Effects of two-months balanced diet in metabolically healthy obesity: lipid correlations with gender and BMI-related differences

Insulin Resistance: A Marker for Fat-to-Lean Body Composition in Japanese Adults

We sought to investigate the relationship between insulin resistance (IR) and body composition as assessed by bioelectrical impedance analysis in Japanese health check-up recipients (1186 men and 1441 women). IR was defined as a Homeostasis Model Assessment of IR (HOMA-IR) ≥ 2.5. In body-composition-related parameters, the fat mass index (F index) was defined as fat mass divided by the height squared (kg/m2). The fat-free mass index (FF index) was defined as fat-free mass divided by the height squared (kg/m2). The F index to FF index ratio (F-FF ratio) was defined as the F index divided by the FF index. Factors related to HOMA-IR were examined. The median HOMA-IR was 1.54 in men and 1.30 in women (p < 0.0001). The median F index was 4.9 kg/m2 in men and 6.1 kg/m2 in women (p < 0.0001). The median FF index was 18.2 kg/m2 in men and 15.1 kg/m2 in women (p < 0.0001). The median F-FF ratio was 0.272 in men and 0.405 in women (p < 0.0001). The F-FF ratio was an independent factor associated with HOMA-IR in the multivariate analysis in both genders, while the F index and FF index were not in both genders. In conclusion, fat and skeletal muscle balance can be controlled by IR in Japanese adults.

Associations of fatty acids composition and estimated desaturase activities in erythrocyte phospholipids with biochemical and clinical indicators of cardiometabolic risk in non-diabetic Serbian women: the role of level of adiposity

Introduction

Fatty acids (FAs) composition and desaturase activities can be altered in different metabolic conditions, but the adiposity-independent associations with clinical and biochemical indicators of cardiometabolic risk are still unclear. This study aimed to analyze the associations of FAs composition and estimated desaturase activities with anthropometric, clinical, and biochemical cardiometabolic risk indicators in non-diabetic Serbian women, and to investigate if these associations were independent of the level of adiposity and other confounders.

Methods

In 76 non-diabetic, otherwise healthy Serbian women, aged 24-68 years, with or without metabolic syndrome or obesity (BMI=23.6±5.6 kg/m2), FA composition in erythrocyte phospholipids was measured by gas-liquid chromatography. Desaturase activities were estimated from product/precursor FAs ratios (D9D:16:1n-7/16:0; D6D:20:3n-6/18:2n-6; D5D:20:4n-6/20:3n-6). Correlations were made with anthropometric, biochemical (serum glucose, triacylglycerols, LDL-C, HDL-C, ALT, AST, and their ratios) and clinical (blood pressure) indicators of cardiometabolic risk. Linear regression models were performed to test the independence of these associations.

Results

Estimated desaturase activities and certain FAs were associated with anthropometric, clinical and biochemical indicators of cardiometabolic risk: D9D, D6D, 16:1n-7 and 20:3n-6 were directly associated, while D5D and 18:0 were inversely associated. However, the associations with clinical and biochemical indicators were not independent of the associations with the level of adiposity, since they were lost after controlling for anthropometric indices. After controlling for multiple confounders (age, postmenopausal status, education, smoking, physical activity, dietary macronutrient intakes, use of supplements, alcohol consumption), the level of adiposity was the most significant predictor of desaturase activities and aforementioned FAs levels, and mediated their association with biochemical/clinical indicators. Vice versa, desaturase activities predicted the level of adiposity, but not other components of cardiometabolic risk (if the level of adiposity was accounted). While the associations of anthropometric indices with 16:1n-7, 20:3n-6, 18:0 and D9D and D6D activities were linear, the associations with D5D activity were the inverse U-shaped. The only adiposity-independent association of FAs profiles with the indicators of cardiometabolic risk was a positive association of 20:5n-3 with ALT/AST ratio, which requires further exploration.

Discussion

Additional studies are needed to explore the mechanisms of the observed associations.

Maternal Exercise Impacts Offspring Metabolic Health in Adulthood: A Systematic Review and Meta-Analysis of Animal Studies

Maternal exercise benefits offspring's metabolic health with long-term repercussions. Here, we systematically reviewed the effects of maternal exercise on offspring obesity outcomes in adulthood. The primary outcome is body weight. The secondary outcomes are glucose and lipid profiles. Two independent authors performed a search in the databases PubMed, EMBASE, and Web of Science. A total of nine studies with 17 different cohorts consisting of 369 animals (two species) were included. Study quality was assessed using the SYRCLE risk of bias. The PRISMA statement was used to report this systematic review. The results showed that maternal exercise contributes to improved glucose tolerance, reduced insulin concentration, and lower total cholesterol and low density lipoprotein levels in adult offspring in mice, which are independent of maternal body weight and offspring dietary condition. Additionally, in rats, maternal exercise leads to a higher body weight in adult offspring, which might be attributed to the high-fat diet of offspring after weaning. These findings further support the metabolic beneficial role of maternal exercise on offspring in adulthood, although the issue of translating the results to the human population is still yet to be addressed.

Metabolically healthy obesity: Misleading phrase or healthy phenotype?

Obesity is a heterogenous condition with multiple different phenotypes. Among these a particular subtype exists named as metabolically healthy obesity (MHO). MHO has multiple definitions and its prevalence varies according to study. The potential mechanisms underlying the pathophysiology of MHO include the different types of adipose tissue and their distribution, the role of hormones, inflammation, diet, the intestinal microbiota and genetic factors. In contrast to the negative metabolic profile associated with metabolically unhealthy obesity (MUO), MHO has relatively favorable metabolic characteristics. Nevertheless, MHO is still associated with many important chronic diseases including cardiovascular disease, hypertension, type 2 diabetes, chronic kidney disease as well as certain types of cancer and has the risk of progression into the unhealthy phenotype. Therefore, it should not be considered as a benign condition. The major therapeutic alternatives include dietary modifications, exercise, bariatric surgery and certain medications including glucagon-like peptide-1 (GLP-1) analogs, sodium-glucose cotransporter-2 (SGLT-2) inhibitors and tirzepatide. In this review, we discuss the significance of MHO while comparing this phenotype with MUO.

The Association between Advanced Liver Fibrosis and Mortality Is Modified by Dietary Quality among Korean Adults: Results from the Korea National Health and Nutrition Examination Survey with Mortality Data

Advanced fibrosis in nonalcoholic fatty liver disease (NAFLD) is associated with an increased risk of mortality; however, an independent association of liver fibrosis with mortality is not well defined. We aimed to investigate the association between advanced liver fibrosis and all-cause and cardiovascular mortality and the mediation effect of diet quality. We analyzed 35,531 participants with suspected NAFLD, excluding competing etiologies of chronic liver disease, from the Korea National Health and Nutrition Examination Survey 2007-2015, and followed up until 31 December 2019. The severity of liver fibrosis was assessed using the NAFLD fibrosis score (NFS) and the fibrosis-4 index (FIB-4). The Cox proportional hazards model was used to examine the association of advanced liver fibrosis with mortality. During a mean 8.1 years of follow-up, 3426 deaths occurred. Advanced liver fibrosis determined by NFS and FIB-4 was associated with increased risks of all-cause and cardiovascular mortality after adjusting for confounders. When NFS and FIB-4 were combined, the high NFS + high FIB-4 group was significantly associated with higher risks of all-cause mortality (hazard ratio [HR] 1.85, 95% CI 1.42-2.43) and cardiovascular mortality (HR 2.04, 95% CI 1.23-3.39), respectively, compared with the low NFS + low FIB-4 group. However, these associations were attenuated in people with high diet quality. Advanced liver fibrosis is an independent risk factor for all-cause and cardiovascular mortality in people with NAFLD, and the association between advanced liver fibrosis and mortality is modified by a high-quality diet.

Vitamin D and ω-3 Polyunsaturated Fatty Acids towards a Personalized Nutrition of Youth Diabetes: A Narrative Lecture

After the discovery of insulin, nutrition has become central in the management of diabetes in order to limit glycemic rise after meals, optimize metabolic control, and prevent complications. Over the past one hundred years, international scientific societies have consecutively refined nutritional needs and optimized food intake for the treatment of diabetes. In particular, over the past century, nutrition applied with pumps for the administration of insulin and continuous glucose monitoring have allowed substantial advancement in the treatment of type 1 diabetes mellitus. The role of some substances, such as vitamin D and n-3 polyunsaturated fatty acids, have been proposed without univocal conclusions, individually or in combination, or in the diet, to improve the nutrition of type 1 and type 2 diabetes. This second condition, which is highly associated with overweight, should be prevented from childhood onwards. Personalized nutrition could bypass the problem, reaching a scientific conclusion on the individual subject. This article focuses on childhood and adolescent diabetes, aims to provide a narrative summary of nutrition over the past century, and promotes the concept of personalized nutrition to pediatricians and pediatric diabetologists as a possible tool for the treatment of type 1 diabetes and the prevention of type 2 diabetes.

The Diagnostic Value of Various Inflammatory Biomarkers for Diagnosing Periprosthetic Joint Infection is Gender-Specific

Objective

Previous studies have suggested that the diagnostic biomarkers of periprosthetic joint infection (PJI) are largely influenced by gender. In the present study, we aimed to evaluate the diagnostic value of traditional inflammatory biomarkers, fibrinolytic biomarkers (fibrinogen and D-dimer), and C-reactive protein (CRP)/albumin for PJI in different genders.

Methods

A single-center retrospective analysis was performed on revision total hip or knee arthroplasty between June 2013 to June 2021, and the study included 80 patients in the PJI group and 136 patients in the non-PJI group. PJI was diagnosed based on the International Consensus Meeting (ICM) in 2018. The levels of CRP, fibrinogen, erythrocyte sedimentation rate (ESR), D-dimer, and albumin count were determined. Receiver operating characteristic (ROC) curves and Youden's index were used to evaluate the diagnostic ability of various biomarkers.

Results

The levels of CRP, fibrinogen, D-dimer, ESR, and CRP/albumin were significantly higher in the PJI group (P < 0.001). In PJI of females, the predictive value of CRP was the highest among the five biomarkers, with the area under the curve (AUC) of 0.98. The optimal predictive cut-off for CRP was 8.86 mg/L, with a sensitivity and specificity of 90.2% and 95.7%, respectively. When combined with the other four biomarkers, the AUC of CRP was 0.98, 0.99, 0.98, and 0.99, respectively. In PJI of males, the predictive value of ESR was the highest among the five biomarkers, with an AUC of 0.92. The optimal predictive cut-off for ESR was 14.50 mm/h, with a sensitivity and specificity of 84.6% and 86.6%, respectively. When combined with the other four biomarkers, the AUC of ESR was 0.95, 0.94, 0.93, and 0.97, respectively.

Conclusion

CRP and ESR were excellent biomarkers for diagnosing PJI in female and male patients, respectively, and their combined use with CPR/albumin could provide higher diagnostic value in different genders.

Maternal AA/EPA Ratio and Triglycerides as Potential Biomarkers of Patients at Major Risk for Pharmacological Therapy in Gestational Diabetes

Gestational diabetes mellitus (GD) is characterized by glycemic and lipid metabolism alterations in an environment of low-grade inflammation. Our trial aimed to assess the effect of nutraceutical supplements (omega-3 fatty acids, anthocyanins, and alpha-cyclodextrins) in GD patients and evaluate the role of anthropometric, metabolic, and inflammatory parameters as biomarkers to identify subjects who require pharmacological hypoglycemic treatment during gestation. Pregnant women with GD at 24-28 weeks of gestation were enrolled in a double-blind trial and randomized to receive either nutraceutical supplements or a placebo for 12 weeks. No statistically significant differences were observed between the two groups in blood and urine measurements of metabolic, inflammatory, and antioxidant parameters. In the whole cohort, pre-pregnancy BMI and anthropometric measurements were significantly different in patients who required pharmacological intervention. These patients showed higher triglycerides, CRP, and insulin levels and gave birth to newborns with significantly higher weights. Subjects with a greater AA/EPA ratio had higher PAF levels and gave birth four days earlier. In conclusion, one-to-one nutritional coaching and poor compliance with nutraceutical supplementation might have outweighed the impact of this intervention. However, triglyceride concentration and the AA/EPA ratio seems to be a biomarker for higher inflammatory levels and GD candidates for pharmacological treatment. An adequate assumption of omega-3 in women with GD, either by a controlled diet or by nutraceutical supplementation, reduces the need for pharmacological therapy.

Adipokines Profile and Inflammation Biomarkers in Prepubertal Population with Obesity and Healthy Metabolic State

(1) Background and aims: Obesity and high body max index (BMI) have been linked to elevated levels of inflammation serum markers such as C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-alpha), adiponectin, and resistin. It has been described that adipose tissue presents a high production and secretion of these diverse pro-inflammatory molecules, which may have local effects on the physiology of the fat cell and also systemic effects on other organs. Our aim was to evaluate the impact that lifestyle modifications, following a Mediterranean Diet (MedDiet) program and physical activity (PA) training, would have on inflammatory biomarkers in a metabolically healthy prepubertal population with obesity (MHOPp) from Malaga (Andalusia, Spain). (2) Methods: 144 MHOPp subjects (aged 5–9 years) were included in this study as they met ≤1 of the following criteria: waist circumference and blood pressure ≥ 90 percentile, triglycerides > 90 mg/dL, high-density lipoprotein cholesterol (HDL-c) < 40 mg/dL, or impaired fasting glucose (≥100 md/dL). Selected subjects followed a personalized intensive lifestyle modification. Anthropometric measurements, inflammation biomarkers, and adipokine profile were analyzed after 12 and 24 months of intervention. (3) Results: 144 MHOPp participants (75 boys—52% and 69 girls—48%; p = 0.62), who were 7.8 ± 1.4 years old and had a BMI 24.6 ± 3.3 kg/m², were included in the study. After 24 months of MedDiet and daily PA, a significant decrease in body weight (−0.5 ± 0.2 SD units; p < 0.0001) and BMI (−0.7 ± 0.2 SD units; p < 0.0001) was observed in the total population with respect to baseline. Serum inflammatory biomarkers (IL-6, TNF-alpha, and CRP) after 24 months of intervention were significantly reduced. Adipokine profile (adiponectin and resistin) did not improve with the intervention, as adiponectin levels significantly decreased and resistin levels increased in all the population. Inflammatory biomarkers and adipokine profile had a significant correlation with anthropometric parameters, body composition, and physical activity. (4) Conclusions: After 24 months of lifestyle modification, our MHOPp reduced their Z-score of BMI, leading to an improvement of inflammatory biomarkers but inducing deterioration in the adipokine profile, which does not improve with MedDiet and physical activity intervention. An adequate education within the family about healthier habits is necessary to prevent and reduce an excessive increase in obesity in childhood.

Improved fatty acid profile reduces body fat and arterial stiffness in obese adolescents upon combinatorial intervention with exercise and dietary restriction

Objective

In order to examine the effect of 4-week combinatorial intervention with exercise training and dietary restriction on serum fatty acids, and to explore the correlation of intervention-induced improvement of serum fatty acid profile with the reduction of body fat and arterial stiffness.

Methods

Thirty-three obese adolescents were randomized into the intervention (n = 19) and control (n = 14) groups. The participants from the intervention group were subjected to 4-week combinatorial intervention with exercise training and dietary restriction while the participants from the control group maintained regular activities and diet habits. Anthropometry, serum fatty acids and arterial stiffness were measured before and after 4-week intervention.

Results

The participants upon combinatorial intervention revealed the improved body compositions and serum fatty acid profile, and reduced arterial stiffness when compared with their basal levels and the control participants (p < 0.05). Moreover, the decrease in myristic acid, stearic acid, arachidic acid, behenic acid, palmitoleic acid, and dihomo-γ-linolenic acid, was associated with the reduction in body fat. A positive correlation between arachidonic acid and left brachial ankle pulse velocity was observed, and the increase in docosahexaenoic acid was associated with the reduction of left brachial ankle pulse wave velocity and the enhancement of right ankle brachial index.

Conclusion

The 4-week combinatorial intervention is a useful strategy to improve serum fatty acid profile along with the reduction of body fat and arterial stiffness in obese adolescents.

The Trends of Medical Care Expenditure with Adjustment of Lifestyle Habits and Medication; 10-Year Retrospective Follow-Up Study

In Japan, the prevention of lifestyle-related diseases is the most important issue for the optimization of medical expenditure. This study aimed to analyze the impact of lifestyle and medication status on medical expenditure. Health checkup data and medical expenditure records of a retrospective cohort of 1463 people aged between 40 and 65 years old who underwent specific health checks at least three times between 2008 and 2017 were analyzed. Regression analysis was performed with medical expenditure as the dependent variable and age, gender, waist ratio, medication status, and lifestyle habits as independent variables using a Tobit model. Focusing on the factors that increase medical expenditure, the regression coefficients of age, medication status, weight gain of 10 kg or more since the age of 20, and walking more than 1 h per day were 0.048 (95% CI 0.04 to 0.06), 1.020 (95% CI 0.88 to 1.16), 0.210 (95% CI 0.06 to 0.36), and -0.208 (95% CI -0.35 to -0.07), respectively. The estimate of 5-year cumulative medical expenditure showed that those with walking habits without medication had the lowest medical expenditure. The result of this study suggests that walking more than 1 h a day may lower health expenditure in the general population.

Associations of short sleep duration with appetite-regulating hormones and adipokines: A systematic review and meta-analysis

In the current study, a systematic review and meta-analysis were conducted to summarize and assess whether short sleep duration is associated with appetite-regulating hormones and adipokine levels. Reference databases were searched for studies related to sleep and appetite-regulating hormones and adipokines. Qualitative and quantitative syntheses were conducted to evaluate the relationship between sleep duration and the level of appetite-regulating hormones and adipokines, including leptin, ghrelin, adiponectin, resistin, and orexin. Twenty-one of 3536 studies, covering a total of 2250 participants, met the inclusion criteria. Leptin, ghrelin, and adiponectin were included in the meta-analysis. Ghrelin levels were higher in the short sleep group (standard mean difference [SMD] = 0.14, 95% CI [0.03, 0.25], p = 0.01). Significant differences between the short sleep group and recommended sleep group were also noted in leptin level experimental subgroup studies (SMD = 0.19, 95% CI [0.03, 0.35], p = 0.02) and ghrelin level cross-sectional subgroup studies (SMD = 0.14, 95% CI [0.02, 0.27], p = 0.03). A rise in leptin and ghrelin levels were also observed in sleep deprivation groups (SMD = 0.24, 95% CI [0.10, 0.39], p = 0.001 and SMD = 0.18, 95% CI [0.04, 0.33], p = 0.01, respectively). In conclusion, short sleep duration is associated with an increased ghrelin level, while sleep deprivation had a significant effect on the levels of both leptin and ghrelin.

Emerging concepts in metabolically healthy obesity

Obesity is a major risk factor for noncommunicable diseases that is responsible for more than 70% of early deaths in the world. In the 1980's decade, some studies started to describe a "benign" obesity phenotype, named "metabolically healthy obesity" (MHO), which represents obesity without comorbidities such as hypertension, cardiovascular diseases, insulin resistance, diabetes, dyslipidemia or metabolic syndrome. However, it is still unclear if this "benign" obesity phenotype is really favorable or just a transition status to unhealthy obesity and if these subjects presented subclinical levels of cardiovascular risk that are not commonly detected. To further elucidate these issues, the investigation of pathophysiological mechanisms that can increase cardiovascular risk in MHO individuals, such as hormones and cytokines, may offer some responses. In parallel, the evaluation of subclinical cardiovascular derangement, using the systemic microcirculation as a proxy, may be an alternative to anticipate overt cardiovascular disease. Overall, further studies are needed to better understand the pathophysiology of MHO as well as to identify high-risk individuals who deserve more intensive management.

Lifestyle-Intervention-Induced Reduction of Abdominal Fat Is Reflected by a Decreased Circulating Glycerol Level and an Increased HDL Diameter

Scope

Abdominal obesity is one of the main modifiable risk factors of age‐related cardiometabolic disease. Cardiometabolic disease risk and its associated high abdominal fat mass, cholesterol, and glucose concentrations can be reduced by a healthier lifestyle. Hence, the aim is to understand the relation between lifestyle‐induced changes in body composition, and specifically abdominal fat, and accompanying changes in circulating metabolic biomarkers.

Methods and results

Data from the Growing Old Together (GOTO) study was used, which is a single arm lifestyle intervention in which 164 older adults (mean age 63 years, BMI 23–35 kg/m²) changed their lifestyle during 13 weeks by 12.5% caloric restriction plus 12.5% increase in energy expenditure. It is shown here that levels of circulating metabolic biomarkers, even after adjustment for body mass index, specifically associate with abdominal fat mass. The applied lifestyle intervention mainly reduces abdominal fat mass (−2.6%, SD = 3.0) and this reduction, when adjusted for general weight loss, is highly associated with decreased circulating glycerol concentrations and increased HDL diameter.

Conclusion

The lifestyle‐induced reduction of abdominal fat mass is particularly associated, independent of body mass index or general weight loss, with decreased circulating glycerol concentrations and increased HDL diameter.

Impact of Intensive Lifestyle Modification on Levels of Adipokines and Inflammatory Biomarkers in Metabolically Healthy Obese Women

Background

For the metabolically healthy obese (MHO) subjects, it is unclear whether weight loss provides cardiometabolic benefits. Our objective was to evaluate whether changes in adipokine and inflammatory biomarker levels were related to lifestyle modification (with Mediterranean diet and physical exercise program).

Methods

115 women (35-55 years) with BMI of 30-40 kg/m² and ≤1 metabolic syndrome criteria were included. After a 2-year intervention, participants were classified by percent weight loss: Group 1, <5%; Group 2, ≥5%-<10%; and Group 3, ≥10%. Anthropometric data, inflammatory biomarker (IL-6, TNFa, and hsCRP) and adipokine levels (adiponectin and resistin), and lifestyle program adherence at baseline and 2 years were analyzed.

Results

The final sample comprised 67 women. 23 (38.3%) lost <5%, 22 (36.7%) lost ≥5%-<10%, and 22 (36.7%) lost ≥10% of baseline weight. After 2 years, in Group 1, adiponectin, hsCRP, IL-6, and TNFa decreased (-1.2 ng/ml, p = 0.003; -2.1 mg/l, p = 0.003; -2.4 pg/ml, p < 0.001; and -2.4 pg/ml, p = 0.001, respectively) and resistin increased (+2.4 ng/ml, p < 0.001). In Group 2, hsCRP and IL-6 decreased (-2.0 mg/l, p = 0.009 and -2.6 pg/ml, p = 0.001) but TNFa increased (+0.2 pg/ml, p = 0.02). In Group 3, resistin increased (+3.5 ng/ml, p < 0.001) but hsCRP, IL-6, and TNFa decreased (-2.0 mg/l, p = 0.009; -2.5 pg/ml, p < 0.001; and -4.1 pg/ml, p < 0.001). Adiponectin, hsCRP, and physical exercise correlated significantly to subjects' dietary adherence.

Conclusion

Weight loss reduces inflammatory biomarkers in the MHO but induces a deterioration in the adipokine profile, which does not improve with diet and exercise intervention. These findings allow us to clarify mechanisms behind inflammation and metabolic disorder genesis so as to prevent development of obesity-associated comorbidities.

Prevalence and association between triglyceride level and lifestyle factors among Malay obese class I and II adults

OBJECTIVE

Hypertriglyceridemia is an independent risk factor for cardiovascular diseases. This study aimed to determine the prevalence and association of triglyceride level and lifestyle factors among Malay obese class I and II adults.

METHOD

This is a cross-sectional study of 65 Malay obese class I and class II adults aged 20-62 years (21 male, 44 female) from sub-urban areas of Malaysia. Overnight fasting venous blood samples were obtained to determine the triglyceride level (mmol/L). Subjects were classified into either normal or elevated triglyceride level groups based on the triglyceride level (normal < 1.6 mmol/L, elevated > 1.7 mmol/L). Unhealthy lifestyle behaviors, defined as smoking status, hours per day spent on sitting passively and sitting with active motion, and the amount of saturated fat, mono-unsaturated and polyunsaturated fat from dietary intake, were measured from 24-h dietary intake and physical activity recall. We compare the variables of unhealthy lifestyle behaviors between subjects with normal and elevated triglyceride level using independent samples t-test.

RESULTS

Among 65 obese class I and II adults, 16 subjects (24.6%) were found to have elevated triglyceride levels (mean ± standard deviation of body mass index 31.89 ± 3.29 kg/m²). There are significant differences between subjects having normal and elevated triglyceride level with gender, marital status, the number of children, smoking status, weight and monounsaturated fat intake (all P-values < .05).

CONCLUSIONS

The findings of this study highlighted elevated triglyceride level in obese adults might be influenced by unhealthy lifestyle behaviors. We suggest that lifestyle modification intervention is appropriate to prevent cardiovascular disease among Malay obese class I and II adults.

ABSI is a poor predictor of insulin resistance in Chinese adults and elderly without diabetes

OBJECTIVE

Recently, a new obesity index (A Body Shape Index, ABSI) based on waist circumference (WC) was developed, and high ABSI corresponds to a more central concentration of body volume. It is well known that central obesity is closely linked with insulin resistance (IR). Therefore, our study aimed to examine the discriminatory power of ABSI for IR in Chinese adults and elderly without diabetes.

SUBJECTS AND METHODS

In 2007, a cross-sectional study was made. In this study, 570 individuals without diabetes were available for analysis (male: 56.1%, mean age: 62.3 ± 6.5 years). Insulin resistance was assessed by homeostasis model assessment (HOMA-IR). Areas under the receiver operating characteristic (ROC) curves were determined to identify variables/models that could predict insulin resistance.

RESULTS

ABSI was associated with IR, the cut-off points was 0.0785 m11/6kg-2/3 to identifying IR and the area under the ROC (AUC) curve was 0.618 (95%CI: 0.561-0.675), which was not better than body mass index BMI (AUC = 0.753; 95%CI: 0.706-0.801), WC (AUC = 0.749; 95%CI: 0.700-0.797), and fasting plasma glucose (FPG, AUC = 0.752; 95%CI: 0.705-0.799). Furthermore, combination with ABSI could improve the discriminatory power of other variables for IR. The AUC curve increased from 0.753 to 0.771for BMI, 0.749 to 0.754 for WC, 0.752 to 0.769 for FPG, respectively.

CONCLUSIONS

ABSI is associated with IR in the general Chinese adults and elderly without diabetes, but the discriminatory power for IR is poor. It is recommended that ABSI be used in combination with other variables.

A novel prescription pedometer-assisted walking intervention and weight management for Chinese occupational population

BACKGROUND AND AIM

Information technology has been previously used for the research and practice of health promotion. Appropriate and effective health promotion methods used by professional groups remain to be investigated. This study aimed to assess the feasibility and effectiveness of a weight management program among the Chinese occupational population using and a novel information technology exercise prescription.

STUDY DESIGN AND PARTICIPANTS

A 3-month open, self-monitored intervention trial, involving individualized pedometer-assisted exercise prescription and a one-time targeted dietary guidance prior to exercise was conducted on the Chinese occupational population aged 18-65 years in China from 2015 to 2016. Data were collected from March 2015 to May 2016 and analyzed from June 2016 to August 2016. Participants were also asked to synchronize exercise data of the pedometer to the Internet-based Health System Center daily (at least weekly), by connecting to the personal computer (PC) using a USB cable or via Bluetooth.

RESULTS

Eligible participants included 802 Chinese occupational persons, and 718 of them followed exercise interventions with 89.5% (718/802) adherence to the exercise programs. Of them, 688 participants completed the program with 85.8% (688/802) adherence to the exercise program and their data were analyzed. Weight decreased by 2.2% among all overweight/obese participants, with 1.8% reduction in waist circumference and 3.3% reduction in body fat percentage (p< 0.001). Weight and body fat percentage in normal-weight individuals decreased by 0.7% and 2.5%, respectively (p < 0.01). A weight gain of 1.0% was observed in all underweight participants (p< 0.05), and 68.2% (208/305) of overweight/obese participants experienced weight loss, with an average reduction of 3.5%, with 20.2% (42/208) of them achieving weight loss ≥5%. Blood pressure and fasting serum glucose decreased significantly in both the overweight/obese and the normal-weight individuals (p < 0.05). The incidence of hypertension was significantly lower and lifestyle behavior significantly improved (p < 0.05).

CONCLUSION

The prescription pedometer-assisted walking intervention can effectively improve exercise adherence and manage weight. This approach was also effective in controlling the risk factors of weight-related chronic diseases.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR) ChiCTR-OOh-16010229.

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

BACKGROUND

We conducted a systematic review and meta-analysis to firstly obtain a reliable estimation of the prevalence of metabolically healthy obese (MHO) individuals in obesity, then assessed the risk of developing metabolic abnormalities (MA) among MHO individuals. At last, we evaluated the effects of traditional lifestyle interventions on metabolic level for MHO subjects.

METHODS

A systematic review and meta-analysis (PRISMA) guideline were conducted, and original studies were searched up to December 31, 2016. The prevalence of MHO in obesity from each study was pooled using random effects models. The relative risks (RRs) were pooled to determine the risk of developing MA for MHO compared with metabolically healthy normal-weight (MHNW) subjects. For the meta-analysis of intervention studies, the mean difference and standardized mean differences were both estimated for each metabolic parameter within each study, and then pooled using a random-effects model.

RESULTS

Overall, 40 population-based studies reported the prevalence of MHO in obesity, 12 cohort studies and 7 intervention studies were included in the meta-analysis. About 35.0% obese individuals were metabolically healthy in the obese subjects. There were dramatic differences in the prevalence among different areas. However, 0.49 (95% confidence intervals [CI]: 0.38 to 0.60) of the MHO individuals would develop one or more MA within 10 years. Compared with MHNW subjects, the MHO subjects presented higher risk of incident MA (pooled RR = 1.80, 95%CI: 1.53-2.11). Following intervention, there was certain and significant improvement of metabolic state for metabolically abnormal obesity (MAO) subjects. Only diastolic blood pressure had reduced for MHO individuals after intervention.

CONCLUSIONS

Almost one-third of the obese individuals are in metabolic health. However, they are still at higher risk of advancing to unhealthy state. Therefore, it is still needed to advise MHO individuals to maintain or adopt a healthy lifestyle, so as to counterbalance the adverse effects of obesity.

Association of desaturase activity and C-reactive protein in European children

BACKGROUND

Desaturase enzymes influence the fatty acid (FA) composition of body tissues and their activity affects the conversion rate of saturated to monounsaturated FA and of polyunsaturated FA (PUFA) to long-chain PUFA. Desaturase activity has further been shown to be associated with inflammation. We investigate the association between delta-9 (D9D), delta-6 (D6D) and delta-5 desaturase (D5D) activity and high-sensitive C-reactive protein (CRP) in young children.

METHODS

In the IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) cohort study children were examined at baseline (T0) and after 2 y (T1). D9D, D6D, and D5D activities were estimated from T0 product-precursor FA ratios. CRP was measured at T0 and T1. In a subsample of 1,943 children with available information on FA, CRP, and covariates, the cross-sectional and longitudinal associations of desaturase activity and CRP were analyzed.

RESULTS

Cross-sectionally, a D9D increase of 0.01 units was associated with a 11% higher risk of having a serum CRP ≥ Percentile 75 (P75) (OR, 99% CI: 1.11 (1.01; 1.22)) whereas D6D and D5D were not associated with CRP. No significant associations were observed between baseline desaturase activity and CRP 2 y later.

CONCLUSION

Cross-sectionally, our results indicate a positive association of D9D and CRP independent of weight status. High D9D activity may increase the risk of subclinical inflammation which is associated with metabolic disorders. As D9D expression increases with higher intake of saturated FA and carbohydrates, dietary changes may influence D9D activity and thus CRP. However, it remains to be investigated whether there is a causal relationship between D9D activity and CRP.

Risk factors that affect metabolic health status in obese children

BACKGROUND

While some obese children are metabolically healthy (MHO), some have additional health problems, such as hypertension, dyslipidemia, insulin resistance, and hepatosteatosis, which increase mortality and morbidity related to cardiovascular diseases (CVD) during adulthood. These children are metabolically unhealthy obese (MUO) children. In this study we assessed the factors that affect metabolic health in obesity and the clinical and laboratory findings that distinguish between MHO and MUO children.

METHODS

In total, 1085 patients aged 6-18 years, with age- and sex-matched BMI exceeding the 95th percentile were included in the study (mean 11.1±2.9 years, 57.6% female, 59.7% pubertal). Patients without dyslipidemia, insulin resistance, hepatosteatosis, or hypertension were considered as MHO. Dyslipidemia was defined as total cholesterol level over 200 mg/dL, triglyceride over 150 mg/dL, LDL over 130 mg/dL, or HDL under 40 mg/dL. Insulin resistance was calculated using the homeostasis model of assesment for insulin resistance (HOMA-IR) index. Hepatosteatosis was evaluated with abdominal ultrasound. Duration of obesity, physical activity and nutritional habits, screen time, and parental obesity were questioned. Thyroid and liver function tests were performed.

RESULTS

Six hundred and forty-two cases (59.2%) were MUO. Older age, male sex, increased BMI-SDS, and sedentary lifestyle were associated with MUO. Excessive junk food consumption was associated with MUO particularly among the prepubertal obese patients.

CONCLUSIONS

Our results revealed that the most important factors that affect metabolic health in obesity are age and BMI. Positive effects of an active lifestyle and healthy eating habits are prominent in the prepubertal period and these habits should be formed earlier in life.

Metabolically healthy obesity across the life course: epidemiology, determinants, and implications

In recent years, different subphenotypes of obesity have been described, including metabolically healthy obesity (MHO), in which a proportion of obese individuals, despite excess body fat, remain free of metabolic abnormalities and increased cardiometabolic risk. In the absence of a universally accepted set of criteria to classify MHO, the reported prevalence estimates vary widely. Our understanding of the determinants and stability of MHO over time and the associated cardiometabolic and mortality risks is improving, but many questions remain. For example, whether MHO is truly benign is debatable, and whether risk stratification of obese individuals on the basis of their metabolic health status may offer new opportunities for more personalized approaches in diagnosis, intervention, and treatment of diabetes remains speculative. Furthermore, as most of the research to date has focused on MHO in adults, little is known about childhood MHO. In this review, we focus on the epidemiology, determinants, stability, and health implications of MHO across the life course.

The C-reactive protein level after total knee arthroplasty is gender specific

PURPOSE

Laboratory diagnostics are part of the routine before and after operations. In all specialist surgical disciplines, including orthopaedic surgery, the acute-phase protein CRP is used to detect inflammatory processes, especially infections. The potential influence of patient gender on the postoperative course of CRP after TKA implantation is still unclear. In order to achieve a more precise evaluation of the complication-free general CRP course after TKA, the objective of the present study is to test the hypothesis that the p.o. course and level of CRP is gender specific in the first 10 days after TKA.

METHODS

A total of 1068 consecutive patients who had been treated with a unilateral primary cemented total knee replacement due to primary osteoarthritis of the knee over a 36-month period were retrospectively included in the study. For all patients, the preoperative CRP value and the postoperative course of CRP from postoperative days 1-10 were recorded and tested for gender specificity.

RESULTS

On days 2-5 and 7-8 after surgery, men had significantly higher CRP values than women. The maximum difference was 45 mg/L on the fourth p.o. day (men 170 mg/L, women 125 mg/L, p = 0.019).

CONCLUSION

The present study was able to show, for the first time, that the complication-free course of CRP in the first 10 days after TKA implantation is gender specific. The impact of the finding on diagnostic is that the gender-specific CRP course provides a more precise evaluation of the complication-free course of CRP after TKA. These results have clinical relevance to the interpretation of postoperative CRP values in order to avoid unnecessary investigations such as puncture or surgical care in female and male patients with uncomplicated TKA. Level of evidence Diagnostic study, III.

Dietary Interventions and Changes in Cardio-Metabolic Parameters in Metabolically Healthy Obese Subjects: A Systematic Review with Meta-Analysis

The aim of this systematic review was to assess the effect of diet on changes in parameters describing the body size phenotype of metabolically healthy obese subjects. The databases Medline, Scopus, Web of Knowledge and Embase were searched for clinical studies carried out between 1958 and June 2016 that reported the effect of dietary intervention on BMI, blood pressure, concentration of fasting triglyceride (TG), high density lipoprotein cholesterol (HDL-C), fasting glucose level, the homoeostatic model assessment of insulin resistance (HOMA-IR) and high sensitivity C-Reactive Protein (hsCRP) in metabolically healthy, obese subjects. Twelve clinical studies met inclusion criteria. The combined analyzed population consists of 1827 subjects aged 34.4 to 61.1 with a BMI > 30 kg/m². Time of intervention ranged from eight to 104 weeks. The baseline characteristics related to lipid profile were more favorable for metabolically healthy obese than for metabolically unhealthy obese. The meta-analyses revealed a significant associations between restricted energy diet and BMI (95% confidence interval (CI): -0.88, -0.19), blood pressure (systolic blood pressure (SBP): -4.73 mmHg; 95% CI: -7.12, -2.33; and diastolic blood pressure (DBP): -2.75 mmHg; 95% CI: -4.30, -1.21) and TG (-0.11 mmol/l; 95% CI: -0.16, -0.06). Changes in fasting glucose, HOMA-IR and hsCRP did not show significant changes. Sufficient evidence was not found to support the use of specific diets in metabolically healthy obese subjects. This analysis suggests that the effect of caloric restriction exerts its effects through a reduction in BMI, blood pressure and triglycerides in metabolically healthy obese (MHO) patients.

Natural Course of Metabolically Healthy Overweight/Obese Subjects and the Impact of Weight Change

Few studies have described the characteristics of metabolically healthy individuals with excess fat in the Chinese population. This study aimed to prospectively investigate the natural course of metabolically healthy overweight/obese (MH-OW/OB) adults, and to assess the impact of weight change on developing metabolic abnormalities. During 2009–2010, 525 subjects without any metabolic abnormalities or other obesity-related diseases were evaluated and reevaluated after 5 years. The subjects were categorized into two groups of overweight/obese and normal weight based on the criteria of BMI by 24.0 at baseline. At follow-up, the MH-OW/OB subjects had a significantly increased risk of developing metabolically abnormalities compared with metabolically healthy normal-weight (MH-NW) individuals (risk ratio: 1.35, 95% confidence interval: 1.17–1.49, p value < 0.001). In the groups of weight gain and weight maintenance, the MH-OW/OB subjects was associated with a larger increase in fasting glucose, triglycerides, systolic blood pressure, diastolic blood pressure and decrease in high-density lipoprotein cholesterol comparing with MH-NW subjects. In the weight loss group, no significant difference of changes of metabolic parameters was observed between MH-OW/OB and MH-NW adults. This study verifies that MH-OW/OB are different from MH-NW subjects. Weight management is needed for all individuals since weight change has a significant effect on metabolic health without considering the impact of weight change according to weight status.

Obesity: systemic and pulmonary complications, biochemical abnormalities, and impairment of lung function

Obesity is currently one of the major epidemics of this millennium and affects individuals throughout the world. It causes multiple systemic complications, some of which result in severe impairment of organs and tissues. These complications involve mechanical changes caused by the accumulation of adipose tissue and the numerous cytokines produced by adipocytes. Obesity also significantly interferes with respiratory function by decreasing lung volume, particularly the expiratory reserve volume and functional residual capacity. Because of the ineffectiveness of the respiratory muscles, strength and resistance may be reduced. All these factors lead to inspiratory overload, which increases respiratory effort, oxygen consumption, and respiratory energy expenditure. It is noteworthy that patterns of body fat distribution significantly influence the function of the respiratory system, likely via the direct mechanical effect of fat accumulation in the chest and abdominal regions. Weight loss caused by various types of treatment, including low-calorie diet, intragastric balloon, and bariatric surgery, significantly improves lung function and metabolic syndrome and reduces body mass index. Despite advances in the knowledge of pulmonary and systemic complications associated with obesity, longitudinal randomized studies are needed to assess the impact of weight loss on metabolic syndrome and lung function.

Associations between whole peripheral blood fatty acids and DNA methylation in humans

Fatty acids (FA) modify DNA methylation in vitro, but limited information is available on whether corresponding associations exist in vivo and reflect any short-term effect of the diet. Associations between global DNA methylation and FAs were sought in blood from lactating infants (LI; n = 49) and adult males (AMM; n = 12) equally distributed across the three conventional BMI classes. AMM provided multiple samples at 2-hour intervals during 8 hours after either a single Western diet-representative meal (post-prandial samples) or no meal (fasting samples). Lipid/glucose profile, HDAC4 promoter and PDK4 5’UTR methylation were determined in AMM. Multiple regression analysis revealed that global (in LI) and both global and PDK4-specific DNA methylation (in AMM) were positively associated with eicosapentaenoic and arachidonic acid. HDAC4 methylation was inversely associated with arachidonic acid post-prandially in AMM. Global DNA methylation did not show any defined within-day pattern that would suggest a short-term response to the diet. Nonetheless, global DNA methylation was higher in normal weight subjects both post-prandially and in fasting and coincided with higher polyunsaturated relative to monounsaturated and saturated FAs. We show for the first time strong associations of DNA methylation with specific FAs in two human cohorts of distinct age, diet and postnatal development stage.

UPDATING THE CONCEPT OF METABOLICALLY HEALTHY OBESITY

Obesity is a well-recognized risk factor for type 2 diabetes, cardiovascular disease, and several types of cancer. However, a proportion of the obese individuals display a significantly lower risk for metabolic complications than expected for their degree of body mass index, and this subtype of obesity was described as "metabolically healthy obesity" (MHO). No universally accepted criteria for the diagnosis of MHO exists and the prevalence of this subtype of obesity varies largely according to criteria used. Broadly, MHO is characterized by a lower amount of visceral fat, a more favorable inflammatory profile, and less insulin resistance as compared to the metabolically unhealthy obesity. Currently, controversies exist regarding the risk of cardiovascular events and all-cause mortality associated with MHO as compared to metabolically-healthy non-obese individuals. Further research is needed in order to identify the MHO phenotype and if MHO is truly healthy for a long period of time or if it is a transient state from normal metabolic/normal weight to abnormal metabolic/obese state. This review will discuss the MHO definition criteria; the differences between MHO and metabolically unhealthy obesity; the possible underlying mechanisms and clinical implications of MHO.