Cardiometabolic Risk Factor in Obese and Normal Weight Individuals in Community Dwelling Men

Individual and combined associations of body mass index and waist circumference with components of metabolic syndrome among multiethnic middle-aged and older adults: A cross-sectional study

OBJECTIVES

Body mass index (BMI) and waist circumference (WC) are closely associated with metabolic syndrome and its components. Hence, a combination of these two obesity markers may be more predictive. In this study, we aimed to investigate the individual and combined associations of BMI and WC with selected components of metabolic syndrome and explored whether age, sex and ethnicity affected the aforementioned associations.

METHODS

A total of 6,298 middle-aged and older adults were included. Based on BMI and WC, the participants were divided into 4 groups: comorbid obesity (BMI ≥ 28 kg/m² and WC< 85/90 cm for women/men), abdominal obesity alone (BMI< 28 kg/m² and WC≥ 85/90 cm for women/men), general obesity alone (BMI ≥ 28 kg/m² and WC< 85/90 cm for women/men) and nonobesity subgroups (BMI< 28 kg/m² and WC< 85/90 cm for women/men). Selected components of metabolic syndrome were evaluated using the criteria recommended by the Chinese Diabetes Society. Poisson regression models with robust variance were used to evaluate the associations of obesity groups with selected components of metabolic syndrome. An interaction test was conducted to explore whether age, sex and ethnicity affect the aforementioned associations.

RESULTS

Compared with participants in the reference group (comorbid obesity), participants in the other 3 groups showed a decreased prevalence of fasting hyperglycemia (PR=0.83, 95% CI=0.73-0.94 for abdominal obesity alone, PR=0.60, 95% CI=0.38-0.96 for general obesity alone and PR=0.46, 95% CI=0.40-0.53 for nonobesity), hypertension (PR=0.86, 95% CI=0.82-0.90 for abdominal obesity alone, PR=0.80, 95% CI=0.65-0.97 for general obesity alone and PR=0.69, 95% CI = 0.66-0.73 for nonobesity) and hypertriglyceridemia (PR=0.88, 95% CI=0.82-0.95 for abdominal obesity alone, PR=0.62, 95% CI=0.47-0.81 for general obesity alone and PR=0.53, 95% CI=0.49-0.57 for nonobesity). However, participants in the abdominal obesity alone and nonobesity groups showed a decreased prevalence of low HDL-C levels while participants in the general obesity alone group did not (PR=0.65, 95% CI=0.41-1.03, p>0.05). In addition, the aforementioned associations were not affected by age, sex or ethnicity (all p for interactions>0.05).

CONCLUSIONS

Comorbid obesity is superior to general and abdominal obesity in identifying individuals at high risk of developing metabolic syndrome in middle-aged and older adults. Great importance should be attached to the combined effect of BMI and WC on the prevention and management of metabolic syndrome.

How Unawareness of Weight Excess Can Increase Cardiovascular Risk?

Background: Obesity is a chronic disease with high prevalence in all age groups. Many overweight and obese people seem to be unaware of excess body weight. Aim: Analysis of people affected by the misperception of excess body weight and their eating behaviors simultaneously with selected health parameters. Methods: The study was conducted in 2017–2019 among 658 participants aged 20–79 from the population study—Bialystok PLUS (Poland). Results were based on clinical examinations and questionnaires. Results: Unawareness of overweight and obesity is common among adults (21.7%). Participants unaware of their overweight and obesity presented much higher risk factors. A high cardiovascular risk profile was observed more often among people not aware of overweight and obesity than among normal weight people (23.0% vs. 10.0%) as well as more common asymptomatic carotid artery atherosclerosis (49.7% vs. 31.3%). The subjective perception of overweight and obesity based on BMI (body mass index) was equal to 26.4 kg/m2 in women and 27.9 kg/m2 in men. The assessment of their diet was less favorable than that of people with normal weight. Conclusions: Unawareness of one’s excessive weight and its health consequences may lead to hesitancy to apply a healthy lifestyle and hence increase the cardiovascular risk in a substantial part of society. Therefore, it should be considered a part of the cardiovascular disease risk spectrum. Measurement of BMI and discussion about its health implications should be a routine procedure during healthcare contacts.

Assessing Insulin Sensitivity and Postprandial Triglyceridemic Response Phenotypes With a Mixed Macronutrient Tolerance Test

The use of meal challenge tests to assess postprandial responses in carbohydrate and fat metabolism is well established in clinical nutrition research. However, challenge meal compositions and protocols remain a variable. Here, we validated a mixed macronutrient tolerance test (MMTT), containing 56-g palm oil, 59-g sucrose, and 26-g egg white protein for the parallel determination of insulin sensitivity and postprandial triglyceridemia in clinically healthy subjects. The MMTT was administered in two study populations. In one, women with overweight/obese BMIs (n = 43) involved in an 8-week dietary intervention were administered oral glucose tolerance tests (OGTTs) and MMTTs within 2 days of each other after 0, 2, and 8 weeks of the dietary intervention. In the other, 340 men and women between 18 and 64 years of age, with BMI from 18–40 kg/m2, completed the MMTT as part of a broad nutritional phenotyping effort. Postprandial blood collected at 0, 0.5, 3, and 6 h was used to measure glucose, insulin, and clinical lipid panels. The MMTT postprandial insulin-dependent glucose disposal was evaluated by using the Matsuda Index algorithm and the 0- and 3 h blood insulin and glucose measures. The resulting MMTT insulin sensitivity index (ISIMMTT) was strongly correlated (r = 0.77, p &lt; 0.001) with the OGTT-dependent 2 h composite Matsuda index (ISIComposite), being related by the following equation: Log (ISIComposite) = [0.8751 x Log(ISIMMTT)] –0.2115. An area under the triglyceride excursion curve &gt;11.15 mg/mL h–1 calculated from the 0, 3, and 6 h blood draws established mild-to-moderate triglyceridemia in agreement with ∼20% greater prevalence of hypertriglyceridemia than fasting indications. We also demonstrated that the product of the 0 to 3 h and 3 to 6 h triglyceride rate of change as a function of the triglyceride incremental area under the curve optimally stratified subjects by postprandial response patterns. Notably, ∼2% of the population showed minimal triglyceride appearance by 6 h, while ∼25% had increasing triglycerides through 6 h. Ultimately, using three blood draws, the MMTT allowed for the simultaneous determination of insulin sensitivity and postprandial triglyceridemia in individuals without clinically diagnosed disease.

Clinical Trial Registration

[https://clinicaltrials.gov/], identifier [NCT02298725; NCT02367287].