Healthy Weight and Obesity Prevention: JACC Health Promotion Series

The prevalence of metabolically healthy obesity and healthy status and related risk factors among Iranian adults: a cohort-based cross-sectional study

Objectives

this study aims to determine the prevalence and determinants of metabolically healthy obesity (MHO) and metabolically healthy status (MHS) within a large Iranian population.

Methods

This cross-sectional study involved 10,134 participants from the Fasa Adult Cohort Study (FACS) in southern Iran. Following the extraction of metabolic, demographic, and socioeconomic variables, prevalence rates were estimated. Logistic regression analysis was conducted using SPSS 22 to examine the relationship between risk factors.

Results

Among all participants, 19.9% (32.7% in men) exhibited metabolically healthy status (MHS), while 31.4% (37.5% in men) were classified as metabolically healthy obese (MHO). The likelihood of MHO was found to be 18% higher in illiterate individuals compared to their literate counterparts. Additionally, for each 1 cm increase in waist circumference, the probability of MHO increased by 5%, while a 1-year increase in age raised the probability by 1.7%, and a 1 MET increase in physical activity reduced the probability by 1.3%. Furthermore, the likelihood of having MHS was 2.4 times greater in women than in men. Employed individuals had a 17% lower probability of MHS compared to unemployed individuals. For every 1 MET increase in physical activity, the probability of MHS decreased by 0.9%, whereas a 1-year increase in age and a 1 cm increase in waist circumference increased the probability by 1.7% and 12%, respectively.

Conclusions

It seems that MHS and MHO is relatively high in studied population and although their multifactorial nature was determined, at the same time, in order to evaluate the changes, it is necessary to pay serious attention to longitudinal monitoring.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01555-8.

Association of metabolic phenotypes with cardiovascular events in patients aged 18-45 with acute coronary syndrome

BACKGROUND

Obesity and metabolic syndrome are related to cardiovascular events. However, the association different metabolic phenotypes and obesity with cardiovascular events among young adults aged 18-45 with acute coronary syndrome (ACS) remains unclear. The study aimed to investigate the prognosis of patients aged 18-45 years with ACS based on their metabolic phenotype.

METHODS

This study included 1787 patients with ACS ≤ 45 years of age who underwent coronary angiography. Patients were divided into four groups according to metabolic phenotype: metabolically healthy non-obesity (MHN); MHO; metabolically unhealthy non-obesity (MUN); and metabolically unhealthy obesity (MUO). The primary outcome was major adverse cardiovascular events (MACE), including all-cause death, myocardial infarction, stroke, or unplanned revascularization.

RESULTS

Among 1787 patients with ACS, the median age was 41.6 years, 1675 (93.7%) were men, 1111 (62.2%) had obesity, and 659 (36.9%) were classified as MHO. During a median 65 months follow-up, 404 MACE occurred. Multivariate analysis showed that MHO was correlated with a decreased risk of MACE, while MUN significantly increased the risk compared to MHN (MHO: HR 0.69, 95%CI 0.52-0.92, P = 0.011; MUN: HR 1.47, 95%CI 1.07-2.02 P = 0.018). Moreover, restricted cubic spline analysis revealed a linear relationship between body mass index (BMI) and the incidence of MACE (Pnonlinear = 0.304, Poverall < 0.001).

CONCLUSIONS

MHO was correlated with a decreased risk of MACE, while MUN significantly increased the risk compared to MHN. Moreover, there was a linear relationship between BMI and the incidence of MACE.

Chronic inflammation in obesity and neurodegenerative diseases: exploring the link in disease onset and progression

Obesity, a worldwide health emergency, is defined by excessive fat accumulation and significantly impacts metabolic health. In addition to its recognized association with cardiovascular disease, diabetes, and other metabolic illnesses, recent studies have revealed the connection between obesity and neurodegeneration. The main reason for this link is inflammation caused by the growth of fat tissue, which activates harmful processes that affect how the brain works. Fat tissue, particularly the fat around the organs, produces various substances that cause inflammation, such as cytokines (TNF-α, IL-6), adipokines (leptin, resistin), and free fatty acids. These chemicals cause low-grade, persistent systemic inflammation, which is becoming more widely acknowledged as a major factor in peripheral metabolic dysfunction and pathology of the central nervous system (CNS). Inflammatory signals in the brain cause neuroinflammatory reactions that harm neuronal structures, change neuroplasticity, and disrupt synaptic function. When obesity-related inflammation is present, the brain's resident immune cells, known as microglia, become hyperactivated, which can lead to the production of neurotoxic chemicals, which can cause neuronal death. This neuroinflammation exacerbates the negative effects of obesity on brain health and is linked to cognitive decline, Alzheimer's disease, and other neurodegenerative disorders. Moreover, the blood-brain barrier (BBB) exhibits increased permeability during inflammatory states, facilitating the infiltration of peripheral immune cells and cytokines into the brain, hence exacerbating neurodegeneration. Adipose tissue is a source of chronic inflammatory mediators, which are examined in this review along with the molecular pathways that connect inflammation brought on by obesity to neurodegeneration. Additionally, it addresses various anti-inflammatory treatment approaches, including lifestyle modifications, anti-inflammatory medications, and gut microbiota modulation, to lessen the metabolic and neurological effects of obesity. Recognizing the link between obesity and inflammation opens up new opportunities for early intervention and the development of targeted treatments to prevent or alleviate neurodegenerative disorders.

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and its combination with obesity indicators as a predictor of all cause and cardiovascular mortality in non-diabetic individuals

BACKGROUND

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) represents a novel composite lipid marker for atherosclerosis and cardiovascular disease (CVD). Nevertheless, the correlation between NHHR and mortality in the non-diabetic population remains indistinct.

METHODS

This study included 20,774 non-diabetic individuals from the 1999-2018 National Health and Nutrition Examination Survey (NHANES). We employed a weighted multivariate Cox proportional hazards model and restricted cubic splines to assess the associations between NHHR, its combination with obesity indicators, and all-cause and CVD mortality.

RESULTS

During a mean follow-up period of 62 months, a total of 897 participant deaths were recorded, of which 155 were attributed to cardiovascular causes. The restricted cubic splines revealed a U-shaped association between NHHR and all-cause mortality, while an L-shaped association was observed for CVD mortality. The analysis of threshold efects revealed that the infection points for NHHR and all-cause and CVD mortality were 2.65 and 2.07, respectively. The cubic spline revealed a nonlinear correlation was observed between NHHR-BMI, NHHR-WC and NHHR-WHtR and all-cause and CVD mortality.

CONCLUSION

NHHR and its combination with obesity indicators can be a meaningful predictor of all-cause mortality and CVD mortality in non-diabetic individuals.

Comparative analysis of obesity indices in discrimination and reclassification of cardiovascular disease risk: The ATTICA study (2002-2022)

BACKGROUND

Despite the established link between obesity and cardiovascular disease (CVD), the optimal anthropometric index for risk prediction remains uncertain.

AIMS

This prospective cohort study aimed to compare various anthropometric indices for their association with 20-year atherosclerotic cardiovascular disease (ASCVD) risk in a healthy adult population and to assess their incremental predictive value.

METHODS

In 2002, n = 3,042 adults free of CVD, residing in Athens metropolitan area, in Greece, were recruited. A 20-year follow-up was conducted in 2022, comprising n = 2,169 participants, of which n = 1,845 had complete data on both CVD occurrence and anthropometric measures.

RESULTS

Almost all the studied anthropometric measures were significantly associated with 20-year ASCVD incidence. However, after full adjustment, none of these measures retained a significant association. The inclusion of any individual obesity index within the SCORE2 model enhanced the model's discriminatory power, while the continuous NRI exhibited positive values, suggesting improved risk reclassification. The indices linked to adipose tissue dysfunction exhibited greater efficacy in distinguishing and reclassifying CVD risk beyond SCORE2. Stratified analysis according to obesity and metabolic health status revealed that the optimal obesity index varies according to individual obesity and metabolic health profiles.

CONCLUSION

Obesity indices are strongly associated with long-term risk of ASCVD, underscoring the major role of excessive body fat in the pathogenesis of this condition. The inclusion of an obesity index in a CVD risk model significantly enhances its predictive accuracy and reclassification of risk, emphasizing the importance of these indices in refining CVD risk assessment among the general population.

Effect of a Community-Based Program on Preschoolers' Physical Activity and Nutrition in Chile

Introduction: Childhood obesity has reached critical levels in Chile, particularly among preschoolers from low-income families who face barriers to nutritious food and physical activity. Early interventions are essential to mitigate long-term health risks. This study evaluates the Chile Active Intervention, a community-based program promoting physical activity and healthy eating among preschoolers attending public daycare centers in Antofagasta, Santiago, and Temuco. Objective: To assess the effectiveness of a structured intervention in improving physical activity levels, dietary habits, and obesity-related risk factors in children aged 3 to 5 years old. Methods: A quasi-experimental design was implemented with intervention and control groups, including 1204 children from public daycare centers. The intervention-comprised educator training on healthy eating structured physical activity sessions tailored for young children and family engagement through "Healthy Days" events. Pre- and post-intervention assessments measured anthropometric variables, body composition, physical activity, and dietary intake. Results: The intervention led to positive changes in weight-for-height Z-scores, body fat percentage, and skinfold thickness, particularly among high-risk children. Physical activity assessments showed reduced sedentary time and increased active play. Dietary improvements included higher fruit and vegetable consumption and reduced ultra-processed food intake. Conclusions: This study demonstrates that early, community-based interventions can effectively improve health behaviors in preschoolers. The program's scalability across Chile is promising, with parental involvement and institutional support being key to sustaining impact. Long-term evaluations are recommended to assess its lasting effects on childhood health outcomes.

An Analysis of Young Women University Students's Physical Activity Levels

The physical activity (PA) level in women, it seems, tends to decrease in adulthood. The aims of the study were: (i) to evaluate the degree of compliance with PA recommendations in young women university students and (ii) to measure steps and the level of PA in different periods during the week. Eighty-eight young adult girls (21.38 ± 2.71 years) were recruited for this study. Participants wore an "Actigraph GT3X" accelerometer for seven days, collecting minutes of moderate-to-vigorous physical activity (MVPA) and steps volume. The results show an 80% of compliance of the 10,000 steps per day and a 220% of compliance of the 300 min/week of MVPA. The analysis shows a trend towards higher steps and PA minutes at the Weekdays (steps/day, BF10 = 168.563, δ = 0.418; meeting recommendations 10,000 steps/day, BF10 = 168.563, δ = 0.419; MVPA minutes/day, BF10 = 10.648, δ = 0.323; meeting recommendations 300 min/week, BF10 = 10.648, δ = 0.324) and during the Out-of-University-Time (steps/day, BF10 = 1.387 × 1010, δ = -0.883; meeting recommendations 10,000 steps/day, BF10 = 1.387 × 1010, δ = -0.886; MVPA minutes/day, BF10 = 1.110 × 1015, δ = -1.138; meeting recommendations 300 min/week, BF10 = 1.1 × 1015, δ = -1.144). This study can provide strategies and motivational PA guidelines at university to enhance well-being in young female university students.

Understanding drunkorexia behaviors among college students using the theory of planned behavior

Drunkorexia refers to high-risk behaviors that involve the intersection of disordered eating behaviors and risky alcohol consumption. This study utilized the extended Theory of Planned Behavior (TPB) to identify potential psychosocial factors that contribute to drunkorexia among students (484 undergraduate students) from a midwestern Mid-sized university. This cross-sectional study used online surveys designed to measure various drunkorexia-related behaviors including alcohol consumption, calorie restriction, excessive exercise, and purging utilizing antecedents of the TPB. About one-fourth of participants reported engagement in drunkorexia. The extended TPB model reported strong predictive validity for intention for calorie restriction, excessive exercise, and purging with instrumental attitudes and capacity being significant predictors for all three behaviors. Findings provide more profound insight regarding patterns of drunkorexia that could inform future theory-based interventions to address drunkorexia among college students.

The renin-angiotensin-aldosterone system and salt sensitivity of blood pressure offer new insights in obesity phenotypes

OBJECTIVE

Individuals who have metabolically healthy overweight/obesity (MHOO) do not have cardiometabolic complications despite an elevated BMI. Renin-angiotensin-aldosterone system (RAAS) activation and salt sensitivity of blood pressure (SSBP) are cardiovascular disease (CVD) risks, which are increased in individuals with higher BMI values. Little is known about the differences in RAAS activation and SSBP between MHOO and metabolically unhealthy overweight/obesity (MUOO) phenotypes.

METHODS

We studied 1430 adults on controlled dietary sodium. Individuals in the MHOO group had BMI ≥ 25 kg/m2 without comorbidities (e.g., diabetes, dyslipidemia, hypertension, CVD), whereas individuals in the MUOO group had BMI ≥ 25 kg/m2 and at least one comorbidity. The control group included healthy individuals (BMI 18.5-24.9 kg/m2).

RESULTS

BMI was similar between the MHOO (28.9 kg/m2) and MUOO groups (29.3 kg/m2; p = 0.317). On liberal sodium, the MUOO group had activated RAAS compared with the MHOO group, including higher plasma aldosterone concentration (mean [SD], 1.11 [0.48] ng/dL; p = 0.020), plasma angiotensin II levels (4.11 [2.0] pg/mL; p = 0.040), and percentage of individuals with plasma renin activity ≥ 1.0 ng/mL/h (+3.6%; p = 0.017). The MUOO group had higher SSBP than the MHOO group (6.0 [1.9] mm Hg; p = 0.002). Applying a zero-to-six-point metabolic health score found that a worse score was associated with higher measurements of RAAS activity and SSBP (p < 0.001).

CONCLUSIONS

Compared to the MHOO group, the MUOO group was characterized by an increase in the following two CVD risk factors: higher RAAS activity and SSBP on controlled sodium diets. Therapeutic interventions targeting the effects of angiotensin II and/or aldosterone may offer cardiometabolic protection for individuals with the MUOO phenotype.

Association between domain-specific physical activity and triglyceride‑glucose (TyG) index among US adults: Evidence from NHANES 2007-2018

OBJECTIVES

The triglyceride-glucose (TyG) index is not only a reliable marker for insulin resistance, but also has broad applications in assessing the risk of various diseases, including cardiovascular disease, stroke, depression, and Alzheimer's disease. The study aims to investigate the relationship between domain-specific moderate- or vigorous-intensity physical activity (MVPA) and TyG index among US adults.

METHODS

The participants from the US National Health and Nutrition Examination Survey (NHANES) (2007-2018) were included. Different PA domains, including occupation-related MVPA (O-MVPA), transportation-related MVPA (T-MVPA), and leisure-time MVPA (LT-MVPA), were assessed by the Global Physical Activity Questionnaire. Weighted multivariable linear regression and the propensity score matching (PSM) method were used to determine the relationship between domain-specific MVPA and TyG index. Furthermore, stratified and mediation analyses were employed to assess the potential effect modifications and mediators on the association.

RESULTS

A total of 12,069 participants were included. The participants had a weighted mean age of 47.43 ± 16.91 years and a weighted mean TyG index of 8.58 ± 0.67. Weighted multivariable linear regression showed that leisure-time MVPA (LT-MVPA), whether at any amount or achieving physical activity guidelines, was negatively associated with TyG index (β = -0.10, 95%CI: -0.13- -0.07, P < 0.001, and β = -0.13, 95%CI: -0.17- -0.10, P < 0.001, respectively). O-MVPA and T-MVPA were not correlated with the TyG index, even at the recommended amount (β = 0.01, 95%CI: -0.02-0.03, P = 0.59 for O-MVPA, and β = -0.02, 95%CI: -0.07-0.02, P = 0.32 for T-MVPA). After PSM, the results were still robust. Furthermore, the stratified analysis found that the correlation between LT-MVPA and TyG index was stronger in females, those with higher family incomes, and non-smokers. Finally, mediation analyses indicated a significant joint mediation effect of BMI on the relationships between LT-MVPA (≥ 150 min/week) and the TyG index, accounting for 31.48% of the total effect.

CONCLUSIONS

LT-MVPA was associated with a decreased TyG index in US adults, while no such association was observed with O-MVPA or T-MVPA. Specific recommendations for PA categories should be provided, especially for populations at risk of diseases linked to a high TyG index or insulin resistance.

Acute Coronary Syndrome in Brazil: Registration of Predisposing Factors and Population Profile in a National Public Reference Cardiological Institute

BACKGROUND

Acute coronary syndrome (ACS) is one of the leading causes of mortality worldwide. Knowing the predisposing factors is essential for preventing it.

OBJECTIVES

To describe the etiological and epidemiological characteristics of the population with ACS admitted to an emergency room in the State of São Paulo.

METHODS

The prospective cohort study, based on electronic medical records from a public cardiology institute located in the state of São Paulo, Brazil, describes 5,580 patients hospitalized with ACS between August 2018 and October 2022. The main epidemiological characteristics, the association between confirmed ACS and risk scores, and adverse events during hospitalization and in the 30-day follow-up after hospital discharge were evaluated. The significance level was set at 5%.

RESULTS

The main factors associated with ACS were hypertension (80.38%), obesity or overweight (72.47%), and previous coronary artery disease (CAD) (59.11%). In the GRACE score, 65.10% were considered low risk, while 81.34% in the TIMI and 71.16% in the HEART were identified as moderate risk. Catheterization represented 84.93% of the diagnostic methods. Clinical treatment was the strategy adopted in 46.47% of the cases. In the 30-day evolution, 3.10% presented major bleeding, 7.86% infarction/reinfarction, 5.55% stroke, and 2.53% evolved to death.

CONCLUSION

The results of the largest Brazilian ACS registry to date highlight the impact of potentially modifiable risk factors on the occurrence of ischemic events in the local population. The findings may contribute to the development of public policies aimed at preventing and controlling the burden of ischemic disease in the country.

The association between lipid-related obesity indicators and severe headache or migraine: a nationwide cross sectional study from NHANES 1999 to 2004

BACKGROUND

The connection between lipid-related obesity indices and severe headache or migraine in young and middle-aged people aged 20-60 remains ambiguous, and there are gaps in the discriminative ability of different indicators for severe headaches or migraines. Consequently, we set out to look into this association utilizing National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2004.

METHODS

After the values of waist-to-height ratio (WHtR), body-mass index (BMI), body roundness index (BRI), visceral adiposity index (VAI), lipid accumulation product (LAP), triglyceride glucose index (TyG), cardiac metabolism index (CMI), waist triglyceride Index (WTI), conicity index (CI) and weight-adjusted waist index (WWI) were estimated, with minimal sufficient adjustment for confounders determined by directed acyclic graph (DAG), weighted univariable and multivariable logistic regression analyses were carried out to ascertain the relationship between them and migraine. Stratified analysis and cross-effect analysis were implemented to examine the variability of intergroup correlations. Restricted cubic splines (RCS) and receiver operating characteristic (ROC) were then employed to examine nonliner relationships and its discriminatory ability for severe headache or migraine, respectively.

RESULTS

3354 United States adults were involved in our study, of whom 839 (25.01%) had severe headache or migraine. After adjusting for relevant covariables, WHtR, BRI, BMI, LAP, WTI and VAI were all associated with migraine and WHtR (OR = 6.38, 95% CI: 2.25,18.09, P < 0.01) showed the best predictive ability. Additionally, WHtR, BMI, and BRI demonstrated linear dose-response relationships with the prevalence of migraine (all Poverall < 0.05, Pnon-linearity > 0.05).

CONCLUSIONS

Among those ten lipid-related obesity indicators evaluated in the study, WHtR, BMI and BRI demonstrated linear positive dose-response relationships with the prevalence of migraine in young and middle-aged individuals within the United States and WHtR showed the best predictive ability. Our study can provide important insight into epidemiological research and comprehensive management of obese patients with migraine.

Global burden of subarachnoid hemorrhage among adolescents and young adults aged 15-39 years: A trend analysis study from 1990 to 2021

OBJECTIVE

This study aims to analyze the global burden of subarachnoid hemorrhage (SAH) among adolescents and young adults (AYAs) aged 15-39 years from 1990 to 2021, highlighting spatial and temporal trends and providing insights for future public health strategies.

METHODS

Data were collected from the Global Burden of Disease Study 2021 (GBD 2021), which includes comprehensive evaluations of health conditions and associated risk factors across 204 countries and territories. The focus was on SAH incidence, prevalence, mortality, and disability-adjusted life years (DALYs) among AYAs. The data were segmented by age groups (15-19, 20-24, 25-29, 30-34, 35-39 years) and socio-demographic index (SDI) quintiles. Statistical analyses, including Joinpoint regression and decomposition analysis, were employed to assess temporal trends and the impact of population growth, aging, and epidemiological changes.

RESULTS

From 1990 to 2021, the global number of SAH incident cases among AYAs increased by 12.6%, from 109,120 cases in 1990 to 122,822 cases in 2021. Prevalent cases rose by 17.1%, from 1,212,170 cases in 1990 to 1,419,127 cases in 2021. Conversely, the number of deaths decreased by approximately 26.6%, from 30,348 cases in 1990 to 22,266 cases in 2021. Similarly, DALYs decreased by 23.7%, from 1,996,041 cases in 1990 to 1,523,328 cases in 2021. Notably, over these thirty years, the age-standardized rates (ASR) of incidence, prevalence, mortality, and DALYs for the AYA population showed an overall decreasing trend, despite fluctuations in specific periods. The age-standardized mortality rate (ASMR) and age-standardized DALYs (ASR for DALYs) decreased continuously with an average annual percentage change (AAPC) of -2.2% (95% CI: -2.36, -2.04) and -2.02% (95% CI: -2.17, -1.88), respectively. The age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) had an AAPC of -0.8% (95% CI: -0.85, -0.75) and -0.65% (95% CI: -0.66, -0.64), respectively. Particularly, the ASIR showed a continuous decline from 1990 to 2015, followed by a slight increase from 2014 to 2019 (APC: 0.14%, 95% CI: 0.03, 0.25), and accelerated growth from 2019 to 2021 (APC: 1.23%, 95% CI: 0.88, 1.57). The ASPR declined from 1990 to 2019, followed by an increase from 2019 to 2021 (APC: 0.15%, 95% CI: 0.05, 0.25). Regional analysis revealed substantial burdens in the Middle-SDI and Low-Middle-SDI regions, with the Middle-SDI region having the highest incidence, prevalence, mortality, and DALYs. Decomposition analysis indicated that population growth was the primary driver of increased SAH cases, while epidemiological changes contributed significantly to the decline in deaths and DALYs.

CONCLUSION

The findings underscore the need for targeted public health interventions, particularly in low and low-middle-SDI regions, to reduce the burden of SAH among AYAs. Improved healthcare resources, enhanced health education, and preventive strategies are crucial. This study provides valuable data to inform future public health policies and resource allocation, emphasizing the importance of addressing the unique challenges faced by AYAs.

Correlations of the triglyceride-glucose index and modified indices with arterial stiffness in overweight or obese adults

Background

Insulin resistance (IR) contributes substantially to the development of cardiovascular disease (CVD) and metabolic disorders, particularly obesity. The homeostatic model assessment of IR is a prevalent IR indicator, but insulin measurement is quite impractical for widely use. Given its convenience and accessibility, the triglyceride-glucose (TyG) index, along with modified indices such as the triglyceride-glucose-waist circumference (TyG-WC) and triglyceride-glucose-waist-height ratio (TyG-WHtR), are gaining recognition as practical tools for assessing IR. This study aimed to investigate the specific correlation between the TyG index and its modified indices with arterial stiffness in an overweight or obese population and to explore novel, self-defined modified TyG indices for identifying individuals at elevated risk for such conditions.

Methods

This retrospective study included 1,143 overweight or obese individuals from 2021 to 2023. Medical data, including brachial-ankle pulse wave velocity (baPWV), were collected. Two novel modified TyG indices, TyG-1h and TyG-2h, were defined by substituting the fasting glucose level in the TyG formula with 1-hour and 2-hour post-load plasma glucose levels, respectively. Multivariate logistic regression analyses were conducted to identify parameters that demonstrated a statistically significant correlation with arterial stiffness, defined as a baPWV threshold of ≥ 1400 cm/s. Additionally, restricted cubic spline (RCS) modelling was employed to further explore these relationships in a visually interpretable manner. To evaluate and compare the diagnostic accuracy of the conventional TyG index and its novel modified versions, receiver operating characteristic (ROC) curve analyses were performed.

Results

Our findings revealed that individuals with arterial stiffness presented significantly elevated TyG index and all its modified versions (P< 0.05). By utilizing a binary logistic regression model and adjusting for potential confounders, we determined that all TyG-related parameters independently correlated with an increased risk of developing arterial stiffness. Moreover, TyG-WHtR displayed the best correlation (OR 3.071, 95% CI 1.496-6.303) when stratified by quartiles, followed by TyG-1h (OR 2.298, 95% CI 1.248-4.234) and TyG-2h (OR 2.115, 95% CI 1.175-3.807). ROC curves suggested that TyG-1h and TyG-2h demonstrated superior diagnostic performance compared to TyG, with AUCs of 0.685, 0.679 and 0.673, respectively.

Conclusions

The modified TyG indices exhibited strong effectiveness in identifying arterial stiffness in Chinese overweight or obese individuals.

Sudden Death in Obesity: Mechanisms and Management

In recent decades, the prevalence of obesity has increased significantly, leading to an epidemic at the global level. Obesity is associated with various metabolic alterations and increases the risk of cardiovascular disease. The most devastating manifestation of cardiovascular disease is sudden cardiac death (SCD), leading to substantial years of potential life lost worldwide. Obesity-related SCD is an increasingly important public health problem and warrants a specific investigative focus on improved risk stratification and prevention. In this review, we summarize the current evidence regarding management of SCD in obesity and discuss knowledge gaps as well as future directions in this field.

The prevalence of metabolically healthy obesity and its transition into the unhealthy state: A 5-year follow-up study

People with metabolically healthy obesity (MHO) are at risk of developing cardiometabolic diseases. We investigated the prevalence of MHO and factors influencing its transition into a metabolically unhealthy state (MUS). This study was conducted as part of the Kerman Coronary Artery Disease Risk Factor Study (KERCADRS). From 2014 to 2018, 9997 people were evaluated. The obesity and metabolic status of the MHO participants were re-examined after 5 years of their initial participation in the study. Out of 347 MHO, 238 individuals were accessed at follow-up. Twenty-nine (12.2%) had metabolic unhealthy normal weight (MUNW), 169 (71.0%) had metabolic unhealthy obesity (MUO), and the others had healthy metabolic state. Among age, total cholesterol, diastolic blood pressure and triglyceride (TG) variables, the baseline serum TG level was associated with a significant increase in the risk of developing MUS during 5 years (p <.05). The TG level optimal cut-off point for predicting the development into MUS was 107 mg/dL with 62.1% sensitivity and 77.5% specificity (AUC = 0.734, p <.001). A high percentage of MHO people transit into MUS during 5 years. A TG level higher than 107 mg/dL can help to identify people at a higher risk of developing into MUS.

Comparison of weight loss effects among overweight/obese adults: A network meta-analysis of mediterranean, low carbohydrate, and low-fat diets

BACKGROUND & AIMS

Eating patterns significantly impact the weight loss process. This study aimed to investigate the influence of primary eating patterns on weight loss measures in overweight and obese adults using network meta-analysis.

METHODS

We systematically searched PubMed, Scopus, Web of Science (WOS), and Google Scholar until May 2, 2023. Our network meta-analysis followed the PRISMA extension guidelines for Comparing Mediterranean, low carbohydrate and low fat diet effects on weight loss among overweight/obese adults. We conducted a Frequentist random-effects network meta-analysis. Summary effects were presented as mean differences (MD) along with corresponding standard deviations (SD). P-scores were used for treatment ranking within the network.

RESULTS

Initial literature searches yielded 1574 citations. Ultimately, 1004 participants from 7 RCTs (or 9 trials) met inclusion criteria. All diets resulted in weight loss. Comparatively, the low-carbohydrate diet exhibited a significant decrease in weight loss compared to the Mediterranean diet (MD = -2.70 kg, 95% CI: -4.65, -0.75). Indirect evidence revealed that both the low-carbohydrate diet (MD = -6.31 kg, 95% CI: -11.23, -1.39) and the low-fat diet (MD = -5.61 kg, 95% CI: -10.61, -0.61) significantly reduced weight among overweight/obese adults compared to the standard hypolipemic diet. Rankings indicated the low-carbohydrate diet as the most effective dietary intervention for enhancing weight loss (P-score = 0.8994) and reducing body fat (P-score = 0.7060).

CONCLUSIONS

Overall, a low-carb diet appears to be among the most effective approaches for weight loss and body fat reduction. However, it's essential to consider that its efficacy may vary based on factors such as age, gender, genetics, and lifestyle habits.

Prevalence and inequalities of obesity and associated complications in China: A multicentre nationwide survey

OBJECTIVES

Obesity is a risk factor for chronic diseases. The prevalence of obesity is rapidly increase and a significant social inequality exists. This study aimed to analyse obesity prevalence and complications in different regions and occupations in China.

STUDY DESIGN

Multicentre cross-sectional study.

METHODS

Data from 62,893 adults in 10 Chinese provinces were collected in 2022. Measures included body mass index (BMI), metabolic status and complications. Analysis was stratified by gender, age, region and occupation, with results adjusted for age and gender.

RESULTS

The average BMI was 23.81 ± 3.42 kg/m2, with overweight and obesity prevalence at 34.29 % and 11.24 %, respectively. North China had the highest obesity rate (27.93 %), followed by West (26.64 %), South (25.37 %) and East China (20.06 %). Functionaries (e.g. as civil servants, corporate executives) had higher BMI than employees or intellectual professionals, while workers had higher BMI than farmers. Intellectual professionals had the lowest rates of metabolically healthy obesity (MHO) at 4.90 % and metabolically unhealthy obesity (MUO) at 3.47 %, followed by employees (MHO 6.63 %, MUO 4.45 %) and functionaries (MHO 6.74 %, MUO 4.94 %). Workers had the highest MHO prevalence rate at 8.51 %, while farmers had the highest MUO rate at 6.16 %. Obesity-associated complications were 1.5-3 times more common among obese individuals than those in the normal BMI category, with inequality observed across different occupational groups.

CONCLUSIONS

In China, a large number of adults with obesity have poor metabolic health, highlighting the importance of considering metabolic status when addressing obesity-related chronic diseases. Addressing the inequality in obesity rates can inform public health strategies to tackle the increasing problem of obesity and its associated complications in China.

Systemic Inflammation Across Metabolic Obesity Phenotypes: A Cross-Sectional Study of Korean Adults Using High-Sensitivity C-Reactive Protein as a Biomarker

Chronic systemic inflammation is a hallmark of obesity. This cross-sectional study aimed to investigate the association between metabolic obesity phenotypes and inflammatory markers in Korean adults (N = 21,112; mean age: 50.9 ± 16.6). Metabolic obesity phenotypes were categorized into metabolically healthy non-obesity (MHNO), metabolically unhealthy non-obesity (MUNO), metabolically healthy obesity (MHO), and metabolically unhealthy obesity (MUO) based on body mass index and the presence of any metabolic abnormalities. High-sensitivity C-reactive protein (hs-CRP) levels were measured. Multiple linear regression was used to determine the association between obesity phenotypes and hs-CRP levels. In the male sample, compared to the MHNO type, the MUNO, MHO, and MUO types were associated with a 22.3% (95% confidence interval; CI: 14.7-30.3%), 15.8% (95% CI: 2.6-30.7%), and 12.5% (95% CI: 3.0-22.9%) increase in the hs-CRP levels, respectively. The association between metabolic obesity types and hs-CRP levels was stronger among the female sample; compared to the MHNO type, the MUNO, MHO, and MUO types were associated with a 30.2% (95% CI: 22.8-38.2%), 16.0% (95% CI: 6.5-26.4%), and 22.8% (95% CI: 13.6-32.8%) increase in the hs-CRP levels, respectively. Our findings indicate a varying profile of systemic inflammation across different metabolic obesity phenotypes.

Evaluating the efficacy of 8 non-invasive models in predicting MASLD and progression: a prospective study

BACKGROUND

Selecting the optimal non-invasive diagnostic model for MASLD (Metabolic Dysfunction-Associated Steatosis Liver Disease) and steatosis progression is a critical issue given the variety of available models. We aimed to compare the performance of eight clinical prediction models for diagnosing and predicting the progression of hepatic steatosis using MRI-PDFF (Magnetic Resonance Imaging-Derived Proton Density Fat Fraction), and validate the findings with FibroScan and histopathological results.

METHODS

In this study, 846 participants were initially enrolled, with 108 undergoing liver biopsy and 706 completing one-year follow-up, including 26 who underwent repeat biopsy. We calculated scores for eight clinical prediction models (FAST, KNAFLD, HSI, FLI, Liver Fat Score, Liver Fat Equation, BAAT, LAP) using collected clinical data and defined steatosis progression as a 30% relative increase in liver fat content (LFC) measured by MRI-PDFF. CAP(Controlled Attenuation Parameter) and LSM (Liver Stiffness Measurement) were obtained by Fibroscan. MRI-PDFF served as the reference standard for evaluating model accuracy, and sensitivity analyses were performed using liver biopsy and Fibroscan results.

RESULTS

Among the eight clinical models, NAS (nonalcoholic fatty liver disease activity score) showed higher correlation with the FAST and KNAFLD models (r: 0.62 and 0.52, respectively). Among the whole cohort (N = 846), KNAFLD was the best model for predicting different degrees of hepatic steatosis (AUC = 0.84). When the KNAFLD score was above 2.935, LFC was significantly higher (4.4% vs. 19.7%, P < 0.001). After 1 year of follow-up (N = 706), FAST performed best in predicting MASLD progression (AUC = 0.84); with dFAST > -0.02, LFC increased (8.6-10.9%, P < 0.05), mean LSM increased by 0.51 kPa, and with dFAST < -0.02, LFC significantly decreased (11.5-8.5%, P < 0.05), mean LSM and NAS decreased by 0.87 kPa and 0.76, respectively (both P < 0.05).

CONCLUSIONS

Most models demonstrated good diagnostic and prognostic capabilities for hepatic steatosis, with FAST and KNAFLD showing particular promise as primary non-invasive tools in clinical practice.

TRAIL REGISTRATION

Chinese Clinical Trial Registry NO: ChiCTR2100054743, Registered December 26, 2021.

Metabolically healthy obesity and left ventricular geometric remodelling in Chinese children

AIM

To investigate the association between metabolically healthy obesity (MHO) and left ventricular geometric remodelling in Chinese children.

MATERIALS AND METHODS

This cross-sectional study used data from two population-based samples in China, including 2871 children aged 6-11 years. Weight status was defined based on body mass index according to the World Health Organization growth chart. Metabolic status was defined based on the 2018 consensus-based criteria proposed by Damanhoury et al. Obes Rev 2018;19:1476-1491 (blood pressure, lipids and glucose). Left ventricular geometric remodelling was determined as concentric remodelling, eccentric hypertrophy, and concentric hypertrophy. Multinomial logistic regression analysis was used to determine odds ratios (ORs) and 95% confidence intervals (CIs) for the association between categories of weight and metabolic status and left ventricular geometric remodelling.

RESULTS

Compared with children with metabolically healthy normal weight, those with MHO had higher odds of left ventricular geometric remodelling, with adjusted ORs (95% CIs) of 2.01 (1.23-3.28) for concentric remodelling, 6.36 (4.03-10.04) for eccentric hypertrophy, and 17.07 (7.97-36.58) for concentric hypertrophy. Corresponding ORs (95% CIs) were 2.35 (1.47-3.75), 10.85 (7.11-16.55), and 18.56 (8.63-39.94), respectively, for children with metabolically unhealthy obesity. In contrast, metabolically unhealthy normal weight was not associated with higher odds of left ventricular geometric remodelling. Findings were consistent in sensitivity analyses that used different definitions of weight and metabolic status and left ventricular geometric remodelling.

CONCLUSIONS

Children with MHO had higher odds of left ventricular geometric remodelling than their metabolically healthy normal weight counterparts. Our findings suggest MHO may not be a benign condition for cardiac health in children.

Achieving equitable access to incretin-based therapies in cardiovascular care

The role of incretin-based therapies, including glucagon-like peptide-1 receptor agonists (GLP1RAs) and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists, in the management of type 2 diabetes mellitus (T2DM) and obesity has been increasingly recognized, along with significant cardiovascular (CV) benefits. Despite the clinical efficacy of incretin-based therapies, high costs, suboptimal access, limited insurance coverage, and therapeutic inertia present substantial barriers to widespread adoption. Overcoming these obstacles is essential for the equitable initiation, access, and utilization of incretin-based therapies. Clinicians must make targeted efforts to ensure health equity in the use of these and other advanced therapies.

Obesity and Weight Loss Strategies for Patients With Heart Failure

Obesity is a common comorbidity among patients with heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF), with the strongest pathophysiologic link of obesity being seen for HFpEF. Lifestyle measures are the cornerstone of weight loss management, but sustainability is a challenge, and there are limited efficacy data in the heart failure (HF) population. Bariatric surgery has moderate efficacy and safety data for patients with preoperative HF or left ventricular dysfunction and has been associated with reductions in HF hospitalizations and medium-term mortality. Antiobesity medications historically carried concerns for cardiovascular adverse effects, but the safety and weight loss efficacy seen in general population trials of glucagon-like peptide 1 (GLP-1) and gastric inhibitory polypeptide/GLP-1 agonists are highly encouraging. Although there are safety concerns regarding GLP-1 agonists in advanced HFrEF, trials of the GLP-1 agonist semaglutide for treatment of obesity have confirmed safety and efficacy in patients with HFpEF.

Multifaceted association of overweight and metabolically unhealthy with the risk of Barrett's esophagus in the UK Biobank cohort

The association of overweight/obesity and metabolically unhealthy (MU) with the risk of developing Barrett's esophagus (BE) remains uncertain. We evaluated whether MU and overweight/obesity are associated with increased BE incidence and whether they have a synergistic impact on BE development. We analyzed the body mass index (BMI) and metabolic indicators at baseline of 402,510 individuals from the UK Biobank with no history of BE. Overweight/obesity and MU were defined as BMI ≥ 25.0 kg/m2 and presence of ≥ 1 MU indicators, respectively. Accordingly, the participants were categorized into four groups: (1) metabolically healthy non-overweight/obesity (MHNO), (2) metabolically unhealthy non-overweight/obesity (MUNO), (3) metabolically healthy overweight/obesity (MHO), and (4) metabolically unhealthy overweight/obesity (MUO). During a median follow-up of 13.5 years, 6195 (1.5%) individuals were newly diagnosed with BE. Among them, 39,281 (9.8%), 92,000 (22.9%), 25,297 (6.3%), and 245,932 (61.1%) individuals were classified as MHNO, MUNO, MHO, and MUO, respectively. In Cox regression analyses, both MU and overweight/obesity were independently associated with BE incidence. Moreover, BE incidence was significantly higher in the MUNO, MHO, and MUO groups, compared to the MHNO group. MU and overweight/obesity are independent risk factors for BE and have a synergistic effect on BE development.

Update on Obesity and Cardiovascular Risk: From Pathophysiology to Clinical Management

Obesity is an epidemic worldwide. Overweight and multiple obesity-related mechanisms, including dysmetabolic alterations, contribute to cardiovascular deleterious effects. Hence, overweight and obesity have been independently associated with increased cardiovascular risk, whose assessment is crucial for preserving life quality and reducing mortality, and to address appropriate therapeutic strategies in obese patients. Beyond the standard of care in managing overweight and obesity in adults (i.e., diet and physical exercise), several relevant pharmacotherapies have been approved, and several procedures and device types for weight loss have been recommended. In such a contest, medical weight management remains one option for treating excess weight. Most drugs used for obesity reduce appetite and increase satiety and, secondarily, slow gastric emptying to reduce body weight and, therefore, act also to improve metabolic parameters. In this contest, agonists of the glucagon-like peptide-1 receptor (GLP-1RAs) modulate different metabolic pathways associated with glucose metabolism, energy homeostasis, antioxidation, and inflammation. Moreover, this class of drugs has shown efficacy in improving glycemic control, reducing the incidence of cardiovascular events in type 2 diabetic patients, and reducing body weight independently of the presence of diabetes. Recently, in overweight or obese patients with pre-existing cardiovascular disease but without diabetes, the GLP-1RA semaglutide reduced the incidence of cardiovascular and cerebrovascular events and death from cardiovascular causes. Thus, semaglutide has been approved for secondary prevention in obese people with cardiovascular disease. Nevertheless, whether this class of drugs is equally effective for primary prevention in obese people has to be demonstrated. In this review, we will summarize updates on the pathophysiology of obesity, the effects of obesity on cardiovascular risk, the impact of different obesity phenotypes on cardiovascular diseases, and the novelties in the clinical management of obesity for cardiovascular prevention.

Comparison of cardiovascular disease risk association with metabolic unhealthy obesity identified by body fat percentage and body mass index: Results from the 1999-2020 National Health and Nutrition Examination Survey

BACKGROUND AND AIM

Cardiovascular disease (CVD) risk among individuals across different categories of metabolic obesity phenotypes is controversial. The study used body fat percentage (BFP) or body mass index (BMI) to categorize obese status and to investigate the association between metabolic obesity phenotypes and CVD risk in a nationally representative population.

METHODS

This cross-sectional study included 49463 adult participants in National Health and Nutrition Examination Survey from 1999 to 2020. Metabolic healthy status was defined by the absence of metabolic syndrome according to the revised National Cholesterol Education Program Adult Treatment Group definition. Obesity was identified by BFP, assessed by dual-energy X-ray absorptiometry scan, and BMI. The primary outcome was CVD prevalence. The multivariable logistic regression model and restricted cubic spline analyses were used to examine the associations between metabolic obesity phenotypes and the risk of CVD.

RESULTS

Among 49463 adult participants, 32.12% were metabolically unhealthy, 34.10% were overweight, 37.94% were obese; and 8.41% had CVD. Compared with metabolic healthy normal weight, metabolic healthy obesity, and metabolic unhealthy normal weight/overweight/obesity were all associated with increased CVD risk with adjusted odds ratios (95% confidence intervals) of 1.45 (1.14-1.85), 2.80(1.53-5.11), 2.55(1.88-3.47), and 2.96(2.18-4.02), respectively. Nonlinear dose-response relationships between BFP and CVD were observed both in metabolically healthy and unhealthy participants (both P for non-linearity<0.0001). When obesity was defined with BMI, there were a similar prevalence of obesity, and similar associations between metabolic obesity phenotypes and CKD risks.

CONCLUSIONS

Metabolic healthy and unhealthy obesity were both associated with higher risks of CVD, whether using BFP or BMI to define obese status. It suggests that metabolic obesity phenotype is a risk factor for CVD.

Association between metabolic obesity phenotypes and the risk of developing prostate cancer: a propensity score matching study based on Xinjiang

Background

Obesity-induced metabolic dysfunction increases the risk of developing tumors, however, the relationship between metabolic obesity phenotypes and prostate cancer (PCa) remains unclear.

Methods

The term metabolic obesity phenotypes was introduced based on metabolic status and BMI categories. Participants were categorized into four groups: metabolically healthy nonobesity (MHNO), metabolically healthy obesity (MHO), metabolically unhealthy nonobesity (MUNO), and metabolically unhealthy obesity (MUO). Propensity score matching was conducted based on age, ethnicity, marriage, etc. Univariate and multivariate conditional logistic regression analyses were used to assess the relationship between metabolic obesity phenotypes, metabolic risk factors, and PCa. Sensitivity analysis was performed to verify the robustness of the results.

Results

After propensity score matching among 564 PCa patients and 1418 healthy individuals, 209 were selected for each of the case and control groups. There were no statistically significant differences in the basic characteristics between the two groups. Univariate and multivariate conditional logistic regression suggested that the risk of developing PCa in both MHO and MUO individuals was higher than in MHNO individuals. Specifically, the risk of developing PCa in MHO individuals was 2.166 times higher than in MHNO individuals (OR=2.166, 95%CI: 1.133-4.139), and the risk in MUO individuals was is 2.398 times higher than in MHNO individuals(OR=2.398, 95%CI:1.271-4.523). Individuals with hyperglycemia and elevated triglycerides also had a higher risk of developing PCa (hyperglycemia:OR=1.488, 95%CI: 1.001-2.210; elevated triglycerides: OR=2.292, 95%CI: 1.419-3.702). Those with more than or equal to three metabolic risk factors had an increased risk of PCa (OR=1.990, 95%CI: 1.166-3.396). Sensitivity analysis indicated an increased risk of PCa in MUO individuals compared to MHNO individuals.

Conclusion

In this retrospective study, individuals with MHO and MUO had a higher risk of developing PCa.

Association of serum 25-hydroxy vitamin D status with cardiometabolic risk factors and total and regional obesity in southern Iran: evidence from the PoCOsteo study

Cardiometabolic risk factors increase the chance of developing cardiovascular disease (CVD) and type 2 diabetes. Most CVD risk factors are influenced by total and regional obesity. A higher risk of developing CVD may be linked to vitamin D deficiency, which is more prevalent in the older population. With the goal of evaluating the association between vitamin D and cardiometabolic risk factors and total and regional obesity in older adults, this research included 25 (OH) vitamin D3 concentrations and biochemical markers associated with cardiometabolic diseases, as well as total and regional adiposity, which was measured by DXA. A total of 1991 older participants in the PoCOsteo study were included. Overall, 38.5% of participants had vitamin D deficiency. After adjusting for confounders, the results of multiple linear and logistic regression suggested an inverse association between vitamin D and body mass index (P = 0.04), waist circumference (P = 0.001), total fat (P = 0.02), android fat (P = 0.001), visceral fat (P < 0.001), subcutaneous fat (P = 0.01), trunk fat (P = 0.006), arm fat (P = 0.03), high systolic blood pressure (P = 0.004), high total cholesterol (P < 0.001), high LDL-cholesterol (P < 0.001), high serum triglycerides (P = 0.001), and high fasting glucose (P < 0.001). Additionally, higher vitamin D concentrations decreased the risk of dyslipidemia by 2%. Our results showed a significant association between serum vitamin D and a number of cardiometabolic risk factors, including total and regional obesity.

Association of Obesity With Psychological Distress in Young Adults: Patterns by Sex and Race or Ethnicity

Background

Recent studies have emphasized the intricate relationship between obesity and psychological distress, unraveling the complex interplay of biological, psychological, and sociocultural factors. However, a conspicuous knowledge gap persists in understanding the association between obesity severity and psychological distress, particularly in young adults, marked by limited empirical data.

Objectives

This study comprehensively investigates the link between obesity and psychological distress among young adults, emphasizing potential variations based on gender and race or ethnicity. Addressing this gap is crucial for informing targeted interventions and understanding the nuanced impact of obesity on mental health in this demographic.

Methods

Utilizing data from the 2013 to 2018 National Health Interview Survey, individuals aged 18 to 26 years were analyzed. Body mass index served as the primary exposure variable, with the Kessler Psychological Distress Scale assessing the primary outcome. Fully-adjusted ordinal regression models were employed for analyses.

Results

Among the 20,954 participants included in this study, representing 35,564,990 adults, 27% were overweight and 24% had obesity. In class III obesity, individuals experienced 1.4 times more psychological distress than those with normal weight (OR: 1.393; 95% CI: 1.181-1.644; P < 0.001). Subgroup analyses revealed consistent trends in non-Hispanic White (OR: 1.615; 95% CI: 1.283-2.032; P < 0.001) and female participants (OR: 1.408; 95% CI: 1.408-2.096; P < 0.001).

Conclusions

This study underscores the association between obesity and psychological distress in young adults, notably impacting non-Hispanic White and female populations. The findings bear significant implications for shaping future health policies, addressing the mental health crisis, and mitigating the increasing prevalence of obesity among young U.S. adults.

Cardiovascular Risk Profile Among Reproductive-Aged Women in the U.S.: The Behavioral Risk Factor Surveillance System, 2015-2020

Introduction

Suboptimal cardiovascular health is associated with adverse pregnancy outcomes and long-term cardiovascular risk. The authors examined trends in cardiovascular risk factors and correlates of suboptimal cardiovascular risk profiles among reproductive-aged U.S. women.

Methods

With data from 335,959 women in the Behavioral Risk Factor Surveillance System (2015-2020), the authors conducted serial cross-sectional analysis among nonpregnant reproductive-aged women (18-44 years) without cardiovascular disease who self-reported information on 8 cardiovascular risk factors selected on the basis of Life's Essential 8 metrics. The authors estimated the prevalence of each risk factor and suboptimal cardiovascular risk profile (≥2 risk factors) and examined trends overall and by age and race/ethnicity. Using multivariable Poisson regression, the authors assessed the sociodemographic correlates of suboptimal cardiovascular risk profile.

Results

The weighted prevalence of women aged <35 years was approximately 64% in each survey year. The prevalence of suboptimal cardiovascular risk profile increased modestly from 72.4% (71.6%-73.3%) in 2015 to 75.9% (75.0%-76.7%) in 2019 (p<0.001). This increase was mainly driven by increases in overweight/obesity (53.1%-58.4%; p<0.001). Between 2015 and 2019, significant increases in suboptimal cardiovascular risk profile were observed among non-Hispanic White (69.8%-72.6%; p<0.001) and Hispanic (75.1%-80.3%; p<0.001) women but not among non-Hispanic Black (82.7%-83.7%; p=0.48) or Asian (68.1%-73.2%; p=0.09) women. Older age, rural residence, and non-Hispanic Black and Hispanic race and ethnicity were associated with a higher prevalence of suboptimal cardiovascular risk profile.

Conclusions

There has been a modest but significant increase in suboptimal cardiovascular risk profile among U.S. women of reproductive age. Urgent preventive efforts are needed to reverse this trend and improve cardiovascular health, particularly among subgroups at increased risk, to mitigate its implications.

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.

Construction and Validation of a Predictive Model for Coronary Artery Disease Using Extreme Gradient Boosting

Purpose

Early recognition of coronary artery disease (CAD) could delay its progress and significantly reduce mortality. Sensitive, specific, cost-efficient and non-invasive indicators for assessing individual CAD risk in community population screening are urgently needed.

Patients and Methods

3112 patients with CAD and 3182 controls were recruited from three clinical centers in China, and differences in baseline and clinical characteristics were compared. For the discovery cohort, the least absolute shrinkage and selection operator (LASSO) regression was used to identify significant features and four machine learning algorithms (logistic regression, support vector machine (SVM), random forest (RF) and extreme gradient boosting (XGBoost)) were applied to construct models for CAD risk assessment, the receiver operating characteristics (ROC) curve and precision-recall (PR) curve were conducted to evaluate their predictive accuracy. The optimal model was interpreted by Shapley additive explanations (SHAP) analysis and assessed by the ROC curve, calibration curve, and decision curve analysis (DCA) and validated by two external cohorts.

Results

Using LASSO filtration, all included variables were considered to be statistically significant. Four machine learning models were constructed based on these features and the results of ROC and PR curve implied that the XGBoost model exhibited the highest predictive performance, which yielded a high area of ROC curve (AUC) of 0.988 (95% CI: 0.986-0.991) to distinguish CAD patients from controls with a sensitivity of 94.6% and a specificity of 94.6%. The calibration curve showed that the predicted results were in good agreement with actual observations, and DCA exhibited a better net benefit across a wide range of threshold probabilities. External validation of the model also exhibited favorable discriminatory performance, with an AUC, sensitivity, and specificity of 0.953 (95% CI: 0.945-0.960), 89.9%, and 87.1% in the validation cohort, and 0.935 (95% CI: 0.915-0.955), 82.0%, and 90.3% in the replication cohort.

Conclusion

Our model is highly informative for clinical practice and will be conducive to primary prevention and tailoring the precise management for CAD patients.

Distinguishing health-related parameters between metabolically healthy and metabolically unhealthy obesity in women

BACKGROUND

Obesity represents a global health crisis, yet a dichotomy is emerging with classification according to the metabolic state into metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO). This study aimed to identify distinctive systemic clinical/endocrinological parameters between MHO individuals, employing a comprehensive comparative analysis of 50 biomarkers. Our emphasis was on routine analytes, ensuring cost-effectiveness for widespread use in diagnosing metabolic health.

SUBJECTS/METHODS

The study included 182 women diagnosed with obesity referred for bariatric surgery at the Endocrinology, Diabetes, and Metabolism Service of São João Hospital and University Centre in Portugal. MUO was defined by the presence of at least one of the following metabolic disorders: diabetes, hypertension, or dyslipidemia. Patients were stratified based on the diagnosis of these pathologies.

RESULTS

Significantly divergent health-related parameters were observed between MHO and MUO patients. Notable differences included: albumin (40.1 ± 2.2 vs 40,98 ± 2.6 g/L, p value = 0.017), triglycerides (110.7 ± 51.1 vs 137.57 ± 82.6 mg/dL, p value = 0.008), glucose (99.49 ± 13.0 vs 119.17 ± 38.9 mg/dL, p value < 0.001), glycated hemoglobin (5.58 ± 0.4 vs 6.15 ± 1.0%, p value < 0.001), urea (31.40 ± 10.0 vs 34.61 ± 10.2 mg/dL, p value = 0.014), total calcium (4.64 ± 0.15 vs 4.74 ± 0.17 mEq/L, 1 mEq/L = 1 mg/L, p value < 0.001), ferritin (100.04 ± 129.1 vs 128.55 ± 102.1 ng/mL, p value = 0.005), chloride (104.68 ± 1.5 vs 103.04 ± 2.6 mEq/L, p value < 0.001), prolactin (13.57 ± 6.3 vs 12.47 ± 7.1 ng/mL, p value = 0.041), insulin (20.36 ± 24.4 vs 23.87 ± 19.6 μU/mL, p value = 0.021), c peptide (3.78 ± 1.8 vs 4.28 ± 1.7 ng/mL, p value = 0.003), albumin/creatinine ratio (15.41 ± 31.0 vs 48.12 ± 158.7 mg/g creatinine, p value = 0.015), and whole-body mineral density (1.27 ± 0.1 vs 1.23 ± 0.1 g/cm2, p value = 0.016).

CONCLUSIONS

Our findings highlight potential additional parameters that should be taken into consideration alongside the commonly used biomarkers for classifying metabolic health in women. These include albumin, urea, total calcium, ferritin, chloride, prolactin, c-peptide, albumin-creatinine ratio, and whole-body mineral density. Moreover, our results also suggest that MHO may represent a transitional phase preceding the development of the MUO phenotype.

Exploring the diagnostic performance of machine learning in prediction of metabolic phenotypes focusing on thyroid function

In this study, we employed various machine learning models to predict metabolic phenotypes, focusing on thyroid function, using a dataset from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2012. Our analysis utilized laboratory parameters relevant to thyroid function or metabolic dysregulation in addition to demographic features, aiming to uncover potential associations between thyroid function and metabolic phenotypes by various machine learning methods. Multinomial Logistic Regression performed best to identify the relationship between thyroid function and metabolic phenotypes, achieving an area under receiver operating characteristic curve (AUROC) of 0.818, followed closely by Neural Network (AUROC: 0.814). Following the above, the performance of Random Forest, Boosted Trees, and K Nearest Neighbors was inferior to the first two methods (AUROC 0.811, 0.811, and 0.786, respectively). In Random Forest, homeostatic model assessment for insulin resistance, serum uric acid, serum albumin, gamma glutamyl transferase, and triiodothyronine/thyroxine ratio were positioned in the upper ranks of variable importance. These results highlight the potential of machine learning in understanding complex relationships in health data. However, it's important to note that model performance may vary depending on data characteristics and specific requirements. Furthermore, we emphasize the significance of accounting for sampling weights in complex survey data analysis and the potential benefits of incorporating additional variables to enhance model accuracy and insights. Future research can explore advanced methodologies combining machine learning, sample weights, and expanded variable sets to further advance survey data analysis.

A National Study Exploring the Association between Fasting Duration and Mortality among the Elderly

(1) Background: The benefits of weight management are widely recognized, and prolonged fasting duration has become a common method for weight control. The suitability of time-restricted eating (TRE) for elderly individuals remains controversial. This study aims to examine the correlation between fasting duration and mortality within a nationally representative cohort of elderly individuals in the United States. (2) Methods: Data were extracted from a prospective cohort study conducted as part of the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. Participants aged over 60 with complete data on dietary intake and mortality follow-up information were included. Fasting duration was assessed using two 24 h dietary recalls. All the participants were categorized into fasting duration quartiles. Mortality outcomes were ascertained through the National Death Index. Cox proportional hazards regression models were utilized to analyze the association between fasting duration and mortality. (3) Results: The final analysis included 10,561 elderly participants (mean age 69.89, 45.58% male). Individuals with the longest fasting duration (over 12.38 h) had a significantly higher risk of CVD mortality compared to those with a normal fasting duration (10.58-12.38 h). This elevated CVD mortality risk was particularly pronounced in males, individuals over 70 years old, and non-shift workers. A non-linear relationship was observed between fasting duration and all-cause mortality and CVD mortality. (4) Conclusions: Prolonged fasting periods are associated with a higher risk of CVD mortality in the elderly population, although this correlation is not evident for all-cause, cancer, or other-cause mortality. A fasting duration of 11.49 h correlates with the lowest mortality risk. Additionally, elderly individuals with the shortest fasting duration exhibit elevated hazard ratios for both cancer and other-cause mortality. As with any health intervention, clinicians should exercise caution when recommending a fasting regimen that is personalized to the health condition of people who are older. Further research through randomized controlled trials should be conducted to comprehensively investigate the impact of TRE on mortality.

Risk of Cardiovascular Events in Metabolically Healthy Overweight or Obese Adults: Role of LDL-Cholesterol in the Stratification of Risk

The objective of this study was to investigate the longitudinal association of metabolically healthy overweight/obese adults with major adverse cardiovascular events (MACE) and the effect of LDL-cholesterol levels on this association. This study was conducted with 15,904 participants from the URRAH study grouped according to BMI and metabolic status. Healthy metabolic status was identified with and without including LDL-cholesterol. The risk of MACE during 11.8 years of follow-up was evaluated with multivariable Cox regressions. Among the participants aged <70 years, high BMI was associated with an increased risk of MACE, whereas among the older subjects it was associated with lower risk. Compared to the group with normal weight/healthy metabolic status, the metabolically healthy participants aged <70 years who were overweight/obese had an increased risk of MACE with an adjusted hazard ratio of 3.81 (95% CI, 1.34-10.85, p = 0.012). However, when LDL-cholesterol < 130 mg/dL was included in the definition of healthy metabolic status, no increase in risk was found in the overweight/obese adults compared to the normal weight individuals (hazard ratio 0.70 (0.07-6.71, p = 0.75). The present data show that the risk of MACE is increased in metabolically healthy overweight/obese individuals identified according to standard criteria. However, when LDL-cholesterol is included in the definition, metabolically healthy individuals who are overweight/obese have no increase in risk.

Evaluating current assessment techniques of cardiorespiratory fitness

INTRODUCTION

Considerable and convincing global data from cohorts across the health spectrum (i.e. apparently healthy to known disease) indicate that cardiorespiratory fitness (CRF) is a major predictor of overall and cardiovascular disease (CVD)-survival, seemingly with greater prognostic resolution compared to other traditional CVD risk factors. Therefore, the assessment of CRF in research and clinical settings is of major importance.

AREAS COVERED

In this manuscript, we review the technology of measuring CRF assessed by the 'gold standard,' cardiopulmonary exercise testing (CPET), as well as with various other methods (e.g. estimated metabolic equivalents, 6-minute walk tests, shuttle tests, and non-exercise equations that estimate CRF), all of which provide significant prognostic information for CVD- and all-cause survival. The literature through May 2024 has been cited.

EXPERT OPINION

The promotion of physical activity in efforts to improve levels of CRF is needed throughout the world to improve lifespan and, more importantly, healthspan. The routine assessment of CRF should be considered a vital sign that is routinely assessed in clinical practice.

The effect of incretin-based drugs on the riks of acute pancreatitis: a review

Objectives

In recent years, new hypoglycaemic drugs that affect the incretin system have become increasingly popular in the treatment of type 2 diabetes mellitus (T2DM): glucagon-like receptor 1 agonists (GLP1RAs), dipeptidyl peptidase 4 inhibitors (DPP4is) and the recently developed dual glucagon-like receptor 1 agonist and glucose-dependent insulinotropic polypeptide (tirzepatide). Their main role of these drugs is to normalise blood glucose levels. In addition, GLP1RAs are approved for the treatment of excessive body weight. The efficacy of drugs affecting the incretin system is well described in the literature, however, there are still only few reports about their safety. This review aims to summarize the results of current research and meta-analyses on risk of acute pancreatitis (AP) during incretin-affecting drugs treatment.

Methods

A narrative review was performed using present literature in an attempt to identify the relationship between AP and incretin-affecting drugs. The following keywords were used: acute pancreatitis, glucagon-like receptor 1 agonists, dipeptidyl peptidase 4 inhibitors and tirzepatide.

Results

It was demonstrated that the use of DPP4is is safe for the majority of patients with T2DM, whereas a risk of AP should be noted in case of GLP1RAs therapy. To date, most studies found no significant association between tirzepatide therapy and the increased risk of AP.

Conclusion

The majority of studies have shown that DPP4is, GLP1RAs and tirzepatide are effective and safe in most T2DM patients. However, the follow-up time for patients treated with tirzepatide is short, therefore more studies are required to confirm the safety of this drug.

Clinical Outcomes in Metabolically Healthy and Unhealthy Obese and Overweight Patients With Atrial Fibrillation: Findings From the GLORIA-AF Registry

OBJECTIVE

To explore the association between metabolic status, body mass index (BMI), and natural history of patients with atrial fibrillation (AF).

METHODS

The global, prospective GLORIA-AF Registry Phase II and III included patients with recent diagnosis of AF between November 2011 and December 2014 for Phase II and between January 2014 and December 2016 for Phase III. With this analysis, we categorized patients with AF according to BMI (normal weight [18.5 to 24.9 kg/m2], overweight [25.0 to 29.9 kg/m2], obese [30.0 to 60.0 kg/m2]) and metabolic status (presence of hypertension, diabetes, and hyperlipidemia). We analyzed risk of major outcomes using multivariable Cox regression analyses; the primary outcome was the composite of all-cause death and major adverse cardiovascular events.

RESULTS

There were 24,828 (mean age, 70.1±10.3 years; 44.6% female) patients with AF included. Higher BMI was associated with metabolically unhealthy status and higher odds of receiving oral anticoagulants and other treatments. Normal-weight unhealthy patients showed a higher risk of the primary composite outcome (adjusted hazard ratio [aHR], 1.20; 95% CI, 1.01 to 1.42) and thromboembolism, whereas a lower risk of cardiovascular death (aHR, 0.35; 95% CI, 0.14 to 0.88) and major adverse cardiovascular events (aHR, 0.56; 95% CI, 0.33 to 0.93) was observed in metabolically healthy obese individuals. Unhealthy metabolic groups were also associated with increased risk of major bleeding (aHR, 1.51 [95% CI, 1.04 to 2.20] and aHR, 1.96 [95% CI, 1.34 to 2.85] in overweight and obese groups, respectively).

CONCLUSION

Increasing BMI was associated with poor metabolic status and with more intensive treatment. Prognosis was heterogeneous between BMI groups, with metabolically unhealthy patients showing higher risk of adverse events.

Body size, insulin sensitivity, metabolic health and risk of cardiovascular disease in Chinese adults: Insights from the China Cardiometabolic Disease and Cancer Cohort (4C) study

AIMS

To assess the excess risk of cardiovascular disease (CVD) associated with different criteria for metabolic health, and the interplay of body size, insulin sensitivity and metabolic health with CVD risk.

MATERIALS AND METHODS

We conducted a prospective study involving 115 638 participants from the China Cardiometabolic Disease and Cancer Cohort (4C) Study. Metabolic health was defined using three different definitions: (1) insulin sensitivity defined by homeostatic model assessment of insulin resistance index; (2) absence of metabolic syndrome according to the National Cholesterol Education Program Adult Treatment Panel III criteria; and (3) simultaneous absence of metabolic abnormalities (diabetes, hypertension, dyslipidaemia). The primary endpoint was a composite of incident CVD events comprising the first occurrence of myocardial infarction, stroke, heart failure, or cardiovascular death.

RESULTS

During a mean 3.61-year follow-up period, obese individuals with insulin sensitivity (multivariable-adjusted hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.37-2.08), or without metabolic syndrome (HR 1.46, 95% CI 1.13-1.89) still exhibited increased CVD risks, when compared to their normal-weight counterparts. Otherwise, those with obesity but simultaneous absence of metabolic abnormalities demonstrated similar CVD risk compared to normal-weight individuals (HR 0.91, 95% CI 0.53-1.59). CVD risk increased with the number of abnormalities across body mass index categories, regardless of insulin sensitivity.

CONCLUSIONS

This study emphasizes the need for refined definitions of metabolic health and advocates for meticulous screening for metabolic abnormalities to reduce cardiovascular risks, even in individuals with normal weight and insulin sensitivity.

Obesity and Transcatheter Aortic Valve Replacement

Amidst an aging population and escalating obesity prevalence, elucidating the impact of obesity on transcatheter aortic valve replacement (TAVR) outcomes becomes paramount. The so-called "obesity paradox"-a term denoting the counterintuitive association of obesity, typically a risk factor for cardiovascular diseases, with improved survival outcomes in TAVR patients relative to their leaner or normal-weight counterparts-merits rigorous examination. This review comprehensively investigates the complex relationship between obesity and the clinical outcomes associated with TAVR, with a specific focus on mortality and periprocedural complications. This study aims to deepen our understanding of obesity's role in TAVR and the underlying mechanisms of the obesity paradox, thereby optimizing management strategies for this patient demographic, tailored to their unique physiological and metabolic profiles.

Rising Trends in Metabolically Healthy Obesity in Cancer Patients and Its Impact on Cardiovascular Events: Insights from a Contemporary Nationwide Analysis in the USA (2016-2020)

Background: Obesity or overweight raises the risk of developing 13 types of cancer, representing 40% of all cancers diagnosed in the United States annually. Given the ongoing debate surrounding the impact of metabolically healthy obesity (MHO) on cardiovascular outcomes, it is crucial to comprehend the incidence of Major Adverse Cardiovascular and Cerebrovascular Events (MACCEs) and the influence of MHO on these outcomes in cancer patients. Methods: Data of hospitalized cancer patients with and without obesity were analyzed from the National Inpatient Sample 2016-2020. Metabolically healthy patients were identified by excluding diabetes, hypertension, and hyperlipidemia using Elixhauser comorbidity software, v.2022.1. After that, we performed a multivariable regression analysis for in-hospital MACCEs and other individual outcomes. Results: We identified 3,111,824 cancer-related hospitalizations between 2016 and 2020. The MHO cohort had 199,580 patients (6.4%), whereas the MHnO (metabolically healthy non-obese) cohort had 2,912,244 patients (93.6%). The MHO cohort had a higher proportion of females, Blacks, and Hispanics. Outcomes including in-hospital MACCEs (7.9% vs. 9.5%; p < 0.001), all-cause mortality (6.1% vs. 7.5%; p < 0.001), and acute myocardial infarction (AMI) (1.5% vs. 1.6%; p < 0.001) were lower in the MHO cohort compared to the MHnO cohort. Upon adjusting for the baseline characteristics, the MHO group had lower odds of in-hospital MACCEs [adjusted odds ratio (AOR) = 0.93, 95% CI (0.90-0.97), p < 0.001], all-cause mortality [AOR = 0.91, 95% CI (0.87-0.94); p < 0.001], and acute ischemic stroke (AIS) [AOR = 0.76, 95% CI (0.69-0.84); p < 0.001], whereas there were higher odds of acute myocardial infarction (AMI) [AOR = 1.08, 95% CI (1.01-1.16); p < 0.001] and cardiac arrest (CA) [AOR = 1.26, 95% CI (1.01-1.57); p = 0.045] in the MHO cohort compared to the MHnO cohort. Conclusions: Hospitalized cancer patients with MHO exhibited a lower prevalence of in-hospital MACCEs than those with MHnO. Additional prospective studies and randomized clinical trials are imperative to validate these findings, particularly in stratifying MHO across various cancer types and their corresponding risks of in-hospital MACCEs.

Follistatin as a Potential Biomarker for Identifying Metabolically Healthy and Unhealthy Obesity: A Cross-Sectional Study

Metabolically healthy obesity (MHO) refers to obese individuals with a favorable metabolic profile, without severe metabolic abnormalities. This study aimed to investigate the potential of follistatin, a regulator of metabolic balance, as a biomarker to distinguish between metabolically healthy and unhealthy obesity. This cross-sectional study included 30 metabolically healthy and 32 metabolically unhealthy individuals with obesity. Blood samples were collected to measure the follistatin levels using an enzyme-linked immunosorbent assay (ELISA). While follistatin did not significantly differentiate between metabolically healthy (median 41.84 [IQR, 37.68 to 80.09]) and unhealthy (median 42.44 [IQR, 39.54 to 82.55]) individuals with obesity (p = 0.642), other biochemical markers, such as HDL cholesterol, triglycerides, C-peptide, and AST, showed significant differences between the two groups. Insulin was the most significant predictor of follistatin levels, with a coefficient of 0.903, followed by C-peptide, which exerted a negative influence at -0.624. Quantile regression analysis revealed nuanced associations between the follistatin levels and metabolic parameters in different quantiles. Although follistatin may not serve as a biomarker for identifying MHO and metabolically unhealthy obesity, understanding the underlying mechanisms that contribute to metabolic dysfunction could provide personalized strategies for managing obesity and preventing associated complications.

Weight loss and lifestyle intervention for cardiorespiratory fitness in obstructive sleep apnea: The INTERAPNEA trial

INTRODUCTION

Although recent trials have shown benefits of weight loss and lifestyle interventions on obstructive sleep apnea (OSA) severity and comorbidities, the effect of these interventions on cardiorespiratory fitness (CRF) remains unknown. This study aimed to investigate the effects of an interdisciplinary weight loss and lifestyle intervention on CRF and self-reported physical fitness in adults with OSA.

METHODS

Eighty-nine men aged 18-65 years with moderate-to-severe OSA and a body mass index ≥25 kg/m2 were randomly assigned to a usual-care group or an 8-week interdisciplinary weight loss and lifestyle intervention. CRF was assessed through the 2-km walking test, and the International Fitness Scale (IFIS) was used to assess self-reported physical fitness.

RESULTS

As compared with usual-care, the intervention group had greater improvements at intervention endpoint in objective CRF (6% reduction in 2-km walking test total time, mean between-group difference, -1.7 min; 95% confidence interval, -2.3 to -1.1), and self-reported overall physical fitness (18% increase in IFIS total score, mean between-group difference, 2.3; 95% CI 1.2 to 3.3). At 6 months after intervention, the intervention group also had greater improvements in both 2-km walking test total time (10% reduction) and IFIS total score (22% increase), with mean between-group differences of -2.5 (CI 95%, -3.1 to -1.8) and 3.0 (CI 95%, 1.8 to 4.1), respectively.

CONCLUSIONS

An 8-week interdisciplinary weight loss and lifestyle intervention resulted in significant and sustainable improvements in CRF and self-reported physical fitness in men with overweight/obesity and moderate-to-severe OSA.

STUDY REGISTRATION

ClinicalTrials.gov registration (NCT03851653).

The triglycerides and glucose index is more strongly associated with metabolically healthy obesity phenotype than the lipid and obesity indices

PURPOSE

The triglycerides and glucose (TyG) index is a reliable biomarker for estimating insulin resistance; however, evidence regarding the use of the TyG index in individuals with metabolically healthy obesity (MHO) is scarce. Thus, we examined the association between the TyG index and the MHO phenotype.

METHODS

Apparently healthy men and women aged 18 years or more with obesity (body mass index [BMI] ≥ 30 kg/m2) were allocated into the following groups: MHO and metabolically unhealthy obesity (MUO). The MHO phenotype was defined by obesity and the absence of the following metabolic disorders: elevated triglyceride concentrations, elevated glucose levels, elevated blood pressure, and low HDL-C. The MUO was defined by individuals with obesity and at least one of the aforementioned cardiovascular risk factors.

RESULTS

A total 827 individuals, 605 (73.1%) women and 222 (26.9%) men were enrolled and allocated into the MHO (n = 104) and MUO (n = 723) groups. The adjusted regression analysis by age, sex, BMI, and waist circumference showed that fasting glucose (OR = 0.90; 95% CI: 0.88-0.93), and triglycerides (OR = 0.97; 95% CI: 0.96-0.98), as well as the triglycerides/HDL-C (OR = 0.18; 95% CI: 0.13-0.26), lipid accumulation product (OR = 0.95; 95% CI: 0.93-0.96), visceral adipose index (OR = 0.38; 95% CI: 0.31-0.46), and TyG index (OR = 0.001; 95% CI: 0.000-0.004) are inversely associated with the MHO, while the HDL-C (OR = 1.10; 95% CI: 1.07-1.12) had a direct association.

CONCLUSIONS

Our results show that the TyG index is more strongly associated with the MHO phenotype than the lipid and obesity indices.