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Cadenas-Sanchez C, Medrano M, Villanueva A, Cabeza R, Idoate F, Osés M, Rodríguez-Vigil B, Álvarez de Eulate N, Alberdi Aldasoro N, Ortega FB, Labayen I. Differences in specific abdominal fat depots between metabolically healthy and unhealthy children with overweight/obesity: The role of cardiorespiratory fitness. Scand J Med Sci Sports 2023. [PMID: 37081735 DOI: 10.1111/sms.14372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/11/2023] [Accepted: 04/03/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVES Fat depots localization has a critical role in the metabolic health status of adults. Nevertheless, whether that is also the case in children remains under-studied. Therefore, the aims of this study were: (i) to examine the differences between metabolically healthy (MHO) and unhealthy (MUO) overweight/obesity phenotypes on specific abdominal fat depots, and (ii) to further explore whether cardiorespiratory fitness plays a major role in the differences between metabolic phenotypes among children with overweight/obesity. METHODS A total of 114 children with overweight/obesity (10.6 ± 1.1 years, 62 girls) were included. Children were classified as MHO (n = 68) or MUO. visceral (VAT), abdominal subcutaneous (ASAT), intermuscular abdominal (IMAAT), psoas, hepatic, pancreatic, and lumbar bone marrow adipose tissues were measured by magnetic resonance imaging. Cardiorespiratory fitness was assessed using the 20 m shuttle run test. RESULTS MHO children had lower VAT and ASAT contents and psoas fat fraction compared to MUO children (difference = 12.4%-25.8%, all p < 0.035). MUO-unfit had more VAT and ASAT content than those MUO-fit and MHO-fit (difference = 34.8%-45.3%, all p < 0.044). MUO-unfit shows also greater IMAAT fat fraction than those MUO-fit and MHO-fit peers (difference = 16.4%-13.9% respectively, all p ≤ 0.001). In addition, MHO-unfit presented higher IMAAT fat fraction than MHO-fit (difference = 13.4%, p < 0.001). MUO-unfit presented higher psoas fat fraction than MHO-fit (difference = 29.1%, p = 0.008). CONCLUSIONS VAT together with ASAT and psoas fat fraction, were lower in MHO than in MUO children. Further, we also observed that being fit, regardless of metabolic phenotype, has a protective role over the specific abdominal fat depots among children with overweight/obesity.
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Affiliation(s)
- Cristina Cadenas-Sanchez
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
- Research Institute for Innovation & Sustainable Food Chain Development (IS-FOOD), Public University of Navarre. Department of Health Sciences, Public University of Navarre, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - María Medrano
- Research Institute for Innovation & Sustainable Food Chain Development (IS-FOOD), Public University of Navarre. Department of Health Sciences, Public University of Navarre, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Arantxa Villanueva
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Smart Cities Institute, Public University of Navarre, Pamplona, Spain
- Department of Electrical, Electronic and Communications Engineering, Public University of Navarre Pamplona, Pamplona, Spain
| | - Rafael Cabeza
- Department of Electrical, Electronic and Communications Engineering, Public University of Navarre Pamplona, Pamplona, Spain
| | - Fernando Idoate
- Radiology Department, Mutua Navarra, Pamplona, Spain
- Department of Health Sciences, Public University of Navarre, Pamplona, Spain
| | - Maddi Osés
- Research Institute for Innovation & Sustainable Food Chain Development (IS-FOOD), Public University of Navarre. Department of Health Sciences, Public University of Navarre, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Beatriz Rodríguez-Vigil
- Osakidetza Basque Health Service, Osatek, Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain
| | - Natalia Álvarez de Eulate
- Sección de Radiología Musculoesquelética, Servicio de Radiología, Hospital Universitario de Navarra, Pamplona, Spain
| | - Nerea Alberdi Aldasoro
- Sección de Radiología Musculoesquelética, Servicio de Radiología, Hospital Universitario de Navarra, Pamplona, Spain
| | - Francisco B Ortega
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Idoia Labayen
- Research Institute for Innovation & Sustainable Food Chain Development (IS-FOOD), Public University of Navarre. Department of Health Sciences, Public University of Navarre, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
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Murlasits Z, Kupai K, Kneffel Z. Role of physical activity and cardiorespiratory fitness in metabolically healthy obesity: a narrative review. BMJ Open Sport Exerc Med 2022; 8:e001458. [PMID: 36484059 PMCID: PMC9723844 DOI: 10.1136/bmjsem-2022-001458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 12/11/2022] Open
Abstract
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.
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Affiliation(s)
- Zsolt Murlasits
- Institute of Sport Science and Physical Education, University of Pécs, Pecs, Hungary
| | - Krisztina Kupai
- Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Kneffel
- Department of Health Sciences and Sport Medicine, Hungarian University of Sports Science, Budapest, Hungary
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Haugen C, Lysne V, Haldorsen I, Tjora E, Gudbrandsen OA, Sagen JV, Dankel SN, Mellgren G. MRI adipose tissue segmentation and quantification in R (RAdipoSeg). Diabetol Metab Syndr 2022; 14:146. [PMID: 36209247 PMCID: PMC9548171 DOI: 10.1186/s13098-022-00913-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 09/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Excess adipose tissue is associated with increased cardiovascular and metabolic risk, but the volume of visceral and subcutaneous adipose tissue poses different metabolic risks. MRI with fat suppression can be used to accurately quantify adipose depots. We have developed a new semi-automatic method, RAdipoSeg, for MRI adipose tissue segmentation and quantification in the free and open source statistical software R. METHODS MRI images were obtained from wild-type mice on high- or low-fat diet, and from 20 human subjects without clinical signs of metabolic dysfunction. For each mouse and human subject, respectively, 10 images were segmented with RAdipoSeg and with the commercially available software SliceOmatic. Jaccard difference, relative volume difference and Spearman's rank correlation coefficients were calculated for each group. Agreement between the two methods were analysed with Bland-Altman plots. RESULTS RAdipoSeg performed similarly to the commercial software. The mean Jaccard differences were 10-29% and the relative volume differences were below ( ±) 20%. Spearman's rank correlation coefficient gave p-values below 0.05 for both mouse and human images. The Bland-Altman plots indicated some systematic and proporitional bias, which can be countered by the flexible nature of the method. CONCLUSION RAdipoSeg is a reliable and low cost method for fat segmentation in studies of mice and humans.
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Affiliation(s)
- Christine Haugen
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Faculty of Biosciences, University of Life Sciences, Ås, Norway
| | - Vegard Lysne
- Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Ingfrid Haldorsen
- Mohn Medical Imaging and Visualization Centre (MMIV), Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Section for Radiology, Departement of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Erling Tjora
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Paediatrics, Haukeland University Hospital, Bergen, Norway
| | | | - Jørn Vegard Sagen
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Simon N Dankel
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Gunnar Mellgren
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway.
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway.
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A Multivariate Analysis of “Metabolic Phenotype” Patterns in Children and Adolescents with Obesity for the Early Stratification of Patients at Risk of Metabolic Syndrome. J Clin Med 2022; 11:jcm11071856. [PMID: 35407464 PMCID: PMC8999358 DOI: 10.3390/jcm11071856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 02/07/2023] Open
Abstract
Background: Metabolic syndrome (MS) is closely linked to obesity; however, not all individuals with obesity will develop obesity-related complications and a metabolically healthy obesity (MHO) group is also described. Objective: To perform a multivariate analysis (MVA) of the anthropometric and biochemical data in pediatric patients with obesity to reveal a “phenotype” predictive for MS. Methods: We analyzed 528 children with obesity (OB) and 119 normal-weight pediatric patients (NW). Adiposity indices were recorded, and MS was detected. MVA was performed. Results: Analysis of the structure of correlation of the variables showed that the variables of waist circumference (WC), body mass index (BMI), and estimated fat mass (eFM) were positively correlated with each other as a whole. In addition, the variables of the triglycerides (TG), triglyceride–glucose (TyG) index, and visceral adiposity index were positively correlated with each other as a whole, although none were correlated with the variables of BMI z-score, waist-to-height ratio, WC, eFM, or weight. The variables that related to insulin resistance (IR) and dyslipidemia were crucial for the early stratification of patients at risk of MS. Conclusions: Independently of body weight, IR, dyslipidemia, hypertriglyceridemia, and fat distribution seem to be the strongest MS risk factors. The early detection of and intervention in these modifiable risk factors are useful to protect children’s health.
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Osorio-Conles Ó, Vega-Beyhart A, Ibarzabal A, Balibrea JM, Vidal J, de Hollanda A. Biological Determinants of Metabolic Syndrome in Visceral and Subcutaneous Adipose Tissue from Severely Obese Women. Int J Mol Sci 2022; 23:ijms23042394. [PMID: 35216509 PMCID: PMC8878297 DOI: 10.3390/ijms23042394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 11/16/2022] Open
Abstract
The metabolic syndrome (MetS) is a cluster of the most dangerous heart attack risk factors: diabetes or raised fasting plasma glucose, abdominal obesity, high cholesterol and high blood pressure. The goal of this study is to compare the state of the main features of obesity-associated white adipose tissue (WAT) dysfunction in 66 women with severe obesity without (MetS-) or with MetS (MetS+). Fat cell area, adipocyte size distribution and histological fibrosis were analysed in visceral (VAT) and abdominal subcutaneous WAT (SAT) in 33 age- and BMI-matched pairs of MetS- and MetS+ subjects. The mRNA expression of 93 genes implicated in obesity-associated WAT dysfunction was analysed by RT-qPCR in both fat depots. MetS+ females showed higher adipocyte hypertrophy in both fat depots and increased fibrosis and expression of macrophage and hypoxia markers in SAT. Transcriptional data suggest increased fatty acid oxidation in SAT and impaired thermogenesis and extracellular matrix remodelling in VAT from MetS+ subjects. A sPLS-DA model, including SAT expression of PPARA and LEPR genes identified MetS with an AUC = 0.87. Despite equal age, BMI and body composition, MetS+ females display morphological and transcriptional differences in both WAT depots, especially in SAT. These factors may contribute to the transition to MetS.
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Affiliation(s)
- Óscar Osorio-Conles
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain;
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain;
- Correspondence: (Ó.O.-C.); (A.d.H.); Tel.: +34-932275707 (ext. 2910) (Ó.O.-C.); +34-932279846 (A.d.H.); Fax: +34932275589 (A.d.H.)
| | - Arturo Vega-Beyhart
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain;
| | - Ainitze Ibarzabal
- Gastrointestinal Surgery Department, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (A.I.); (J.M.B.)
| | - José María Balibrea
- Gastrointestinal Surgery Department, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (A.I.); (J.M.B.)
| | - Josep Vidal
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain;
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain;
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Ana de Hollanda
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain;
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red Fisiopatologia de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Correspondence: (Ó.O.-C.); (A.d.H.); Tel.: +34-932275707 (ext. 2910) (Ó.O.-C.); +34-932279846 (A.d.H.); Fax: +34932275589 (A.d.H.)
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Association of dyslipidemia, diabetes and metabolic syndrome with serum ferritin levels: a middle eastern population-based cross-sectional study. Sci Rep 2021; 11:24080. [PMID: 34916585 PMCID: PMC8677797 DOI: 10.1038/s41598-021-03534-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/29/2021] [Indexed: 12/14/2022] Open
Abstract
Elevated serum ferritin (SFer) levels are implicated in many energy metabolism abnormalities. The association between SFer levels and metabolic disorders has not been studied in Middle Eastern populations. We aimed at exploring the association between SFer levels and serum lipids, diabetes determinants, and metabolic syndrome in a sample of Qatari adults. This study used biochemical parameters obtained from 1928 participants from the Qatar Biobank cohort. We utilized adjusted multivariable logistic regression analysis to estimate the odds ratios (ORs) for dyslipidemia, type 2 diabetes, the homeostasis model assessment of insulin resistance (HOMA-IR), and metabolic syndrome (MetS) according to sex-specific SFer quartiles (Q1 to Q4). Results revealed that the ORs for dyslipidemia increased progressively and significantly across the SFer quartiles, up to two folds in Q4 for women (OR 2.47 (1.68–3.62)) and men (OR 2.24 (1.41–3.55)) versus Q1 (OR:1). Exclusively in women, the ORs for IR (HOMA-IR > 3.58) increased significantly in Q4 (OR 1.79 (1.19–2.70)) versus OR 1 in Q1 as did the ORs for diabetes (OR: 2.03 (1.15–3.57) in Q4 versus OR 1 in Q1). We observed the same result when we pooled the participants with prediabetes and diabetes in one group. The OR for MetS also increased significantly across the Sfer Quartiles from OR: 1 in Q1 to 1.92 (1.06–3.02) in Q4 for women and to 2.07 (1.08–3.98) in Q4 in men. Our results suggest the elevated Sfer levels as a potential risk biomarker for dyslipidemia and MetS in adult Qatari men and women, and diabetes and IR in women only.
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Kim HK, Kim CH. Quality Matters as Much as Quantity of Skeletal Muscle: Clinical Implications of Myosteatosis in Cardiometabolic Health. Endocrinol Metab (Seoul) 2021; 36:1161-1174. [PMID: 34986299 PMCID: PMC8743592 DOI: 10.3803/enm.2021.1348] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/13/2021] [Indexed: 12/12/2022] Open
Abstract
Although age-related changes in skeletal muscles are closely associated with decreases in muscle strength and functional decline, their associations with cardiometabolic diseases in the literature are inconsistent. Such inconsistency could be explained by the fact that muscle quality-which is closely associated with fatty infiltration of the muscle (i.e., myosteatosis)-is as important as muscle quantity in cardiometabolic health. However, muscle quality has been less explored compared with muscle mass. Moreover, the standard definition of myosteatosis and its assessment methods have not been established yet. Recently, some techniques using single axial computed tomography (CT) images have been introduced and utilized in many studies, as the mass and quality of abdominal muscles could be measured opportunistically on abdominal CT scans obtained during routine clinical care. Yet, the mechanisms by which myosteatosis affect metabolic and cardiovascular health remain largely unknown. In this review, we explore the recent advances in the assessment of myosteatosis and its changes associated with aging. We also review the recent literature on the clinical implication of myosteatosis by focusing on metabolic and cardiovascular diseases. Finally, we discuss the challenges and unanswered questions that need addressing to set myosteatosis as a therapeutic target for the prevention or treatment of cardiometabolic diseases.
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Affiliation(s)
- Hong-Kyu Kim
- Subdivision of Endocrinology and Metabolism, Health Screening and Promotion Center, Asan Medical Center, Seoul, Korea
- Corresponding authors: Hong-Kyu Kim Subdivision of Endocrinology and Metabolism, Health Screening and Promotion Center, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-4802, Fax: +82-2-3010-4917, E-mail:
| | - Chul-Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
- Chul-Hee Kim Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Wonmi-gu, Bucheon 14584, Korea Tel: +82-32-621-5155, Fax: +82-32-621-5018, E-mail:
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Zoghi G, Shahbazi R, Mahmoodi M, Nejatizadeh A, Kheirandish M. Prevalence of metabolically unhealthy obesity, overweight, and normal weight and the associated risk factors in a southern coastal region, Iran (the PERSIAN cohort study): a cross-sectional study. BMC Public Health 2021; 21:2011. [PMID: 34740348 PMCID: PMC8569952 DOI: 10.1186/s12889-021-12107-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Obesity is a substantial risk factor for cardiovascular and metabolic diseases. Epidemiologic studies have shown that some obese and overweight individuals are metabolically healthy. We aimed to determine the prevalence of metabolically unhealthy obesity (MUO), metabolically unhealthy overweight (MUOW), and metabolically unhealthy normal weight (MUNW) in a southern coastal area of Iran, Bandare-Kong Non-Communicable Diseases (BKNCD) Cohort Study. Methods This population-based study included the participants of BKNCD, as part of the Prospective Epidemiological Research Studies in IrAN (PERSIAN). Metabolic health was defined as not fulfilling the metabolic syndrome (MetS) criteria. Results Among the 3917 participants in this study with the mean age of 48.29 ± 9.39 years, including 1691 (43.2%) males, the age- and sex-standardized prevalence of MUO, MUOW, and MUNW was 13.9, 16.8, and 6.4%, respectively. Binary logistic regression analysis revealed that the adjusted odds of all metabolically unhealthy states were higher in older age groups, except for MUO whose adjusted odds were lower in the 65–70 age group compared to the 55–64 age group. Illiteracy was significantly correlated with MUOW (adjusted OR: 1.43, 95% CI 1.09–1.87, P = 0.010); however, it was not associated with MUO or MUNW. Higher body mass index (BMI) was significantly correlated with MUNW but it was not associated with MUOW or MUO. Higher waist circumference (WC) was also significantly associated with all metabolically unhealthy states. Conclusion The age- and sex-standardized prevalence of MUO, MUOW, and MUNW was 13.9, 16.8, and 6.4%, respectively in the current study. Advanced age and higher WC were significantly correlated with all metabolically unhealthy states, while illiteracy and higher BMI were only associated with MUOW and MUNW, respectively. Metabolic health rather than weight loss should be the focus and objective of public prevention programs.
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Affiliation(s)
- Ghazal Zoghi
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Roghayeh Shahbazi
- Cellular and Molecular Medicine Department, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Masoumeh Mahmoodi
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Azim Nejatizadeh
- Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Masoumeh Kheirandish
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
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Gutiérrez-Cuevas J, Santos A, Armendariz-Borunda J. Pathophysiological Molecular Mechanisms of Obesity: A Link between MAFLD and NASH with Cardiovascular Diseases. Int J Mol Sci 2021; 22:ijms222111629. [PMID: 34769060 PMCID: PMC8583943 DOI: 10.3390/ijms222111629] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
Obesity is now a worldwide epidemic ensuing an increase in comorbidities’ prevalence, such as insulin resistance, type 2 diabetes (T2D), metabolic dysfunction-associated fatty liver disease (MAFLD), nonalcoholic steatohepatitis (NASH), hypertension, cardiovascular disease (CVD), autoimmune diseases, and some cancers, CVD being one of the main causes of death in the world. Several studies provide evidence for an association between MAFLD and atherosclerosis and cardio-metabolic disorders, including CVDs such as coronary heart disease and stroke. Therefore, the combination of MAFLD/NASH is associated with vascular risk and CVD progression, but the underlying mechanisms linking MAFLD/NASH and CVD are still under investigation. Several underlying mechanisms may probably be involved, including hepatic/systemic insulin resistance, atherogenic dyslipidemia, hypertension, as well as pro-atherogenic, pro-coagulant, and pro-inflammatory mediators released from the steatotic/inflamed liver. MAFLD is strongly associated with insulin resistance, which is involved in its pathogenesis and progression to NASH. Insulin resistance is a major cardiovascular risk factor in subjects without diabetes. However, T2D has been considered the most common link between MAFLD/NASH and CVD. This review summarizes the evidence linking obesity with MAFLD, NASH, and CVD, considering the pathophysiological molecular mechanisms involved in these diseases. We also discuss the association of MAFLD and NASH with the development and progression of CVD, including structural and functional cardiac alterations, and pharmacological strategies to treat MAFLD/NASH and cardiovascular prevention.
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Affiliation(s)
- Jorge Gutiérrez-Cuevas
- Department of Molecular Biology and Genomics, Institute for Molecular Biology in Medicine and Gene Therapy, University of Guadalajara, CUCS, Guadalajara 44340, Jalisco, Mexico
- Correspondence: (J.G.-C.); (J.A.-B.); Tel.: +52-331-062-2083 (J.G.-C.); +52-333-677-8741 (J.A.-B.)
| | - Arturo Santos
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Campus Guadalajara, Zapopan 45201, Jalisco, Mexico;
| | - Juan Armendariz-Borunda
- Department of Molecular Biology and Genomics, Institute for Molecular Biology in Medicine and Gene Therapy, University of Guadalajara, CUCS, Guadalajara 44340, Jalisco, Mexico
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Campus Guadalajara, Zapopan 45201, Jalisco, Mexico;
- Correspondence: (J.G.-C.); (J.A.-B.); Tel.: +52-331-062-2083 (J.G.-C.); +52-333-677-8741 (J.A.-B.)
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Natarajan H, Shanthi Rani CS, Krishna Kumar D, Anjana RM, Ranjit U, Venkatesan U, Uma Sankari G, Pradeepa R, Mohan V, Deepa M. Future risk of diabetes among Indians with metabolic and phenotypic obesity: Results from the 10-year follow-up of the Chennai Urban Rural Epidemiology Study (CURES-158). Acta Diabetol 2021; 58:1051-1058. [PMID: 33759049 DOI: 10.1007/s00592-021-01698-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/27/2021] [Indexed: 12/19/2022]
Abstract
AIM To investigate the risk of type 2 diabetes (T2DM) among the combinations of BMI categories and metabolic syndrome in Asian Indians. MATERIALS AND METHODS Individuals from the Chennai Urban Rural Epidemiology Study cohort (n = 1,368), free of diabetes at baseline were stratified by BMI and metabolic health as metabolically healthy non-obese (MHNO), metabolically healthy obese (MHO), metabolically obese non-obese (MONO) and metabolically obese obese (MOO). Phenotypic obesity was defined as BMI ≥ 25 kg/m2 and metabolic obesity as presence of any two of the metabolic abnormalities: hyperglycemia, high blood pressure, high triglyceridemia or low HDL cholesterol. Hazard ratios for progression to diabetes were estimated using Cox proportional hazard regression. RESULTS During median 9.1 years of follow-up, incident cases of diabetes were highest among MOO-45.1%, followed by MONO-41.3%, MHO-27.1% and MHNO-15.9%. Incidence rates of diabetes among MOO, MONO, MHO and MHNO were 57.8, 50.9, 30.4 and 18.1 per 1000 person years, respectively. Hazard ratio for diabetes development were 1.71 in MHO, 2.87 in MONO, and 3.39 in MOO compared with MHNO. CONCLUSIONS Increased BMI and metabolic risk factor clustering independently contribute to the increased risk of T2DM in obese individuals. Screening for metabolic abnormalities should be performed routinely in clinic to identify high-risk individuals and institute appropriate preventive measures.
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Affiliation(s)
- Hariharasudan Natarajan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Center for Advanced Research on Diabetes, No 4, Conran Smith Road, Gopalapuram, Chennai, 600086, India
| | - Coimbatore Subramanian Shanthi Rani
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Center for Advanced Research on Diabetes, No 4, Conran Smith Road, Gopalapuram, Chennai, 600086, India
| | - Dharman Krishna Kumar
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Center for Advanced Research on Diabetes, No 4, Conran Smith Road, Gopalapuram, Chennai, 600086, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Center for Advanced Research on Diabetes, No 4, Conran Smith Road, Gopalapuram, Chennai, 600086, India
| | - Unnikrishnan Ranjit
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Center for Advanced Research on Diabetes, No 4, Conran Smith Road, Gopalapuram, Chennai, 600086, India
| | - Ulagamathesan Venkatesan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Center for Advanced Research on Diabetes, No 4, Conran Smith Road, Gopalapuram, Chennai, 600086, India
| | - Ganesan Uma Sankari
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Center for Advanced Research on Diabetes, No 4, Conran Smith Road, Gopalapuram, Chennai, 600086, India
| | - Rajendra Pradeepa
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Center for Advanced Research on Diabetes, No 4, Conran Smith Road, Gopalapuram, Chennai, 600086, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Center for Advanced Research on Diabetes, No 4, Conran Smith Road, Gopalapuram, Chennai, 600086, India.
| | - Mohan Deepa
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Center for Advanced Research on Diabetes, No 4, Conran Smith Road, Gopalapuram, Chennai, 600086, India
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11
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Potential of Erythrocyte Membrane Lipid Profile as a Novel Inflammatory Biomarker to Distinguish Metabolically Healthy Obesity in Children. J Pers Med 2021; 11:jpm11050337. [PMID: 33922764 PMCID: PMC8145511 DOI: 10.3390/jpm11050337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 02/07/2023] Open
Abstract
Metabolically healthy obesity (MHO) has been described as BMI ≥ 30 kg/m2, without metabolic disorders traditionally associated with obesity. Beyond this definition, a standardized criterion, for adults and children, has not been established yet to explain the absence of those metabolic disorders. In this context, biomarkers of inflammation have been proposed as suitable candidates to describe MHO. The use of mature red blood cell fatty acid (RBC FA) profile is here proposed since its membrane lipidome includes biomarkers of pro- and anti-inflammatory conditions with a strict relationship with metabolic and nutritional status. An observational study was carried out in 194 children (76 children with obesity and 118 children with normal weight) between 6 and 16 years old. RBC FAs were analyzed by gas chromatography-flame ionization detector (GC-FID). An unsupervised hierarchical clustering method was conducted on children with obesity, based on the RBC FA profile, to isolate the MHO cluster. The MHO cluster showed FA levels similar to children with normal weight, characterized by lower values of arachidonic acid, (total ω-6 FA, ω6/ω3 FA ratios and higher values for EPA, DHA, and total ω-3 FA) (for all of them p ≤ 0.01) compared to the rest of the children with obesity (obese cluster). The MHO cluster also presented lipid indexes for higher desaturase enzymatic activity and lower SFA/MUFA ratio compared to the obese cluster. These differences are relevant for the follow-up of patients, also in view of personalized protocols providing tailored nutritional recommendations for the essential fatty acid intakes.
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12
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Gómez-Zorita S, Queralt M, Vicente MA, González M, Portillo MP. Metabolically healthy obesity and metabolically obese normal weight: a review. J Physiol Biochem 2021; 77:175-189. [PMID: 33704694 DOI: 10.1007/s13105-020-00781-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 12/23/2020] [Indexed: 02/07/2023]
Abstract
Despite the general relationship between obesity and its co-morbidities, there are both obese individuals who scarcely present the associated pathologies (metabolically healthy obese; MHO) and individuals who present obesity alterations despite having normal weight (metabolically obese normal weight; MONW). It is still difficult to define metabolically MHO and MONW individuals because different classifications have been used in the studies reported. Indeed, different inclusion criteria have been used to discriminate between metabolically healthy and metabolically unhealthy subjects. Due to this and other reasons, such as differences in ethnicity, genetics, and lifestyle of the populations, data concerning the prevalence of MHO and MONW are very variable. The main determinants of MHO are type of growth (hypertrophy or hyperplasia), anatomical location, inflammation of adipose tissue, ectopic fat accumulation, genetic factors, and lifestyles factors. In the case of MONW, the main determinants are genetic background and lifestyle factors. With regard to treatment, it is not clear whether MHO subjects would benefit from traditional lifestyle interventions, based on diet energy restriction and increased physical activity. For MONW subjects, there is still no specialized treatment, and the therapies are the same as those used in obese subjects.
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Affiliation(s)
- Saioa Gómez-Zorita
- Nutrition and Obesity Group. Department of Nutrition and Food Science, University of the Basque Country (UPV/EHU) and Lucio Lascaray Research Institute, Vitoria, Spain. .,BIOARABA Health Research Institute, Vitoria, Spain. .,CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Vitoria, Spain.
| | - Maite Queralt
- Nutrition and Obesity Group. Department of Nutrition and Food Science, University of the Basque Country (UPV/EHU) and Lucio Lascaray Research Institute, Vitoria, Spain
| | - Maria Angeles Vicente
- BIOARABA Health Research Institute, Vitoria, Spain.,Alava University Hospital (Osakidetza), Vitoria, Spain
| | - Marcela González
- Nutrition and Food Science Department, Faculty of Biochemistry and Biological Sciences, National University of Litoral and National Scientific and Technical Research Council (CONICET), 3000, Santa Fe, Argentina
| | - María P Portillo
- Nutrition and Obesity Group. Department of Nutrition and Food Science, University of the Basque Country (UPV/EHU) and Lucio Lascaray Research Institute, Vitoria, Spain.,BIOARABA Health Research Institute, Vitoria, Spain.,CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Vitoria, Spain
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13
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Healthy Obese Subjects Differ in Chronotype, Sleep Habits, and Adipose Tissue Fatty Acid Composition from Their Non-Healthy Counterparts. Nutrients 2020; 13:nu13010119. [PMID: 33396200 PMCID: PMC7824395 DOI: 10.3390/nu13010119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/22/2020] [Accepted: 12/26/2020] [Indexed: 02/06/2023] Open
Abstract
Obesity is not the same in all individuals and two different phenotypes have been described: metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO). The aim of this study was to identify factors that explain metabolic health status in a rigorously matched Spanish population. Subcutaneous and visceral fat, adipocyte size and fatty acid composition, cardiometabolic markers in serum, and lifestyle habits were assessed. Higher physical activity in the mornings (Odds Ratio (95% Confidence Interval) (OR (95% CI) = 1.54 (1.09–2.18), p = 0.01)), earlier bedtimes (8:30–10:30 pm) (OR = 2.11 (1.02–4.36), p = 0.04), a complete breakfast (OR = 1.59 (1.07–2.36), p = 0.02), and a greater number of meals per day (4.10 ± 0.05 vs. 3.93 ± 0.05, p < 0.01), were associated with the MHO phenotype. Concentrations of 20:5 n-3 eicosapentaenoic acid (0.26 ± 0.46 vs. 0.10% ± 0.11%, p = 0.04) and 18:3 n-6 gamma-linolenic acid (0.37 ± 0.24 vs. 0.23% ± 0.22%, p = 0.04) in subcutaneous adipocytes were higher and omental adipocyte size (187 094 ± 224 059 µm3 vs. 490 953 ± 229 049 µm3, p = 0.02) was lower in MHO subjects than in those with MUO. Visceral fat area differed between MHO and MUO subjects (135 ± 60 cm2 vs. 178 ± 85 cm2, p = 0.04, respectively). The study highlights specific lifestyle habits that could form part of obesity therapies, not only involving healthier eating habits but also earlier sleeping and exercise patterns.
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14
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Intervertebral Disc and Adipokine Leptin-Loves Me, Loves Me Not. Int J Mol Sci 2020; 22:ijms22010375. [PMID: 33396484 PMCID: PMC7795371 DOI: 10.3390/ijms22010375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 12/25/2022] Open
Abstract
Leptin—the most famous adipose tissue-secreted hormone—in the human body is mostly observed in a negative connotation, as the hormone level increases with the accumulation of body fat. Nowadays, fatness is becoming another normal body shape. Fatness is burdened with numerous illnesses—including low back pain and degenerative disease of lumbar intervertebral disc (IVD). IVD degeneration and IVD inflammation are two indiscerptible phenomena. Irrespective of the underlying pathophysiological background (trauma, obesity, nutrient deficiency), the inflammation is crucial in triggering IVD degeneration. Leptin is usually depicted as a proinflammatory adipokine. Many studies aimed at explaining the role of leptin in IVD degeneration, though mostly in in vitro and on animal models, confirmed leptin’s “bad reputation”. However, several studies found that leptin might have protective role in IVD metabolism. This review examines the current literature on the metabolic role of different depots of adipose tissue, with focus on leptin, in pathogenesis of IVD degeneration.
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15
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Smith GI, Mittendorfer B, Klein S. Metabolically healthy obesity: facts and fantasies. J Clin Invest 2020; 129:3978-3989. [PMID: 31524630 DOI: 10.1172/jci129186] [Citation(s) in RCA: 326] [Impact Index Per Article: 81.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Although obesity is typically associated with metabolic dysfunction and cardiometabolic diseases, some people with obesity are protected from many of the adverse metabolic effects of excess body fat and are considered "metabolically healthy." However, there is no universally accepted definition of metabolically healthy obesity (MHO). Most studies define MHO as having either 0, 1, or 2 metabolic syndrome components, whereas many others define MHO using the homeostasis model assessment of insulin resistance (HOMA-IR). Therefore, numerous people reported as having MHO are not metabolically healthy, but simply have fewer metabolic abnormalities than those with metabolically unhealthy obesity (MUO). Nonetheless, a small subset of people with obesity have a normal HOMA-IR and no metabolic syndrome components. The mechanism(s) responsible for the divergent effects of obesity on metabolic health is not clear, but studies conducted in rodent models suggest that differences in adipose tissue biology in response to weight gain can cause or prevent systemic metabolic dysfunction. In this article, we review the definition, stability over time, and clinical outcomes of MHO, and discuss the potential factors that could explain differences in metabolic health in people with MHO and MUO - specifically, modifiable lifestyle factors and adipose tissue biology. Better understanding of the factors that distinguish people with MHO and MUO can produce new insights into mechanism(s) responsible for obesity-related metabolic dysfunction and disease.
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16
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Abstract
A peculiar category of persons with obesity lacking common metabolic disturbances has been depicted and termed as metabolically healthy obesity (MHO). Yet, although MHO patients are free of obesity-associated complications, they might not be entirely precluded from developing cardio-metabolic disorders. Among patients with morbid obesity (MO) who are referred to bariatric surgery, a subset of metabolically healthy MO (MHMO) has been identified and the question arises if these patients would benefit from surgery in terms of mitigating the peril of cardio-metabolic complications. We revisited the pathophysiological mechanisms that define MHO, the currently available data on the cardio-metabolic risk of these patients and finally we reviewed the benefits of bariatric surgery and the urge to better characterize MHMO before submission to surgery.
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Affiliation(s)
- Adriana Florinela Cătoi
- Pathophysiology Department, Faculty of Medicine, 'Iuliu Hațieganu', University of Medicine and Pharmacy Cluj-Napoca Romania, Cluj-Napoca, Romania.
| | - Luca Busetto
- Department of Medicine, University of Padova, Padua, Italy
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17
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Lagacé JC, Brochu M, Dionne IJ. A counterintuitive perspective for the role of fat-free mass in metabolic health. J Cachexia Sarcopenia Muscle 2020; 11:343-347. [PMID: 31999082 PMCID: PMC7113531 DOI: 10.1002/jcsm.12520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Fat-free mass (FFM) has long been recognized to play a role in metabolic homeostasis. Over the years, it has become widely accepted by the scientific and general community alike that having a greater FFM can be protective for metabolic health. Hence, in the context of an aging population concurrently facing sarcopenia and an elevated incidence of metabolic diseases, substantial efforts are being made to study and develop interventions aiming to maintain or increase FFM. However, accumulating evidence now suggests that a large FFM may be deleterious to metabolic health, at least in some populations. The objective of this article is thus to raise awareness surrounding these results and to explore possible explanations and mechanisms underlying this counterintuitive association.
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Affiliation(s)
- Jean-Christophe Lagacé
- Metabolic Unit, Research Centre on Aging, CIUSSS de l'Estrie-CHUS, Québec, Canada.,Faculty of Physical Activity Sciences, University of Sherbrooke, Québec, Canada
| | - Martin Brochu
- Metabolic Unit, Research Centre on Aging, CIUSSS de l'Estrie-CHUS, Québec, Canada.,Faculty of Physical Activity Sciences, University of Sherbrooke, Québec, Canada
| | - Isabelle J Dionne
- Metabolic Unit, Research Centre on Aging, CIUSSS de l'Estrie-CHUS, Québec, Canada.,Faculty of Physical Activity Sciences, University of Sherbrooke, Québec, Canada
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18
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Metabolically Healthy Obesity-Heterogeneity in Definitions and Unconventional Factors. Metabolites 2020; 10:metabo10020048. [PMID: 32012784 PMCID: PMC7074352 DOI: 10.3390/metabo10020048] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 02/06/2023] Open
Abstract
The concept of heterogeneity among obese individuals in their risk for developing metabolic dysfunction and associated complications has been recognized for decades. At the origin of the heterogeneity idea is the acknowledgement that individuals with central obesity are more prone to developing type 2 diabetes and cardiovascular disease than those with peripheral obesity. There have been attempts to categorize subjects according to their metabolic health and degree of obesity giving rise to different obese and non-obese phenotypes that include metabolically unhealthy normal-weight (MUHNW), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO). Individuals belonging to the MHO phenotype are obese according to their body mass index although exhibiting fewer or none metabolic anomalies such as type 2 diabetes, dyslipidemia, hypertension, and/or unfavorable inflammatory and fribinolytic profiles. However, some authors claim that MHO is only transient in nature. Additionally, the phenotype categorization is controversial as it lacks standardized definitions possibly blurring the distinction between obesity phenotypes and confounding the associations with health outcomes. To add to the discussion, the factors underlying the origin or protection from metabolic deterioration and cardiometabolic risk for these subclasses are being intensely investigated and several hypotheses have been put forward. In the present review, we compare the different definitions of obesity phenotypes and present several possible factors underlying them (adipose tissue distribution and cellularity, contaminant accumulation on the adipose tissue, dysbiosis and metabolic endotoxemia imposing on to the endocannabinoid tone and inflammasome, and nutrient intake and dietary patterns) having inflammatory activation at the center.
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19
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MacLeod L, Bouchard DR, Hébert JJ, Boudreau JG, Sénéchal M. Association Between a Comprehensive Movement Assessment and Metabolically Healthy Overweight Obese Adults. Sci Rep 2020; 10:1173. [PMID: 31980712 PMCID: PMC6981154 DOI: 10.1038/s41598-020-58089-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 01/10/2020] [Indexed: 11/18/2022] Open
Abstract
Physical activity (PA) and sedentary behavior are associated with metabolic health in overweight and obese individuals. However, the role of comprehensive health-related movement guidelines on PA, recreational screen time, and sleep among Metabolically Healthy Overweight-Obese (MHO) individuals is unknown. We investigated differences in comprehensive movement assessment scores between adults classified as MHO or Non-MHO. The sample included 513 adults (46.2% male), aged 19 to 85 years, body mass index (BMI) ≥ 25, from cycle 2005–2006 of the National Health and Nutrition Examination Survey. Comprehensive movement assessment outcomes were defined as meeting modified 24-Hour Movement Guidelines criteria, with thresholds adapted for adults. 13.8% of participants were MHO (normal serum glucose, triglycerides, HDL-cholesterol, and systolic and diastolic blood pressure). Only 1.4% of MHO participants met all guidelines. MHO and Non-MHO participants had similar comprehensive movement assessment scores (MHO: 18.3% vs. Non-MHO: 10.9%; p = 0.072). MHO individuals had less continuous recreational screen time than Non-MHO individuals (1.8 ± 1.4 hrs/day vs. 2.5 ± 1.6 hrs/day; p < 0.001). Meeting the recreational screen time recommendation was the only variable associated with the MHO phenotype (OR:4.84 95%CI: 2.33–10.07). This association remained after adjusting for age, sex, ethnicity, education, and BMI (OR: 3.53 95%CI: 1.72–7.24). Our results suggest the importance of limiting recreational screen time in adults to optimize cardiometabolic risk profile in individuals living with overweight or obesity. Using movement guidelines with a screen time component to assess the risk associated with health outcomes in adults appears to provide a better assessment.
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Affiliation(s)
- Luke MacLeod
- Cardiometabolic Exercise & Lifestyle Laboratory, University of New Brunswick, 90 Mackay Drive, Fredericton, New Brunswick, E3B 5A3, Canada
| | - Danielle R Bouchard
- Cardiometabolic Exercise & Lifestyle Laboratory, University of New Brunswick, 90 Mackay Drive, Fredericton, New Brunswick, E3B 5A3, Canada.,Faculty of Kinesiology, University of New Brunswick, 90 Mackay Drive, Fredericton, New Brunswick, E3B 5A3, Canada
| | - Jeffrey J Hébert
- Faculty of Kinesiology, University of New Brunswick, 90 Mackay Drive, Fredericton, New Brunswick, E3B 5A3, Canada.,School of Psychology and Exercise Science, Murdoch University, 90 South Street, Murdoch, Western Australia, Australia
| | - Jonathan G Boudreau
- New Brunswick Institute for Research, Data and Training, University of New Brunswick, 38 Dineen Drive, 304F Keirstead Hall, Fredericton, New Brunswick, E3B 5A3, Canada
| | - Martin Sénéchal
- Cardiometabolic Exercise & Lifestyle Laboratory, University of New Brunswick, 90 Mackay Drive, Fredericton, New Brunswick, E3B 5A3, Canada. .,Faculty of Kinesiology, University of New Brunswick, 90 Mackay Drive, Fredericton, New Brunswick, E3B 5A3, Canada.
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20
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Ma LZ, Huang YY, Wang ZT, Li JQ, Hou XH, Shen XN, Ou YN, Dong Q, Tan L, Yu JT, Initiative ADN. Metabolically healthy obesity reduces the risk of Alzheimer's disease in elders: a longitudinal study. Aging (Albany NY) 2019; 11:10939-10951. [PMID: 31789604 PMCID: PMC6932886 DOI: 10.18632/aging.102496] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 11/17/2019] [Indexed: 01/09/2023]
Abstract
A subgroup of overweight/obese individuals, who had favorable metabolic profiles, was termed as metabolically healthy overweight/obese (MHO). Several studies suggested that MHO individuals were not at increased risk of cardiovascular disease and all-course mortality. However, whether MHO is associated with excess risk of Alzheimer’s disease (AD) in elders remains unclear. To explore the risk of AD among MHO phenotype and investigate whether MHO associates with neurodegenerative biomarkers of AD, we assessed body mass index-metabolic status phenotypes of 1199 longitudinal elders from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort using the Adult Treatment Panel-III (ATP- III) criteria. MHO subjects were at a significantly decreased risk for AD (adjusted HR=0.73, 95% CI: 0.54-0.97) compared with metabolically healthy normal weight (MHNW) subjects. In multivariable linear regression models, the cross-sectional associations of MHO with cerebrospinal fluid (CSF) biomarkers, brain Aβ load, and cortical structure were explored. MHO was positively correlated with CSF-Aβ (β=0.746, P=0.015), hippocampal volume (β=0.181, P=0.011), and whole brain volume (β=0.133, P=0.004). The MHO phenotype of the elder conferred a decreased risk of AD and its role may be driven by Aβ.
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Affiliation(s)
- Ling-Zhi Ma
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Yu-Yuan Huang
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zuo-Teng Wang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Jie-Qiong Li
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Xiao-He Hou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Xue-Ning Shen
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ya-Nan Ou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Qiang Dong
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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21
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Raczkowska E, Bronkowska M. The Effect of the Body Mass Indexes of Young Healthy Individuals on the Glyacemic Indexes of Traditional and Modified Vegetarian Meals. Nutrients 2019; 11:E2546. [PMID: 31652553 PMCID: PMC6835997 DOI: 10.3390/nu11102546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 11/16/2022] Open
Abstract
Blood glucose concentration increases after the consumption of any carbohydrate-containing meal. Several factors affect the course of glucose metabolism, including nutritional status. This study evaluated the effect of the nutritional statuses of adults on their glycaemic responses after the consumption of some vegetarian meals (dumplings with potato and curd cheese stuffing; curd cheese dumplings; pancakes with curd cheese), prepared according to the traditional recipe and a partly modified recipe. The 105 participants, aged 20-27 years, with different body mass indexes (BMI), took an oral glucose tolerance test after the intake of a standard glucose solution, and also after each meal (previously analysed for energy value and approximate composition). The consumption of each meal by participants with different nutritional statuses elicited different glycaemic responses, which were reflected in the diverse glycaemic indexes (GIs). The partial modification of the meal recipes contributed to lowering their GIs. Vast differences were observed in the glycaemic responses among the surveyed participants after the consumption of the same meals. The GIs of meals should be determined in different groups of people.
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Affiliation(s)
- Ewa Raczkowska
- Department of Human Nutrition, Faculty of Biotechnology and Food Sciences, Wrocław University of Environmental and Life Sciences, 51-630 Wrocław, Poland.
| | - Monika Bronkowska
- Department of Human Nutrition, Faculty of Biotechnology and Food Sciences, Wrocław University of Environmental and Life Sciences, 51-630 Wrocław, Poland.
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22
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Camhi SM, Must A, Gona PN, Hankinson A, Odegaard A, Reis J, Gunderson EP, Jacobs DR, Carnethon MR. Duration and stability of metabolically healthy obesity over 30 years. Int J Obes (Lond) 2019; 43:1803-1810. [PMID: 30158567 PMCID: PMC6395568 DOI: 10.1038/s41366-018-0197-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/19/2018] [Accepted: 07/30/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Obese adults who are free from metabolic risk factors may develop risk factors over time. Our objective was to characterize development of obesity and duration of metabolically healthy obese (MHO) over 30 years. METHODS Participants in CARDIA who developed obesity (BMI ≥ 30 kg/m2) at follow-up exams during years 7, 10, 15, 20, 25, and 30 were analyzed. MHO was defined as obese and having 0 or 1 risk factor: ≥SBP/DBP 130/85 mmHg; fasting glucose ≥100 mg/dL/5.55 mmol/L; fasting triglycerides (≥150 mg/dL/1.69 mmol/L); and HDL-C (men <40 mg/dL/1.036 mmol/L, women <50 mg/dL/1.295 mmol/L) or on any medication(s) for these conditions. MHO duration (years) and obesity duration (years) were estimated for each subsequent time-point; and an overall cumulative duration was also calculated over available follow-up. MHO duration (%) was approximated as MHO duration ÷ obesity duration. Stable MHO was defined as 100% MHO duration over follow-up, while transient MHO was defined as <1-99%. Chi-squared tests were used to compare proportions by sex and race across obesity phenotypes. Multivariable-adjusted ANCOVA, adjusting for baseline BMI, age, race, and sex, was used to analyze obesity duration in all individuals who developed obesity, and also compare MHO duration (%) across race and sex in transient MHO individuals. RESULTS Of the 987 eligible participants who developed obesity, 51% were African American (AA), 56% were women. Higher percentages of AA were classified as transient MHO, and higher proportions of females were MHO (both p < 0.0001). Obesity duration (years) was higher in transient MHO compared with stable MHO (mean difference: 6.2 ± 0.5 years, p < 0.0001). Of those with transient MHO, African Americans (51.4 ± 1.6%) were more likely to have longer MHO duration compared to Caucasians (44.4 ± 1.9%, p = 0.005). CONCLUSION MHO status can be a transient phenotype which differs by sex and race. Future studies are needed to explore modifiable lifestyle/behavioral predictors associated with longer MHO duration.
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Affiliation(s)
| | | | | | | | | | - Jared Reis
- National Heart, Lung, and Blood Institute at the National Institutes of Health, Bethesda, MD, USA
| | - Erica P Gunderson
- Cardiovascular and Metabolic Conditions Section, Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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Kang EY, Yim JE. Differences in dietary intakes, body compositions, and biochemical indices between metabolically healthy and metabolically abnormal obese Korean women. Nutr Res Pract 2019; 13:488-497. [PMID: 31814924 PMCID: PMC6883231 DOI: 10.4162/nrp.2019.13.6.488] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/22/2018] [Accepted: 06/17/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND/OBJECTIVES There are various factors that affect metabolic abnormalities related to obesity. The purpose of this study is to analyze the differences in dietary intakes and body compositions of obese women according to metabolic risks and to classify them as metabolically healthy obese (MHO) or metabolically abnormal obese (MAO). SUBJECTS/METHODS This study was conducted on 59 obese Korean women aged 19 to 60 years. NCEP-ATPIII criteria were applied and the women classified as MHO (n = 45) or MAO (n = 14). Body composition of each subject was measured by using dual-energy x-ray absorptiometry (DEXA). Three-day food records were used to analyze dietary intake. Eating habits and health-related behaviors were determined through questionnaires. Indirect calorimetry was used to measure resting metabolic rate and respiratory rate. RESULTS The average age of the subjects was 43.7 years. The analysis of body composition according to phenotype revealed significantly higher body fat mass (P < 0.05), arm fat mass (P < 0.05), and android fat mass (P < 0.05), as measured by DEXA, in the MAO group than in the MHO group. There was no significant difference in the dietary intake of the two groups. However, eating behaviors differed. Compared to the MHO group, the MAO women had a shorter meal time (less than 10 minutes), a preference of oily foods, and a tendency to eat until full. Therefore, the eating habits of MHO women were more positive than those of MAO women. CONCLUSIONS The results suggest that fat distribution in each body region affects various metabolic abnormalities. A high level of arm fat mass in obese Korean women may increase metabolic risk. In addition, eating habits of obese Korean women are considered to be environmental factors affecting the metabolic phenotype of obese Korean women.
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Affiliation(s)
- Eun Yeong Kang
- Department of Food and Nutrition, Changwon National University, 20 Changwondaehak-ro Uichang-gu, Changwon 51140, Korea
| | - Jung-Eun Yim
- Department of Food and Nutrition, Changwon National University, 20 Changwondaehak-ro Uichang-gu, Changwon 51140, Korea
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Yu X, Wang L, Zhang W, Ming J, Jia A, Xu S, Li Q, Ji Q. Fasting triglycerides and glucose index is more suitable for the identification of metabolically unhealthy individuals in the Chinese adult population: A nationwide study. J Diabetes Investig 2019; 10:1050-1058. [PMID: 30417578 PMCID: PMC6626942 DOI: 10.1111/jdi.12975] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/29/2018] [Accepted: 11/04/2018] [Indexed: 01/07/2023] Open
Abstract
AIMS/INTRODUCTION Metabolic unhealth can be defined by the components of metabolic syndrome, which is closely connected to insulin resistance. We aimed to determine a simple index to identify metabolic unhealth in the Chinese adult population. MATERIALS AND METHODS A total of 30,291 individuals were screened from the China National Diabetes and Metabolic Disorders Study carried out from June 2007 to May 2008. Metabolic unhealth was defined using components of metabolic syndrome, except waist circumference. We compared the three surrogate indices of insulin resistance: the product of fasting triglycerides and glucose (TyG), triglycerides divided by high-density lipoprotein cholesterol and the metabolic score for insulin resistance for the evaluation of metabolic status. RESULTS All indices had high sensitivity and specificity for the identification of metabolic unhealth, especially the TyG index with an area under the curve of 0.863 for men and 0.867 for women. Participants were divided into subgroups for further analysis. The TyG index also showed high diagnostic values, especially for younger individuals and men with normal waist circumference. Sex-specific cut-offs for three indices were also used to define metabolic unhealth. The TyG index showed the highest agreement with κ values of 0.603 and 0.605 for men and women between the components of metabolic syndrome and three indices. CONCLUSIONS We propose that the TyG index, just read in one blood laboratory test report, is simpler and more suitable for the identification of metabolically unhealthy individuals as well as who have high risk of cardiometabolic diseases of the Chinese adult population.
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Affiliation(s)
- Xinwen Yu
- Department of EndocrinologyXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Li Wang
- Department of EndocrinologyXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Wencheng Zhang
- Department of EndocrinologyXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Jie Ming
- Department of EndocrinologyXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Aihua Jia
- Department of EndocrinologyXijing HospitalThe Fourth Military Medical UniversityXi'anChina
- Department of EndocrinologyThe First Hospital of YulinYulinChina
| | - Shaoyong Xu
- Department of EndocrinologyXiangyang Central Hospital of Hubei University of Arts and ScienceXiangyangChina
- Department of Health StatisticsFaculty of Preventive MedicineThe Fourth Military Medical UniversityXi'anChina
| | - Qiaoyue Li
- Department of EndocrinologyXijing HospitalThe Fourth Military Medical UniversityXi'anChina
| | - Qiuhe Ji
- Department of EndocrinologyXijing HospitalThe Fourth Military Medical UniversityXi'anChina
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25
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Mustafina SV, Shcherbakova LV, Kozupeeva DA, Malyutina SK, Ragino YI, Rymar OD. Тhe prevalence of metabolically healthy obesity: data from the epidemiological survey in of Novosibirsk. OBESITY AND METABOLISM 2019. [DOI: 10.14341/omet9615] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Obesity is associated with numerous metabolic complications, such as type 2 diabetes mellitus (DM2), dyslipidemia, arterial hypertension (AH), cardiovascular diseases and some forms of cancer. Nevertheless, the literature describes a group of obese individuals who are more resistant to the development of metabolic disorders. At present, this phenomenon is known as "Metabolically healthy obesity", "metabolically healthy obesity" (MZO). Despite the presence of excess weight or obesity, a favorable metabolic profile can be observed in this cohort of patients, characterized by preserved insulin sensitivity, absence of arterial hypertension, normal lipid, hormonal profile, absence of inflammation and unchanged hepatic transaminases.
Aims: To study the prevalence of metabolically healthy obesity (MHO) and its characteristics in men and women at the age of 4569 years in Novosibirsk.
Materials and methods: To study covered 3197 persons from the base of the international project HAPPIE. They had a body mass index (BMI 30 kg/m). Metabolically healthy obesity was determined as obesity (BMI 30 kg/m, with 2 and fewer components of metabolic syndrome (MS) by criteria NCEP ATP III, 2001. Statistical analisys SPSS-13.
Results: The prevalence of metabolic healthy obesity (MHO) was 42% (38% for men and 43% for women). The examined people with MHO have reliably more favorable average level of TG, HDL-cholesterol, indicators of blood glucose, systolic arterial pressure and diastolic arterial pressure and less waist circumference. In the groups withMHO and MS abdominal obesity is common in men at 95 and 71%, in women at 99 and 90%; hyperTG in men at 74 and 9%, in women at 72 and 5,5%; lower level HDL-cholesterol in 16 and 1% for men, and in 44,5% and 3% for women; AP in 96 and 77% and 94 and 71% in men and women respectively, the frequency fasting of hyperglycaemia 77 and 21% in men and 60 and 5% in women was markedly different. According to the data obtained by us, the frequency in the sample is high and amounted to 42%. In the subgroup the most commonly found is the MHO phenotype 53%, than in the men -38%, р 0,001
Conclusions: According to our data, the frequency of metabolic healthy obesity in the sample is high and amounted to 42%. In the female subgroup, a metabolically healthy phenotype is more common 43% than in the male 38%, p 0.001. Metabolically healthy obese individuals are characterized by a significantly lower incidence of fasting hyperglycaemia and dyslipidemia.
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Cirulli ET, Guo L, Leon Swisher C, Shah N, Huang L, Napier LA, Kirkness EF, Spector TD, Caskey CT, Thorens B, Venter JC, Telenti A. Profound Perturbation of the Metabolome in Obesity Is Associated with Health Risk. Cell Metab 2019; 29:488-500.e2. [PMID: 30318341 PMCID: PMC6370944 DOI: 10.1016/j.cmet.2018.09.022] [Citation(s) in RCA: 205] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 06/27/2018] [Accepted: 09/25/2018] [Indexed: 12/29/2022]
Abstract
Obesity is a heterogeneous phenotype that is crudely measured by body mass index (BMI). There is a need for a more precise yet portable method of phenotyping and categorizing risk in large numbers of people with obesity to advance clinical care and drug development. Here, we used non-targeted metabolomics and whole-genome sequencing to identify metabolic and genetic signatures of obesity. We find that obesity results in profound perturbation of the metabolome; nearly a third of the assayed metabolites associated with changes in BMI. A metabolome signature identifies the healthy obese and lean individuals with abnormal metabolomes-these groups differ in health outcomes and underlying genetic risk. Specifically, an abnormal metabolome associated with a 2- to 5-fold increase in cardiovascular events when comparing individuals who were matched for BMI but had opposing metabolome signatures. Because metabolome profiling identifies clinically meaningful heterogeneity in obesity, this approach could help select patients for clinical trials.
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Affiliation(s)
| | | | | | - Naisha Shah
- Human Longevity, Inc., San Diego, CA 92121, USA
| | - Lei Huang
- Human Longevity, Inc., San Diego, CA 92121, USA
| | | | | | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - C Thomas Caskey
- Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Bernard Thorens
- Center for Integrative Genomics, University of Lausanne, Lausanne, Switzerland
| | | | - Amalio Telenti
- The Scripps Research Institute, La Jolla, CA 92037, USA.
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Cavero-Redondo I, Sui X, Blair SN, Lavie CJ, Álvarez-Bueno C, Martínez-Vizcaíno V. Lifetime predictors of stroke in subjects without a diagnosis of hypertension: the aerobics center longitudinal study. Neuropsychiatr Dis Treat 2019; 15:849-856. [PMID: 31040684 PMCID: PMC6459140 DOI: 10.2147/ndt.s193842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND PURPOSE Although several studies have assessed the importance of traditional risk factors in predicting stroke, none have concurrently addressed the stroke-predicting ability of these risk factors across the lifespan of subjects without a hypertension (HTN) diagnosis. Thus, this study aimed to assess the importance of blood-pressure-related risk indicators, cardiorespiratory fitness (CRF), weight status, diabetes mellitus (DM), and lifestyle factors as predictors of stroke in different stages of life among non-hypertensive subjects. MATERIALS AND METHODS This study was a long-term follow-up study including 33,254 men and 10,598 women from the Aerobics Center Longitudinal Study (ACLS) who were 18-100 years old and did not have a HTN diagnosis at baseline. Logistic regression models were constructed using forward selection procedures for each age category, with stroke occurrence as the dependent variable, and pulse pressure (PP), mean arterial pressure (MAP), systolic blood pressure (SBP), smoking status, CRF, drinking behavior, DM status, and weight status as potential predictors. RESULTS In total, 507 subjects had a stroke during an average follow-up period of 17 years (range=1-34 years). Logistic regression models showed that MAP values (P=0.043) in those aged 19-39 years; SBP (P<0.001), CRF (P=0.001), weight status (P=0.005), and alcohol consumption (P=0.001) in those 40-60 years old; and CRF (P=0.002), weight status (P=0.005), and DM status (P=0.037) in those over 60 years old were predictors of stroke. CONCLUSION These findings suggest that, among individuals without a baseline HTN diagnosis, classic modifiable risk factors for stroke change across different stages of life.
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Affiliation(s)
- Iván Cavero-Redondo
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain,
| | - Xuemei Sui
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Steven N Blair
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Celia Álvarez-Bueno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain,
| | - Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain, .,Universidad Autónoma de Chile, Facultad de Ciencias de la Salud, Talca, Chile
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Davids SF, Matsha TE, Peer N, Erasmus RT, Kengne AP. Changes in Obesity Phenotype Distribution in Mixed-ancestry South Africans in Cape Town Between 2008/09 and 2014/16. Front Endocrinol (Lausanne) 2019; 10:753. [PMID: 31781031 PMCID: PMC6851026 DOI: 10.3389/fendo.2019.00753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/17/2019] [Indexed: 11/13/2022] Open
Abstract
Background: The concept of obesity phenotypes encompasses a different approach to evaluating the relationship between obesity and cardiometabolic diseases. Considering the minimal research on obesity phenotypes in Africa, we investigated these changes from 2008/09 to 2014/16 in the mixed ancestry population in Cape Town, South Africa. Methods: In all, 928 (2008/09) and 1969 (2014/16) ≥20 year old participants were included in two community-based cross-sectional studies. For obesity phenotype classification, a combination of body mass index (BMI) categories and prevalent cardiometabolic disease risk factors were used, with the presence of ≥2 cardiometabolic abnormalities defining abnormal metabolic status. Interaction tests were used to investigate changes in their distribution across the years of study. Results: Distribution of BMI categories differed significantly between the 2 years; normal weight, overweight and obese: 27.4, 27.4, and 45.3% in 2008/09 vs. 34.2, 23.6, and 42.2% in 2014/16 (p = 0.001). There was no differential effect in the distribution of obesity phenotypes pattern across the two time-points (interaction p = 0.126). Across BMI categories, levels of cardiometabolic risk factors linearly deteriorated in both metabolically healthy and abnormal participants (all p ≤ 0.018 for linear trends). Findings were not sensitive to the number of metabolic abnormalities included in the definition of obesity phenotypes. Conclusions: Our study showed negligible differences in obesity phenotypes over time, but a high burden of metabolic abnormalities among normal weight participants, and a significant proportion of metabolically health obese individuals. Further investigation is needed to improve risk stratification and cost-effective identification of individuals at high risk for cardiometabolic diseases.
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Affiliation(s)
- Saarah Fatoma Davids
- Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
- SAMRC/CPUT/Cardiometabolic Health Research Unit, Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Bellville, South Africa
| | - Tandi Edith Matsha
- SAMRC/CPUT/Cardiometabolic Health Research Unit, Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Bellville, South Africa
| | - Nasheeta Peer
- Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Rajiv Timothy Erasmus
- Department of Chemical Pathology, Faculty of Medicine and Health Sciences, and National Health Laboratory Service (NHLS), Stellenbosch University, Cape Town, South Africa
| | - Andre Pascal Kengne
- Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- *Correspondence: Andre Pascal Kengne
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29
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Wrzosek M, Wiśniewska K, Sawicka A, Tałałaj M, Nowicka G. Early Onset of Obesity and Adult Onset of Obesity as Factors Affecting Patient Characteristics Prior to Bariatric Surgery. Obes Surg 2018; 28:3902-3909. [PMID: 30022421 PMCID: PMC6223752 DOI: 10.1007/s11695-018-3381-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Patients who are slated for bariatric surgery vary in terms of their age at onset of obesity, duration of obesity, and their health complications. Therefore, we aimed to explore a relationship between the age at onset of obesity, metabolic parameters, and health problems in bariatric surgery candidates. METHODS A total of 469 unrelated adults with obesity prior to bariatric surgery were included in this study. The study group consisted of 246 individuals who became obese < 20 years of age, and 223 individuals who became obese ≥ 20 years. Clinical, biochemical, anthropometric assessments, and DXA-derived measures were taken. RESULTS Patients with early onset of obesity had a higher total body fat mass, and higher body fat percentage, and a 1.84 times higher risk of BMI above 40 kg/m2 than patients with adult onset of obesity (≥ 20 years). Multivariable logistic regression demonstrated that, among bariatric surgery candidates with early onset of obesity, the frequency of hypertension and type 2 diabetes was significantly lower than that in cases with an adult onset of obesity, despite a longer duration of obesity and higher BMI. CONCLUSIONS The age at which an individual reaches obesity has a significant impact on patient characteristics on the day he or she is evaluated for bariatric surgery. A younger age at obesity onset is a predicting factor for a higher BMI in patients, but they are less likely to clinically manifest well-established consequences of obesity, such as diabetes or hypertension, compared to patients with adult onset of obesity.
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Affiliation(s)
- Małgorzata Wrzosek
- Department of Biochemistry and Pharmacogenomics, and Center for Preclinical Studies, Medical University of Warsaw, Banacha 1, 02-097 Warsaw, Poland
| | - Klaudia Wiśniewska
- Farmakon (students’ scientific group) at Department of Biochemistry and Pharmacogenomics, Medical University of Warsaw, Warsaw, Poland
- Centre of Promotion of Healthy Nutrition and Physical Activity, Institute of Food and Nutrition, Warsaw, Poland
| | - Ada Sawicka
- Department of Geriatrics, Internal Medicine and Metabolic Bone Diseases, Medical Centre of Postgraduate Education, Prof. W. Orlowski Hospital in Warsaw, Warsaw, Poland
| | - Marek Tałałaj
- Department of Geriatrics, Internal Medicine and Metabolic Bone Diseases, Medical Centre of Postgraduate Education, Prof. W. Orlowski Hospital in Warsaw, Warsaw, Poland
| | - Grażyna Nowicka
- Department of Biochemistry and Pharmacogenomics, and Center for Preclinical Studies, Medical University of Warsaw, Banacha 1, 02-097 Warsaw, Poland
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Abstract
Individuals with obesity do not represent a single homogenous group in terms of cardio‐metabolic health prospects. The concept of metabolically healthy obesity is a crude way of capturing this heterogeneity and has resulted in a plethora of research linking to future outcomes to show that it is not a benign condition. By contrast, very few studies have looked back in time and modelled the life course processes and exposures that explain the heterogeneity in cardio‐metabolic health and morbidity and mortality risk among people with the same body mass index (BMI) (or waist circumference or percentage body fat). The aim of the Medical Research Council New Investigator Research Grant (MR/P023347/1) ‘Body size trajectories and cardio‐metabolic resilience to obesity in three United Kingdom birth cohorts’ is to reveal the body size trajectories, pubertal development patterns and other factors (e.g. early‐life adversity) that might attenuate the positive associations of adulthood obesity makers (e.g. BMI) with cardio‐metabolic disease risk factors and other outcomes, thereby providing some degree of protection against the adverse effects of obesity. This work builds on the Principle Investigator's previous research as part of the Cohort and Longitudinal Studies Enhancement Resources initiative and focuses on secondary data analysis in the nationally representative UK birth cohort studies (initiated in 1946, 1958 and 1970), which have life course body size and exposure data and a biomedical sweep in adulthood. The grant will provide novel evidence on the life course processes and exposures that lead to some people developing a cardio‐metabolic complication or disease or dying while other people with the same BMI do not. This paper details the grant's scientific rationale, research objectives and potential impact.
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Affiliation(s)
- W Johnson
- Loughborough University Loughborough UK
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31
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Kuk JL, Rotondi M, Sui X, Blair SN, Ardern CI. Individuals with obesity but no other metabolic risk factors are not at significantly elevated all-cause mortality risk in men and women. Clin Obes 2018; 8:305-312. [PMID: 29998631 PMCID: PMC6175472 DOI: 10.1111/cob.12263] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/04/2018] [Accepted: 05/29/2018] [Indexed: 12/25/2022]
Abstract
Studies have examined mortality risk for metabolically healthy obesity, defined as zero or one metabolic risk factors but not as zero risk factors. Thus, we sought to determine the independent mortality risk associated with obesity or elevated glucose, blood pressure or lipids in isolation or clustered together. The sample included 54 089 men and women from five cohort studies (follow-up = 12.8 ± 7.2 years and 4864 [9.0%] deaths). Individuals were categorized as having obesity or elevated glucose, blood pressure or lipids alone or clustered with obesity or another metabolic factor. In our study sample, 6% of individuals presented with obesity but no other metabolic abnormalities. General obesity (hazard ratios [HR], 95% CI = 1.10, 0.8-1.6) and abdominal obesity (HR = 1.24, 0.9-1.7) in the absence of metabolic risk factors were not associated with mortality risk compared to lean individuals. Conversely, diabetes, hypertension and dyslipidaemia in isolation were significantly associated with mortality risk (HR range = 1.17-1.94, P < 0.05). However, when using traditional approaches, obesity (HR = 1.12, 1.02-1.23) is independently associated with mortality risk after statistical adjustment for the other metabolic risk factors. Similarly, metabolically healthy obesity, when defined as zero or one risk factor, is also associated with increased mortality risk (HR = 1.15, 1.01-1.32) as compared to lean healthy individuals. Obesity in the absence of metabolic abnormalities may not be associated with higher risk for all-cause mortality compared to lean healthy individuals. Conversely, elevation of even a single metabolic risk factor is associated with increased mortality risk.
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Affiliation(s)
- J. L. Kuk
- School of Kinesiology and Health ScienceYork UniversityTorontoOntarioCanada
| | - M. Rotondi
- School of Kinesiology and Health ScienceYork UniversityTorontoOntarioCanada
| | - X. Sui
- Department of Exercise Science, Arnold School of Public HealthUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - S. N. Blair
- Department of Exercise Science, Arnold School of Public HealthUniversity of South CarolinaColumbiaSouth CarolinaUSA
- Department of Epidemiology and Biostatistics, Arnold School of Public HealthUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - C. I. Ardern
- School of Kinesiology and Health ScienceYork UniversityTorontoOntarioCanada
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Metabolically Healthy versus Unhealthy Morbidly Obese: Chronic Inflammation, Nitro-Oxidative Stress, and Insulin Resistance. Nutrients 2018; 10:nu10091199. [PMID: 30200422 PMCID: PMC6164113 DOI: 10.3390/nu10091199] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/23/2018] [Accepted: 08/29/2018] [Indexed: 01/09/2023] Open
Abstract
Metabolically heathy obesity is characterised by the presence of obesity in the absence of metabolic disturbances. The aim of our study was to analyse pro-inflammatory, nitro-oxidative stress, and insulin-resistance (IR) markers in metabolically healthy morbidly obese (MHMO) with respect to metabolically unhealthy morbidly obese (MUHMO) with metabolic syndrome (MS) and to identify the potential predictors of MS in the MHMO group. Two groups of MHMO and MUHMO with MS were analysed. We evaluated serum high sensitivity C reactive protein (hsCRP), tumor necrosis factor alpha (TNF-α), chemerin, nitrite and nitrate (NOx), total oxidant status (TOS), total antioxidant response (TAR), fasting blood glucose, insulin, and homeostasis model assessment of insulin resistance (HOMA-IR.) MHMO have similar hsCRP and TNF-α values as the MUHMO with MS, while chemerin was significantly lower in MHMO. NOx was higher in MUHMO with MS patients, while no difference regarding TOS and TAR was found between the two groups. HOMA-IR and insulin values were lower in MHMO as compared to the MUHMO with MS group. Insulin, HOMA-IR, and chemerin were identified predictors of MS in MHMO. In conclusion, MHMO and MUHMO display similarities and differences in terms of chronic inflammation, nitro-oxidative stress, and IR. Markers of IR and chemerin are possible predictors of MS in MHMO.
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Xie J, Zhang S, Yu X, Yang Y, Liu Z, Yuan G, Hu S. Association between Liver Enzymes with Metabolically Unhealthy Obese Phenotype. Lipids Health Dis 2018; 17:198. [PMID: 30134916 PMCID: PMC6106819 DOI: 10.1186/s12944-018-0847-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/10/2018] [Indexed: 01/07/2023] Open
Abstract
Background Obesity could be classified into two phenotypes: metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUHO). This study investigated the ability of liver enzymes to identify obesity phenotype. Methods We conducted a cross-sectional study in 2197 obese adults (age > 40 years and BMI ≥25 kg/m2) in a rural area of central China. Results In this population, 75% of the participants have more than one cardiometabolic risk factor. Both GGT and ALT were strongly related to the MUHO phenotype. The association between the fourth quartile of GGT and MUHO risk was strong and independent of confounder risk factors in both genders (adjusted ORs, 1.73 (95%CI 1.03–2.92) for male and 1.82 (95%CI 1.29–2.57) for female). The association between the fourth quartile of ALT and MUHO risk was strong and independent in female, but not in male (adjusted ORs, 1.65 (95%CI 0.86–3.19) for male and 1.88 (95%CI 1.29–2.75) for female). Additionally, AST was not associated with MUHO phenotype. Conclusions Both GGT and ALT are effective markers for identifying MUHO in this population. Furthermore, the ability of GGT may be superior to ALT in male.
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Affiliation(s)
- Junhui Xie
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, Hubei Province, China
| | - Shujun Zhang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, Hubei Province, China
| | - Xuefeng Yu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, Hubei Province, China.
| | - Yan Yang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, Hubei Province, China
| | - Zhelong Liu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, Hubei Province, China
| | - Gang Yuan
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, Hubei Province, China
| | - Shuhong Hu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, Hubei Province, China
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Doumatey AP, He WJ, Gaye A, Lei L, Zhou J, Gibbons GH, Adeyemo A, Rotimi CN. Circulating MiR-374a-5p is a potential modulator of the inflammatory process in obesity. Sci Rep 2018; 8:7680. [PMID: 29769661 PMCID: PMC5955981 DOI: 10.1038/s41598-018-26065-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 05/04/2018] [Indexed: 01/12/2023] Open
Abstract
Obese individuals without expected metabolic co-morbidities are referred to as metabolically healthy obese (MHO). The molecular mechanisms underlying this phenotype remain elusive. MicroRNAs may be involved in the MHO phenotype. To test this hypothesis, we screened 179 serum miRNAs in 20 African-American women (10 MHOs and 10 metabolically abnormal obese individuals -MAO). We identified 8 differentially expressed miRNAs (DEMs) with validation in an independent sample of 64 MHO and 34 MAO. Of the eight DEMs in the screening phase (p ≤ 0.05), miR-374a-5p remained significant (p = 0.04) with directional consistency in the validation sample. Ingenuity Pathway analysis revealed that miR-374a-5p putatively targeted 37 mRNAs (e.g. chemokines and transcription factors) which are members of canonical pathways involved in inflammation (IL-17A signaling) and lipid metabolism. Analysis restricted to adipocytes, the main source of circulating miRNAs in obesity, identified 3 mRNAs (CCL2, STEAP2, EN1) as the main target of miR-374a-5p. Evaluation of the 3 mRNAs in an independent sample showed that CCL2 was significantly downregulated (p = 0.0005). In summary, MiR-374a-5p is upregulated in MHO compared to MAO individuals and appears to show association with downregulation of pro-inflammatory markers that are linked to insulin resistance. Given the correlative nature of our findings, functional studies are needed.
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Affiliation(s)
- Ayo P Doumatey
- Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, National Human Genome Research Institute, Bethesda, MD, USA. .,The Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA.
| | - William J He
- Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, National Human Genome Research Institute, Bethesda, MD, USA.,The Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA.,Johns Hopkins University, Krieger School of Arts and Sciences, Baltimore, Maryland, USA
| | - Amadou Gaye
- Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, National Human Genome Research Institute, Bethesda, MD, USA
| | - Lin Lei
- Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, National Human Genome Research Institute, Bethesda, MD, USA.,The Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jie Zhou
- Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, National Human Genome Research Institute, Bethesda, MD, USA.,The Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Gary H Gibbons
- Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, National Human Genome Research Institute, Bethesda, MD, USA.,National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Adebowale Adeyemo
- Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, National Human Genome Research Institute, Bethesda, MD, USA.,The Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Charles N Rotimi
- Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, National Human Genome Research Institute, Bethesda, MD, USA. .,The Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA.
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Mongraw-Chaffin M, Foster MC, Anderson CAM, Burke GL, Haq N, Kalyani RR, Ouyang P, Sibley CT, Tracy R, Woodward M, Vaidya D. Metabolically Healthy Obesity, Transition to Metabolic Syndrome, and Cardiovascular Risk. J Am Coll Cardiol 2018; 71:1857-1865. [PMID: 29699611 PMCID: PMC6002856 DOI: 10.1016/j.jacc.2018.02.055] [Citation(s) in RCA: 254] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/08/2018] [Accepted: 02/09/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Debate over the cardiometabolic risk associated with metabolically healthy obesity (MHO) continues. Many studies have investigated this relationship by examining MHO at baseline with longitudinal follow-up, with inconsistent results. OBJECTIVES The authors hypothesized that MHO at baseline is transient and that transition to metabolic syndrome (MetS) and duration of MetS explains heterogeneity in incident cardiovascular disease (CVD) and all-cause mortality. METHODS Among 6,809 participants of the MESA (Multi-Ethnic Study of Atherosclerosis) the authors used Cox proportional hazards and logistic regression models to investigate the joint association of obesity (≥30 kg/m2) and MetS (International Diabetes Federation consensus definition) with CVD and mortality across a median of 12.2 years. We tested for interaction and conducted sensitivity analyses for a number of conditions. RESULTS Compared with metabolically healthy normal weight, baseline MHO was not significantly associated with incident CVD; however, almost one-half of those participants developed MetS during follow-up (unstable MHO). Those who had unstable MHO had increased odds of CVD (odds ratio [OR]: 1.60; 95% confidence interval [CI]: 1.14 to 2.25), compared with those with stable MHO or healthy normal weight. Dose response for duration of MetS was significantly and linearly associated with CVD (1 visit with MetS OR: 1.62; 95% CI: 1.27 to 2.07; 2 visits, OR: 1.92; 95% CI: 1.48 to 2.49; 3+ visits, OR: 2.33; 95% CI: 1.89 to 2.87; p value for trend <0.001) and MetS mediated approximately 62% (44% to 100%) of the relationship between obesity at any point during follow-up and CVD. CONCLUSIONS Metabolically healthy obesity is not a stable or reliable indicator of future risk for CVD. Weight loss and lifestyle management for CVD risk factors should be recommended to all individuals with obesity.
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Affiliation(s)
- Morgana Mongraw-Chaffin
- Department of Epidemiology & Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | | | - Cheryl A M Anderson
- Department of Family Medicine and Public Health, University of California-San Diego, La Jolla, California; Department of Medicine, University of California-San Diego, La Jolla, California; Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Gregory L Burke
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Nowreen Haq
- New York University School of Medicine, New York, New York
| | - Rita R Kalyani
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Pamela Ouyang
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Russell Tracy
- Departments of Pathology & Laboratory Medicine and Biochemistry, Larner College of Medicine at the University of Vermont, Colchester, Vermont
| | - Mark Woodward
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland; The George Institute for Global Health, University of Oxford, Oxford, United Kingdom; The George Institute for Global Health, University of New South Wales, Australia
| | - Dhananjay Vaidya
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
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Abstract
PURPOSE OF REVIEW The aim of this review is to summarize knowledge of the prevalence, relevant physiology, and consequences of obesity and visceral adiposity in HIV-infected adults, including highlighting gaps in current knowledge and future research directions. RECENT FINDINGS Similar to the general population, obesity prevalence is increasing among HIV-infected persons, and obesity and visceral adiposity are associated with numerous metabolic and inflammatory sequelae. However, HIV- and antiretroviral therapy (ART)-specific factors may contribute to fat gain and fat quality in treated HIV infection, particularly to the development of visceral adiposity, and sex differences may exist. Obesity and visceral adiposity commonly occur in HIV-infected persons and have significant implications for morbidity and mortality. Future research should aim to better elucidate the HIV- and ART-specific contributors to obesity and visceral adiposity in treated HIV infection, with the goal of developing targeted therapies for the prevention and treatment of obesity and visceral adiposity in the modern ART era.
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Affiliation(s)
- Jordan E Lake
- University of Texas Health Science Center at Houston, 6431 Fannin St., MSB 2.112, Houston, TX, 77030, USA.
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37
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Bermudez V, Rojas J, Salazar J, Martinez MS, Olivar LC, Calvo MJ, Mindiola A, Añez R, Wilches-Duran S, Cerda M, Graterol M, Graterol R, Hernandez JD, Garicano C, Velasco M. Biochemical and clinical characterization of metabolic phenotypes: a cross-sectional study from Maracaibo city, Venezuela. F1000Res 2018; 7:230. [PMID: 35136588 PMCID: PMC8796010 DOI: 10.12688/f1000research.13897.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/27/2018] [Indexed: 04/06/2024] Open
Abstract
Background: In 1980, Reuben Andresen observed that in certain individuals, obesity did not increase mortality, introducing an atypical phenotype called "healthy obese". Other studies reported that 10-15 % of lean individuals presented insulin resistance, hyperglycemia and dyslipidemia. The objective of this study was to evaluate biochemical and clinical characteristics of metabolic phenotypes in Maracaibo city. Methods: A descriptive, cross-sectional sub-analysis of The Maracaibo City Metabolic Syndrome Prevalence Study, with a randomized multistage sampling was performed including 1226 non diabetic individuals from both sexes. For phenotype definition, the subjects were first classified according to their BMI into Normal-Weight, Overweight and Obese; then divided in metabolically healthy and unhealthy using a two-step analysis cluster being predictive variables: HOMA2-IR, HOMA2-βcell, triglycerides. To evaluate the relationship with coronary risk, a multiple logistic regression model was performed. Results: In the studied population, 43.9% (n=538) were healthy normal weight, 5.2% (n=64) unhealthy normal weight, 17.4% (n=217) healthy obese and 33.5% (n=411) unhealthy obese subjects. Atypical phenotypes, Metabolically Unhealthy Normal-Weight (MUNW) was more frequent in males (56.3%), whereas Metabolically Unhealthy Obese (MUO) was more frequent in females (51.3%). This phenotypes had a higher coronary event risk, especially for obese individuals (MHO: OR=1.85 CI95%: 1.11-3.09; p=0.02 and MUO: OR=2.09 CI95%: 1.34-3.28; p<0.01). Conclusion: Individuals with atypical metabolic phenotypes are common in Maracaibo city. Related factors may include insulin resistance, basal glucose, and triglycerides levels. Lastly, obese subjects show a higher coronary event risk even those with normal metabolic status.
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Affiliation(s)
- Valmore Bermudez
- Grupo de Investigación Altos Estudios de Frontera (ALEF), Universidad Simón Bolívar, Cucuta, Colombia
- Endocrine and Metabolic Diseases Research Center, The University of Zulia, Maracaibo, Venezuela
| | - Joselyn Rojas
- Endocrine and Metabolic Diseases Research Center, The University of Zulia, Maracaibo, Venezuela
- Pulmonary and Critical Care Medicine Department, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Juan Salazar
- Endocrine and Metabolic Diseases Research Center, The University of Zulia, Maracaibo, Venezuela
| | - Maria Sofia Martinez
- Endocrine and Metabolic Diseases Research Center, The University of Zulia, Maracaibo, Venezuela
| | - Luis Carlos Olivar
- Endocrine and Metabolic Diseases Research Center, The University of Zulia, Maracaibo, Venezuela
| | - Maria Jose Calvo
- Endocrine and Metabolic Diseases Research Center, The University of Zulia, Maracaibo, Venezuela
| | - Andres Mindiola
- Geriatric Research Education and Clinical Center (GRECC), U.S Department of Veterans Affairs, Miami, FL, USA
| | - Roberto Añez
- Endocrine and Metabolic Diseases Research Center, The University of Zulia, Maracaibo, Venezuela
| | - Sandra Wilches-Duran
- Grupo de Investigación Altos Estudios de Frontera (ALEF), Universidad Simón Bolívar, Cucuta, Colombia
| | - Marcos Cerda
- Grupo de Investigación Altos Estudios de Frontera (ALEF), Universidad Simón Bolívar, Cucuta, Colombia
| | - Modesto Graterol
- Grupo de Investigación Altos Estudios de Frontera (ALEF), Universidad Simón Bolívar, Cucuta, Colombia
| | - Rosemily Graterol
- Grupo de Investigación Altos Estudios de Frontera (ALEF), Universidad Simón Bolívar, Cucuta, Colombia
| | - Juan Diego Hernandez
- Grupo de Investigación Altos Estudios de Frontera (ALEF), Universidad Simón Bolívar, Cucuta, Colombia
| | - Carlos Garicano
- Grupo de Investigación Altos Estudios de Frontera (ALEF), Universidad Simón Bolívar, Cucuta, Colombia
| | - Manuel Velasco
- Department of Pharmacology, “JM Vargas” Medical School, Central University of Venezuela, Caracas, Venezuela
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Bermudez V, Rojas J, Salazar J, Martinez MS, Olivar LC, Calvo MJ, Mindiola A, Añez R, Wilches-Duran S, Cerda M, Graterol M, Graterol R, Hernandez JD, Garicano C, Velasco M. Biochemical and clinical characterization of metabolic phenotypes: a cross-sectional study from Maracaibo city, Venezuela. F1000Res 2018; 7:230. [PMID: 35136588 PMCID: PMC8796010 DOI: 10.12688/f1000research.13897.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2018] [Indexed: 04/06/2024] Open
Abstract
Background: In 1980, Reuben Andresen observed that in certain individuals, obesity did not increase mortality, introducing an atypical phenotype called "healthy obese". Other studies reported that 10-15 % of lean individuals presented insulin resistance, hyperglycemia and dyslipidemia. The objective of this study was to evaluate biochemical and clinical characteristics of metabolic phenotypes in Maracaibo city. Methods: A descriptive, cross-sectional study with a randomized multistage sampling was performed including 1226 non diabetic individuals from both sexes. For phenotype definition, the subjects were first classified according to their BMI into Normal-Weight, Overweight and Obese; then divided in metabolically healthy and unhealthy using a two-step analysis cluster. To evaluate the relationship with coronary risk, a multiple logistic regression model was performed. Results: In the studied population, 5.2% (n=64) corresponded to unhealthy lean subjects, and 17.4% (n=217) to healthy obese subjects. Metabolically unhealthy normal-weight (MUNW) phenotype was found in males in 53.3% in contrast to 51.3% of metabolically unhealthy obese (MUO) phenotype found in females. An association between metabolically unhealthy phenotypes and a higher risk of a coronary event was found, especially for obese individuals (MHO: OR=1.85 CI95%: 1.11-3.09; p=0.02 and MUO: OR=2.09 CI95%: 1.34-3.28; p<0.01). Conclusion: Individuals with atypical metabolic phenotypes exist in Maracaibo city. Related factors may include insulin resistance, basal glucose levels, and triglycerides levels. Lastly, cardiovascular risk exhibited by healthy obese individuals should be classified in categories of major coronary risk related to lean subjects.
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Affiliation(s)
- Valmore Bermudez
- Grupo de Investigación Altos Estudios de Frontera (ALEF), Universidad Simón Bolívar, Cucuta, Colombia
- Endocrine and Metabolic Diseases Research Center, The University of Zulia, Maracaibo, Venezuela
| | - Joselyn Rojas
- Endocrine and Metabolic Diseases Research Center, The University of Zulia, Maracaibo, Venezuela
- Pulmonary and Critical Care Medicine Department, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Juan Salazar
- Endocrine and Metabolic Diseases Research Center, The University of Zulia, Maracaibo, Venezuela
| | - Maria Sofia Martinez
- Endocrine and Metabolic Diseases Research Center, The University of Zulia, Maracaibo, Venezuela
| | - Luis Carlos Olivar
- Endocrine and Metabolic Diseases Research Center, The University of Zulia, Maracaibo, Venezuela
| | - Maria Jose Calvo
- Endocrine and Metabolic Diseases Research Center, The University of Zulia, Maracaibo, Venezuela
| | - Andres Mindiola
- Geriatric Research Education and Clinical Center (GRECC), U.S Department of Veterans Affairs, Miami, FL, USA
| | - Roberto Añez
- Endocrine and Metabolic Diseases Research Center, The University of Zulia, Maracaibo, Venezuela
| | - Sandra Wilches-Duran
- Grupo de Investigación Altos Estudios de Frontera (ALEF), Universidad Simón Bolívar, Cucuta, Colombia
| | - Marcos Cerda
- Grupo de Investigación Altos Estudios de Frontera (ALEF), Universidad Simón Bolívar, Cucuta, Colombia
| | - Modesto Graterol
- Grupo de Investigación Altos Estudios de Frontera (ALEF), Universidad Simón Bolívar, Cucuta, Colombia
| | - Rosemily Graterol
- Grupo de Investigación Altos Estudios de Frontera (ALEF), Universidad Simón Bolívar, Cucuta, Colombia
| | - Juan Diego Hernandez
- Grupo de Investigación Altos Estudios de Frontera (ALEF), Universidad Simón Bolívar, Cucuta, Colombia
| | - Carlos Garicano
- Grupo de Investigación Altos Estudios de Frontera (ALEF), Universidad Simón Bolívar, Cucuta, Colombia
| | - Manuel Velasco
- Department of Pharmacology, “JM Vargas” Medical School, Central University of Venezuela, Caracas, Venezuela
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Bermudez V, Rojas J, Salazar J, Martinez MS, Olivar LC, Calvo MJ, Mindiola A, Añez R, Wilches-Duran S, Cerda M, Graterol M, Graterol R, Hernandez JD, Garicano C, Velasco M. Biochemical and clinical characterization of metabolic phenotypes: a cross-sectional study from Maracaibo city, Venezuela. F1000Res 2018; 7:230. [PMID: 35136588 PMCID: PMC8796010 DOI: 10.12688/f1000research.13897.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 11/20/2022] Open
Abstract
Background: In 1980, Reuben Andresen observed that in certain individuals, obesity did not increase mortality, introducing an atypical phenotype called "healthy obese". Other studies reported that 10-15 % of lean individuals presented insulin resistance, hyperglycemia and dyslipidemia. The objective of this study was to evaluate biochemical and clinical characteristics of metabolic phenotypes in Maracaibo city. Methods: A descriptive, cross-sectional sub-analysis of The Maracaibo City Metabolic Syndrome Prevalence Study, with a randomized multistage sampling was performed including 1226 non diabetic individuals from both sexes. For phenotype definition, the subjects were first classified according to their BMI into Normal-Weight, Overweight and Obese; then divided in metabolically healthy and unhealthy using a two-step analysis cluster being predictive variables: HOMA2-IR, HOMA2-βcell, triglycerides. To evaluate the relationship with coronary risk, a multiple logistic regression model was performed. Results: In the studied population, 43.9% (n=538) were healthy normal weight, 5.2% (n=64) unhealthy normal weight, 17.4% (n=217) healthy obese and 33.5% (n=411) unhealthy obese subjects. Atypical phenotypes, Metabolically Unhealthy Normal-Weight (MUNW) was more frequent in males (56.3%), whereas Metabolically Unhealthy Obese (MUO) was more frequent in females (51.3%). This phenotypes had a higher coronary event risk, especially for obese individuals (MHO: OR=1.85 CI95%: 1.11-3.09; p=0.02 and MUO: OR=2.09 CI95%: 1.34-3.28; p<0.01). Conclusion: Individuals with atypical metabolic phenotypes are common in Maracaibo city. Related factors may include insulin resistance, basal glucose, and triglycerides levels. Lastly, obese subjects show a higher coronary event risk even those with normal metabolic status.
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Affiliation(s)
- Valmore Bermudez
- Grupo de Investigación Altos Estudios de Frontera (ALEF), Universidad Simón Bolívar, Cucuta, Colombia
- Endocrine and Metabolic Diseases Research Center, The University of Zulia, Maracaibo, Venezuela
| | - Joselyn Rojas
- Endocrine and Metabolic Diseases Research Center, The University of Zulia, Maracaibo, Venezuela
- Pulmonary and Critical Care Medicine Department, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Juan Salazar
- Endocrine and Metabolic Diseases Research Center, The University of Zulia, Maracaibo, Venezuela
| | - Maria Sofia Martinez
- Endocrine and Metabolic Diseases Research Center, The University of Zulia, Maracaibo, Venezuela
| | - Luis Carlos Olivar
- Endocrine and Metabolic Diseases Research Center, The University of Zulia, Maracaibo, Venezuela
| | - Maria Jose Calvo
- Endocrine and Metabolic Diseases Research Center, The University of Zulia, Maracaibo, Venezuela
| | - Andres Mindiola
- Geriatric Research Education and Clinical Center (GRECC), U.S Department of Veterans Affairs, Miami, FL, USA
| | - Roberto Añez
- Endocrine and Metabolic Diseases Research Center, The University of Zulia, Maracaibo, Venezuela
| | - Sandra Wilches-Duran
- Grupo de Investigación Altos Estudios de Frontera (ALEF), Universidad Simón Bolívar, Cucuta, Colombia
| | - Marcos Cerda
- Grupo de Investigación Altos Estudios de Frontera (ALEF), Universidad Simón Bolívar, Cucuta, Colombia
| | - Modesto Graterol
- Grupo de Investigación Altos Estudios de Frontera (ALEF), Universidad Simón Bolívar, Cucuta, Colombia
| | - Rosemily Graterol
- Grupo de Investigación Altos Estudios de Frontera (ALEF), Universidad Simón Bolívar, Cucuta, Colombia
| | - Juan Diego Hernandez
- Grupo de Investigación Altos Estudios de Frontera (ALEF), Universidad Simón Bolívar, Cucuta, Colombia
| | - Carlos Garicano
- Grupo de Investigación Altos Estudios de Frontera (ALEF), Universidad Simón Bolívar, Cucuta, Colombia
| | - Manuel Velasco
- Department of Pharmacology, “JM Vargas” Medical School, Central University of Venezuela, Caracas, Venezuela
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Khawaja KI, Mian SA, Fatima A, Tahir GM, Khan FF, Burney S, Hasan A, Masud F. Phenotypic and metabolic dichotomy in obesity: clinical, biochemical and immunological correlates of metabolically divergent obese phenotypes in healthy South Asian adults. Singapore Med J 2018; 59:431-438. [PMID: 29430577 DOI: 10.11622/smedj.2018019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Metabolic heterogeneity among obese individuals is thought to translate into variations in cardiovascular risk. Identifying obese people with an unfavourable metabolic profile may allow preventive strategies to be targeted at high-risk groups. This study aimed to identify clinical, biochemical and immunological differences between insulin-sensitive and insulin-resistant obese subgroups, to understand the population-specific pathophysiological basis of the adverse cardiovascular risk profile in the latter group. METHODS Cardiovascular risk indicators, including anthropometric parameters, blood pressure, acanthosis nigricans area, and related biochemical, endocrine and inflammatory markers, were determined in 255 healthy South Asian volunteers aged 18-45 years, with a 2:1 ratio of obese/overweight to normal-weight individuals. Lifetime atherosclerotic cardiovascular disease (ASCVD) risk was also calculated. RESULTS Body mass index (BMI) and insulin sensitivity-based tertiles independently showed incremental trends in waist-hip ratio, skinfold thickness, acanthosis nigricans area, blood pressure, serum lipids, hepatic enzymes, adipokines, inflammatory markers and ten-year ASCVD risk. The anthropometric, biochemical and inflammatory parameters of obese insulin-sensitive and obese insulin-resistant groups differed significantly. Extreme group analysis after excluding the middle tertiles of both insulin resistance and BMI also showed significant difference in anthropometric indicators of cardiovascular risk and estimated lifetime ASCVD risk between the two obese subgroups. CONCLUSION Obese insulin-sensitive individuals had a favourable metabolic profile compared to the obese insulin-resistant group. The most consistent discriminative factor between these phenotypic classes was anthropometric parameters, which underscores the importance of clinical parameters as cardiovascular risk indicators in obesity.
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Affiliation(s)
- Khadija Irfan Khawaja
- Department of Endocrinology and Metabolism, Services Institute of Medical Sciences and Services Hospital, Lahore, Pakistan
| | - Saqib Ali Mian
- Diabetes Care Centre, King Salman Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Aziz Fatima
- Department of Endocrinology and Metabolism, Services Institute of Medical Sciences and Services Hospital, Lahore, Pakistan
| | - Ghulam Murtaza Tahir
- Department of Endocrinology and Metabolism, Services Institute of Medical Sciences and Services Hospital, Lahore, Pakistan
| | - Fehmida Farrukh Khan
- Department of Endocrinology and Metabolism, Services Institute of Medical Sciences and Services Hospital, Lahore, Pakistan
| | - Saira Burney
- Department of Endocrinology and Metabolism, Services Institute of Medical Sciences and Services Hospital, Lahore, Pakistan
| | - Ali Hasan
- Medical Unit No. 4, Services Institute of Medical Sciences and Services Hospital, Lahore, Pakistan
| | - Faisal Masud
- King Edward Medical University, Lahore, Pakistan
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Lake JE, Li X, Palella FJ, Erlandson KM, Wiley D, Kingsley L, Jacobson LP, Brown TT. Metabolic health across the BMI spectrum in HIV-infected and HIV-uninfected men. AIDS 2018; 32:49-57. [PMID: 28926404 PMCID: PMC5718950 DOI: 10.1097/qad.0000000000001651] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES In the general population, metabolic health often declines as BMI increases. However, some obese individuals maintain metabolic health. HIV and antiretroviral therapy have been associated with metabolic disturbances. We hypothesized that HIV-infected (HIV) men on suppressive antiretroviral therapy experience less metabolic health than HIV-uninfected (HIV) men across all BMI categories. DESIGN/METHODS In a cross-sectional analysis of 1018 HIV and 1092 HIV men enrolled in the multicenter AIDS cohort study, Poisson regression with robust variance determined associations between HIV serostatus and metabolic health prevalence (defined as meeting ≤2 of 5 National Cholesterol Education Program Adult Treatment Panel III metabolic syndrome criteria), adjusting for age, race, BMI category, smoking, and hepatitis C virus infection status. RESULTS HIV men were younger (54 vs. 59 years) and had lower median BMI (25 vs. 27 kg/m). Nonobese HIV men had lower metabolic health prevalence than HIV men (BMI ≤25 kg/m: 80 vs. 94%, P < 0.001; BMI 25-29 kg/m: 64 vs. 71%, P = 0.05), but metabolic health prevalence among obese men did not differ by HIV serostatus (BMI 30-34 kg/m: 35 vs. 39%, P = 0.48; BMI ≥35 kg/m: 27 vs. 25%, P = 0.79). In the adjusted model, nonobese HIV men were less likely to demonstrate metabolic health than nonobese HIV men. Among HIV men, per year darunavir, zidovudine, and stavudine use were associated with lower metabolic health likelihood. CONCLUSION Metabolically healthy obesity prevalence does not differ by HIV serostatus. However, among nonobese men, HIV infection is associated with lower metabolic health prevalence, with associations between lack of metabolic health and darunavir and thymidine analog nucleoside reverse transcriptase inhibitor exposure observed.
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Affiliation(s)
- Jordan E Lake
- McGovern School of Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Xiuhong Li
- Johns Hopkins University, Baltimore, Maryland
| | - Frank J Palella
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Huang LO, Loos RJF, Kilpeläinen TO. Evidence of genetic predisposition for metabolically healthy obesity and metabolically obese normal weight. Physiol Genomics 2017; 50:169-178. [PMID: 29341865 DOI: 10.1152/physiolgenomics.00044.2017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Obesity has evolved into a global pandemic that constitutes a major threat to public health. The majority of obesity-related health care costs are due to cardiometabolic complications, such as insulin resistance, dyslipidemia, and hypertension, which are risk factors for Type 2 diabetes and cardiovascular disease. However, many obese individuals, often called metabolically healthy obese (MHO), seem to be protected from these cardiometabolic complications. Conversely, there is a group of individuals who suffer from cardiometabolic complications despite being of normal weight; a condition termed metabolically obese normal weight (MONW). Recent large-scale genomic studies have provided evidence that a number of genetic variants show an association with increased adiposity but a favorable cardiometabolic profile, an indicator for the genetic basis of the MHO and MONW phenotypes. Many of these loci are located in or near genes that implicate pathways involved in adipogenesis, fat distribution, insulin signaling, and insulin resistance. It has been suggested that a threshold for subcutaneous adipose tissue expandability may be at play in the manifestation of MHO and MONW, where expiry of adipose tissue storage capacity could lead to ectopic lipid accumulation in non-adipose tissues such as liver, muscle, heart, and pancreatic beta cells. Understanding the genetic aspects of the mechanisms that underpin MHO and MONW is crucial to define appropriate public health action points and to develop effective intervention measures.
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Affiliation(s)
- Lam O Huang
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark
| | - Ruth J F Loos
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai , New York, New York.,The Genetics of Obesity and Related Metabolic Traits Program, The Icahn School of Medicine at Mount Sinai , New York, New York.,The Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Tuomas O Kilpeläinen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark.,Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai , New York, New York
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Yoon DY, Lee YA, Lee J, Kim JH, Shin CH, Yang SW. Prevalence and Clinical Characteristics of Metabolically Healthy Obesity in Korean Children and Adolescents: Data from the Korea National Health and Nutrition Examination Survey. J Korean Med Sci 2017; 32:1840-1847. [PMID: 28960038 PMCID: PMC5639066 DOI: 10.3346/jkms.2017.32.11.1840] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 07/29/2017] [Indexed: 12/21/2022] Open
Abstract
Metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) are differentiated by the presence of cardiometabolic risk factors (CMRFs) and insulin resistance (IR). This study aimed to evaluate the prevalence and clinical characteristics of MHO in Korean children and adolescents and to investigate the anthropometric, laboratory, and lifestyle predictors of MHO. This study included data from 530 obese subjects, aged 10-19 years, obtained from the Fourth Korea National Health and Nutrition Examination Survey. Subjects were classified into MHO and MUO groups according to the presence of CMRF (MHO(CMRF)/MUO(CMRF)) and degree of IR (MHO(IR)/MUO(IR)). Demographic, anthropometric, cardiometabolic, and lifestyle factors were compared between the groups. Logistic regression analysis and receiver operating characteristic curve analysis were performed to identify factors that predicted MHO. The prevalence of MHO(CMRF) and MHO(IR) in obese Korean youth was 36.8% (n = 197) and 68.8% (n = 356), respectively. CMRF profiles were significantly less favorable in MUO children. Longer and more vigorous physical activity and less protein intake were associated with MHO(CMRF) phenotype. The best predictors of MHO(CMRF) and MHO(IR) were waist circumference (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.77-0.88; P < 0.001) and body mass index (BMI) standard deviation score (OR, 0.24; 95% CI, 0.15-0.39; P < 0.001), respectively. The prevalence of MHO differed depending on how it was defined. To adequately manage obesity in youth, the approach to individuals with MHO and MUO should be personalized due to variation in clinical characteristics. Longitudinal studies are needed to evaluate long-term consequences of MHO.
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Affiliation(s)
- Da Young Yoon
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jieun Lee
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jae Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Sei Won Yang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Maffetone PB, Rivera-Dominguez I, Laursen PB. Overfat Adults and Children in Developed Countries: The Public Health Importance of Identifying Excess Body Fat. Front Public Health 2017; 5:190. [PMID: 28791284 PMCID: PMC5523552 DOI: 10.3389/fpubh.2017.00190] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/12/2017] [Indexed: 12/13/2022] Open
Abstract
The global overfat pandemic is a serious public health crisis that places a substantial burden on economic resources in developed countries. The term overfat refers to the presence of excess body fat that can impair health, even for normal weight non-obese individuals. Excess body fat is associated with cardiometabolic dysfunction, a clinical situation that can progressively worsen, potentially leading to various common disease risk factors, chronic diseases, increased morbidity and mortality, and reduced quality of life. The prevalence of overfat populations in 30 of the world’s most developed countries is substantially higher than recent global estimations, with the largest growth due to a relatively recent increased number of people with excess abdominal fat. Abdominal overfat is the most unhealthful form of this condition, so it is concerning that average waist circumference measures, generally indicative of abdominal overfat, have increased. Despite a leveling off appearance of being overweight and/or obese in some developed countries, the overfat pandemic continues to grow.
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Affiliation(s)
| | | | - Paul B Laursen
- Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand
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Sinn DH, Min YW, Son HJ, Rhee PL, Paik SW, Hong SN, Gwak GY. Metabolically-healthy obesity is associated with higher prevalence of colorectal adenoma. PLoS One 2017. [PMID: 28636624 PMCID: PMC5479542 DOI: 10.1371/journal.pone.0179480] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background The risk of colorectal adenoma (CRA), an important precursor of colorectal cancer, is largely unknown among obese individuals without obesity-related metabolic abnormalities, a condition described as metabolically-healthy obese (MHO). The aim of this study was to examine the association among metabolic status, the different categories of body mass index (BMI), and CRA in a large cohort of adults. Methods We analyzed the association among metabolic status, BMI categories and CRA in asymptomatic adults who underwent a first-time colonoscopy as part of the comprehensive health check-up program at the Health Promotion Center of Samsung Medical Center, from January 2005 to December 2012. Being metabolically healthy was defined as lacking any metabolic syndrome components and having a homeostasis model assessment of insulin resistance <2.5. Results The prevalence of “any,” “multiple,” and “high-risk” CRA was 25.6%, 8.3%, and 4.4% among 9,182 metabolically-healthy participants, and 35.9%, 12.5%, and 7.0% among 17,407 metabolically-unhealthy participants, respectively. Increased BMI showed a significant dose-dependent relationship with the prevalence of “any,” “multiple,” and “high-risk” CRA, in both metabolically-healthy and unhealthy participants. In multivariable-adjusted models that accounted for potential confounders including age, sex, smoking, alcohol, first-degree family history of colorectal cancer, and aspirin use, the odds ratio (OR) for any CRA comparing MHO with metabolically-healthy normal-weight (MHNW) participants was 1.25 (95% confidence interval (CI), 1.09–1.43). Further adjustment for metabolic components associated with obesity did not significantly change the association. Similarly, the ORs for multiple CRAs and high risk CRA were higher in MHO participants than MHNW participants [ORs (95% CI), 1.63 (1.31–2.04) and 1.53 (1.14–2.04), respectively]. Conclusions The MHO phenotype was closely associated with higher prevalence of CRA, including high-risk adenoma. This finding supports the conclusion that MHO increases the risk of colorectal cancer.
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Affiliation(s)
- Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yang Won Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hee Jung Son
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Center for Health Promotion, Samsung Medical Center, Seoul, South Korea
| | - Poong-Lyul Rhee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung Woon Paik
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung Noh Hong
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- * E-mail: (SNH); (GYG)
| | - Geum-Youn Gwak
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- * E-mail: (SNH); (GYG)
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Becerra NLM, Needleman B, Noria S, Bradley D. Obstructive sleep apnea: Is it a biomarker of metabolic health in obesity. ACTA ACUST UNITED AC 2017; 6:23-29. [PMID: 31815206 DOI: 10.1016/j.obmed.2017.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Context The prevalence of obstructive sleep apnea (OSA) increases with obesity, and OSA has been linked to increased cardiovascular risk via hypoxemia and sleep disruption. Objective and Main Outcome Measures We hypothesized that if OSA contributes to cardio-metabolic risk, then 1) obese individuals with OSA will have more cardio-metabolic disease, and 2) patients with OSA who are non-adherent to CPAP treatment will have a greater incidence of cardio-metabolic abnormalities. Design setting and patients We prospectively recruited obese patients (n = 83; BMI 49 ± 9 kg/m2). All patients had polysomnography and were stratified by 1) the absence/presence of OSA, and 2) metabolic health. Detailed CPAP reports were analyzed for compliance and OSA severity in 38 subjects. Results OSA by polysomnography was present in 69% of patients. While 79% of patients with OSA and 54% without OSA were categorized as MAO (χ2 = 5.47, p < 0.02), when adjusted for age, gender and BMI this difference was not significant (p = 0.36). Insulin levels were higher in the OSA group, but when adjusted there was no significant difference (p = 0.350). In patients on CPAP therapy, there was a negative associative trend between OSA control (apnea-hypopnea index) and beta-cell function (HOMA-β) (r = -0.406, p = 0.076), but no association between CPAP compliance and AHI with age, BMI, glucose, insulin, adiponectin, or insulin resistance. Conclusions OSA is not independently associated with overall cardio-metabolic health and insulin resistance in obese patients, even when accounting for treatment compliance. The strongest predictors of the obese metabolic healthy phenotype in OSA patients are age, gender and BMI.
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Affiliation(s)
- Nancy L Mora Becerra
- Dorothy M. Davis Heart and Lung Research Institute, Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH, United States.,Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Ronald Reagan UCLA Medical Center, Los Angeles, CA, United States
| | - Bradley Needleman
- The Center for Minimally Invasive Surgery, Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - Sabrena Noria
- The Center for Minimally Invasive Surgery, Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - David Bradley
- Dorothy M. Davis Heart and Lung Research Institute, Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
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Hirsch KR, Smith-Ryan AE, Blue MNM, Mock MG, Trexler ET. Influence of segmental body composition and adiposity hormones on resting metabolic rate and substrate utilization in overweight and obese adults. J Endocrinol Invest 2017; 40:635-643. [PMID: 28211029 PMCID: PMC5444984 DOI: 10.1007/s40618-017-0616-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/11/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE Low resting metabolic rate (RMR) and high carbohydrate reliance at rest are associated with weight gain, but are highly variable in obese individuals. This study determined the relationship of total and segmental body composition and adiposity hormones with RMR and respiratory exchange ratio (RER) in overweight and obese adults. METHODS In 49 men (n = 23) and premenopausal women (n = 26) [mean ± SD; age = 35.0 ± 8.9 years; body mass index (BMI) = 33.6 ± 5.2 kg·m-2; percent body fat (%fat) = 40.0 ± 8.0%], RMR and RER were evaluated using indirect calorimetry. Total and segmental body composition [fat mass (FM), percent fat (%fat), lean mass (LM), visceral adipose tissue (VAT)] were estimated using dual-energy X-ray absorptiometry. Fasted blood and saliva samples were analyzed for insulin, leptin, estradiol, and cortisol. RESULTS In men (M) and women (W), RMR significantly correlated (p < 0.05) with FM (M: R = 0.535; W: R = 0.784) and LM (M: R = 0.645; W: R = 0.867). Of the segmental measures, trunk LM (M: R = 0.593; W: R = 0.879; p < 0.05) and leg LM (M: R = 0.664; W: R = 0.821; p < 0.05) had the strongest correlations with RMR. In men, but not women, RER significantly correlated with FM (R = 0.449; p = 0.032), trunk FM (R = 0.501; p = 0.015), and VAT (R = 0.456; p = 0.029). In men, RMR positively correlated with cortisol (R = 0.430, p = 0.040) and estradiol (R = 0.649, p = 0.001) and RER positively correlated with insulin (R = 0.525, p = 0.010). In women, RMR positively correlated with insulin (R = 0.570, p = 0.006), but RER was not significantly correlated with hormones (p > 0.05). CONCLUSIONS Segmental evaluation of body composition, specifically in the lower extremities and abdomen, may be an effective and efficient way to evaluate metabolic status. Sex-specific evaluations are also imperative.
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Affiliation(s)
- K R Hirsch
- Applied Physiology Lab, Department of Exercise and Sport Science, University of North Carolina, 209 Fetzer Hall, CB# 8700, Chapel Hill, NC, 27599-8700, USA
- Human Movement Science Curriculum, Department of Allied Health Science, University of North Carolina, Chapel Hill, NC, USA
| | - A E Smith-Ryan
- Applied Physiology Lab, Department of Exercise and Sport Science, University of North Carolina, 209 Fetzer Hall, CB# 8700, Chapel Hill, NC, 27599-8700, USA.
- Human Movement Science Curriculum, Department of Allied Health Science, University of North Carolina, Chapel Hill, NC, USA.
| | - M N M Blue
- Applied Physiology Lab, Department of Exercise and Sport Science, University of North Carolina, 209 Fetzer Hall, CB# 8700, Chapel Hill, NC, 27599-8700, USA
- Human Movement Science Curriculum, Department of Allied Health Science, University of North Carolina, Chapel Hill, NC, USA
| | - M G Mock
- Applied Physiology Lab, Department of Exercise and Sport Science, University of North Carolina, 209 Fetzer Hall, CB# 8700, Chapel Hill, NC, 27599-8700, USA
| | - E T Trexler
- Applied Physiology Lab, Department of Exercise and Sport Science, University of North Carolina, 209 Fetzer Hall, CB# 8700, Chapel Hill, NC, 27599-8700, USA
- Human Movement Science Curriculum, Department of Allied Health Science, University of North Carolina, Chapel Hill, NC, USA
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Abraham PA, Attipoe S, Kazman JB, Zeno SA, Poth M, Deuster PA. Role of plasma adiponectin /C-reactive protein ratio in obesity and type 2 diabetes among African Americans. Afr Health Sci 2017; 17:99-107. [PMID: 29026382 DOI: 10.4314/ahs.v17i1.13] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Obesity is a modifiable risk factor for hypertension and T2D. Objective(s): We examined relations between fasting plasma adiponectin (ADIP), C-reactive protein (CRP) concentrations and markers of T2D in African Americans (AA). METHODS Fasting plasma ADIP, CRP, Insulin (IN), HOMA-IR, lipid profiles, body fat percent (%BF), waist circumference (WC), body mass index (BMI) and blood pressure measures were determined in AA women (W: n=77) and men (M: n=34). Participants were classified into: 1) Normal fasting glucose (FG) and Normal %BF; 2) Normal FG and High %BF; and 3) High FG. RESULTS Compared to men, women had significantly higher mean ADIP (W: 31.4±2.9 vs. M: 18.0±4.4 ng/L), CRP (W: 3.2±0.3 vs. M: 2.0±0.5 mg/L), %BF (W: 41.2±0.9 vs. M: 27.2±1.3), and BMI (W: 32.3±0.7 vs. M: 29.2±1.1 kg/m2). Women with normal FG and %BF had significantly higher ADIP (64.0±6.0) and lower CRP (1.3±0.6) concentrations than normal FG/ high %BF (ADIP: 37.0±5.0 and CRP: 3.1 ±0.5) and high FG (ADIP: 15.1±4.1 and CRP: 4.0 ± 0.5) groups. Women with high ADIP to CRP ratio had favorable metabolic and anthropometric profiles. CONCLUSION Low ADIP and high CRP are associated with excessive %BF and FG in AA women. ADIP/CRP, may be useful for detecting metabolic dysregulation.
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Affiliation(s)
- Preetha Anna Abraham
- Department of Military and Emergency Medicine (MEM) Uniformed Services University of Health Sciences (USUHS) 4301 Jones Bridge Rd, Bethesda, MD 20814 (PA, SA, JK, SZ, PD)
| | - Selasi Attipoe
- Department of Military and Emergency Medicine (MEM) Uniformed Services University of Health Sciences (USUHS) 4301 Jones Bridge Rd, Bethesda, MD 20814 (PA, SA, JK, SZ, PD)
| | - Josh B Kazman
- Department of Military and Emergency Medicine (MEM) Uniformed Services University of Health Sciences (USUHS) 4301 Jones Bridge Rd, Bethesda, MD 20814 (PA, SA, JK, SZ, PD)
| | - Stacey Anne Zeno
- Department of Military and Emergency Medicine (MEM) Uniformed Services University of Health Sciences (USUHS) 4301 Jones Bridge Rd, Bethesda, MD 20814 (PA, SA, JK, SZ, PD)
| | - Merrily Poth
- Department of Military and Emergency Medicine (MEM) Uniformed Services University of Health Sciences (USUHS) 4301 Jones Bridge Rd, Bethesda, MD 20814 (PA, SA, JK, SZ, PD)
| | - Patricia Anne Deuster
- Department of Military and Emergency Medicine (MEM) Uniformed Services University of Health Sciences (USUHS) 4301 Jones Bridge Rd, Bethesda, MD 20814 (PA, SA, JK, SZ, PD)
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Owei I, Umekwe N, Provo C, Wan J, Dagogo-Jack S. Insulin-sensitive and insulin-resistant obese and non-obese phenotypes: role in prediction of incident pre-diabetes in a longitudinal biracial cohort. BMJ Open Diabetes Res Care 2017; 5:e000415. [PMID: 28878939 PMCID: PMC5574414 DOI: 10.1136/bmjdrc-2017-000415] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 04/25/2017] [Accepted: 06/11/2017] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE We measured insulin sensitivity with euglycemic clamp (Si-clamp) in initially normoglycemic African Americans (AA) and European Americans (EA), to probe the existence of subphenotypes of obesity and leanness, and their impact on incident dysglycemia during longitudinal follow-up. RESEARCH DESIGN AND METHODS 320 healthy subjects (176 AA, 144 EA; mean age 44.2±10.6 years) underwent baseline assessments, including Si-clamp and homeostasis model of insulin resistance (HOMA-IR) and were stratified into: insulin-resistant obese (IRO) (body mass index (BMI) >30 kg/m2, Si-clamp <0.1, HOMA-IR >2.5); insulin-sensitive obesity (ISO) (BMI >30 kg/m2, Si-clamp >0.1, HOMA-IR <2.5); insulin-resistant non-obese (IRN) (BMI <28 kg/m2, Si-clamp <0.1, HOMA-IR >2.5); insulin-sensitive non-obese (ISN) (BMI <28 kg/m2, Si-clamp >0.1, HOMA-IR <2.5). Outcome measures were cardiometabolic risks and incident pre-diabetes/type 2 diabetes (T2D) during 5.5 years. RESULTS Compared with IRO, subjects with ISO had lower abdominal fat, triglycerides and high-sensitivity C reactive protein and higher adiponectin (p=0.015 to <0.0001). IRN subjects had higher cardiometabolic risk markers than ISN (p=0.03 to <0.0001). During 5.5-year follow-up, incident pre-diabetes/T2D was lower in ISO (31.3% vs 48.7%) among obese subjects and higher in IRN (47.1% vs. 26.0%) among non-obese subjects (p=0.0024). Kaplan-Meier analysis showed significantly different pre-diabetes/T2D survival probabilities across insulin sensitivity/adiposity phenotypes (p=0.0001). CONCLUSIONS Insulin sensitivity predicts ~40% decrease in the relative risk of incident pre-diabetes/T2D among obese persons, whereas insulin resistance predicts ~80% increased risk among non-obese persons. This is the first documentation of healthy and unhealthy phenotypes of obesity and leanness in a prospective biracial cohort, using rigorous measurement of insulin sensitivity.
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Affiliation(s)
- Ibiye Owei
- Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Nkiru Umekwe
- Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Casey Provo
- Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jim Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Samuel Dagogo-Jack
- Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Disability, Physical Inactivity, and Impaired Health-Related Quality of Life Are Not Different in Metabolically Healthy vs. Unhealthy Obese Subjects. Nutrients 2016; 8:nu8120759. [PMID: 27897994 PMCID: PMC5188414 DOI: 10.3390/nu8120759] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/06/2016] [Accepted: 11/16/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Obesity represents a major health hazard, affecting morbidity, psychological status, physical functionality, quality of life, and mortality. The aim of the present study was to explore the differences between metabolically healthy (MHO) and metabolically unhealthy (MUO) obese subjects with regard to physical activity, disability, and health-related quality of life (HR-QoL). METHODS All subjects underwent a multidimensional evaluation, encompassing the assessment of body composition, metabolic biomarkers and inflammation, physical activity level (IPAQ questionnaire), disability (TSD-OC test), and HR-QoL (SF-36 questionnaire). MHO and MUO were defined based on the absence or the presence of the metabolic syndrome, respectively. RESULTS 253 subjects were included (54 men and 199 women; age: 51.7 ± 12.8 vs. 50.3 ± 11.7 years, p = 0.46; BMI: 38.1 ± 5.7 vs. 38.9 ± 6.7 kg/m², p = 0.37). No significant difference was observed in body composition. There was no difference between MHO and MUO considering inflammation (hs-CRP: 6517.1 ± 11,409.9 vs. 5294.1 ± 5612.2 g/L; p = 0.37), physical inactivity (IPAQ score below 3000 METs-min/week in 77.6% of MHO vs. 80% of MUO subjects; p = 0.36), obesity-related disability (TSD-OC score > 33%, indicating a high level of obesity-related disability, in 20.2% of MHO vs. 26.5% of MUO subjects; p = 0.28), and the HR-QoL (SF-36 total score: 60 ± 20.8 vs. 62.8 ± 18.2, p = 0.27). DISCUSSION AND CONCLUSION The metabolic comorbidity and the impairment of functional ability and psycho-social functioning may have a different timing in the natural history of obesity. Alterations in the physical activity level and mobility disabilities may precede the onset of metabolic abnormalities. (Trial registration 2369 prot 166/12-registered 23 February 2012; Amendment 223/14-registered 13 February 2014).
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