Metabolically healthy obesity and unhealthy normal weight rural adults in Xinjiang: prevalence and the associated factors

Association between major dietary patterns and obesity phenotypes in southwest China: baseline survey results from Hechuan

Background

This study aimed to identify the main dietary patterns in Hechuan and clarify how they are associated with obesity phenotypes.

Methods

A cross-sectional study was conducted based on a baseline survey of a general population cohort study in southwest China. A semi-quantitative food frequency questionnaire (FFQ) was used to investigate the dietary habits of the participants in the past year. Principal component analysis was conducted to identify the main dietary patterns, and multinomial logistic regression analysis was conducted to describe the association between the major dietary patterns and obesity phenotypes.

Results

Three major dietary patterns were identified. The participants who followed the wheaten food dietary pattern had a higher likelihood of having metabolically normal obesity (MHO) (odds ratio (OR) 1.05, 95% confidence interval (CI) 1.02-1.08), metabolically abnormal normal weight (MUNW) (OR 1.08, 95%CI 1.00-1.16), and metabolically abnormal obesity (MUO) (OR 1.07, 95%CI 1.04-1.11). Specifically, those with the highest wheaten food dietary pattern were 1.60 times more likely to have MHO (OR 1.60, 95%CI 1.25-2.05), 2.62 times more likely to have MUNW (OR 2.62, 95%CI 1.28-5.37), and 2.01 times more likely to have MUO (OR 2.01, 95%CI 1.51-2.69) than those with the lowest wheaten food dietary pattern.

Conclusion

The wheaten food dietary pattern may increase the risk of obesity and metabolic abnormalities. Therefore, timely interventions should be carried out for this group of people.

Longitudinal study on metabolic abnormalities and diabetes risk in normal-weight japanese adults

Background

Diabetes is a significant global health concern, with a growing prevalence in Japan. Individuals with normal body mass index who are metabolically unhealthy exhibit an elevated risk of diabetes onset. Investigating the relationship between Metabolically Unhealthy Normal-weight (MUNW) status and the risk of diabetes in non-diabetic individual is vital for implementing early preventive strategies.

Methods

Using data from the NAGALA cohort, This study categorized 8,194 Japanese adults based on the score of metabolic syndrome (MetS) components they possessed. Cox proportional hazards regression models and multivariate logistic regression were used to assess the relationship between MUNW and the risk of developing diabetes, with analyses stratified by age and sex.

Results

During an average follow-up of 7.19 years, 123 participants (1.5%) were diagnosed with diabetes. Among the participants, 766 (9.35%) were classified as MUNW, and 157 (1.92%) as having MetS. Compared to those with no MetS components, individuals with 1, 2, and ≥3 MetS components had progressively higher adjusted hazard ratios (HRs) for developing diabetes, at 4.56, 8.79, and 25.16, respectively. Further stratified analysis revealed that men aged ≤40 years had the highest risk of developing diabetes. For men, the adjusted HRs for having 1, 2, and ≥3 MetS components were 5.61, 7.80, and 28.59, respectively, and for participants aged ≤40 years, the HRs were 12.31, 25.57, and 129.82, respectively.

Conclusion

The prevalence of MUNW in non-diabetic individuals in Japan is 9.35%. The score of MetS components was positively correlated with the risk of diabetes. Early intervention and lifestyle modifications are crucial, especially for MUNW individuals and notably young Japanese men aged ≤40 years, for the prevention and management of diabetes.

Exploring metabolically healthy obesity: prevalence, characteristics, and cardiovascular risk in the Iranian population based on the STEPS 2021

Background

Regarding the rapidly increasing prevalence of obesity throughout the globe, it remains a serious public health concern. A subgroup of obesity that does not meet metabolic syndrome criteria is called metabolically healthy obesity (MHO). However, whether the MHO phenotype increases cardiovascular disease (CVD) risk is controversial. This study aimed to evaluate the prevalence of MHO and its 10-year CVD risk in Iranian populations.

Methods

Based on the STEPS 2021 project in Iran, we collected data on 18119 Iranians 25 years and older from all 31 provinces after applying many statistical factors. Using the Framingham score, we evaluated the 10-year cardiovascular risk associated with the various MHO definition criteria for Iranian populations.

Results

The prevalence of MHO was 6.42% (5.93-6.91) at the national level according to the AHA-NHLBI definition, and 23.29% of obese women and 24.55% of obese men were classified as MHOs. Moreover, the MHO group was younger than the metabolically unhealthy obesity (MUO) group based on all definitions (p < 0.001). The odds ratio of MUO individuals being classified as high-risk individuals by the Framingham criteria for CVD was significantly higher than that of MHO individuals by all definitions, with a crude odds ratio of 3.55:1 based on AHA-NHLBI definition.

Conclusion

This study reveals a significant prevalence of MHO in the Iranian population, with approximately 25% of obese individuals classified as MHO. While MHO is associated with a lower risk of cardiovascular disease compared to MUO, MHO carries the potential for transitioning to an unhealthy state.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01364-5.

Joint association of physical activity and diet quality with dyslipidemia: a cross-sectional study in Western China

OBJECTIVE

This study aims to investigate the prevalence of dyslipidemia and assess the joint association of physical activity (PA) and diet quality on dyslipidemia risk in urban areas of Xinjiang.

METHODS

Conducted from July 2019 to September 2021 in Xinjiang, China, this cross-sectional study involved 11,855 participants (mean age 47.1 ± 9.4 years, 53.1% male). Standard methods were used to measure plasma cholesterol levels, and validated questionnaires were employed to evaluate dietary habits and PA. The definition of dyslipidemia is based on 2023 Chinese guidelines for lipid management. PA was divided into guideline-recommended moderate-to-vigorous physical activity (MVPA) and non-MVPA, following World Health Organization guidelines. The Food Frequency Questionnaire was used to obtain the intake frequency of each dietary term. Each item was scored based on consumption frequency and divided into three groups (good, intermediate, and poor) based on total dietary score. Multivariate logistic regression analysis was performed to identify dyslipidemia risk factors, as well as the joint association of PA and diet quality.

RESULTS

Dyslipidemia prevalence among urban adults in Xinjiang was 39.3%, with notable sex disparities (52.6% in males vs. 24.3% in females, P < 0.001). Among participants with dyslipidemia, the awareness, treatment and control rates were 6.9%, 3.1%, and 1.9%, respectively. A significant multiplicative interaction between PA and diet quality is associated with dyslipidemia (P for interaction < 0.05). Less PA and poor diet quality were associated with an increased odds of dyslipidemia. Even individuals with poor (OR = 1.464, 95% CI: 1.106-1.939) or intermediate (OR = 1.229, 95% CI: 1.003-1.505) diet quality but adhering to recommended MVPA had lower odds of dyslipidemia compared to those with good diet quality but inadequate MVPA (OR = 1.510, 95% CI: 1.252-1.821).

CONCLUSIONS

Dyslipidemia prevalence was 39.3% in urban adults in Xinjiang, with limited awareness, treatment, and control. Following guideline-recommended MVPA and maintaining good diet quality were protective against dyslipidemia. Low levels of PA associated with a higher prevalence of dyslipidemia, even in individuals with good diet quality.

Validation of non-invasive indicators in the screening of metabolic dysfunction-associated fatty liver disease: a cross-sectional study among Uighurs in rural Xinjiang

BACKGROUND

Metabolic dysfunction-associated fatty liver disease (MAFLD) is the most common chronic liver disease in China. Our study aimed to evaluate the screening value of the fatty liver index (FLI), hepatic steatosis index (HSI), lipid accumulation product (LAP), visceral adiposity index (VAI), and Zhejiang University index (ZJU), as well as other single indicators for MAFLD. We aimed to find the optimal screening tool and its appropriate cut-off values for rural Uyghur adults.

METHODS

We completed a survey of 14,321 Uyghur adults in 51 groups in Kashgar, Xinjiang, in 2016 using a typical sampling method, with 12,794 patients ultimately included in statistical analyses. Fatty liver was diagnosed using ultrasonography.

RESULTS

The prevalence of fatty liver disease (FLD) and MAFLD was 16.73% and 16.55%, respectively, and the FLI, HSI, LAP, VAI, and ZJU were all independently associated with an increased risk of MAFLD. The areas under the receiver operating characteristic curves (AUCs) of the FLI for diagnosing MAFLD in men and women were 0.853 and 0.847, respectively. The AUCs of the body mass index (BMI) for diagnosing MAFLD in men and women were 0.850 and 0.852, respectively. Compared with other metabolic-related markers, FLI had the largest AUC. In men, the optimal cut-off values of FLI and BMI for diagnosing MAFLD were 45 (sensitivity 84.83%, specificity 69.57%) and 27.4 (sensitivity 78.47%, specificity 76.30%), respectively. In women, the optimal cut-off values of FLI and BMI for diagnosing MAFLD were 45 (sensitivity 80.11%, specificity 74.23%) and 28.0 (sensitivity 79.56%, specificity 75.41%), respectively. In men and women, an FLI score of < 30 ruled out MAFLD, while a score of ≥ 50 was a basis for diagnosis.

CONCLUSION

FLI and BMI had good screening ability for MAFLD and were superior to HSI, LAP, VAI, and ZJU in both sexes.

Prevalence of combined metabolic health and weight status by various diagnosis criteria and association with cardiometabolic disease in Korean adults

The purpose of this study was to compare the cardiometabolic disease prevalence and risk factors between individuals categorized as metabolically unhealthy and healthy (MU vs. MH), with normal-weight and obesity (Nw vs. Ob), according to different established criteria for combined metabolic health and weight status; and to assess the optimal metabolic health diagnostic classifications to predict cardiometabolic disease risk factors. Data were obtained from the 2019 and 2020 Korean National Health and Nutrition Examination Surveys. We applied the nine accepted metabolic health diagnostic classification criteria. Statistical analysis was applied to frequency, multiple logistic regression, and ROC curve analysis. The prevalence of MHNw ranged from 24.6% to 53.9%, MUNw from 3.7% to 37.9%, MHOb from 3.4% to 25.9%, and MUOb from 16.3% to 39.1%. For hypertension, the MUNw had an increased risk ranging from 1.90 to 3.24 times compared with MHNw; MHOb ranged from 1.84 to 3.76 times; MUOb ranged from 4.18 to 6.97 times (all p < .05). For dyslipidemia, the MUNw had an increased risk ranging from 1.33 to 2.25 times compared with MHNw; MHOb ranged from 1.47 to 2.33 times; MUOb ranged from 2.31 to 2.67 times (all p < .05). For diabetes, the MUNw had an increased risk ranging from 2.27 to 11.93 times compared with MHNW; MHOb ranged from 1.36 to 1.95 times; MUOb ranged from 3.60 to 18.45 times (all p < .05). Our study findings revealed that AHA/NHLBI-02 and NCEP-02 can be the best diagnostic classifications criteria for cardiometabolic diseases risk factors.

Association of major dietary patterns and different obesity phenotypes in Southwest China: the China Multi-Ethnic Cohort (CMEC) Study

PURPOSE

Dietary behavior is an important part of lifestyle interventions for obesity and its cardiovascular comorbidities. However, little is known about associations between dietary patterns and obesity phenotypes in Southwest China, a region with unique dietary patterns and significant heterogeneity in obesity.

METHODS

Data from the baseline survey of the China Multi-Ethnic Cohort in Southwest China were analyzed (n = 64,448). Dietary intakes during the past year were measured with the semi-quantitative Food Frequency Questionnaire (s-FFQ). Principal component factor analysis (PCFA) was used to identify dietary patterns. Multinomial logistic regressions were used to examine the associations between dietary patterns and obesity phenotypes and stratified analyses were performed to assess whether the associations differed across demographic variables.

RESULTS

Three dietary patterns were identified and then named according to their apparent regional gathering characteristics: the Sichuan Basin dietary pattern (characterized by high intakes of various foods), the Yunnan-Guizhou Plateau dietary pattern (characterized by agricultural lifestyles), and the Qinghai-Tibet Plateau dietary pattern (characterized by animal husbandry lifestyles), respectively. Higher adherence to the Sichuan Basin dietary pattern was positively associated with metabolically healthy overweight/obesity (MHO, OR 1.13, 95% CI 1.05-1.21) but negatively associated with metabolically unhealthy normal weight (MUNW, OR 0.78, 95% CI 0.65-0.95). Higher adherence to the other two dietary patterns was positively associated with MHO and metabolically unhealthy overweight/obesity (MUO). Besides, differences in socioeconomic status also affected the relationship between dietary patterns and obesity phenotypes.

CONCLUSIONS

Adherence to the more diverse Sichuan basin dietary pattern performed a mixed picture, while the other two may increase the risk of obesity phenotypes, which indicates nutritional interventions are urgently needed.

Metabolic Dysfunction-Associated Fatty Liver Disease Is Associated with the Risk of Incident Cardiovascular Disease: A Prospective Cohort Study in Xinjiang

In 2020, a group of international experts proposed a new term ‘metabolic dysfunction-associated fatty liver disease’ (MAFLD) to replace ‘non-alcoholic fatty liver disease’. This study aimed to describe the epidemic characteristics of MAFLD, incidence of cardiovascular disease (CVD), and relationship between MAFLD and incident CVD. In 2016, 12,794 Uyghur adults from Kashgar, Xinjiang, were grouped according to the presence or absence of MAFLD. The primary outcome was the occurrence of CVD events. Fatty liver was diagnosed using ultrasound. The prevalence of MAFLD was 16.55%. After excluding patients with previous CVD, 11,444 participants were followed up for a median period of 4.7 years. During the follow-up period, the overall CVD incidence was 10.40% (1190/11,444). The incidence of CVD in the patients with MAFLD was significantly higher than that in the non-MAFLD patients (18.38% vs. 9.02%, p < 0.001; multivariable-adjusted hazard ratio = 1.37, 95% CI = 1.20−1.56). The prevalence of MAFLD was relatively low, whereas the incidence of CVD was relatively high among the Uyghur adults in rural Xinjiang. Individuals with MAFLD have a higher risk of developing CVD independent of traditional cardiovascular risk factors, obesity, type 2 diabetes mellitus (T2DM), and dyslipidaemia.