The Relationship between Metabolically Obese Non-Obese Weight and Stroke: The Korea National Health and Nutrition Examination Survey

Association between metabolically obese but normal weight and cardiovascular diseases in Korean menopausal women

OBJECTIVE

The aim of this study was to present useful data for developing effective health management strategies for cardiovascular disease (CVD) prevention in postmenopausal women by investigating health-related behaviors and the prevalence of CVD for different types of obesity classified according to metabolic health status and body mass index criteria.

METHODS

Using the 2016 Korean National Health and Nutrition Examination Survey VII-1 data, 1,190 menopausal women aged 50 years or older were analyzed in this cross-sectional study. The participants were divided into four groups as follows: metabolically healthy and normal weight (MHNW), metabolically obese but normal weight (MONW), metabolically healthy but obese, and metabolically obese and obese. Complex-samples general linear analysis, t tests, and logistic regression analysis were used to compare the differences in health-related behaviors and the risk of CVD among the four groups.

RESULTS

The risk for stroke was 3.61 times higher (95% CI, 1.18-11.03) in the MONW group than in the MHNW group.

CONCLUSIONS

We found a strong association between the MONW group of obesity and the risk for CVD, particularly stroke, in postmenopausal women. These findings would serve as valuable evidence for developing and implementing interventions to prevent stroke in postmenopausal women in the MONW group.

Analysis of medical service utilization for post-stroke sequelae in Korea between 2016 and 2018: a cross-sectional study

In this retrospective cross-sectional observational study, the medical service utilization of post-stroke sequelae patients was examined using a national patient sample. The Korean Health Insurance Review and Assessment Service-National Patients Sample database was used to investigate the medical service utilization of 19,562 patients, diagnosed with post-stroke sequelae of cerebrovascular disease (I69) in Korea between January 2016 and December 2018. We compared the demographic characteristics, diagnosis code subtypes, frequency of healthcare utilization, medical costs, and comorbidities of standard care (SC) and Korean medicine (KM) users. Overall, patients aged ≥ 65 years accounted for the highest percentage, and utilization of medical services increased among patients aged ≥ 45 years. Outpatient care was higher among SC (79.23%) and KM (99.38%) users. Sequelae of cerebral infarction accounted for the highest percentage of diagnosis subtypes. Physical therapy and rehabilitation therapy were most frequent in SC, whereas injection/procedure and acupuncture were most frequent in KM. Cerebrovascular circulation/dementia drugs were prescribed most frequently in SC. Circulatory, digestive, endocrine, and metabolic disorders were the most common comorbidities in SC, whereas musculoskeletal and connective tissue disorders were most common in KM. Overall, SC and KM users showed differences in the number of medical service claims, cost of care, and comorbidities. Our findings provide basic research data for clinicians, researchers, and policy makers.

New metabolic health definition might not be a reliable predictor for mortality in the nonobese Chinese population

Background

Recently, a new metabolic health (MH) definition was developed from NHANES-III. In the origin study, the definition may stratify mortality risks in people who are overweight or normal weight. We aimed to investigate the association between the new MH definition and all-cause mortality in a nonobese Chinese population.

Methods

The data were collected in 1992 and then again in 2007 from the same group of 1157 participants. The association between the new MH definition and all-cause mortality were analyzed by Cox regression models with overlap weighting according to propensity score (PS) as primary analysis.

Results

At baseline in 1992, 920 (79.5%) participants were categorized as MH, and 237 (20.5%) participants were categorized as metabolically unhealthy (MUH) based on this new definition. During a median follow-up of 15 years, all-cause mortality occurred in 17 (1.85%) participants in MH group and 13 (5.49%) in MUH group, respectively. In the crude sample, Kaplan–Meier analysis demonstrated a significantly higher all-cause mortality in MUH group when compared to MH group (log-rank p = 0.002), and MUH was significantly associated with increased all-cause mortality when compared to MH with HR at 3.04 (95% CI: 1.47–6.25, p = 0.003). However, Kaplan–Meier analysis with overlap weighting showed that the cumulative incidence of all-cause mortality was not significantly different between MH and MUH groups (adjusted p = 0.589). Furthermore, in the primary multivariable Cox analysis with overlap weighting, adjusted HR for all-cause mortality was 1.42 (95% CI: 0.49—4.17, p = 0.519) in MUH group in reference to MH group. Other additional PS analyses also showed the incidence of all-cause mortality was not significantly different between the two groups.

Conclusion

The new MH definition may be not appropriate for mortality risk stratification in non-obese Chinese people. Further investigations are needed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14062-3.

Metabolically Abnormal But Normal-Weight Individuals Had a Higher Risk of Type 2 Diabetes Mellitus in a Cohort Study of a Chinese Population

Aims

Obesity is a heterogeneous disease in terms of body mass index (BMI) and metabolic status. The purpose of this study was to investigate the risk of type 2 diabetes mellitus (T2DM) in subjects with metabolically abnormal but normal weight (MANW) in China.

Materials and Methods

A prospective cohort with a total of 17,238 participants of the Zhejiang metabolic syndrome cohort was recruited. According to the standard of the Working Group on Obesity in China, general obesity is defined. Metabolic abnormality was defined as two or more abnormal components (elevated triglycerides (TG), low high-density lipoprotein cholesterol (HDL-C), elevated systolic blood pressure (SBP) or diastolic blood pressure (DBP) or use of antihypertensive therapy, and elevated fasting plasma glucose or antidiabetic treatment). The hazard ratio (HR) and its 95% CI were calculated using a multiple regression model, adjusted for the potential confounding factors.

Results

Compared with metabolically normal and normal weight (MNNW) subjects, the metabolically abnormal and obesity/overweight (MAO) subjects had the highest risk of T2DM disease, with an HR of 4.67 (95% CI: 3.23-6.76), followed by MANW subjects (HR = 2.61, 95% CI: 1.74-3.92) and metabolically normal but obesity/overweight (MNO) subjects (HR = 2.09, 95% CI: 1.29-3.38) after adjusting for age, sex, smoking, drinking, physical activity, and family history of diabetes. Compared with that in the MNNW subjects, the HR in MANW subjects was significantly higher than that in MNO subjects. In normal-weight subjects, the HR of T2DM was significantly positively correlated with the number of components with metabolic abnormalities.

Conclusions

MANW subjects had a higher risk of T2DM. MANW subjects should be given more attention in the prevention and control of common chronic diseases.

Metabolically healthy obesity and metabolically obese normal weight: a review

Despite the general relationship between obesity and its co-morbidities, there are both obese individuals who scarcely present the associated pathologies (metabolically healthy obese; MHO) and individuals who present obesity alterations despite having normal weight (metabolically obese normal weight; MONW). It is still difficult to define metabolically MHO and MONW individuals because different classifications have been used in the studies reported. Indeed, different inclusion criteria have been used to discriminate between metabolically healthy and metabolically unhealthy subjects. Due to this and other reasons, such as differences in ethnicity, genetics, and lifestyle of the populations, data concerning the prevalence of MHO and MONW are very variable. The main determinants of MHO are type of growth (hypertrophy or hyperplasia), anatomical location, inflammation of adipose tissue, ectopic fat accumulation, genetic factors, and lifestyles factors. In the case of MONW, the main determinants are genetic background and lifestyle factors. With regard to treatment, it is not clear whether MHO subjects would benefit from traditional lifestyle interventions, based on diet energy restriction and increased physical activity. For MONW subjects, there is still no specialized treatment, and the therapies are the same as those used in obese subjects.

Increased Stroke Risk in Metabolically Abnormal Normal Weight: a 10-Year Follow-up of 102,037 Participants in China

The purpose of this study was to investigate the risks of stroke in subjects with metabolically abnormal normal weight (MANW) in China. We recruited 102,037 participants from the Zhejiang Metabolic Syndrome Cohort and the Kailuan cohort. The mean years of follow-up were 9.9 years. General obesity was defined by body mass index (BMI) ≥ 28, overweight by BMI < 28 and ≥ 24, and normal weight by BMI < 24 and ≥ 18.5. Metabolic abnormality was defined as two or more abnormal components (elevated triglycerides, low high-density lipoprotein cholesterol, elevated systolic blood pressure or diastolic blood pressure, or use of antihypertensive drug therapy, elevated fasting plasma glucose, or antidiabetic treatment). A multiple Cox regression model was used to calculate hazard ratio (HR) and its 95% confidence interval (CI), adjusted by potential confounding factors. Overall HR of the risks in two cohorts was calculated by a meta-analysis. Compared with the subjects who were metabolically normal with normal weight (MNNW), the pooled HR for stroke in MANW subjects was 1.82 (95% CI, 1.59-2.07). The risks of stroke in MANW subjects were significantly lower than that in subjects with metabolically abnormal obesity (MAO), but higher than that in those with metabolically normal obesity (MNO) (P < 0.05). These associations remained in the subtypes of cerebral infarction and cerebral hemorrhage. In normal-weight subjects, the HR for stroke was significantly positively correlated with the number of abnormal metabolic components (P_trend < 0.001). In brief, metabolic abnormality increased the risk of stroke irrespective of obesity status. MANW individuals showed a greater risk of stroke, and this risk was positively correlated with the number of abnormal metabolic components.

Lifestyle counselling by persuasive information and communications technology reduces prevalence of metabolic syndrome in a dose-response manner: a randomized clinical trial (PrevMetSyn)

OBJECTIVES

The aim was to investigate whether lifestyle changes produced by persuasive Information and Communication Technology (ICT) counselling can lower the prevalence of metabolic syndrome (MetS).

METHODS

A total of 532 participants (20-60 years, body mass index 27-35 kg/m²) were randomly assigned to six arms according to counselling type (no, short-term, or intensive) with or without ICT intervention. In this report the prevalence of MetS and its components were compared between no-ICT group and ICT group. Moreover, the frequency of the web information system usage was analysed for the number of logins, responses to weekly messages, and other record variables.

RESULTS

The ICT group had significantly lower proportion of MetS (33.7% vs. 45.3%, p = .022) than the no-ICT group at 2-year follow-up. In mixed model, the ICT group had lower prevalence of MetS than no-ICT group (OR 0.50, 95%CI 0.27-0.90) after intervention. The tertile with the highest utilization had 71% lower prevalence of MetS compared with the lowest utilization tertile or the no-ICT group.

CONCLUSIONS

Web-based ICT is able to reduce the prevalence of MetS. In addition, higher utilization of the web information system is associated with a greater decrease in the prevalence of MetS. Key messages Our internet health behaviour change support system based on persuasive design and cognitive behaviour therapy markedly reduces metabolic syndrome in overweight/obese subjects. As a stand-alone tool it may save healthcare personnel resources as it is suitable at a low cost for both obese/overweight patients and the public at large.

Fat-to-muscle ratio as a predictor of insulin resistance and metabolic syndrome in Korean adults

BACKGROUND

The present study evaluated the associations of the fat-to-muscle ratio (FMR) with metabolic syndrome (MetS) and insulin resistance (IR) in Korean adults using nationally representative survey data.

METHODS

A two-stage stratified sampling method was reflected in a cross-sectional study involving a total of 13 032 participants aged ≥ 19 years who participated in the fourth and fifth Korea National Health and Nutrition Examination Surveys. The homeostasis model assessment for IR (HOMA-IR) was used to evaluate IR and was calculated as follows: [fasting plasma glucose level (mg/dL) × fasting plasma insulin level (uIU/mL)]/405. MetS was defined using the 2006 International Diabetes Federation criteria, and FMR was measured using whole-body dual-energy X-ray absorptiometry and calculated as follows: total fat mass (kg) divided by total lean mass (kg). In addition, the optimal FMR cut-off values for detecting MetS and the odds ratios (ORs) for MetS risk were determined according to the FMR quartile and sex.

RESULTS

Among all participants, the proportion of women was 58.4%, and the mean age was 44.22 ± 0.26 years. The FMR significantly differed between men and women (0.30 ± 0.002 vs. 0.53 ± 0.003, respectively, P < 0.001), and the prevalence of MetS and IR gradually increased as FMR increased (P for trend: <0.001). The optimal FMR cut-off value for detecting MetS was higher in women than in men (0.555 vs. 0.336, respectively). The negative predictive value was the highest in normal-weight participants (0.9992 in women and 0.9986 in men), while the positive predictive value was the highest in obese participants (0.5994 in women and 0.5428 in men). Based on the derived cut-off FMR, a high FMR was associated with poor outcomes in terms of cardiometabolic risk markers (P < 0.001). The multivariable-adjusted ORs for MetS, abdominal obesity, and IR (HOMA-IR ≥ 3) were 5.35 [95% confidence interval (CI): 4.39-6.52], 7.67 (95% CI: 6.33-9.30), and 3.25 (95% CI: 2.70-3.92), respectively, in men and 5.59 (95% CI: 4.66-6.72), 7.48 (95% CI: 6.35-8.82), and 2.55 (95% CI: 2.17-3.00), respectively, in women.

CONCLUSIONS

In the present study, a high FMR was significantly associated with the prevalence of MetS and IR. The present findings also showed that FMR can be a novel indicator for detecting the absence or presence of MetS, particularly in metabolically healthy normal-weight individuals and metabolically obese obese-weight individuals.