expressed genes (DEGs). The MHOW group constituted 12.6%, while the MUNW group constituted 32.4% of the total study population. Pro-inflammatory markers like interleukin-6, tumor necrosis factor (TNF)-α, and ferritin were increased in metabolically unhealthy groups in comparison to metabolically healthy groups. Gene expression profiling of MUNW and MHOW individuals resulted in differential expression of 7470 and 5864 genes, respectively. The gene ontology (GO) biological pathway analysis showed significant enrichment of the ‘JAK/STAT signaling pathway’ in MUNW and ‘The information-processing pathway at the IFN-β enhancer′ pathway in MHOW. The G6PC3 gene has genetically emerged as a new distinct gene showing its involvement in insulin resistance. Biochemical, as well as genetic analysis, revealed that MUNW and MHOW are the transition state between healthy and obese individuals with simply having fewer metabolic abnormalities. Moreover, it is possible that the state of obesity is a biological adaptation to cope up with the unhealthy parameters.

Influence of Habitual Dairy Food Intake on LDL Cholesterol in a Population-Based Cohort

Background: Cholesterol has a pivotal role in human physiology, exerting both structural and functional activity. However, higher blood cholesterol levels, especially low-density lipoprotein cholesterol (LDL-C), are a major cardiovascular risk factor. Therefore, special attention has been given to the effect of dietary factors in influencing LDL-C blood levels. In particular, much research has focused on dairy products, since they are a main component of different dietary patterns worldwide. A large body of evidence did not support the hypothesis that dairy products significantly increase circulating LDL-C, but no definitive data are available. Hence, we aimed to assess the relationships among LDL-C, habitual dairy food intake and anthropometric variables in a cohort representative of the general population in a Mediterranean area. Methods: We evaluated 802 healthy adults included in the ABCD_2 (Alimentazione, Benessere Cardiovascolare e Diabete) study (ISRCTN15840340), a longitudinal observational single-center study of a cohort representative of the general population of Palermo, Sicily. The habitual intake of dairy products was assessed with a validated food frequency questionnaire, and LDL-C serum levels and several anthropometric parameters were measured. Results: The group with high LDL-C serum concentrations (≥130 vs. <130 mg/dL) exhibited higher age, body mass index (BMI), waist-to-hip ratio (WHR), body fat percentage, systolic and diastolic blood pressure, carotid intima-media thickness and glycated hemoglobin. The habitual diet was not different between the groups in terms of macronutrient, cholesterol, egg and dairy food intake, with the exception of the weekly number of portions of milk (higher in the low LDL-C group vs. the high LDL-C group) and ricotta cheese (higher in the high LDL-C group vs. the LDL-C group). No significant correlation was found between LDL-C blood levels and the habitual intake of dairy products or the dietary intake of cholesterol and fats. The multivariate regression analyses (R² = 0.94) showed that LDL-C blood levels were significantly associated with the habitual intake of milk (p < 0.005) and ricotta cheese (p < 0.001) and with BMI (p < 0.001). Conclusion: Our study reported that total dairy food consumption was not correlated with LDL-C blood levels. However, multivariate analyses showed an inverse association between serum LDL-C and milk intake as well as a positive association between ricotta cheese intake and LDL-C concentrations. More studies are needed to better characterize the relationship between dairy products and circulating LDL-C.

Older age does not influence the success of weight loss through the implementation of lifestyle modification

OBJECTIVE

Age is sometimes a barrier for acceptance of patients into a hospital-based obesity service. Our aim was to explore the effect of age on the ability to lose weight through lifestyle interventions, implemented within a hospital-based obesity service.

DESIGN

Retrospective study.

PATIENTS

We included a cohort of randomly selected patients with morbid obesity (n = 242), who attended our hospital-based obesity service during 2005-2016 and received only lifestyle weight loss interventions.

MEASUREMENTS

Primary outcome measures were percentage weight loss (%WL) and percentage reduction in body mass index (%rBMI) following implemented lifestyle interventions. Data were stratified according to patient age at referral: group 1 (age < 60 years, n = 167) and group 2 (age ≥ 60 years, n = 75). Weight loss was compared between groups, and correlations with age at referral were explored.

RESULTS

The duration of hospital-based weight loss interventions ranged between 1 and 143 months (mean: 38.9 months; SD: 32.3). Baseline BMI at referral differed significantly between groups 1 and 2 (49.7 kgm^-2 [SD: 8.7] vs 46.9 kgm^-2 [SD: 6.1], respectively; P < .05). Following implemented lifestyle interventions, between groups 1 and 2 there were no differences in %WL (6.9% [SD: 16.7] vs 7.3% [SD: 11.60], respectively; P = NS) or %rBMI (8.1% [SD: 14.9] vs 7.8% [SD: 11.7], respectively; p = NS). Overall, there was no significant correlation between patient age at referral and %WL (r = -.13, p = NS).

CONCLUSIONS

Older age does not influence the success of weight loss through the implementation of lifestyle modification within a hospital-based obesity service. Therefore, age per se should not influence clinical decisions regarding acceptance of patients to hospital-based obesity services.

The association between parity and metabolic syndrome and its components in normal-weight postmenopausal women in China

BACKGROUND

Studies analyzing the association between parity and normal-weight metabolic syndrome (MetS) in postmenopausal women of normal weight remain limited, this study aimed to explore the association between parity and MetS among Chinese normal-weight postmenopausal women.

METHODS

In total, 776 normal-weight undiagnosed type 2 diabetes postmenopausal women who visited the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University for a routine health check-up between 1 January 2017 and 31 December 2019 were included in the cross-sectional study. All individuals had fully completed information records encompassing standardized electronic medical records, physical examinations, and biochemical measurements. Metabolic health was defined as fewer than 2 parameters of the MetS were present, in combination with normal weight. Continuous variables which were normally distributed were expressed as means and standard deviation. Comparisons among normally distributed continuous variables were made using one-way ANOVA while that among non-normal distribution parameters were made using Kruskal-Wallis. The association between parity and MetS was analyzed using multivariate logistic regression. All of the analyses were performed with SPSS statistical software (Version 23.0, SPSS, Inc., Chicago, IL, USA) and the statistical software package EmpowerStats ( http://www.empowerstats.com , X&Y Solutions, Inc., Boston, MA).

RESULTS

After adjusting for potential confounding factors including hip circumference, parity was failed to show a significantly relationship with MetS in normal-weight women(P=0.054). Women with a higher parity (≥3) had an increased OR of abdominal obesity, while the OR (95% CI) of the parity 3 group was 2.06 (1.13, 3.77) and that of the parity ≥4 group was 3.08(1.42, 6.66) the P for trend was 0.002 after adjusting for potential confounding factors. No significant differences were detected for other metabolic disorders including high levels of triglycerides (TG), blood pressure, fasting plasma glucose (FPG), and decreased high-density lipoprotein cholesterol (HDL-C) in different parity groups.

CONCLUSIONS

Higher parity was not associated with a higher risk of MetS in normal weight Chinese postmenopausal women. As for the components of MetS, only waist circumference was associated with multiparity even after controlling for hip circumference.

Prevalence and epidemiological determinants of metabolically obese but normal-weight in Chinese population

BACKGROUND

There is metabolic heterogeneity in normal-weight individuals, however, there has been limited research in the Chinese population. This study aimed to investigate the prevalence, distribution and epidemiological determinants of metabolically obese but normal-weight (MONW) in a Chinese population.

METHODS

A total of 17,876 normal-weight individuals were recruited from 37,815 individuals in Zhejiang province in southeastern China. Normal-weight was defined as a body mass index (BMI) of 18.5-23.9 kg/m2. Metabolically abnormal traits were assessed by metabolic syndrome criteria from the International Diabetes Federation (IDF) in 2015. MONW was defined as individuals who had at least two metabolically abnormal trait but normal weight. Multiple logistic regression was used to investigate MONW risk factors, adjusting for potential confounders.

RESULTS

The prevalence of metabolic abnormality was 34.1% in normal-weight individuals, and the overall prevalence of MONW was 16.1% in the general population. Different MONW distributions were found between men and women depending on age. Compared with women, men had a significantly higher MONW prevalence among those aged < 45 years old, and there was a lower prevalence for those aged ≥50 years old. Higher BMI or waist circumference (WC), central obesity, menopause, and family histories of hypertension, diabetes, and cardiovascular diseases, increased MONW risk. Higher education levels, regular alcohol drinking, and balanced or vegetarian food preferences reduced MONW risk.

CONCLUSIONS

Normal-weight individuals have metabolic heterogeneity in China. The MONW distribution between men and women depends on age. BMI, WC, dietary factors, and family history of chronic diseases, are associated with metabolic status.

Metabolically healthy obese and metabolic syndrome of the lean: the importance of diet quality. Analysis of MAGNETIC cohort

BACKGROUND

Obesity is considered as an indispensable component of metabolic health assessment and metabolic syndrome diagnosis. The associations between diet quality and metabolic health in lean, young adults have not been yet established whilst data addressing this issue in overweight and obese subjects is scarce. Our analysis aimed to establish the link between diet quality (measured with data-driven dietary patterns and diet quality scores) and metabolic syndrome (MS) in young adults, regardless of their adiposity status.

METHODS

A total of 797 participants aged 18-35 years old were included in the study. Participants were assigned into metabolic syndrome (MS) group if at least two abnormalities within the following parameters were present: blood pressure, triglycerides, total cholesterol, HDL cholesterol, blood glucose. Participants with one or none abnormalities were considered as metabolically healthy subjects (MH), Diet quality was assessed with two approaches: 1) a posteriori by drawing dietary patterns (DPs) with principal component analysis (PCA) and 2) a priori by establishing diet quality scores and the adherence to pro-Healthy-Diet-Index (pHDI) and non-Healthy-Diet-Index (nHDI). Logistic regression with backward selection based on Akaike information criterion was carried out, to identify factors independently associated with metabolic health.

RESULTS

Within the MS group, 31% were of normal weight. Three PCA-driven DPs were identified, in total explaining 30.0% of the variance: "Western" (11.8%), "Prudent" (11.2%) and "Dairy, breakfast cereals & treats" (7.0%). In the multivariate models which included PCA-driven DPs, higher adherence to middle and upper tertiles of "Western" DP (Odds Ratios [OR] and 95% Confidence Intervals [95% CI]: 1.72, 1.07-2.79 and 1.74, 1.07-2.84, respectively), was associated with MS independently of clinical characteristics including BMI and waist-hip ratio (WHR). Similar results were obtained in the multivariate model with diet quality scores - MS was independently associated with higher scores within nHDI (2.2, 0.92-5.28).

CONCLUSIONS

Individuals with MS were more likely to adhere to the western dietary pattern and have a poor diet quality in comparison to metabolically healthy peers, independently of BMI and WHR. It may imply that diet composition, as independent factor, plays a pivotal role in increasing metabolic risk. Professional dietary advice should be offered to all metabolically unhealthy patients, regardless of their body mass status.

Calcium and Phosphate Levels are Among Other Factors Associated with Metabolic Syndrome in Patients with Normal Weight

BACKGROUND AND PURPOSE

We aimed to assess the association between calcium and phosphorous and metabolic syndrome (MetS) in normal-weight individuals.

PATIENTS AND METHODS

The study sample comprised 460 normal-weight (body mass index <25kg/m²) adults aged 18-35 years. The diagnosis of MetS was based on the presence of at least two of the following: 1) systolic blood pressure (SBP) ≥130 mmHg or diastolic blood pressure (DBP) ≥85 mmHg, 2) triglycerides (TG) >150 mg/dl, 3) high-density lipoprotein cholesterol (HDL-C) <1 mmol/in men and <1.2 mmol/l in women, 4) total cholesterol (TC) >5.2 mmol/l, and 5) fasting glucose (FBG) >5.55 mmol/l.

RESULTS

Patients with MetS were more often male and slightly older and they had a higher body mass index (BMI) and waist circumference. By definition, patients with MetS had higher levels of BP, GLC, glycated hemoglobin A1c, TC, low-density lipoprotein cholesterol (LDL-C), TG, and apolipoprotein B but significantly lower concentrations of HDL-C and apolipoprotein A. Moreover, subjects with MetS had higher activity of the liver enzymes alanine aminotransferase, alkaline phosphatase and gamma-glutamyl transpeptidase (GGTP). Higher concentrations of uric acid, creatinine and albumin (ALB) were also observed in subjects with MetS. The factors associated with MetS in the multivariate analysis were higher GGTP activity (OR per 5 unit increase - 1.23 (1.11-1.37); p<0.0001), a higher BMI (OR - 1.28 (1.1-1.52); p=0.003), a higher concentration of calcium (OR per 0.1 mmol/l increase - 1.79 (1.21-2.7); p=0.004), higher ALB levels (OR per 5 g/l increase - 1.76 (1.11-2.95), p=0.02); higher phosphorous levels (OR per 0.1 mmol/l increase - 0.82 (0.67-0.99); p=0.04), and a good household situation (odds ratio (OR) - 0.58 95% confidence interval (CI) (0.31-1.07); p=0.08).

CONCLUSION

Calcium and phosphorus levels are significantly associated with MetS in normal-weight individuals.

Personal, behavioral, and environmental predictors of healthy weight maintenance during the transition to adulthood

There is a high prevalence of overweight among U.S. young adults and the intergenerational implications of excess weight gain at this life stage are great. We used Project EAT (Eating and Activity in Teens and Young Adults) study data to identify personal, behavioral, and environmental factors that predicted healthy weight maintenance during the transition from adolescence to adulthood and as individuals progressed from the third to fourth decade of life. The sample included 1120 young adults who were secondary school students in Minneapolis-St. Paul at Time 1 (1998-1999) and responded at follow-ups in 2008-2009 and 2015-2016. Results showed individual factors and multiple environmental factors contribute to maintenance. The most consistent findings suggest that having higher body satisfaction and avoiding unhealthy weight control behaviors (e.g., skipping meals) and dieting are protective against excess weight gain for women and men. For example, the odds ratio associated with a one standard deviation increase in the probability of using an extreme weight control behavior from adolescence and adulthood was 0.67 (CI: 0.54, 0.84) among women and 0.34 (CI: 0.12, 0.96) among men indicating decreased odds of maintaining a healthy weight. Social support for healthy eating and physical activity were protective whereas close relationships with individuals who were dieting (e.g., parents, significant others) reduced the likelihood of maintaining a healthy weight. Primary prevention strategies should continue beyond adolescence and involve peer social support to encourage young people at a healthy weight to be satisfied with their shape/size and avoid restrictive weight control behaviors.

Cultural primer for cardiometabolic health: health disparities, structural factors, community, pathways to improvement, and clinical applications

The quest to optimize cardiometabolic health has created great interest in nonmedical health variables in the population, community-based research and coordination, and addressing social, ethnic, and cultural barriers. All of these may be of equal or even greater importance than classical health care delivery in achieving individual well-being. One dominant issue is health disparity - causes, methods of reduction, and community versus other levels of solutions. This communication summarizes some major views regarding social structures, followed by amplification and synthesis of central ideas in the literature. The role of community involvement, tools, and partnerships is also presented in this Primer. Recent views of how these approaches could be incorporated into cardiometabolic initiatives and strategies follow, with implications for research. Two examples comparing selected aspects of community leverage and interventions in relation to individual approaches to health care equity are examined in depth: overall performance in reducing cardiovascular risk and mortality, and the recent National Diabetes Prevention Program, both touching upon healthy diets and adherence. Finally, the potential that precision medicine offers, and possible effects on disparities are also discussed.