Metabolically healthy obesity, transition to unhealthy metabolic status, and vascular disease in Chinese adults: A cohort study

Different associations between body mass index and Alzheimer's markers depending on metabolic health

BACKGROUND

Increasing evidence supports the association between body mass index (BMI), Alzheimer's disease, and vascular markers. Recently, metabolically unhealthy conditions have been reported to affect the expression of these markers. We aimed to investigate the effects of BMI status on Alzheimer's and vascular markers in relation to metabolic health status.

METHODS

We recruited 1,736 Asians without dementia (71.6 ± 8.0 years). Participants were categorized into underweight, normal weight, or obese groups based on their BMI. Each group was further divided into metabolically healthy (MH) and unhealthy (MU) groups based on the International Diabetes Foundation definition of metabolic syndrome. The main outcome was Aβ positivity, defined as a Centiloid value of 20.0 or above and the presence of vascular markers, defined as severe white matter hyperintensities (WMH). Logistic regression analyses were performed for Aβ positivity and severe WMH with BMI status or interaction terms between BMI and metabolic health status as predictors. Mediation analyses were performed with hippocampal volume (HV) and baseline Mini-Mental State Examination (MMSE) scores as the outcomes, and linear mixed models were performed for longitudinal change in MMSE scores.

RESULTS

Being underweight increased the risk of Aβ positivity (odds ratio [OR] = 2.37, 95% confidence interval [CI] 1.13-4.98), whereas obesity decreased Aβ positivity risk (OR = 0.63, 95% CI 0.50-0.80). Especially, obesity decreased the risk of Aβ positivity (OR = 0.38, 95% CI 0.26-0.56) in the MH group, but not in the MU group. Obesity increased the risk of severe WMH (OR = 1.69, 1.16-2.47). Decreased Aβ positivity mediate the relationship between obesity and higher HV and MMSE scores, particularly in the MH group. Obesity demonstrated a slower decline in MMSE (β = 1.423, p = 0.037) compared to being normal weight, especially in the MH group.

CONCLUSIONS

Our findings provide new evidence that metabolic health has a significant effect on the relationship between obesity and Alzheimer's markers, which, in turn, lead to better clinical outcomes.

Association between transitions in metabolic health and colorectal cancer across categories of body size phenotype: a prospective cohort study

OBJECTIVE

We aimed to investigate the associations of changes in metabolic health across categories of body size phenotype with the risk of colorectal cancer in a community-based prospective cohort.

METHODS

In the current study, a total of 70,987 participants were included. Changes in metabolic health across categories of body size phenotype were assessed between the health examination for the first time in the years 2006 through 2009 and a 2010/2011 health examination. A multivariate Cox proportional hazards model was used to assess the associations of changes in metabolic health across body size phenotype categories with risk of colorectal cancer.

RESULTS

During the median follow-up time of 11.04 years, 428 (0.60%) participants developed colorectal cancer. Compared with metabolically healthy normal-weight (MHNW) participants who remained MH, the risk of colorectal cancer was increased by 144% (95% CI: 1.21-4.95) for participants with metabolically healthy obesity (MHO) who converted to a metabolically unhealthy (MU) phenotype. Participants who were MU at baseline were still at increased risk of colorectal cancer, regardless of obesity status.

CONCLUSIONS

The MHO phenotype was a dynamic status over time, and converting to MU during follow-up and being initially MU were associated with having an increased risk of colorectal cancer, regardless of degree of obesity and body size phenotype.

Coronary artery calcification burden, atherogenic index of plasma, and risk of adverse cardiovascular events in the general population: evidence from a mediation analysis

BACKGROUND

Dyslipidemia and abnormal cholesterol metabolism are closely related to coronary artery calcification (CAC) and are also critical factors in cardiovascular disease death. In recent years, the atherogenic index of plasma (AIP) has been widely used to evaluate vascular sclerosis. This study aimed to investigate the potential association of AIP between CAC and major adverse cardiovascular events (MACEs).

METHODS

This study included 1,121 participants whose CACs were measured by multislice spiral CT. Participants' CAC Agatston score, CAC mass, CAC volume, and number of vessels with CACs were assessed. AIP is defined as the base 10 logarithm of the ratio of triglyceride (TG) concentration to high-density lipoprotein-cholesterol (HDL-C) concentration. We investigated the multivariate-adjusted associations between AIP, CAC, and MACEs. The mediating role of the AIP in CAC and MACEs was subsequently discussed.

RESULTS

During a median follow-up of 31 months, 74 MACEs were identified. For each additional unit of log-converted CAC, the MACE risk increased by 48% (HR 1.48 [95% CI 1.32-1.65]). For each additional unit of the AIP (multiplied by 10), the MACEs risk increased by 19%. Causal mediation analysis revealed that the AIP played a partial mediating role between CAC (CAC Agatston score, CAC mass) and MACEs, and the mediating proportions were 8.16% and 16.5%, respectively. However, the mediating effect of CAC volume tended to be nonsignificant (P = 0.137).

CONCLUSIONS

An increased AIP can be a risk factor for CAC and MACEs. Biomarkers based on lipid ratios are a readily available and low-cost strategy for identifying MACEs and mediating the association between CAC and MACEs. These findings provide a new perspective on CAC treatment, early diagnosis, and prevention of MACEs.

Association of a Healthy Lifestyle With Ambulatory 24-Hour Blood Pressure Among Chinese Youths: A Cross-Sectional Study

BACKGROUND

This study aims to explore the association between a healthy lifestyle and abnormal ambulatory blood pressure (ABP) in Chinese youths.

METHODS

A school-based sample of 1,296 college students was investigated. A lifestyle score was calculated by synthesizing 5 lifestyle factors, including smoking, alcohol consumption, diet, physical activity, and sleeping. The total score ranged from 0 to 5, with a higher score indicating a healthier lifestyle. This score was then divided into 3 categories representing low adherence to a healthy lifestyle (0-2), medium adherence (3), and high adherence (4-5). Abnormal 24-hour blood pressure (BP) was defined as systolic BP (SBP) ≥ 130 mm Hg and/or diastolic BP (DBP) ≥ 80 mm Hg. Abnormal daytime BP was determined as daytime SBP ≥ 135 mm Hg and/or DBP ≥ 85 mm Hg, while abnormal nighttime BP was characterized as nighttime SBP ≥ 120 mm Hg and/or DBP ≥ 70 mm Hg. We assessed the associations using the binomial regression model.

RESULTS

Mean age was 18.81 years, and 74.5% were women. The prevalence of abnormal 24-hour BP, daytime BP, and nighttime BP are 4.2%, 3.7%, and 9.0%, respectively. We found that participants with a high level of adherence to a healthy lifestyle had a significantly lower prevalence of abnormal 24-hour BP [prevalence ratios (PR) = 0.15, 95% CI: 0.05, 0.48] and abnormal daytime BP (PR = 0.16, 95%CI: 0.05, 0.52), when compared to those with a low level of adherence and after adjusting for the potential covariates.

CONCLUSIONS

A healthier lifestyle is associated with a better ambulatory BP profile among youths.

Metabolically healthy obesity and risks of cardiovascular disease and all-cause mortality, a matched cohort study: the Shizuoka study

BACKGROUND

Metabolically healthy obesity is not always a benign condition. It is associated with an increased incidence of cardiovascular disease and all-cause mortality. We investigated the prognostic significance of metabolically healthy obesity by comparing clinical profile-matched metabolically healthy obesity and non-obesity groups.

METHODS

We analyzed a health insurance dataset with annual health checkup data from Japan. The analyzed data included 168,699 individuals aged <65 years. Obesity was defined as ≥25 kg/m2 body mass index. Metabolically healthy was defined as ≤1 metabolic risk factor (high blood pressure, low high-density lipoprotein cholesterol, high low-density lipoprotein cholesterol, or high hemoglobin A1c). Incidence rates of stroke, myocardial infarction, and all-cause mortality identified from the insurance data were compared between metabolically healthy obesity and non-obesity groups (n = 8644 each) using a log-rank test.

RESULTS

The stroke (obesity: 9.2 per 10,000 person-years; non-obesity: 10.5; log-rank test p = 0.595), myocardial infarction (obesity: 3.7; non-obesity: 3.1; p = 0.613), and all-cause mortality (obesity: 26.6; non-obesity: 23.2; p = 0.304) incidence rates did not differ significantly between the metabolically healthy obesity and non-obesity groups, even when the abdominal obesity was considered in the analysis. The lack of association was also observed in the comparison between the metabolically unhealthy obesity and non-obesity groups (n = 10,965 each). The population with metabolically healthy obesity reported negligibly worse metabolic profiles than the population with non-obesity at the 5.6-year follow-up.

CONCLUSION

Obesity, when accompanied by a healthy metabolic profile, did not increase the risk of cardiovascular outcomes and all-cause mortality.

Associations between life's essential 8 and metabolic health among us adults: insights of NHANES from 2005 to 2018

BACKGROUND

Metabolic unhealth (MUH) is closely associated with cardiovascular disease (CVD). Life's Essential 8 (LE8), a recently updated cardiovascular health (CVH) assessment, has some overlapping indicators with MUH but is more comprehensive and complicated than MUH. Given the close relationship between them, it is important to compare these two measurements.

METHODS

This population-based cross-sectional survey included 20- to 80-year-old individuals from 7 National Health and Nutrition Examination Survey (NHANES) cycles between 2005 and 2018. Based on the parameters provided by the American Heart Association, the LE8 score (which ranges from 0 to 100) was used to classify CVH into three categories: low (0-49), moderate (50-79), and high (80-100). The MUH status was evaluated by blood glucose, blood pressure, and blood lipids. The associations were assessed by multivariable regression analysis, subgroup analysis, restricted cubic spline models, and sensitivity analysis.

RESULTS

A total of 22,582 participants were enrolled (median of age was 45 years old), among them, 11,127 were female (weighted percentage, 49%) and 16,595 were classified as MUH (weighted percentage, 73.5%). The weighted median LE8 scores of metabolic health (MH) and MUH individuals are 73.75 and 59.38, respectively. Higher LE8 scores were linked to lower risks of MUH (odds ratio [OR] for every 10 scores increase, 0.53; 95% CI 0.51-0.55), and a nonlinear dose-response relationship was seen after the adjustment of potential confounders. This negative correlation between LE8 scores, and MUH was strengthened among elderly population.

CONCLUSIONS

Higher LE8 and its subscales scores were inversely and nonlinearly linked with the lower presence of MUH. MUH is consistent with LE8 scores, which can be considered as an alternative indicator when it is difficult to collect the information of health behaviors.

Exposure to light at night (LAN) and risk of overweight/obesity, hypertension, and diabetes: a systematic review and meta-analysis

Current studies have presented conflicting findings regarding the associations between light at night (LAN) exposure and the risk of overweight/obesity, hypertension, and diabetes. Our study systematically summarized the evidence of the association between LAN exposure and the risk of overweight/obesity, hypertension, and diabetes. We searched five databases (PubMed, Web of Science, Embase, Scopus, and Cochrane) for observational studies published up to 1 August 2023. The pooled odds ratio (ORs) and 95% confidence intervals (CIs) were estimated by random-effects models for the association. Eighteen studies were included in the meta-analysis. Compared with the group with the lowest level of LAN, the group with the highest level of LAN is associated with an increased risk of overweight/obesity (pooled OR = 1.19, 95%CI: 1.13-1.26), hypertension (pooled OR: 1.86, 95% CI:1.28-2.72), and diabetes (pooled OR = 1.21, 95%CI: 1.07-1.31). Our meta-analysis demonstrated LAN exposure is associated with increased risk of overweight/obesity, hypertension, and diabetes.

Correlation between serum trimethylamine-N-oxide and body fat distribution in middle-aged and older adults: a prospective cohort study

BACKGROUND

Trimethylamine-N-oxide (TMAO) is linked with obesity, while limited evidence on its relationship with body fat distribution. Herein, we investigated the associations between serum TMAO and longitudinal change of fat distribution in this prospective cohort study.

METHODS

Data of 1964 participants (40-75y old) from Guangzhou Nutrition and Health Study (GNHS) during 2008-2014 was analyzed. Serum TMAO concentration was quantified by HPLC-MS/MS at baseline. The body composition was assessed by dual-energy X-ray absorptiometry at each 3-y follow-up. Fat distribution parameters were fat-to-lean mass ratio (FLR) and trunk-to-leg fat ratio (TLR). Fat distribution changes were derived from the coefficient of linear regression between their parameters and follow-up duration.

RESULTS

After an average of 6.2-y follow-up, analysis of covariance (ANCOVA) and linear regression displayed women with higher serum TMAO level had greater increments in trunk FLR (mean ± SD: 1.47 ± 4.39, P-trend = 0.006) and TLR (mean ± SD: 0.06 ± 0.24, P-trend = 0.011). Meanwhile, for women in the highest TMAO tertile, linear mixed-effects model (LMEM) analysis demonstrated the annual estimated increments (95% CI) were 0.03 (95% CI: 0.003 - 0.06, P = 0.032) in trunk FLR and 1.28 (95% CI: -0.17 - 2.73, P = 0.083) in TLR, respectively. In men, there were no similar significant observations. Sensitivity analysis yielded consistent results.

CONCLUSION

Serum TMAO displayed a more profound correlation with increment of FLR and TLR in middle-aged and older community-dwelling women in current study. More and further studies are still warranted in the future.

TRIAL REGISTRATION

NCT03179657.

Metabolically healthy obesity: from epidemiology and mechanisms to clinical implications

The concept of metabolic health, particularly in obesity, has attracted a lot of attention in the scientific community, and is being increasingly used to determine the risk of cardiovascular diseases and diabetes mellitus-related complications. This Review assesses the current understanding of metabolically healthy obesity (MHO). First, we present the historical evolution of the concept. Second, we discuss the evidence for and against its existence, the usage of different definitions of MHO over the years and the efforts made to provide novel definitions of MHO. Third, we highlight epidemiological data with regard to cardiovascular risk in MHO, which is estimated to be moderately elevated using widely used definitions of MHO when compared with individuals with metabolically healthy normal weight, but potentially not elevated using a novel definition of MHO. Fourth, we discuss novel findings about the physiological mechanisms involved in MHO and how such knowledge helps to identify and characterize both people with MHO and those with metabolically unhealthy normal weight. Finally, we address how the concept of MHO can be used for risk stratification and treatment in clinical practice.

Association Between Peritoneal Glucose Absorption, Lipid Metabolism, and Cardiovascular Disease Risk in Nondiabetic Patients on Peritoneal Dialysis

BACKGROUND

Excessive sugar intake increases the energy metabolic burden and the risk of cardiovascular disease (CVD). Patients on peritoneal dialysis absorb much more glucose than the World Health Organization recommends, but the link to CVD is unclear.

OBJECTIVE

To identify the association between peritoneal glucose absorption, lipid metabolism, and CVD.

METHODS

We applied generalized additive mixed effects and mixed effects Cox proportional hazard models to evaluate the impact of peritoneal glucose absorption on lipid profiles and CVD risk. We performed subgroup analyses by using protein intake (normalized protein nitrogen appearance [nPNA] and normalized protein catabolic rate [nPCR] were used to assess protein intake) and high-sensitivity C-reactive protein (hs-CRP).

RESULTS

After multivariable adjustment, peritoneal glucose absorption per 10 g/d increase was associated with an increase in cholesterol of 0.145 (95% confidence interval [CI]: 0.086-0.204) mmol/L. No link with the total risk of CVD was observed; however, protein intake and hs-CRP levels affected the relationship between glucose absorption and CVD risk. Patients with values for nPNA and nPCR <1.0 g/(kg·d) were associated with a lower risk of CVD (hazard ratio [HR] 95% CI: 0.68 (0.46-0.98)) with glucose absorption per 10 g/d increase. While patients with hs-CRP levels ≥3 mg/d or values for nPNA or nPCR ≥1.0 g/(kg·d) were associated with a higher risk of CVD (HR 95% CI: 1.32 (1.07-1.63); 1.31 (1.02-1.68)) for glucose absorption per 10 g/d increase.

CONCLUSIONS

Our study found a positive correlation between peritoneal glucose absorption and lipid profiles. Increased glucose absorption was associated with a lower risk of CVD in lower protein intake patients and a higher risk of CVD in higher hs-CRP or protein intake levels in patients on peritoneal dialysis.

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

Background

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

Methods

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

Results

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

Conclusion

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

Supplementary Information

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

The Relationship of Waist Circumference with the Morbidity of Cardiovascular Diseases and All-Cause Mortality in Metabolically Healthy Individuals: A Population-Based Cohort Study

Background

This study explores the relationship between waist circumference and morbidity of cardiovascular diseases (CVD) and all-cause mortality in metabolically healthy individuals.

Methods

A cohort of 5775 metabolically healthy participants from the 2001-2014 US National Health and Nutrition Examination Survey and National Death Index database was tracked over a median period of 81 months. These participants were divided into quartiles (Q1, Q2, Q3, Q4) based on increasing waist circumference. To compensate for missing covariates, multivariate multiple imputation methods were used. Adjusted logistic regression models were employed to examine the correlation between waist circumference and cardiovascular disease prevalence. Furthermore, Kaplan-Meier curves and multivariable Cox regression analysis were utilized to evaluate the association between waist circumference and all-cause mortality, both qualitatively and quantitatively.

Results

The adjusted logistic regression model indicated that a 10 cm increase in waist circumference was associated with a 1.45 times higher prevalence of CVD. As a categorical variable, there was a significant upward trend in CVD incidence across quartiles of waist circumference. The adjusted odds ratios (95% confidence intervals) were 2.41 (1.13-5.53) for Q2, 2.65 (1.18-6.39) for Q3, and 2.53 (0.9-7.44) for Q4, compared to Q1. Notably, individuals with high waist circumference showed significantly poorer survival compared to those with low waist circumference (p = 0.008). The Cox regression analysis revealed that each 10 cm increase in waist circumference contributed to an ~8% increase in all-cause mortality.

Conclusions

This study underscores a positive correlation between waist circumference and both CVD morbidity and all-cause mortality in metabolically healthy individuals. The findings highlight the significance of routinely monitoring waist circumference for effective CVD risk management, regardless of metabolic health status.

Triceps skinfold thickness trajectories and the risk of all-cause mortality: A prospective cohort study

BACKGROUND

The measurement of triceps skinfold (TSF) thickness serves as a noninvasive metric for evaluating subcutaneous fat distribution. Despite its clinical utility, the TSF thickness trajectories and their correlation with overall mortality have not been thoroughly investigated.

AIM

To explore TSF thickness trajectories of Chinese adults and to examine their associations with all-cause mortality.

METHODS

This study encompassed a cohort of 14747 adults sourced from the China Health and Nutrition Survey. Latent class trajectory modeling was employed to identify distinct trajectories of TSF thickness. Subjects were classified into subgroups reflective of their respective TSF thickness trajectory. We utilized multivariate Cox regression analyses and mediation examinations to explore the link between TSF thickness trajectory and overall mortality, including contributory factors.

RESULTS

Upon adjustment for multiple confounding factors, we discerned that males in the 'Class 2: Thin-stable' and 'Class 3: Thin-moderate' TSF thickness trajectories exhibited a markedly reduced risk of mortality from all causes in comparison to the 'Class 1: Extremely thin' subgroup. In the mediation analyses, the Geriatric Nutritional Risk Index was found to be a partial intermediary in the relationship between TSF thickness trajectories and mortality. For females, a lower TSF thickness pattern was significantly predictive of elevated all-cause mortality risk exclusively within the non-elderly cohort.

CONCLUSION

In males and non-elderly females, lower TSF thickness trajectories are significantly predictive of heightened mortality risk, independent of single-point TSF thickness, body mass index, and waist circumference.

The transition of metabolic phenotypes and cardiovascular events: Panasonic cohort study 16

OBJECTIVE

The study objective was to investigate whether changes in metabolic phenotype affect the risk of cardiovascular events.

METHODS

All 117,589 participants were included in this retrospective cohort study. The metabolic phenotypes of the participants were assessed at two points (the second evaluation was set 2 years after the first evaluation), and the incidence rate of cardiovascular events was observed for 11 years. The main outcome was 3-point major adverse cardiac events (MACE), which comprises cardiovascular death, nonfatal coronary artery disease, and nonfatal stroke incidence.

RESULTS

Of the participants, 2748 (2.3%) cases of 3-point MACE were identified during follow-up. The stable metabolically healthy obesity group had a higher risk of 3-point MACE than those with stable metabolically healthy nonobesity (MHNO). Additionally, the change from metabolically healthy obesity to MHNO for 2 years decreased the risk of 3-point MACE (hazard ratio [HR], 1.12: 95% CI: 0.84-1.47) to the same level as stable MHNO. However, the change from metabolically abnormal nonobesity and metabolically abnormal obesity to MHNO for 2 years maintained a higher risk of 3-point MACE (HR, 1.66 [95% CI: 1.36-2.01]; HR, 1.91 [95% CI: 1.22-2.81]) than those with stable MHNO.

CONCLUSIONS

Change in metabolic phenotype is associated with incident 3-point MACE.

Socioeconomic disparities in the association of age at first live birth with incident stroke among Chinese parous women: A prospective cohort study

Background

Stroke has become a significant public health issue in China. Although studies have shown that women's age at first live birth (AFLB) might be associated with incident stroke, there is limited evidence on this relationship among Chinese parous women. Likewise, the nature of this association across urban-rural socioeconomic status (SES) has yet to be explored. In this prospective study, we sought to investigate the associations of women's AFLB with the risk of incident stroke and its subtypes (ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage) and to explore the differences of these associations as well as the population-level impacts across SES classes.

Methods

We used data on 290 932 Chinese parous women from the China Kadoorie Biobank who were recruited in the baseline survey between 2004 and 2008 and followed up until 2015. We used latent class analysis to identify urban-rural SES classes and Cox proportional hazard regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for AFLB's association with incident stroke. We then calculated population attributable fraction (PAF) to demonstrate the population-level impact of later AFLB on stroke.

Results

Around 8.9% of parous women developed stroke after AFLB. Compared with women with AFLB <22 years, those with older AFLB had a higher risk of total stroke, with fully adjusted HRs (95% CI) of 1.71 (95% CI = 1.65-1.77) for 22-24 years and 3.37 (95% CI = 3.24-3.51) for ≥25 years. The associations of AFLB with ischaemic stroke were stronger among rural-low-SES participants. We found the highest PAFs of ischaemic stroke (60.1%; 95% CI = 46.2-70.3) associated with later AFLB for urban-high-SES individuals.

Conclusions

Older AFLB was associated with higher risks of incident stroke and its subtypes among Chinese parous women, with stronger associations between AFLB and ischaemic stroke among rural-low-SES participants. Targeted medical advice for pregnant women of different ages could have long-term benefits for stroke prevention.

Association between metabolic phenotypes of overweight/obesity and cardiovascular diseases in postmenopausal women

BACKGROUND AND AIM

Obesity and metabolic abnormalities were associated with an increased risk of cardiovascular disease. However, it is unclear how metabolic weight phenotypes relate to cardiovascular diseases in postmenopausal women. This study aimed to explore the relationships in postmenopausal women.

METHODS AND RESULTS

We included 15,575 postmenopausal women aged 35-75 years (median age, 60.6) without cardiovascular disease at baseline from a subcohort of the China Patient-centered Evaluative Assessment of Cardiac Events Million Persons Project. Metabolically unhealthy phenotype was defined as having ≥2 risk factors of metabolic syndrome: blood pressure ≥130/85 mm Hg or current use of antihypertensive drugs, fasting glucose ≥5.6 mmol/L or current use of antidiabetic agents, triglycerides ≥1.7 mmol/L, and high-density lipoprotein cholesterol <1.3 mmol/L. Cox regression analysis was used to evaluate the risks of cardiovascular diseases. Over a median follow-up period of 3.55 (interquartile range, 2.59-4.44) years, a total of 1354 cardiovascular events occurred. Compared to metabolically healthy normal weight, the multivariate-adjusted hazard ratios and their 95% confidence intervals were 1.41 (1.16-1.72) for metabolically unhealthy normal weight, 1.42 (1.16-1.73) for metabolically healthy overweight/obesity, and 1.75 (1.48-2.08) for metabolically unhealthy overweight/obesity. Subdividing overweight/obesity into separate groups revealed higher total cardiovascular disease risk only in metabolically unhealthy individuals across body mass index categories.

CONCLUSION

In postmenopausal women, both metabolically healthy overweight/obesity and metabolically unhealthy normal weight were associated with a higher risk of cardiovascular disease compared to metabolically healthy normal weight, and the greatest risk was observed in the metabolically unhealthy overweight/obesity category.

Correlation analysis between occupational stress and metabolic syndrome in workers of a petrochemical enterprise: based on two assessment models of occupational stress

BACKGROUND

Occupational stress is becoming a common phenomenon around the world. Being in a high occupational stress state for a long time may destroy the metabolic balance of the body, thereby increasing the risk of metabolic diseases. There is limited evidence regarding the correlation between occupational stress and metabolic syndrome (MetS), particularly in the petrochemical workers.

METHODS

A total of 1683 workers of a petrochemical enterprise in China were included in the survey by cluster sampling method. The occupational stress assessment was carried out by the Job Content Questionnaire and the Effort-Reward Imbalance Questionnaire, and the general demographic characteristics, work characteristics, occupational hazards, lifestyle and health examination data of the participants were collected. Logistic regression and multiple linear regression were used to analyze the correlations and influencing factors between occupational stress and its dimensions with MetS and its components.

RESULTS

A total of 1683 questionnaires were sent out, and 1608 were effectively collected, with an effective recovery rate of 95.54%. The detection rates of occupational stress in Job Demand-Control (JDC) and Effort-Reward Imbalance (ERI) models were 28.4% and 27.2%, respectively. In this study, 257 participants (16.0%) were diagnosed with MetS. Compared with the non-MetS group, body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides (TG) and fasting blood-glucose (FBG) levels were significantly higher in the MetS group, and high density lipoprotein-cholesterol (HDL-C) levels were significantly lower (P < 0.001). The results of multiple linear regression showed that after adjusting for nation, marital status, education, work system, smoking and drinking, and further adjusting for occupational hazards, the D/C ratio was significantly negatively correlated with SBP in the JDC model. Social support was negatively correlated with WC. In the ERI model, there was a significant positive correlation between over-commitment and FBG.

CONCLUSIONS

The detection rates of occupational stress and MetS were high in workers of a petrochemical enterprise. In the JDC model, occupational stress was negatively correlated with SBP, and social support was negatively correlated with WC. In the ERI model, there was a significantly positive correlation between over-commitment and FBG.

Effect of BMI on cumulative live birth rates in patients that completed IVF treatment: a retrospective cohort study of 16,126 patients

Although several studies have reported that high maternal BMI could influence the cumulative live birth rate (CLBR) in fresh embryo transfer cycles, the association of BMI with CLBR remains unclear in patients that completed IVF treatment. In this study, we examined the association of maternal BMI with CLBR, including repetitive one oocyte pick-up (OPU) and all fresh and frozen embryo transfer until live birth or embryos were run out. A total of 16,126 patients' data were included in the analysis and were divided into four groups based on BMI. We found that patients' characteristics, embryo parameters, and pregnancy outcomes differed among different BMI groups. Multivariate logistic regression showed that being underweight was associated with a higher possibility of having live birth than the reference group (OR (95% CI) 1.40 (1.22-1.59), P < 0.001), whereas being overweight and obese were associated with a lower possibility of having live birth than the reference group ((OR (95% CI) 0.81 (0.74-0.90), P < 0.001) and (OR (95% CI) 0.68 (0.55-0.85), P < 0.001)). After adjustment for confounding factors, the reference group was associated with a higher possibility of having live birth, with a significant difference found between the obese and reference groups (OR (95% CI) 0.55 (0.43-0.70), P < 0.001). An association was found between CLBR and BMI, indicating that an increase in BMI results in a decline in CLBR. Moreover, the CLBR of patients with different characteristics differed in the various BMI groups. Taken together, our data show that maternal BMI has a significant impact on CLBR.

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

AIMS

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

DATA SYNTHESIS

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

CONCLUSIONS

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

SYSTEMATIC REVIEW REGISTRATION

PROSPERO number: CRD42021234948.

Metabolically healthy obesity, transition from metabolic healthy to unhealthy status, and carotid atherosclerosis

BACKGROUND

Evidence of the effects of metabolically healthy obesity (MHO) on atherosclerosis is limited; the transition effects of metabolic health and obesity phenotypes have been ignored. We examined the association between metabolic health and the transition to atherosclerosis risk across body mass index (BMI) categories in a community population.

METHODS

This cross-sectional study was based on a national representative survey that included 50,885 community participants aged ≥40 years. It was conducted from 01 December 2017 to 31 December 2020, in 13 urban and 13 rural regions across Hunan China. Metabolic health was defined as meeting less than three abnormalities in blood pressure, glucose, high-density lipoprotein cholesterol, triglycerides, or waist circumference. The participants were cross-classified at baseline based on their metabolic health and obesity. In addition, the relationship between atherosclerosis and transitions in metabolic health status based on 4733 participants from baseline to the second survey after 2 years was considered. The relationship between metabolic health status and the risk of transition to Carotid atherosclerosis (CA) was assessed using logistic regression and Cox proportional hazards regression analyses.

RESULTS

In this study, the mean age of the participants was 60.7 years (standard deviation [SD], 10.91), 53.0% were female, and 51.2% had CA. As compared with metabolically healthy normal weight (MHN), those with MHO phenotype (odd ratio [OR] 1.10, 95% confidence interval [CI] 1.02-1.21), metabolically unhealthy normal weight (OR 1.27, 95% CI 1.19-1.35), metabolically unhealthy overweight (OR 1.41, 95% CI 1.33-1.48), and metabolically unhealthy obese (OR 1.54, 95% CI 1.44-1.64) had higher risk for CA. However, during the follow-up of 2 years, almost 33% of the participants transitioned to a metabolically unhealthy status. As compared with stable healthy normal weight, transition from metabolically healthy to unhealthy status (hazard ratios [HR] 1.21, 95% [CI] 1.02-1.43) and stable metabolically unhealthy overweight or obesity (MUOO) (HR 1.32, 95% CI 1.17-1.48) were associated with higher risk of CA.

CONCLUSIONS

In the community population, obesity remains a risk factor for CA despite metabolic health. However, the risks were highest for metabolically unhealthy status across all BMI categories. A large proportion of metabolically healthy overweight or participants with obesity converts to an unhealthy phenotype over time, which is associated with an increased risk of CA.

Skeletal muscle index together with body mass index is associated with secondary osteoporosis in patients with rheumatoid arthritis

OBJECTIVE

The objective of this study was to explore the associations of body mass index (BMI), fat mass index (FMI), skeletal mass index (SMI) and secondary osteoporosis (OP) in patients with rheumatoid arthritis (RA).

METHODS

The bone mineral density (BMD) at sites of the femur neck (Neck), total hip (Hip) and lumbar vertebrae 1-4 (L1-4) was measured by dual-energy X-ray absorptiometry. The skeletal muscle index, body fat percentage and mineral content were measured by biological electrical impedance for calculating BMI, FMI and SMI.

RESULTS

A total of 433 patient with RA and 158 healthy controls were enrolled. The BMDs at each site of the RA patients were lower compared with those of the healthy controls (p < 0.0001), and the prevalence of OP (36.1%, 160/443) and sarcopenia (65.2%, 288/443) in the RA patients were higher than those in the controls (12.7%, 20/158, p < 0.0001; 9.0%, 14/156, p < 0.0001). Significant differences in the BMD, FMI, SMI, mineral content, body fat percentage and skeletal muscle mass were found among the RA patients in the different BMI groups (p < 0.05). In RA patients with BMI < 18.5 kg/m2, the prevalence of OP in the RA patients with sarcopenia was similar to that in those without sarcopenia (44.4% vs. 66. 7%, χ2 = 0. 574, p = 0.449). In the RA patients with a normal BMI or who were overweight or obese, prevalence of OP in the RA patients with sarcopenia was significantly higher than that in the RA patients without sarcopenia (42.8% vs. 21.7%, χ2 = 10.951, p = 0.001; 61.1% vs. 13.0%, χ2 = 26.270, p < 0.0001). In the RA patients without sarcopenia, the prevalence of OP in the RA patients in the different BMI groups was different (p = 0.039). In the RA patients with sarcopenia, there was no significant difference in the prevalence of OP among the RA patients in the different BMI groups (p = 0. 128). The linear correlation analysis showed that the SMI in RA patients was positively correlated with the BMD of each site measured and BMI and FMI (p < 0.0001). However, there was a negative linear correlation between SMI and disease duration (p = 0.048). The logistic regression analysis found that SMI (OR = 0.569, p = 0.002, 95% CI 0.399-0.810), BMI (OR = 0.884, p = 0.01, 95% CI 0.805-0.971) and gender (1 = female, 2 = male) (OR = 0.097, p < 0.0001, 95% CI 0.040-0.236) were protective factors for OP in RA, while age (OR = 1.098, p < 0.0001, 95% CI 1.071-1.125) was the risk factor.

CONCLUSION

BMI and SMI are associated with the occurrence of OP in RA patients, and both SMI and BMI are important protective factors for OP secondary to RA.

Association of Abnormal Lung Function and Its Subtypes With Arterial Stiffness: A Longitudinal Cohort Study

BACKGROUND

Prior studies have reported the cross-sectional relationship between lung function and arterial stiffness, while the longitudinal association remains unclear to date. This study aimed to investigate whether abnormal lung function and its subtypes at baseline are associated with increased arterial stiffness using a cohort.

METHODS AND RESULTS

This was a secondary analysis extracting 2461 participants from Beijing Health Management Cohort as baseline and annually followed for development of arterial stiffness. Abnormal lung function was defined by forced expiratory volume in 1s <80% of the predicted value, forced vital capacity of the predicted value, or forced expiratory volume in 1s/forced vital capacity ratio <70%. Increased arterial stiffness was determined by brachial-ankle pulse wave velocity ≥1400 cm/s. Cox proportional hazards model was used to calculate the hazard ratio and population attributable fraction. The mean age was 42.8±8.1 years, and 444 (18.0%) cases developed increased arterial stiffness during a median follow-up of 3.0 years. The adjusted hazard ratio (95% CI) of arterial stiffness was 1.47 (95% CI, 1.10-1.96) for abnormal lung function, with a population attributable fraction of 3.9% (95% CI, 0.8-7.1). Of subtypes, only obstructive ventilatory dysfunction was significantly associated with arterial stiffness (adjusted hazard ratio, 2.06 [95% CI, 1.27-3.36]), not restricted ventilatory dysfunction (adjusted hazard ratio, 0.95 [95% CI, 0.54-1.65]). Consistent results were observed on multiple sensitivity analyses.

CONCLUSIONS

Our study indicated a longitudinal association of abnormal lung function with increased arterial stiffness using a large cohort, especially for the obstructive ventilatory dysfunction.

Association between Metabolically Healthy Status and Risk of Gastrointestinal Cancer

PURPOSE

Although obesity is associated with numerous diseases, the risks of disease may depend on metabolically healthy status. Nevertheless, it is unclear to whether metabolically healthy status affects risk of gastrointestinal (GI) cancer in general Chinese population.

MATERIALS AND METHODS

A total of 114,995 participants who met the criteria were included from the Kailuan Study. The study participants were divided into four groups according to body mass index (BMI)/waist circumference (WC) and metabolic status. Incident of GI cancer (esophageal cancer, gastric cancer, liver cancer, biliary cancer, pancreatic cancer, and colorectal cancer) during 2006-2020 were confirmed by review of medical records. The Cox proportional hazard regression models were used to assess the association metabolically healthy status with the risk of GI cancer by calculating the hazard ratios (HR) and 95% confidence interval (CI).

RESULTS

During a mean 13.76 years of follow-up, we documented 2,311 GI cancers. Multivariate Cox regression analysis showed that compared with the metabolically healthy normal-weight group, metabolically healthy obese (MHO) participants demonstrated an increased risk of developing GI cancer (HR, 1.54; 95% CI, 1.11 to 2.13) by BMI categories. However, such associations were not found for WC category. These associations were moderated by age, sex, and anatomical site of the tumor. Individuals with metabolic unhealthy normal-weight or metabolic unhealthy obesity phenotype also have an increased risk of GI cancer.

CONCLUSION

MHO phenotype was associated with increased risk of GI cancer. Moreover, individuals who complicated by metabolic unhealthy status have an increased risk of developing GI cancer. Hence, clinicians should consider the risk of incident GI cancer in people with abnormal metabolically healthy status and counsel them about metabolic fitness and weight control.

Alisol B 23-acetate promotes white adipose tissue browning to mitigate high-fat diet-induced obesity by regulating mTOR-SREBP1 signaling

OBJECTIVE

Obesity is a global health concern with management strategies encompassing bariatric surgery and anti-obesity drugs; however, concerns regarding complexities and side effects persist, driving research for more effective, low-risk strategies. The promotion of white adipose tissue (WAT) browning has emerged as a promising approach. Moreover, alisol B 23-acetate (AB23A) has demonstrated efficacy in addressing metabolic disorders, suggesting its potential as a therapeutic agent in obesity management. Therefore, in this study, we aimed to investigate the therapeutic potential of AB23A for mitigating obesity by regulating metabolic phenotypes and lipid distribution in mice fed a high-fat diet (HFD).

METHODS

An obesity mouse model was established by administration of an HFD. Glucose and insulin metabolism were assessed via glucose and insulin tolerance tests. Adipocyte size was determined using hematoxylin and eosin staining. The expression of browning markers in WAT was evaluated using Western blotting and quantitative real-time polymerase chain reaction. Metabolic cage monitoring involved the assessment of various parameters, including food and water intake, energy metabolism, respiratory exchange rates, and physical activity. Moreover, oil red O staining was used to evaluate intracellular lipid accumulation. A bioinformatic analysis tool for identifying the molecular mechanisms of traditional Chinese medicine was used to examine AB23A targets and associated signaling pathways.

RESULTS

AB23A administration significantly reduced the weight of obese mice, decreased the mass of inguinal WAT, epididymal WAT, and perirenal adipose tissue, improved glucose and insulin metabolism, and reduced adipocyte size. Moreover, treatment with AB23A promoted the expression of browning markers in WAT, enhanced overall energy metabolism in mice, and had no discernible effect on food intake, water consumption, or physical activity. In 3T3-L1 cells, AB23A inhibited lipid accumulation, and both AB23A and rapamycin inhibited the mammalian target of rapamycin-sterol regulatory element-binding protein-1 (mTOR-SREBP1) signaling pathway. Furthermore, 3-isobutyl-1-methylxanthine, dexamethasone and insulin, at concentrations of 0.25 mmol/L, 0.25 μmol/L and 1 μg/mL, respectively, induced activation of the mTOR-SREBP1 signaling pathway, which was further strengthened by an mTOR activator MHY1485. Notably, MHY1485 reversed the beneficial effects of AB23A in 3T3-L1 cells.

CONCLUSION

AB23A promoted WAT browning by inhibiting the mTOR-SREBP1 signaling pathway, offering a potential strategy to prevent obesity. Please cite this article as: Han LL, Zhang X, Zhang H, Li T, Zhao YC, Tian MH, Sun FL, Feng B. Alisol B 23-acetate promotes white adipose tissue browning to mitigate high-fat diet-induced obesity by regulating mTOR-SREBP1 signaling. J Integr Med. 2024; 22(1): 83-92.

Gender Disparities in Patients' Decisions about the Management of Myocardial Infarction in East Chinese Province

Background

Previous studies showed that there are gender disparities in various respects of acute myocardial infarction (AMI), including risk factors, symptoms, and outcomes. However, few of them noticed the gender disparities in patients' decision about the management of AMI, which might also be associated with the outcome.

Aims

To identify gender disparities in patients' decisions about the management of myocardial infarction.

Methods

In this cohort study, the critical time points including the time of symptom onset, visiting hospital, diagnosis of AMI, consent to coronary angiography (CAG), beginning of CAG, and balloon dilation were recorded. Medication and major adverse cardiac event (MACE) within 6 months were also recorded.

Results

Female patients took more time from symptom onset to visiting hospital (P = 0.001), from diagnosis of AMI to consent to CAG (P < 0.05), and from door to needle/balloon than male (P < 0.05). Less female patients accepted CAG (P < 0.05) and coronary intervention/bypass grafting (P < 0.05). Less female patients kept good inherence to antiplatelet therapy (P < 0.05) and statins (P < 0.05) than male, more female preferred traditional Chinese medicine (TCM) than male patient (P < 0.05), and most of them had MACE within 6 months (P < 0.05). Patients' good adherence to antiplatelet therapy and statins and accepting coronary intervention/bypass grafting were associated with a reduced risk of MACE.

Conclusion

Female patients were more reluctant to make decisions about emergency management of AMI and tended to choose conservative treatment. More female patients preferred TCM than evidence-based medicine. Their reluctance about the critical management of AMI and poor adherence to evidence-based medicine were associated with an elevated risk of MACE.

Transitions in Metabolic Health and Onset Age of Cardiovascular Diseases

INTRODUCTION

The cardiometabolic risk associated with metabolically healthy obesity remains the subject of debate. It is unclear whether changes in metabolically healthy obesity status affect premature cardiovascular disease (CVD) risk. Authors aimed to investigate the association of metabolically healthy obesity and its transition over time with incident CVD by age at onset.

METHODS

In a community-based, prospective cohort study, 54,441 adults without CVD in or before 2010 were followed for incident CVD until 2020. This sample was analyzed in 2022. Four age groups were examined (<55, 55-65, 65-75, and ≥75 years) for CVD onset. In each age group, participants were cross-classified by BMI categories and metabolic health. The Cox proportional hazards model with age as the underlying time scale was used to examine the associations of metabolic health status and its transition with CVD across BMI categories.

RESULTS

During a median follow-up of 9.59 years, 3,038 participants developed CVD. Individuals with metabolically unhealthy obesity at baseline had the highest hazard ratio for CVD onset at any age, ranging from 2.68 (95% CI=2.02, 3.55) for CVD onset in those aged <55 years to 1.55 (95% CI=1.09, 2.10) for CVD onset in those aged ≥75 years. Individuals who had metabolically healthy obesity at baseline or even remained metabolically healthy during 2006-2010 were still at increased risk of premature CVD, and the association attenuated with increasing age of CVD onset.

CONCLUSIONS

The metabolically healthy obesity phenotype is dynamic and its transition to a metabolically unhealthy phenotype or even stable metabolically healthy obesity is associated with an increased risk of CVD. The associations were more evident for CVD onset at younger ages.

The ZJU index is associated with the risk of obstructive sleep apnea syndrome in Chinese middle-aged and older people: a cross-sectional study

BACKGROUND

The ZJU index, a novel calculation that combines body mass index, triglycerides, fasting blood glucose and the ratio of alanine aminotransferase to aspartate aminotransferase, is a closely related measure of obesity and insulin resistance. Studies of the ZJU index in relation to obstructive sleep apnea syndrome (OSAS) have not been reported. This study assessed the correlation between the ZJU values and OSAS risk.

METHODS

A total of 2,130 participants who underwent polysomnographic monitoring were included in the study. The participants' basic information and laboratory biochemical indicators were collected, and the ZJU index was computed. The ZJU index was divided into quartiles. The correlation between the different ZJU index levels and OSAS risk was assessed using logistic regression. Drew a receiver operating characteristic (ROC) relationship curve, with prediction efficacy judged by the area under the curve (AUC), and found the optimum cut-off point for ZJU index to predict OSAS. Relative risks were presented as odds ratios (OR). The range of OR values is expressed in the form of 95% confidence intervals (95% CI).

RESULTS

The number of patients diagnosed with OSAS increased progressively with increasing ZJU index (T1: 9.4%; T2: 20.6%; T3: 28.3%; T4: 41.7%; P < 0.001). The additional confounders were adjusted by the logistic regression models, the study revealed an independent correlation between ZJU index and OSAS. (P < 0.001). The OSAS risk was notably higher at the highest ZJU index levels. (OR = 2.046 [95% CI: 1.057 to 3.964]). The ROC curve for the ZJU index showed an AUC of 0.64 (P < 0.001) for males and 0.75 (P < 0.001) for females, with a specificity of 64% and 55% and a sensitivity of 60% and 92% for males and females, respectively, with the optimum cut-off values of 36.568 and 34.722, respectively.

CONCLUSION

A high ZJU index was significantly associated with an increasing risk of OSAS. The ZJU is expected to be a meaningful index for detecting OSAS in the general population.

Trends in weight change patterns across life course among US adults, 1988-2018: population-based study

BACKGROUND

To examine trends in weight change patterns from young adulthood through midlife to late adulthood and their sex and racial/ethnic disparities among US adults from 1988 to 2018.

METHODS

A total of 48,969 participants from the National Health and Nutrition Examination Survey 1988-1994 and 2001-2018 were included.

RESULTS

The age-adjusted prevalence of stable non-obesity between young adulthood and midlife declined significantly from 84.1% (95 CI, 82.9-85.3%) in 1988-1994 to 68.7% (67.1-70.2%) in 2013-2018, and between midlife and late adulthood from 71.2% (69.2-73.1%) to 52.4% (50.5-54.2%). The magnitude of increase in the prevalence of weight gain from young adulthood to midlife (from 10.8% [9.9-11.6%] in 1988-1994 to 21.2% [20-22.3%] in 2013-2018; P < 0.001 for trend) was greater than that from midlife to late adulthood (from 14.1% [12.9-15.3%] to 17.2% [16.2-18.1%]; P = 0.002 for trend). The magnitude of increase in the prevalence of stable obesity from young adulthood to midlife (from 3.9% [3.1-4.8%] in 1988-1994 to 9.2% [8.2-10.3%] in 2013-2018; P < 0.001 for trend) was smaller than that from midlife to late adulthood (from 11.2% [10.1-12.2%] to 24.8% [23.3-26.3%]; P < 0.001 for trend). The declining trends in the prevalence of stable non-obesity and increasing trends in the prevalence of weight gain and stable obesity from young adulthood through midlife to late adulthood were also observed for all sex and race/ethnicity subgroups. The magnitude of decrease in the prevalence of stable non-obesity, and the magnitude of increase in the prevalence of weight gain from young adulthood through midlife to late adulthood were greater in men than in women (all P for interaction < 0.01). Weight gain patterns for those aged ≥ 65 years were substantially different from the younger age groups.

CONCLUSIONS

More young people born in later years are encountering obesity and accumulate greater obesity exposure across their lives than young people born in earlier years.

Expression of ICAM-1 and E-selectin in different metabolic obesity phenotypes: discrepancy for endothelial dysfunction

OBJECTIVES

Endothelial dysfunction, the earliest vascular alteration, is a consequence of metabolic disorders associated with obesity. However, it is still unclear whether a proportion of obese individuals without metabolic alterations associated with obesity, defined as "metabolically healthy obesity (MHO)", exhibit better endothelial function. We therefore aimed to investigate the association of different metabolic obesity phenotypes with endothelial dysfunction.

METHODS

The obese participants without clinical cardiovascular disease from the MESA (Multi-Ethnic Study of Atherosclerosis) were allocated to the different metabolic obesity phenotypes based on their metabolic status, including MHO and metabolically unhealthy obesity (MUO). Associations of metabolic obesity phenotypes with the biomarkers of endothelial dysfunction, including soluble intercellular adhesion molecule-1 (sICAM-1) and soluble E-selectin (sE-selectin), were evaluated using multiple linear regression models.

RESULTS

Plasma levels of sICAM-1 and sE-selectin were respectively measured in 2371 and 968 participants. Compared to the non-obese participants, those with MUO were associated with higher concentrations of sICAM-1 (β 22.04, 95% CI 14.33-29.75, P < 0.001) and sE-selectin (β 9.87, 95% CI 6.00-13.75, P < 0.001) after adjusting for confounders. However, no differences were found for the concentrations of sICAM-1 (β 0.70, 95% CI - 8.91 to 10.32, P = 0.886) and sE-selectin (β 3.69, 95% CI - 1.13 to 8.51, P = 0.133) in the participants with MHO compared to the non-obese participants.

CONCLUSIONS

Individuals with MUO were associated with elevated biomarkers of endothelial dysfunction, but the association with endothelial dysfunction was not found in those with MHO, indicating that the individuals with MHO might exhibit better endothelial function.

Longitudinal association of serum 25-hydroxyvitamin D levels with metabolically healthy body size transition in children and adolescents: A prospective cohort study with 2 years of follow-up

BACKGROUND AND AIMS

Although the associations of vitamin D with obesity and metabolic abnormalities have been reported, the role of vitamin D in the transition of obesity phenotype remains unclear but is highly desired since it is crucial to identify potential methods for obesity management. Therefore, we aimed to investigate the relationship between vitamin D and the risk for metabolically unhealthy obesity (MUO) or metabolically healthy obesity (MHO) in metabolically healthy children with 2 years of follow-up.

METHODS

Data were collected from a population-based cohort consisting of 6424 metabolically healthy children aged 6-16 years at baseline. Metabolic abnormalities including hypertension, high triglycerides (TG), low high-density lipoprotein cholesterol (HDL-C), hyperglycemia, and hyperuricemia were assessed both at baseline and follow-up. Baseline serum 25-hydroxyvitamin D (25[OH]D) concentrations were measured as exposure. The obesity phenotype transition was evaluated by weight status with the combination of metabolic health status from baseline to follow-up.

RESULTS

During a 2-year follow-up, 889 (13.8 %) incident MUO cases occurred. For participants with obesity, each 10 nmol/L increment in 25(OH)D concentrations was associated with a 21 % (95%CI: 13 %∼43 %) and a 7 % (95%CI: 1 %∼14 %) decreased risk in high TG and hyperuricemia, respectively. A 51 % (95%CI: 22 %∼69 %) lower risk of MUO was observed in participants with sufficient vitamin D levels (≥50 nmol/L) compared to those with vitamin D deficiency (<30 nmol/L). Besides, among children who were MHO at baseline, those with sufficient vitamin D levels (≥50 nmol/L) were more likely to transition to metabolically healthy normal weight (MHNW) than vitamin D deficient individuals (<30 nmol/L).

CONCLUSIONS

Vitamin D may prevent the development of MUO and help increase the transition from MHO to MHNW. The findings highlight that vitamin D might be an effective nutrient for obesity management.

Long-term exposures to ambient particulate matter and ozone pollution with lower extremity deep vein thrombosis after surgical operations: a retrospective case-control study in Beijing, China

BACKGROUND

Lower extremity deep vein thrombosis (LEDVT) after surgical operations is a common and fatal disease leading to unfavorable outcomes including death. Nevertheless, there has been insufficient evidence on the associations between ambient air pollution and LEDVT, particularly studies from developing regions.

METHODS

Based on 302 LEDVT cases and 302 controls in a general hospital in Beijing, China, this unmatched retrospective case-control study investigated the associations of fine particulate matter (PM2.5), inhalable particulate matter (PM10), and ozone (O3) with odds of LEDVT.

RESULTS

Per 10 μg/m3 increase in PM2.5, PM10, and O3 at 3-month, 6-month, and 2-year average was associated with increased LEDVT odds [odds ratios (ORs) for PM2.5: 1.10 (95%CI: 1.05, 1.14), 1.14 (95%CI: 1.09, 1.18), and 1.30 (95%CI: 1.06, 1.61); ORs for PM10: 1.06 (95%CI: 1.02, 1.10), 1.12 (95%CI: 1.08, 1.16), and 1.29 (95%CI: 1.03, 1.61); ORs for O3: 1.00 (95%CI: 0.96, 1.04), 1.16 (95%CI: 1.02, 1.31), and 2.08 (95%CI: 1.03, 4.18), respectively]. The stratified analyses, exposure-responses curves, and sensitivity analyses further highlighted the robustness of our findings.

CONCLUSIONS

Long-term exposures to ambient PM2.5, PM10, and O3 may increase the risk of LEDVT in patients after surgical operations. The results may be implicated in the prevention and control of adverse clinical outcomes of surgical patients associated with ambient air pollution.

Metabolic phenotyping of BMI to characterize cardiometabolic risk: evidence from large population-based cohorts

Obesity is a risk factor for type 2 diabetes and cardiovascular disease. However, a substantial proportion of patients with these conditions have a seemingly normal body mass index (BMI). Conversely, not all obese individuals present with metabolic disorders giving rise to the concept of "metabolically healthy obese". We use lipidomic-based models for BMI to calculate a metabolic BMI score (mBMI) as a measure of metabolic dysregulation associated with obesity. Using the difference between mBMI and BMI (mBMIΔ), we identify individuals with a similar BMI but differing in their metabolic health and disease risk profiles. Exercise and diet associate with mBMIΔ suggesting the ability to modify mBMI with lifestyle intervention. Our findings show that, the mBMI score captures information on metabolic dysregulation that is independent of the measured BMI and so provides an opportunity to assess metabolic health to identify "at risk" individuals for targeted intervention and monitoring.

Higher ratio of serum uric acid to serum creatinine (SUA/SCr) increases the risk of metabolic unhealthy phenotype

BACKGROUND AND AIM

It is very important to understand which factors play roles in switching from a healthy to an unhealthy metabolism. It is unclear if SUA/SCr is an independent risk factor for metabolic unhealthy phenotype. We examined whether SUA/SCr is associated with an increased risk for metabolic unhealthy phenotype in the Chinese population.

METHODS AND RESULTS

As many as 3158 subjects aged 25-75 years who had a metabolic healthy phenotype at baseline were included in the retrospective cohort study. They were assigned to four groups based on the quartile of SUA/SCr. We compared the demographic and clinical characteristics among the four groups. The correlation between SUA/SCr and the risk of metabolic unhealthy phenotype in the overall population and stratified by subgroups was examined by logistic regression analyses. Greater SUA/SCr values were correlated with greater BMI, systolic and diastolic BP, TC, TG, RBC, WBC, HB, ALT, SUA and eGFR. During the two-year follow-up, 632 of the study subjects (20.01%) developed new-onset metabolic unhealthy phenotype from the total of 3158 study subjects. A statistically significant increase in the rates of metabolic unhealthy phenotype was observed with increasing SUA/SCr levels within each group. After multivariate adjustment, the adjusted ORs and 95% CIs were 1.44 (1.03-2.00) and 2.11 (1.52-2.94) in the Q3 group and Q4 group, respectively.

CONCLUSION

SUA/SCr was positively related to the risk of metabolic unhealthy phenotype in the Chinese subjects, suggesting the potential of SUA/SCr to serve as an independent risk predictor in the development of metabolic unhealthy phenotype.

Impacts of obesity on global subclinical left cardiac function represented by CMR-derived myocardial strain, TyG index may be a predictor

Obesity is a recognized risk factor for heart failure. People with similar weights may have different metabolic health. Notably, insulin resistance is a hallmark of obesity and a feature of heart failure. We aimed to evaluate the effects of obesity and metabolic health status on subclinical left cardiac function. We also investigated whether insulin resistance (TyG index) plays a role in BMI-linked subclinical left cardiac dysfunction. The study involved 403 volunteers. Hierarchical multiple regression models were used to assess associations between obesity, metabolic health, and overall subclinical left cardiac function. Mediating analysis was used to explore the role of the TyG index in the association between BMI and left cardiac function. Finally, ROC analysis was performed to explore the predictive value of the TyG index in subclinical left cardiac dysfunction. The correlation analysis showed that metabolic unhealth increased the risk of subclinical left ventricular (LV) dysfunction; obesity was associated with an increased risk of global left cardiac dysfunction regardless of metabolic health status. The TyG index mediated 25% of the associations between BMI and Left atrial (LA) functional parameters. ROC analysis exhibited that the TyG index can be used as a predictor of LA dysfunction (AUC = 0.63), and the optimal cut-off point for the TyG index is 9.33. Even a "non-obese metabolically unhealthy" is a detrimental state of early LV function; obesity remains a major risk factor for global subclinical left cardiac dysfunction. Using the TyG index could allow early identification of individuals at high risk of subclinical left cardiac dysfunction.Registration number: ChiCTR2200057991; Date of registration: 2022-03-25. URL: http://www.chictr.org.cn/showproj.aspx?proj=162316 .

Exposure to multiple neonicotinoid insecticides, oxidative stress, and gestational diabetes mellitus: Association and potential mediation analyses

As the most extensively used insecticides worldwide, neonicotinoid insecticides (NNIs) have received a growing global concern over their adverse health effects. This study aimed to assess the associations of urinary concentrations of NNIs in early pregnancy with gestational diabetes mellitus (GDM) and the mediation roles of oxidative DNA damage, RNA damage, and lipid peroxidation in the associations. With a prospective nested case-control study, 519 GDM cases and 519 controls were matched on the infant's sex and maternal age. Urinary biomarkers of NNIs exposure and oxidative stress were measured in early pregnancy. We estimated the associations of single and the mixture of NNIs and their metabolites with GDM by conditional logistic regression and quantile g-computation models, respectively. The mediating roles of oxidative stress were evaluated by the structural equation model. The odds of GDM significantly increased by 15 %, 18 %, 26 %, 42 %, 49 %, and 13 % in each unit increment of ln-transformed concentrations of urinary imidacloprid (IMI), imidacloprid-olefin (IMI-olefin), desnitro-imidacloprid (DN-IMI), thiamethoxam (THM), clothianidin, and desmethyl-clothianidin, respectively. Exposure to the mixture of NNIs was associated with increased odds of GDM (adjusted OR: 1.76; 95 %CI: 1.45, 2.13). Advanced maternal age enhanced the associations of 5-hydroxy-IMI, DN-IMI, and IMI-olefin with GDM (P < 0.05), and being overweight/obese before pregnancy strengthened the effects of IMI, IMI-olefin, and THM on GDM (P < 0.05). In the association of NNIs exposure and GDM, the proportions mediated by oxidative DNA damage, RNA damage, and overall oxidative stress were 9.8 %, 11.8 %, and 14.5 %, respectively (P < 0.05). Exposure to individual NNIs and a mixture of NNIs were associated with GDM, and maternal age and pre-pregnancy BMI may modify the association. The possible mechanism underlying the association between NNIs and GDM may involve oxidative damage to nucleic acids.

Tirzepatide and potential use for metabolically healthy obesity

Metabolically healthy obesity or metabolically healthy overweight (MHO) is best described as being absent of any major metabolic disorder or cardiovascular diseases such as type 2 diabetes mellitus, dyslipidemia, hypertension, and atherosclerotic cardiovascular disease despite being obese or overweight. Nevertheless, MHO is being recognized as an important risk factor for the development of cardiovascular, cerebrovascular, and peripheral artery disease. In addition, these patients are at a high risk of conversion to the metabolically unhealthy phenotype. Tirzepatide is a newly developed glucose-lowering agent which acts on the glucose-dependent insulinotropic peptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors. It has been shown to result in several highly beneficial outcomes including weight loss and a significant improvement in important metabolic parameters such as HbA1c, fasting serum glucose, and triglyceride/lipoprotein levels. These findings suggest that tirzepatide could potentially be beneficial to metabolically healthy obese or metabolically healthy overweight patients in reducing their risk of adverse cardiovascular outcomes and conversion to the metabolically unhealthy phenotype. In this review, we aim to discuss the potential benefits of using the novel anti-diabetic tirzepatide in the management of MHO to prevent the development of cardiovascular events and to decrease the likelihood of conversion to the unhealthy phenotype. We initially describe the clinical outcomes of MHO as well as the association of MHO with developing future cardiovascular events. We then delineate the currently available evidence behind the clinical effects of tirzepatide. We finally discuss the potential advantages of using tirzepatide in the management of MHO.

Metabolically healthy obesity: Misleading phrase or healthy phenotype?

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

Total saponins from Panax japonicus reduce inflammation in adipocytes through the miR155/SOCS1/NFκB signaling pathway

BACKGROUND

The rising incidence of metabolic diseases due to chronic inflammation in the adipose tissue has been attributed to factors such as high fat diet (HFD). Previous studies have demonstrated that the total saponins from Panax japonicus (TSPJ) can reduce HFD-induced adipocyte inflammation, but the underlying mechanism remains unclear. In this work, we explored the molecular mechanism by which TSPJ reduces inflammation response in adipocytes.

METHODS

We first established C57BL/6 mouse and 3T3-L1 adipocyte models. Lentiviruses packaged with the plasmids were injected into mice through the tail vein or into adipocytes to generate the in vivo and in vitro models with miR155 knockdown and overexpression. The mice were fed with HFD to trigger inflammation and administered TSPJ (25 mg/kg∙d and 75 mg/kg∙d) by gavage. The adipocytes were treated with palmitic acid (PA) to trigger inflammation response, then treated with TSPJ (25 μg/ml and 50 μg/ml). Finally, the expression of miR155, inflammatory factors, SOCS1, and NFκB pathway-related proteins was explored.

RESULTS

TSPJ significantly inhibited the expression of inflammation-related genes and the miR155 expression in adipocytes both in vitro and in vivo. The dual luciferase reporter gene assay revealed that miR155 mediated the downregulation of SOCS1. TSPJ significantly inhibited and upregulated the phosphorylation of the NFκB protein and the SOCS1 proteins, respectively.

CONCLUSION

TSPJ inhibits miR155 to upregulate the SOCS1 expression, which subsequently inhibits the NFκB signaling pathway, thereby mitigating the inflammatory response in the adipocytes of HFD mice.

How does obesity affect mortality through blood pressure and blood glucose in Chinese and US citizens? Insights from a causal mediation analysis of two large cohorts

Background

Obesity, which has reached the scale of a global pandemic, is a leading cause of premature death. It is unclear to what extent its effect on mortality was driven by blood pressure or glucose levels in people of different ethnicities.

Methods

We conducted a causal mediation analysis to estimate the mediation effect of blood pressure and glucose between body mass index (BMI) or waist-hip ratio (WHR) on mortality based on data from the China Kadoorie Biobank (CKB) (n = 458 385) and US National Health and Nutrition Examination Survey (NHANES) (1999-2008, n = 20 726).

Results

The WHR's effect on mortality was mediated by blood pressure and glucose in the CKB data set by 38.7% (95% confidence interval (CI) = 34.1, 43.2) and 36.4% (95% CI = 31.6, 42.8), whereas in NHANES by 6.0% (95% CI = 2.3, 8.3) and 11.2% (95% CI = 4.7, 22.7), respectively. For associations between BMI and mortality in subjects with overweight or obesity, the mediator proportion of blood glucose and pressure was 49.4% (95% CI = 40.1, 62.5) and 16.9% (95% CI = 13.6, 22.9) in CKB and 9.10% (95% CI = 2.2, 25.9) and 16.7% (95% CI = 7.3, 49.0) in NHANES, respectively. We stratified the patients by their blood glucose, blood pressure level, or both into four groups. The effect of WHR on mortality was comparable across subgroups in either cohort. The associations between BMI and mortality were stronger in patients with higher blood pressure in CKB (P = 0.011) and blood glucose in NHANES (P = 0.035) in patients with overweight and obesity.

Conclusions

The relationship between WHR and mortality in the CKB data set was potentially caused by blood pressure and glucose to a much greater extent than in the NHANES one. The effect of BMI influenced by blood pressure was significantly higher among Chinese individuals with overweight and obesity. These results implicate a different intervention strategy is required for blood pressure and blood glucose in China and US to prevent obesity and obesity-related premature death.

Metabolic health and adiposity transitions and risks of type 2 diabetes and cardiovascular diseases: a systematic review and meta-analysis

BACKGROUND

Metabolic health status and levels of adiposity are prone to change over time. Mixed results have been reported regarding the extent by which changes in metabolic health and weight affect cardiometabolic risks. This systematic review and meta-analysis aims to examine the association between transitions in metabolic health and adiposity status on risk of incident type 2 diabetes (T2DM) and cardiovascular disease (CVD) events.

METHODS

A systematic literature search was conducted on MEDLINE and EMBASE through August 2022 for prospective cohort studies examining transitions in metabolic health and adiposity status and risk of incident T2DM and CVDs without restrictions on language or publication status. Meta-analysis was performed to summarize hazard ratios for T2DM and composite CVD events separately using random-effects model.

RESULTS

A total of 17 studies were included. Compared to stable metabolically healthy status, transition to metabolically unhealthy status significantly increased the risk of incident T2DM and composite CVD events among individuals with normal weight and individuals with overweight/obesity. Compared to stable metabolically unhealthy status, transition to metabolically healthy status significantly lowered the risk among individuals with normal weight and individuals with overweight/obesity. When metabolic health status remained unchanged, progression from normal weight to overweight/obesity significantly increased risk of CVDs but not risk of T2DM.

CONCLUSION

The impact of change in metabolic health on the risks of T2DM and CVD is more prominent than that of change to body mass index category. Obesity treatment should consider prioritizing improvement in metabolic health parameters over focusing on the extent of weight loss only.

The joint associations of high birth weight and not having siblings with metabolic obesity phenotype among school-aged children and adolescents: A National Survey in China

OBJECTIVE

Birth weight (BW) and sibling's status are two important indicators of early intrauterine environment and subsequent living environment, but no evidence has emerged on their joint associations on metabolic obesity phenotype. To determine the joint associations between BW and single-child status with childhood metabolic obesity phenotype was our purpose.

METHODS

A cross-sectional assessment of children and adolescents aged 7-18 years was performed in Chinese seven provinces in 2013. We obtained anthropometric, blood pressure and biochemical measurements, and distributed questionnaires covering demographic, neonatal and lifestyle characteristics. The metabolic obesity phenotype was defined by 2018 consensus-based criteria. Logistic regression and restricted cubic spline models were applied to evaluate the associations of BW and metabolic obesity phenotype, and estimate the multiplicative interactions and the combined associations of BW and single-child status with metabolic obesity phenotype.

RESULTS

Of enrolled 12 346 children and adolescents, the prevalence of metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) was 1.96% and 3.03%. There were 8.95% and 4.03% children with high BW or low BW, and 67.55% did not have siblings. High BW was positively associated with MHO (OR = 1.94, 95%CI = 1.28-2.94). Single-child also had increased odds of MHO and MUO (p < 0.05), and it had joint associations with high BW showing 0.85- to 2.58-fold higher odds of MUO and MHO.

CONCLUSIONS

High BW and single-child status have joint positive associations with the subsequent odds of MHO and MUO, which should be jointly prevented through earlier screening and subsequent preventive strategies.

Risk of subclinical atherosclerosis across metabolic transition in individuals with or without fatty liver disease: a prospective cohort study

BACKGROUND

Metabolic dysfunction is a major determinant in the progression of fatty liver disease. It is pivotal to evaluate the metabolic status and subsequent transition in fatty liver population and to identify the risk of subclinical atherosclerosis.

METHODS

The prospective cohort study included 6260 Chinese community residents during 2010-2015. Fatty liver was determined as hepatic steatosis (HS) by ultrasonography. Metabolic unhealthy (MU) status was defined as having diabetes and/or ≥ 2 metabolic risk factors. Participants were categorized into 4 groups according to the combination of metabolic healthy (MH)/MU and fatty liver status (MHNHS, MUNHS, MHHS and MUHS). Subclinical atherosclerosis was assessed by elevated brachial-ankle pulse wave velocity, pulse pressure and/or albuminuria.

RESULTS

31.3% of the participants had fatty liver disease and 76.9% were in MU status. During a 4.3-year follow-up, 24.2% of participants developed composite subclinical atherosclerosis. Multivariable adjusted odds ratios for composite subclinical atherosclerosis risk were (1.66 [1.30-2.13]) in MUNHS group and (2.57 [1.90-3.48]) in MUHS group. It seemed that participants with fatty liver disease were more prone to be remained in MU status (90.7% vs.50.8%) and less likely to regress to MH status (4.0% vs. 8.9%). Fatty liver participants progressed to (3.11 [1.23-7.92]) or maintained MU status (4.87 [3.25-7.31]) significantly impelled the development of the composite risk, while regressing to MH status (0.15 [0.04-0.64]) were more intended to mitigate the risk.

CONCLUSIONS

The current study emphasized the importance of assessing metabolic status and its dynamic changes, especially in the fatty liver population. Regressing from MU to MH status not only benefited the systematic metabolic profile but also ameliorated future cardiometabolic complications.

Increasing burden of stroke in China: A systematic review and meta-analysis of prevalence, incidence, mortality, and case fatality

BACKGROUND

The epidemiology of stroke is evolving in China as the population undergoes demographic, lifestyle, and economic transitions. An updated review is pertinent to providing feedback on current, and in planning future, prevention and management strategies.

AIMS

To identify high-quality epidemiological studies for quantifying the prevalence, incidence, mortality, and case fatality for stroke in China.

METHODS

A search was undertaken across a range of bibliographic databases on 30 November 2021 without time limitation. Assessments were made of the risk of bias of the included studies. The outcomes were synthesized using a random-effects model. Subgroup analysis and meta-regression models were used to define the source of heterogeneity.

RESULTS

Of 9407 identified records, 26 population-based studies were included. Due to significant heterogeneity across the studies, the original range for crude rates of indices was wide. The pooled annual prevalence was 1329.5/100,000 (95% confidence interval (CI) 713.6-2131.9, p < 0.001), incidence 442.1/100,000 (327.6-573.8, p < 0.001), mortality 154.1/100,000 (52.6-308.8, I² = 100%, p < 0.001), and case fatality 35.8% (26.1% to 46.1%, I² = 97%, p < 0.001). The prevalence and incidence of stroke have increased, but stroke-related case fatality has declined in China over recent decades. There are significant regional and rural-urban differences in incidence rates.

CONCLUSION

Despite improved public health policies and healthcare delivery, the burden of stroke remains high in China. Further coordinated efforts are required in prevention and community care to offset the likelihood of further expansion in the absolute number of stroke cases in this large population.

Risk factors for postoperative cerebral infarction in patients after lung resection: a single-center case-control study

Background

Patients who undergo lung resection are at risk of postoperative cerebral infarction, but the risk factors remain unclear, so the present study was a comprehensive investigation in patients who underwent lung resection for pulmonary nodules.

Methods

The clinical characteristics of patients with postoperative cerebral infarction and patients who underwent lung resection on the same day but did not develop cerebral infarction were retrospectively compared. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for cerebral infarction after lung resection.

Results

A total of 22 patients with postoperative cerebral infarction and 316 controls were included. Multivariate logistic regression analysis revealed that a history of cerebral infarction [odds ratio (OR), 7.289; P=0.030], activated partial thromboplastin time (APTT) <26.5 s (OR, 3.704; P=0.018), body mass index (BMI) ≥24.0 kg/m2 (OR, 3.656; P=0.015), and surgical method (P=0.005) were independent risk factors for cerebral infarction after lung resection. Compared with patients undergoing lobectomy, the risk for postoperative cerebral infarction was significantly increased in patients undergoing segmentectomy (OR, 24.322; P=0.001), wedge resection (OR, 6.992; P=0.018), or combined surgical approach (OR, 29.921; P=0.028).

Conclusions

A history of cerebral infarction, APTT <26.5 s, BMI ≥24.0 kg/m2, and surgical method were independent risk factors for cerebral infarction after lung resection. Strengthening thromboprophylaxis in patients with these risk factors may help to reduce the incidence of postoperative cerebral infarction.

Associations of metabolic heterogeneity of obesity with frailty progression: Results from two prospective cohorts

BACKGROUND

Previous studies indicated that obesity would accelerate frailty progression. However, obesity is heterogeneous by different metabolic status. The associations of metabolic heterogeneity of obesity with frailty progression remain unclear.

METHODS

A total of 6730 participants from the China Health and Retirement Longitudinal Study (CHARLS) and 4713 from the English Longitudinal Study of Ageing (ELSA) were included at baseline. Metabolic heterogeneity of obesity was evaluated based on four obesity and metabolic phenotypes as metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), metabolically healthy overweight/obesity (MHOO), and metabolically unhealthy overweight/obesity (MUOO). Frailty status was assessed by the frailty index (FI) ranging from 0 to 100 and frailty was defined as FI ≥ 25. Linear mixed-effect models were used to analyse the associations of metabolic heterogeneity of obesity with frailty progression.

RESULTS

In the CHARLS, MUOO and MUNW presented the accelerated FI progression with additional annual increases of 0.284 (95% CI: 0.155 to 0.413, P < 0.001) and 0.169 (95% CI: 0.035 to 0.303, P = 0.013) as compared with MHNW. MHOO presented no accelerated FI progression (β: -0.011, 95% CI: -0.196 to 0.173, P = 0.904) as compared with MHNW. In the ELSA, the accelerated FI progression was marginally significant for MUOO (β: 0.103, 95% CI: -0.005 to 0.210, P = 0.061) and MUNW (β: 0.157, 95% CI: -0.011 to 0.324, P = 0.066), but not for MHOO (β: -0.047, 95% CI: -0.157 to 0.062, P = 0.396) in comparison with MHNW. The associations of MUOO and MUNW with the accelerated FI progression were stronger after excluding the baseline frail participants in both cohorts. The metabolic status changed over time. When compared with stable MHNW, participants who changed from MHNW to MUNW presented the accelerated FI progression with additional annual increases of 0.356 (95% CI: 0.113 to 0.599, P = 0.004) and 0.255 (95% CI: 0.033 to 0.477, P = 0.024) in the CHARLS and ELSA, respectively. The accelerated FI progression was also found in MHOO participants who transitioned to MUOO (CHARLS, β: 0.358, 95% CI: 0.053 to 0.663, P = 0.022; ELSA, β: 0.210, 95% CI: 0.049 to 0.370, P = 0.011).

CONCLUSIONS

Metabolically unhealthy overweight/obesity and normal weight, but not metabolically healthy overweight/obesity, accelerated frailty progression as compared with metabolically healthy normal weight. Regardless of obesity status, transitions from healthy metabolic status to unhealthy metabolic status accelerated frailty progression as compared with stable metabolically healthy normal weight. Our findings highlight the important role of metabolic status in frailty progression and recommend the stratified management of obesity based on metabolic status.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Joint effect of multiple air pollutants on cardiometabolic health in normal-weight and obese adults: A novel insight into the role of circulating free fatty acids

The cardiometabolic effects of air pollution in the context of mixtures and the underlying mechanisms remain not fully understood. This study aims to investigate the joint effect of air pollutant mixtures on a broad range of cardiometabolic parameters, examine the susceptibility of obese individuals, and determine the role of circulating fatty acids. In this panel study, metabolically healthy normal-weight (MH-NW, n = 49) and obese (MHO, n = 39) adults completed three longitudinal visits (257 person-visits in total). Personal exposure levels of PM_2.5, PM₁₀, O₃, NO₂, SO₂, CO and BC were estimated based on fixed-site monitoring data, time-activity logs and infiltration factor method. Blood pressure, glycemic homeostasis, lipid profiles, systematic inflammation and coagulation biomarkers were measured. Targeted metabolomics was used to quantify twenty-eight plasma free fatty acids (FFAs). Bayesian kernel machine regression models were applied to establish the exposure-response relationships and identify key pollutants. Significant joint effects of measured air pollutants on systematic inflammation and coagulation biomarkers were observed in the MHO group, instead of the MH-NW group. Lipid profiles showed the most significant changes in both groups and O₃ contributed the most to the total effect. Specific FFA patterns were identified, and de novo lipogenesis (DNL)-related pattern was most closely related to blood lipid profiles. In particular, interaction analysis suggested that DNL-related FFA pattern augmented the effects of O₃ on triglyceride (TG, P_interaction = 0.040), high-density lipoprotein cholesterol (HDL-C, P_interaction = 0.106) and TG/HDL-C (P_interaction = 0.020) in the MHO group but not MH-NW group. This modification was further confirmed by interaction analysis with estimated activity of SCD1, a key enzyme in the DNL pathway. Therefore, despite being metabolically healthy, obese subjects have a higher cardiometabolic susceptibility to air pollution, especially O₃, and the DNL pathway may represent an intrinsic driver of lipid susceptibility. This study provides new insights into the cardiometabolic susceptibility of obese individuals to air pollution.

Association Between Serum Bilirubin, Lipid Levels, and Prevalence of Femoral and Carotid Atherosclerosis: A Population-Based Cross-Sectional Study

BACKGROUND

Bilirubin may prevent lipid peroxidation and have important antiatherosclerotic effects. We determined associations of serum bilirubin and lipid with peripheral atherosclerosis.

METHODS

We included 4290 participants (35% men; median age, 60 years) from the southeast China who underwent B-mode ultrasound examination. Increased intima-media thickness or a focal structure encroaching into the arterial lumen by at least 0.5 mm or >50% of the surrounding intima-media thickness value was regarded as having atherosclerosis. Fasting serum bilirubin and lipid levels were measured. Cholesterol/(HDL [high-density lipoprotein] cholesterol+bilirubin), and LDL (low-density lipoprotein cholesterol)/(HDL+bilirubin) ratios were calculated. Unconditional and multinomial logistic regression models were used to examine associations of bilirubin or lipid with prevalence of peripheral atherosclerosis. Mediation analyses were performed to assess the effect of bilirubin on atherosclerosis risk mediated via lipid.

RESULTS

Compared with participants with the lowest levels of bilirubin, those with the highest tertile were less likely to have carotid or femoral atherosclerosis (odds ratios were 0.55-0.74). The highest levels of bilirubin significantly reduced the odds of concurrent carotid and femoral atherosclerosis by 35% to 45%. Participants with the highest levels of cholesterol, LDL, cholesterol/(HDL+bilirubin), and LDL/(HDL+bilirubin) ratios had 2.8- to 3.7-fold increased odds of concurrent carotid and femoral atherosclerosis. LDL accounted for 25.65% of the total bilirubin-atherosclerosis association. LDL and cholesterol mediated the associations between direct bilirubin and atherosclerosis (proportion: 20.40%, 9.67%, respectively).

CONCLUSIONS

Increased serum bilirubin levels are inversely associated with the prevalence of carotid or femoral atherosclerosis. LDL and cholesterol may mediate these associations.