The risk of metabolic abnormalities and cardiovascular disease in metabolically healthy obese people aged 40 years and above in Guiyang urban areas: A 3-year follow-up study / 中华内分泌代谢杂志

Objective:To explore whether metabolically healthy obesity(MHO) is a healthy state by observing the incidence of metabolic syndrome(MS) including its components and cardiovascular disease(CVD) in this population.Methods:In 2011, a cohort of 10 140 residents aged 40-79 years old was selected with cluster sampling in the Guiyang urban area. Fasting plasma glucose(FPG), blood lipids, and blood pressure were examined to assess their metabolic status. Height and weight were also measured. Among them, 1 299 metabolically healthy subjects were divided into 3 groups according to body mass index, namely metabolically healthy normal weight(MHNW), metabolically healthy overweight(MHOW), and MHO. Three groups were reassembled in 2014, and finally a total of 966 subjects with baseline and complete follow-up data were included in the analysis. The relationship between MS and its components, and the incidence of CVD were compared among the three groups.Results:(1) After an average follow-up of 3 years, 47.77% of the MHO population transformed into a metabolically unhealthy state. There was no significant difference in the incidence of MS components among the three groups( P>0.05), but there was a significant difference in the incidence of MS( P<0.05); (2) There was no significant difference in the incidence of CVD among the three groups after 3 years of follow-up. Logistic regression was used to analyze the risk factors of CVD in the three groups. Taking the MHNW as the control group, after adjusting for age, gender, FPG, blood lipids, and blood pressure, the risk ratio of the MHOW group was 0.941(0.661-1.202), and MHO group was 0.974(0.702-1.291). Conclusions:After 3 years of follow-up, although the risk of CVD in the MHO population did not increase significantly, the incidences of MS, triglycerides, and FPG abnormality increased compared with the normal people, suggesting that the MHO is not a " stable" healthy state.

Comparison of criteria for metabolically healthy overweight/obesity in Shanghai Changfeng study / 中华内科杂志

Objective:To establish a more suitable and practicable criterion of metabolically healthy overweight/obesity (MHO/O) in Chinese, a comparison study on different criteria of MHO/O was conducted in subjects aged over 45-year-old in Shanghai Changfeng Community.Method:A total of 3 301 overweight/obese subjects over 45 years old (men 1 521, women 1 789) in Shanghai Changfeng Community was included in the study. According to the inclusion or exclusion of waist circumference (WC), homeostasis model assessment of insulin resistance (HOMA-IR) ≥2.5, and numbers of abnormal metabolic components, the MHO/O criteria were divided into 7 types: Adult Treatment Panel Ⅲ (ATP-Ⅲ) (with WC)<1 component, ATP-Ⅲ (with WC)<2 components, ATP-Ⅲ (with WC)<3 components, ATP-Ⅲ (without WC)<1 component, ATP-Ⅲ (without WC)<2 components, adjusted metabolic associated fatty liver disease (MAFLD) criteria<1 component, and adjusted MAFLD criteria<2 components. The prevalence of MHO/O and its relationship with the changes of body mass index (BMI), and the differences of the characteristics of MHO/O among the 7 types of metabolic health standards were compared.Result:The prevalence of MHO/O according to the ATP-Ⅲ (with WC)<1, ATP-Ⅲ (with WC)<2, ATP-Ⅲ (with WC)<3, ATP-Ⅲ (without WC)<1, ATP-Ⅲ (without WC)<2, adjusted MAFLD criteria<1, and adjusted MAFLD criteria<2 was 2.85%, 15.48%, 39.87%, 8.00%, 33.66%, 2.33%, 12.24%, respectively. The prevalence of MHO/O decreased as BMI increased. When BMI ≥ 28 kg/m 2, the prevalence of MHO/O by ATP-Ⅲ (with WC)<1 and adjusted MAFLD criteria<1 dropped to 0. Conclusion:The adjusted MAFLD criterion without abnormal metabolic components is the most practicable definition of MHO/O.

Are young Iranian women with metabolically healthy obesity at increased risk of CVD incidence? / Jovens iranianas obesas metabolicamente saudáveis têm maior risco de incidência de DCV?

Abstract Background The association between the Metabolically Healthy Obese (MHO) phenotype in the absence of metabolic syndrome and subsequent cardiovascular disease remains unclear. Objectives We examined the association between MHO and CVD risk in young Iranian women. Methods We studied 183 women aged 20-35 years from a population of 308 candidates. We classified participants into 4 phenotypes. We measured body composition, blood pressure, and biochemical factors in all participants. Results The Metabolically Healthy Normal Weight (MHNW) and Normal Weight Obese (NWO) phenotypes had no statistical differences in any biochemistry variables. FBS, TG, LDL/HDL, Cholesterol/HDL, hs-CRP, and atherogenic index of plasma (AIP) were all higher in Metabolically Unhealthy Obese (MUO) than MHO individuals, whereas HDL was higher in MHO than in MUO individuals. LDL/HDL and hs-CRP were higher in MHO participants than MHNW participants, whereas HDL-c was higher in MHNW than MHO. Conclusions Results of the present study demonstrate that young women displaying the MHO phenotype have a favorable metabolic profile as shown by lower FBS, TG, LDL-c/HDL, Cho/HDL, hs-CRP, and AIP and higher HDL levels than the MUO phenotype. However, MHO individuals were still at greater risk of CVD incidence (lower HDL and higher hs-CRP levels) than MHNW individuals.

Resumo Contexto A associação entre o fenótipo obeso metabolicamente saudável (OMS) na ausência de síndrome metabólica e doença cardiovascular subsequente permanece incerta. Objetivos Examinamos a associação entre o fenótipo OMS e risco de DCV em jovens iranianas. Métodos Analisamos 183 mulheres com idade de 20-35 anos de uma população de 308 candidatas. Classificamos as participantes em quatro fenótipos. Mensuramos composição corporal, pressão arterial e fatores bioquímicos em todas as participantes. Resultados Os fenótipos com peso normal metabolicamente saudável (PNMS) e obeso com peso normal não apresentaram diferenças estatísticas em nenhuma das variáveis bioquímicas. Os níveis de glicemia sanguínea em jejum (GSJ), triglicerídeos (TG), relação LDL/HDL, HDL, proteína C reativa ultrassensível (PCR-us) e índice aterogênico do plasma (IAP) foram mais elevados em obesas metabolicamente não saudáveis (OMNS) do que em indivíduos OMSs, enquanto o HDL foi maior em OMSs do que em indivíduos OMNSs. A relação LDL/HDL e o nível de PCR-us foram mais elevados em participantes OMSs do que em participantes com PNMS, enquanto o HDL foi maior naquelas com PNMS do que nas OMSs. Conclusões Os resultados do presente estudo demonstram que mulheres jovens com o fenótipo OMS têm um perfil metabólico favorável, conforme demonstrado pelos níveis menores de GSJ, TG, relação LDL/HDL, HDL, PCR-us e IAP e pelos níveis maiores de HDL em comparação às mulheres com o fenótipo OMNS. Entretanto, indivíduos OMSs ainda apresentavam maior risco de DCV incidente (níveis menores de HDL e maiores de PCR-us) do que indivíduos com PNMS.

¿Cuál es la prevalencia de obesidad metabólicamente saludable en población chilena? / What is the prevalence of metabolically healthy obesity in Chile?

RESUMEN La obesidad es un importante factor de riesgo cardiovascular. No obstante, no todas las personas obesas tienen un perfil metabólico alterado ni todas las personas normo-peso poseen un perfil metabólico normal. Objetivo: determinar la prevalencia de diferentes fenotipos metabólicos asocia-dos al estado nutricional en Chile. Métodos: se incluyeron 1.733 participantes de la Encuesta Nacional de Salud 2009-2010. El estado nutricional (obesidad o normo-peso) fue determinado a través del IMC mientras que la condición metabólica (saludable o no) en base a cuatro parámetros: glicemia, presión arterial, colesterol HDL y triglicéridos. Con estos parámetros de determinaron 4 fenotipos, entre ellos, MUNO: metabólicamente no saludable no obeso y MHO: obeso metabólicamente saludable. Resultados: La prevalencia de MHO fue de 3,3% mientras que un 17,4% presentaba MUNO. Adicionalmente, la prevalencia de MHO disminuyó en la medida que aumentó la edad y la mayor proporción de individuos metabólicamente saludables se encontraba en el grupo de altos ingresos y con un nivel educacional superior (técnico-universitario). Conclusión: Se evidencia una baja prevalencia de MHO, así como también una alta prevalencia de individuos MUNO en la población chilena. Futuras acciones preventivas deberían no sólo considerar el estado nutricional sino también la condición metabólica de la población.

ABSTRACT Obesity is an important cardiovascular risk factor. However, not all obese individuals have an unhealthy metabolic pro-file and vice versa. Therefore, the aim of this study was to determine the prevalence of different metabolic phenotypes by nutritional status in Chile. Methods: 1,733 individuals from the National Health Survey 2009-10 were included in this study. Nutritional status (obesity or normal-weight) was determined by BMI whereas metabolic profile was determined through four parameters: Glycaemia, blood pressure, HDL cholesterol and triglycerides. Four metabolic phenotypes were derived, among them: MUNO: metabolically unhealthy and non-obese and MHO: metabolically healthy obesity. Results: The prevalence of MHO in the Chilean population was 3.3% while the prevalence of MUNO was 17.4%. Moreover, the prevalence of MHO decreased as age increased and a greater proportion of metabolically healthy individuals were in the highest gross income group and in the technical-university educational level. Conclusion: This study shows a low prevalence of MHO and a higher prevalence of MUNO in the Chilean population. Future preventive actions should take into account not only the nutritional status, but also the metabolic profile of the population.

Incidence of Prostate Cancer according to Metabolic Health Status: a Nationwide Cohort Study

BACKGROUND: We assessed the association between metabolic health status and incidence of prostate cancer using the National Health Check-ups (NHC) database of Korea. METHODS: A total of 11,771,252 men who participated in the NHC between 2009 and 2012 and 56,552 men who were newly diagnosed with prostate cancer were analyzed. Normal-weight and obesity were defined as body mass index (BMI) < 25 kg/m2 and ≥ 25 kg/m2, respectively. Metabolic obesity was defined as the presence ≥ 3 components of the metabolic syndrome. Participants were stratified into 4 groups: metabolically healthy, normal-weight; metabolically obese, normal-weight (MONW); metabolically healthy, obese (MHO); and metabolically obese, obese. Multivariate Cox regression analysis was performed to examine the relationship between metabolic health status and incidence of prostate cancer. RESULTS: During a mean 5.4 ± 1.1 years of follow-up, 56,552 patients were registered with a diagnosis of prostate cancer. When analyzed according to metabolic health status classification, the multivariable-adjusted hazard ratio (HR) was 1.143 for the MONW group, 1.097 for the MHO group, showing the HR for the MONW group was higher than that for the MHO group. As the number of metabolic syndrome components increased, HR increased significantly. When stratified based on BMI, metabolically obese patients showed significantly higher HR than metabolically healthy patients in all BMI groups. CONCLUSION: This population-based nationwide study revealed an association between metabolic health status and the incidence of prostate cancer, and the risk increased according to the number of components of the metabolic syndrome.

Clinical characteristics of metabolically healthy obese individuals and risk analysis of progression into abnormal glucose and lipid metabolism / 中华内分泌代谢杂志

Objective To investigate the clinical characteristics of metabolically healthy obese ( MHO) individuals, and to explore the risk of progression into metabolic disorders after 3 years. Methods A total of 3943 residents in Jining City were evaluated twice from February 2012 to August 2015, and 3766 individuals were enrolled excluding those with missing data. Of the subjects, 875 subjects were screened as metabolic normal population, which were divided into MHO(n = 127), metabolically healthy overweight (MHOW, n = 386), and metabolically healthy normal weight ( MHNW, n = 362) groups. T test, x2 test, and logistic regression analysis were used for data analysis. Results The incidence of MHO was 11. 63％ (127 / 1092) in obesity, and the proportion of MHO in females was higher than that in males(13. 91％ vs 7. 82％ , P<0. 05). Compared with MHNW group, the levels of HbA1C , fasting insulin, low density lipoprotein-cholesterol ( LDL-C), triglyceride ( TG), glutamyl transpeptidase (GGT), systolic blood pressure(SBP), diastolic blood pressure(DBP), and waist circumference(WC) were higher in MHO while glomerular filtration rate (GFR) and high density lipoprotein-cholesterol (HDL-C) were lower(all P<0. 05); and fasting insulin, LDL-C, TG, GGT, SBP, WC were higher in MHOW while HDL-C was lower (all P<0. 05). The levels of fasting insulin, TG, SBP, WC were higher in MHO while GFR and HDL-C were lower compared with MHOW(all P<0. 05). Following up for 3 years, the incidences of dyslipidemia in MHNW, MHOW, and MHO were 17. 96％ (65 / 362), 32. 90％ (127 / 386), 42. 52％ (54 / 127), respectively, with significant difference among three groups(P<0. 05). The incidences of hyperglycemia in the three groups were 20. 17％ (73 / 362), 22. 80％(88 / 386), 26. 77％ (34 / 127), respectively, without significant difference among groups ( all P > 0. 05). After adjustment for some factors including sex, age, fasting insulin, glutamic pyruvic transaminase, glutamic oxaloacetic transaminase, GGT, and creatinine, the risks of dyslipidemia in MHO ( OR = 2. 193, 95％ CI 1. 359-3. 539, P<0. 05) and MHOW(OR= 1. 705, 95％ CI 1. 190-2. 443, P<0. 05) were significantly increased as compared with MHNW. Conclusion Compared with MHNW individuals, MHOW/ MHO individuals show an obviously different clinical feature as well as with higher risks of dyslipidemia after 3 years.

Phenotypic and metabolic dichotomy in obesity: clinical, biochemical and immunological correlates of metabolically divergent obese phenotypes in healthy South Asian adults

<p><b>INTRODUCTION</b>Metabolic heterogeneity among obese individuals is thought to translate into variations in cardiovascular risk. Identifying obese people with an unfavourable metabolic profile may allow preventive strategies to be targeted at high-risk groups. This study aimed to identify clinical, biochemical and immunological differences between insulin-sensitive and insulin-resistant obese subgroups, to understand the population-specific pathophysiological basis of the adverse cardiovascular risk profile in the latter group.</p><p><b>METHODS</b>Cardiovascular risk indicators, including anthropometric parameters, blood pressure, acanthosis nigricans area, and related biochemical, endocrine and inflammatory markers, were determined in 255 healthy South Asian volunteers aged 18-45 years, with a 2:1 ratio of obese/overweight to normal-weight individuals. Lifetime atherosclerotic cardiovascular disease (ASCVD) risk was also calculated.</p><p><b>RESULTS</b>Body mass index (BMI) and insulin sensitivity-based tertiles independently showed incremental trends in waist-hip ratio, skinfold thickness, acanthosis nigricans area, blood pressure, serum lipids, hepatic enzymes, adipokines, inflammatory markers and ten-year ASCVD risk. The anthropometric, biochemical and inflammatory parameters of obese insulin-sensitive and obese insulin-resistant groups differed significantly. Extreme group analysis after excluding the middle tertiles of both insulin resistance and BMI also showed significant difference in anthropometric indicators of cardiovascular risk and estimated lifetime ASCVD risk between the two obese subgroups.</p><p><b>CONCLUSION</b>Obese insulin-sensitive individuals had a favourable metabolic profile compared to the obese insulin-resistant group. The most consistent discriminative factor between these phenotypic classes was anthropometric parameters, which underscores the importance of clinical parameters as cardiovascular risk indicators in obesity.</p>

Prevalence and Clinical Characteristics of Metabolically Healthy Obesity in Korean Children and Adolescents: Data from the Korea National Health and Nutrition Examination Survey

Metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) are differentiated by the presence of cardiometabolic risk factors (CMRFs) and insulin resistance (IR). This study aimed to evaluate the prevalence and clinical characteristics of MHO in Korean children and adolescents and to investigate the anthropometric, laboratory, and lifestyle predictors of MHO. This study included data from 530 obese subjects, aged 10–19 years, obtained from the Fourth Korea National Health and Nutrition Examination Survey. Subjects were classified into MHO and MUO groups according to the presence of CMRF (MHO(CMRF)/MUO(CMRF)) and degree of IR (MHO(IR)/MUO(IR)). Demographic, anthropometric, cardiometabolic, and lifestyle factors were compared between the groups. Logistic regression analysis and receiver operating characteristic curve analysis were performed to identify factors that predicted MHO. The prevalence of MHO(CMRF) and MHO(IR) in obese Korean youth was 36.8% (n = 197) and 68.8% (n = 356), respectively. CMRF profiles were significantly less favorable in MUO children. Longer and more vigorous physical activity and less protein intake were associated with MHO(CMRF) phenotype. The best predictors of MHO(CMRF) and MHO(IR) were waist circumference (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.77–0.88; P < 0.001) and body mass index (BMI) standard deviation score (OR, 0.24; 95% CI, 0.15–0.39; P < 0.001), respectively. The prevalence of MHO differed depending on how it was defined. To adequately manage obesity in youth, the approach to individuals with MHO and MUO should be personalized due to variation in clinical characteristics. Longitudinal studies are needed to evaluate long-term consequences of MHO.

Análisis de la longitud de los telómeros en obesos metabólicamente sanos / Analysis of telomere length in the metabolically healthy obese

La obesidad es el principal componente del síndrome metabólico (SM) y determina la progresión de la enfermedad a las complicaciones metabólicas. Los individuos obesos metabólicamente sanos (OMS) parecen estar protegidos contra esas complicaciones. La longitud de los telómeros (LT) es un nuevo marcador del envejecimiento celular, que tiene una relación compleja con el SM. El objetivo principal de este estudio fue investigar por primera vez la LT en OMS y estudiar la asociación entre LT y el número de componentes del SM. Se estudió a 398 mujeres con una edad media de 46,76 ± 15,47 años (rango: 18-86 años), que se agruparon en: individuos con normopeso sin ningún componente del SM (NP0), obesos sin SM (OMS) y de acuerdo con el número de componentes de SM en los grupos sin ningún componentes de SM (0), con uno o 2 componentes (1 + 2) y con SM por la presencia de 3 o más componentes (SM). La LT de los OMS no se diferenció de la de los NP0, pero fue significativamente mayor que la de los individuos con SM (p = 0,032). Se observó una disminución de la LT con el aumento progresivo del número de componentes del SM (p = 0,004), en donde el grupo 0 presentó una LT significativamente mayor que los grupos 1 + 2 (p = 0,027) y SM (p = 0,003). Demostramos por primera vez que las mujeres OMS presentan una LT similar a las mujeres NP0 y más larga que aquellas mujeres con SM. Además, confirmamos que la LT se acorta con el aumento en el número de alteraciones del SM.

Obesity is the principal component in Metabolic Syndrome (MetS) and determines the progression of metabolic complications. Metabolically healthy obese individuals (MHO) seem to be protected against those complications. Telomere length (TL), as a novel marker of cellular aging, has a complex relationship with MetS. The principal aim of this study was to investigate TL in MHO, and to study the association between TL and the number of MetS components. A study was conducted on 398 women (mean age: 46.76 ± 15.47 years; range: 18 - 86 years), grouped according to the number of MetS components (0, 1 + 2, MetS), a group of normal-weight individuals with 0 MetS components (NW0), and a group of obese without MetS (MHO). No differences were found in the TL of the MHO group compared to the NW0, but it was significantly higher than that of individuals with MetS (P = .032). A decrease in TL was observed with a progressive increase in the number of MetS components (P = .004), whereas the group of individuals without MetS components had significantly longer TL than the groups with 1 and 2 components (P = .027), and MetS (P = .003). Shorter TL is not associated with MHO, but is related to MetS and with an increased number of metabolic abnormalities.

Somatotype characteristics of normal-weight and obese women among different metabolic subtypes

ABSTRACT Background Obesity is a well known risk factor for the development of metabolic abnormalities. However, some obese people are healthy and on the other hand some people with normal weight have adverse metabolic profile, therefore it can be assumed that there is a difference in physical characteristics amongst these people. The aim of this study was to establish whether there are somatotype differences between metabolically healthy and metabolically obese women who are obese or of normal weight. Subjects and methods Study included 230 women aged 44.76 ± 11.21y. Metabolic status was assessed according to IDF criteria, while somatotype was obtained using Heath & Carter method. Results Significant somatotype differences were observed in the group of women with normal-weight: metabolically healthy women had significantly lower endomorphy, mesomorphy and higher ectomorphy compared to metabolically obese normal-weight women (5.84-3.97-2.21 vs. 8.69-6.47-0.65). Metabolically healthy obese women had lower values of endomorphy and mesomorphy and higher values of ectomorphy compared to ‘at risk’ obese women but the differences were not statistically significant (7.59-5.76-0.63 vs. 8.51-6.58-0.5). Ectomorphy was shown as an important determinant of the favorable metabolic profile (cutoff point was 0.80). Conclusion We concluded that, in addition to fat mass, metabolic profile could be predicted by the structure of lean body mass, and in particular by body linearity.

Obesity and adipose tissue remodeling / 中国药理学通报

Obesity is a major risk factor for the generation and development of diabetes, atherosclerosis, hyperlipidemia and cancer. Obesity is accompanied with remodeling of adipose tis-sue, such as changed cell component and function, angiogene-sis, extracellular matrix remodeling and infiltration of inflamma-tory cells. It is important for the prevention of obesity to study adipose tissue remodeling. This review summarizes recent ad-vances in adipose tissue remodeling.

Association between serum Klotho and oxidative stress in metabolically healthy obese individuals / 安徽医科大学学报

Objective To investigate the association between serum Klotho and oxidative stress in metabolically healthy obese individuals. Methods 180 physicalexamination subjects were investigated. They were devided into 3 groups:60 cases of normal weight and metabolic normality,60 cases of metabolically healthy but obese( MHO) ,60 cases of obesity with metabolic syndrome. Fasting blood glucose(FBG),2 h blood glucose(2 hBG),triglyceride ( TG) ,high densitylipoprotein cholesterol( HDL-C) , systolic blood pressure, diastolic blood pressure,body height, body weight,waist circumference,body mass index( BMI) were recorded. Malondialdehyde( MDA) ,superoxide dis-mutase( SOD) ,total antioxidation capacity( TAOC) ,Klotho were detected by ELISA. The difference of clinical pa-rameters,metabolic parameters,oxidative stress and Klotho among these three groups was compared by the methods of covariance analysis. Regression analysis and pearson correlation were used to evaluate the relationship of Klotho with oxidative stress. Results Compared with the control group, TAOC, SOD, Klotho were decreased significantly while MDA elevated significantly in both MHO group and obesity with metabolic syndrome group(P<0. 05). Com-pared with MHO group, TAOC, Klotho were significantly lower in obesity with metabolic syndrome ( P<0. 05 ) . Klotho protein was significantly positively associated with SOD, TAOC, negatively associated with waist circumfer-ence,BMI,FBG,2 hBG(r= -0. 182,-0. 225,-0. 221,-0. 202,-0. 188,P<0. 05). SOD,TAOC were deter-minants for Klotho. Conclusion The balancebetween oxidative and antioxidative system is disturbed in subjects with MHO. Klotho protein may maintain the normal metabolism of thebody by regulating the oxidative stress.

Characteristics of Young Korean Metabolically Healthy Obese Patient: Based on Retrospective Analysis of Republic of Korea Navy Soldiers' Medical Examination

OBJECTIVE: The aim of this study was to evaluate the characteristics of the young Korean obese but metabolically healthy subjects and to identify the factors associated with metabolic health status among them. METHODS: We reviewed the medical record of South-Korea Navy soldiers at 1st marine division with routine medical examination. Within this population, we selected obese subjects whose body mass index (BMI) were more than 25 kg/m². The clinical characteristics between obese subjects with metabolically healthy and unhealthy factors were retrospectively compared. RESULTS: Of the 1,522 subjects with medical record, 319 (20.9%) subjects were identified as obese. Among them, 60 subjects (18.8%) were classified as metabolically unhealthy, whereas 259 (81.2%) subjects were metabolically healthy. Multivariate analysis revealed that higher BMI (odds ratio, OR 1.26, 95% confidence interval, CI, 1.07-1.49), higher alanine transaminase (ALT) (OR 1.03, 95% CI 1.01-1.06), and drinking alcohol (OR 3.65, 95% CI 1.02-13.02) were associated with metabolically unhealthy status in obese subjects. Meanwhile, regular physical activity was associated with metabolically healthy status in obese subjects. (OR 0.33, 95% CI 0.17-0.62) CONCLUSION: This study found that higher BMI, higher ALT, and drinking alcohol were related to metabolically unhealthy status in young Korean obese subjects; meanwhile, regular physical activity was related to metabolically healthy status.

Serum Phospholipid Docosahexaenoic Acid Is Inversely Associated with Arterial Stiffness in Metabolically Healthy Men

We hypothesized that lower proportion of serum phospholipid docosahexaenoic acid (DHA) is inversely associated with increased cardiovascular risk and vascular function in metabolically healthy men. To elucidate it, we first compared serum phospholipid free fatty acid (FA) compositions and cardiovascular risk parameters between healthy men (n = 499) and male patients with coronary artery disease (CAD, n = 111) (30-69 years) without metabolic syndrome, and then further-analyzed the association of serum phospholipid DHA composition with arterial stiffness expressed by brachial-ankle pulse wave velocity (ba-PWV) in metabolically healthy men. Basic parameters, lipid profiles, fasting glycemic status, adiponectin, high sensitivity C-reactive protein (hs-CRP) and LDL particle size, and serum phospholipid FA compositions were significantly different between the two subject groups. Serum phospholipid DHA was highly correlated with most of long-chain FAs. Metabolically healthy men were subdivided into tertile groups according to serum phospholipid DHA proportion: lower ( 3.235%). Fasting glucose, insulin resistance, hs-CRP and ba-PWVs were significantly higher and adiponectin and LDL particle size were significantly lower in the lower-DHA group than the higher-DHA group after adjusted for confounding factors. In metabolically healthy men, multiple stepwise regression analysis revealed that serum phospholipid DHA mainly contributed to arterial stiffness (β'-coefficients = -0.127, p = 0.006) together with age, systolic blood pressure, triglyceride (r = 0.548, p = 0.023). Lower proportion of serum phospholipid DHA was associated with increased cardiovascular risk and arterial stiffness in metabolically healthy men. It suggests that maintaining higher proportion of serum phospholipid DHA may be beneficial for reducing cardiovascular risk including arterial stiffness in metabolically healthy men.

Clinical Characteristics and Metabolic Health Status of Obese Korean Children and Adolescents / 가정의학회지

BACKGROUND: This study aimed to determine the prevalence of metabolically healthy and unhealthy obesity (MHO and MUO, respectively) and examine the demographic, anthropometric, and lifestyle predictors of metabolic health status in Korean children and adolescents. METHODS: This study was based on data collected from the Korean Children-Adolescent Study in 2010. A total of 1,700 children (846 boys and 854 girls) were included in the primary cohort and classified into metabolically healthy and unhealthy groups according to factors related to the metabolic syndrome. Demographic and biochemical features were evaluated in study participants. Logistic regression estimated the odds ratios of having more fat mass among MUO compared with MHO children after adjusting for confounding factors. RESULTS: Mean body mass index was higher in the MUO group than in the MHO group (24.83 vs. 23.02 kg/m2, respectively). The proportion of obese participants was also higher in the MUO group (59.4%) than in the MHO group (20.7%). MHO children were more likely to have parents with better socioeconomic status and a higher fruit and vegetable intake compared with MUO children. Higher fat mass and percent fat was associated with MUO according to multiple logistic regression analysis. CONCLUSION: Fat mass and percent fat are associated with metabolically healthy phenotypes of obesity among children and adolescents.

Metabolic and Cardiovascular Implications of a Metabolically Healthy Obesity Phenotype

Metabolically healthy obesity (MHO) is a new concept in which an individual may exhibit an obese phenotype in the absence of any metabolic abnormalities. There are a number of definitions of MHO that utilize a variety of components. The findings of clinical and basic studies indicate that subjects with MHO do not exhibit an increased mortality, an increased risk of cardiovascular disease, or an increased risk of type 2 diabetes mellitus, as compared to normal-weight controls. Although these findings imply that metabolic health is a more important factor than obesity, several studies have shown that subjects with MHO have a similar risk of metabolic or cardiovascular diseases as those with metabolically unhealthy obesity. Thus, there is still debate regarding not only the implications of the MHO phenotype but its very existence. Accordingly, future studies should focus on developing a unified definition of MHO and distinguishing subjects who will be at a high risk for metabolic and cardiovascular diseases.

Comparison of Metabolic Characteristics of Metabolically Healthy but Obese (MHO) Middle-Aged Men According to Different Criteria / 가정의학회지

BACKGROUND: To compare the prevalence and metabolic characteristics of metabolically healthy but obese (MHO) individuals according to different criteria. METHODS: We examined 186 MHO middle-aged men (age, 37.2 years; body mass index [BMI], 27.2 kg/m2). The following methods were used to determine MHO: the National Cholesterol Education Program (NCEP) Adult Treatment Panel III criteria, 0-2 cardiometabolic abnormalities; the Wildman criteria, 0-1 cardiometabolic abnormalities; the Karelis criteria, 0-1 cardiometabolic abnormalities; the homeostasis model assessment [HOMA] criteria (lowest quartile of HOMA). After dividing the overall subjects into two age groups, we compared the prevalence and clinical characteristics between MHO and at-risk groups according to four different criteria. RESULTS: The prevalence of MHO using the NCEP, Wildman, Kaleris, and HOMA criteria were 70.4%, 59.7%, 28.5%, and 24.2%, respectively. The agreement between the groups according to the NCEP and Wildman criteria was substantial (kappa = 0.8, P < 0.001). Among individuals 35 years or younger, and regardless of method, the MHO subjects had significantly lower weight, waist circumference, BMI, body fat percentage, insulin, HOMA, alanine aminotransferase, triglyceride (TG), and TG/high density lipoprotein cholesterol (HDL-C) ratio than the at-risk subjects (P < 0.05); However, among individuals older than 35 years old, and regardless of method, the MHO subjects had different insulin, HOMA, HDL-C, and TG/HDL-C levels than the at-risk subjects (P < 0.05). CONCLUSION: The differences in metabolic profile between MHO and at-risk groups varied according to age. MHO prevalence varies considerably according to the criteria employed. Expert consensus is needed in order to define a standardized protocol for determining MHO.

Prevalence and Characteristics of Metabolically Obese but Normal Weight and Metabolically Healthy but Obese in Middle-aged Koreans: the Chungju Metabolic Disease Cohort (CMC) Study

BACKGROUND: We attempted to determine the prevalence and characteristics of metabolically obese but normal weight (MONW) and metabolically healthy but obese (MHO) individuals in a large cohort of middle-aged Koreans. METHODS: 8,987 non-diabetic subjects were selected from the Chungju Metabolic disease Cohort Study performed in 2003-2006. MONW was defined as a body mass index (BMI) > or = 18.5 and or = 25 kg/m2 with HOMA-IR in the lowest quartile. RESULTS: The mean age of the subjects was 62.3 +/- 10.5 years (men 40.4%). The age-adjusted prevalence of MONW and MHO were 4.3% (5.3% men, 3.7% women) and 5.6% (3.6% men, 7.0% women), respectively. 14.2% of men and 12.9% of women were classified as MONW among the normal weight population, whereas 10.7% of men and 14.5% of women were classified as MHO among the obese subjects. The prevalence of prediabetes was significantly higher in the MONW group than in the MHO group (34.7 vs. 12.5%, P < 0.0001 in men; 23.1 vs. 8.8%, P < 0.0001 in women). The MONW group evidenced an equivalent risk of coronary heart disease (CHD) relative to the MHO group (10.77 +/- 0.68 vs. 10.22 +/- 0.90% in men; 7.02 +/- 0.34 vs. 7.26 +/- 0.26% in women, means +/- standard error [SE]). CONCLUSION: The subjects in the MONW group are characterized by a high risk of diabetes and CHD, despite their normal weights. Their substantial prevalence in the population emphasizes the importance of identifying subjects in the MONW group, and warrants more intensive risk management.