Liver enzymes and vitamin D levels in metabolically healthy but obese individuals: Korean National Health and Nutrition Examination Survey

Associations of ALT, AST and ALT/AST ratio with metabolically unhealthy obesity in the elderly

Aims

This study aimed to clarify the effects of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and ALT/AST ratio on metabolically unhealthy obese (MUHO) and to estimate the predictors of MUHO in the elderly.

Methods

19,812 individuals aged 65 years and older from a health check-up in Qingdao, China in 2021 were chosen as subjects in the current study. Binary logistic regression models were performed to evaluate the relationship between ALT, AST, ALT/AST ratio and MUHO. Receiver operating characteristic (ROC) analysis was performed to estimate the predictive value of ALT, AST and ALT/AST ratio for the diagnosis of MUHO.

Results

The risks for MUHO increased across quartiles of ALT level and ALT/AST ratio in both genders. The adjusted odds ratios (ORs) for MUHO in the highest quartile of ALT were 3.20-fold higher than the reference quartile in men and 3.05-fold higher in women. Compared with the first quartile of ALT/AST ratio, the adjusted ORs for MUHO in the highest quartile were 3.64 (95% CI: 3.17-4.19) in men and 3.60 (95% CI: 3.11-4.16) in women, respectively. In ROC curve analysis for predicting MUHO, the area under the ROC curve (AUC) values were 0.63 (p < 0.001) for ALT and 0.64 (p < 0.001) for ALT/AST ratio in men, and 0.62 (p < 0.001) for ALT and 0.64 (p < 0.001) for ALT/AST ratio in women. However, AST was not significantly associated with MUHO both in men and in women (p>0.05).

Conclusion

ALT and ALT/AST ratio might be considered as two simple and reliable diagnostic indicators for MUHO in the elderly.

Relationship between the thrombospondin-1/Toll-like receptor 4 (TSP1/TLR4) pathway and vitamin D levels in obese and normal weight subjects with different metabolic phenotypes

Thrombospondin-1 (TSP1) contributes to obesity-associated inflammation via activating Toll-like receptor 4 (TLR4). The regulatory role of vitamin D on this pathway has been suggested. This study aimed to investigate the relationship between TSP1/TLR4 pathway and vitamin D in obese and normal weight subjects with different metabolic phenotypes. Thirty obese and thirty normal weight men were selected. Anthropometric parameters and serum TSP1, TLR4, TNF-α, vitamin D, and metabolic profile were determined. Metabolic phenotypes of obese and normal weight subjects were determined. Findings revealed enhanced TSP1/TLR4/TNF-α levels and reduced 25(OH)D levels in obese compared to normal weight subjects and metabolically unhealthy compared to metabolically healthy subjects. TSP1 correlated positively with parameters of unhealthy metabolic profile. TSP1, TLR4 and TNF-α levels significantly negatively correlated with vitamin D levels. In conclusion, vitamin D might exert a regulatory role on TSP1/TLR4 pathway, providing a potential mechanism that links hypovitaminosis D with risk of metabolic dysfunction.

Metabolic status indicators and influencing factors in non-obese, non-centrally obese nonalcoholic fatty liver disease

Non-obese nonalcoholic fatty liver disease (NAFLD) is characterized by metabolic disorders and related complications. This study aimed to provide an integrated description of clinical, metabolic, and influencing factors for a specific category of patients with non-obese NAFLD. A total of 36 participants with body mass index (BMI) < 28 kg/m2 and visceral adipose tissue < 100 cm2 were classified into 2 groups: the non-obese, non-centrally obese control group (n = 17) and non-obese, non-centrally obese NAFLD group (n = 19). Hypertriglyceridemia, impaired fasting glucose, low high-density lipoprotein cholesterol levels, and hypertension were used to determine whether participants were metabolically abnormal. Based on a logistic regression model, odds ratios for the factors influencing NAFLD with 95% confidence intervals were calculated. Insulin resistance (IR) and fasting plasma glucose (FPG) levels were higher in the NAFLD group than in the control group (P < .05). The NAFLD group had a higher metabolic abnormality rate than the healthy control group (36.84% vs 5.88%, P = .044). Correlation analysis showed that IR was positively correlated with FPG and triglyceride (P < .05). BMI was the main influencing factor of NAFLD (regression coefficient β = 0.631; odds ratio = 1.879; 95% confidence interval, 1.233-2.863). NAFLD patients with a BMI < 28 kg/m2 and visceral adipose tissue < 100 cm2 had more apparent IR, higher FPG, and a higher metabolic abnormality rate. IR may be affected by FPG and triglyceride. Even in non-obese and non-centrally obese individuals, BMI should be controlled to avoid NAFLD.

Factors of Obesity and Metabolically Healthy Obesity in Asia

The East Asian region (China, Japan, and South Korea) is comprised of almost 1.5 billion people and recent industrialization has brought with it a pandemic of rising obesity, even in children. As these countries are rapidly aging and functioning at sub-replacement birthrates, the burgeoning costs of obesity-related care may threaten socialized healthcare systems and quality of life. However, a condition called metabolically healthy obesity (MHO) has been found to be without immediate cardiopulmonary or diabetic risk. Thus, maintenance of the MHO condition for the obese in East Asia could buffer the burden of long-term obesity care on medical systems and knowledge of the biochemical, genetic, and physiological milieu associated with it could also provide new targets for intervention. Diverse physiological, psychological, environmental, and social factors play a role in obesogenesis and the transition of MHO to a metabolically unhealthy obesity. This review will give a broad survey of the various causes of obesity and MHO, with special emphasis on the East Asian population and studies from that region.

Associations of serum multivitamin levels with the risk of non-alcoholic fatty liver disease: A population-based cross-sectional study in U.S. adults

Vitamins were closely associated with non-alcoholic fatty liver disease (NAFLD) development, but no study had explored the association of serum multivitamin levels with NAFLD risk. We assessed the association between serum levels of both single-vitamin and multivitamins (VA, VB6, VB9, VB12, VC, VD, and VE) and the risk of NAFLD, using the database of National Health and Nutrition Examination Survey (NHANES) (cycles 2003–2004 and 2005–2006). We employed multivariable logistic regression and weighted quantile sum (WQS) regression models to explore the association of serum multivitamin levels with NAFLD. Among all 2,294 participants, 969 participants with NAFLD were more likely to be male, older, less educated, or have hypertension/high cholesterol/diabetes. After adjustment of covariates, serum VC/VD/VB6/VB9 levels were negatively correlated with NAFLD risk, while serum VA/VE levels were positively correlated with NAFLD risk. In the WQS model, elevated serum VA/VE levels and lowered serum VC/VD/VB6 levels were linearly associated with increased NAFLD risk. There was a non-linear relationship between serum VB9/VB12 levels and NAFLD risk. There were evident associations between serum multivitamin levels and reduced NAFLD risk, which was mainly driven by VD/VB9/VC. In conclusion, our findings suggested that serum multivitamin levels were significantly associated with the risk of NAFLD.

Vitamin D is directly associated with favorable glycemic, lipid, and inflammatory profiles in individuals with at least one component of metabolic syndrome irrespective of total adiposity: Pró-Saúde Study, Brazil

Vitamin D insufficiency has been suggested as a risk factor for several metabolic disorders. The objective of the study was to investigate the association between serum 25 hydroxyvitamin D [25(OH)D] and metabolic health markers of Brazilian individuals with normal-weight, overweight or obesity. We hypothesized that serum 25(OH)D would be inversely associated with glycemic, lipid and inflammatory markers indicative of metabolic abnormality. Data of 511 individuals (33-79 years), recruited from a longitudinal investigation (Pró-Saúde Study), were analyzed cross-sectionally. Anthropometric, biochemical, body composition, socio-demographic and lifestyle data were collected. Based on body mass index (BMI; normal weight, overweight, obesity) and metabolic health (metabolically healthy (MH) and metabolically unhealthy (MU)) categories, the participants were classified into 6 phenotypes. Individuals having zero components of the metabolic syndrome were considered as "MH". MH obesity was frequent in 2.0% of the participants and 56.0% exhibited vitamin D insufficiency (<20 ng/mL). In the subgroups of the same BMI category, there were no significant differences in 25(OH)D concentrations between individuals classified as MH and MU. After adjustments (including %body fat and BMI), an inverse association was observed between 25(OH)D and visceral adipose tissue (B = -6.46, 95% confidence interval, CI: -12.87, -0.04), leptin (B = -0.09, 95% confidence interval, CI: -0.14, -0.03), insulin (B = -0.21, 95%CI: -0.34, -0.07), HOMA-IR (B = -0.06, 95%CI: -0.10, -0.02), triglycerides (B = -2.44, 95%CI: -3.66, -1.22), and TNF-α (B = -0.12, 95%CI: -0.24, -0.005) only in MU individuals. Our results indicate that the association of 25(OH)D concentrations with a favorable biochemical profile (glycemic, lipidic and inflammatory) seems to depend on the individual's overall metabolic health, suggesting more benefits from higher serum vitamin D in MU individuals, regardless of their adiposity.

Vitamin D Deficiency Is Inversely Associated with Homeostatic Model Assessment of Insulin Resistance

The study was conducted to comprehensively assess the association of the concentration of vitamin D in the blood and insulin resistance in non-diabetic subjects. The objective was to pool the results from all observational studies from the beginning of 1980 to August 2021. PubMed, Medline and Embase were systematically searched for the observational studies. Filters were used for more focused results. A total of 2248 articles were found after raw search which were narrowed down to 32 articles by the systematic selection of related articles. Homeostatic Model Assessment of Insulin Resistance (HOMAIR) was used as the measure of insulin resistance and correlation coefficient was used as a measure of the relationship between vitamin D levels and the insulin resistance. Risk of bias tables and summary plots were built using Revman software version 5.3 while Comprehensive meta-analysis version 3 was used for the construction of forest plot. The results showed an inverse association between the status of vitamin D and insulin resistance (r = -0.217; 95% CI = -0.161 to -0.272; p = 0.000). A supplement of vitamin D can help reduce the risk of insulin resistance; however further studies, like randomized controlled trials are needed to confirm the results.

Association and interaction between vitamin D level and metabolic syndrome for non-alcoholic fatty liver disease

INTRODUCTION/OBJECTIVES

Previous studies have shown conflicting results regarding the association between hypovitaminosis D and non-alcoholic fatty liver disease (NAFLD). The aim of this study is to explore the individual and combined effect of hypovitaminosis D and metabolic syndrome (MS) on NAFLD.

MATERIALS AND METHODS

In this cross-sectional study, 874 subjects were enrolled. 25(OH)D was assessed by a sequential competitive immuno-fluoro-assay method. The Fatty Liver Index (FLI) was used for NAFLD screening. Binary logistic regression and additive interaction were performed to investigate the association between vitamin D status, MS and NAFLD.

RESULTS

Severe vitamin D deficiency was found to be positively related to NAFLD, with a higher risk in women than in men (OR = 6.4, 95% CI [2.8-15], p < 0.0001 vs. OR = 5.8, 95% CI [1.9-17.7], p = 0.002). In men, this association was partially masked by obesity. The additive interaction with MS was significant in women but not in men, the relative excess risk due to interaction was of 7.2, 95% CI [1.3-12.9], p = 0.02), the attributable proportion due to the combined effect was of 0.6, 95% CI [0.4-0.8], p < 0.0001. The interaction mechanism is synergistic; the synergy index: was of 2.9, 95% CI [1.6-5.3], p = 0.0006.

CONCLUSION

A positive association has been found between severe vitamin D deficiency and NAFLD. Moreover, an excess risk in women combining both MS and severe vitamin D deficiency was quantified.

Are There Differences in Hair Mineral Concentrations Between Metabolically Healthy and Unhealthy Obese Adults?

Obesity is a risk factor for metabolic syndrome, dyslipidemia, hypertension, insulin resistance, type 2 diabetes mellitus, and cardiovascular disease. However, obesity is not a homogenous state and not all subjects in an obese population are at an increased risk for metabolic abnormalities. Thus, obesity types can be subdivided into metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) according to metabolic status. Body minerals are important and are involved in various metabolic processes that may be related to obesity. Thus, this study determined whether hair mineral concentrations differ between MHO and MUO adults. The associations between metabolic risk factors and hair mineral concentrations were analyzed in 141 obese Korean adults (62 MHO subjects and 79 MUO subjects). The MUO subjects showed significantly higher triglyceride levels, systolic blood pressure, waist circumference and body mass index, lower high-density lipoprotein cholesterol levels, and greater insulin resistance as reflected by the homeostasis model assessment-insulin resistance (HOMA-IR) index compared with MHO subjects. No significant differences in hair mineral concentrations were detected between MHO and MUO adults. Hair iron and cobalt concentrations were significantly negatively correlated with blood pressure in subjects with MHO. In addition, hair zinc concentration was associated with decreased systolic blood pressure. The results of this study suggest that mineral status in obese adults may play a role in metabolic abnormalities. Further studies with a larger number of subjects are warranted to identify the nature of the relationship between hair mineral status and metabolic risk in MHO and MUO subjects.

Association of Serum 25-Hydroxyvitamin D Level With Metabolic Phenotypes of Obesity in Children and Adolescents: The CASPIAN-V Study

Background and Objective: Different metabolic phenotypes of obesity are related to cardiometabolic risk factors in children and adolescents. Vitamin D, as one important factor, could be related to different subgroups of metabolic obesity and might affect metabolic disorders. The purpose of this study was to evaluate the relationship between serum 25-hydroxyvitamin D concentration and subsets of metabolic phenotypes of obesity in children and adolescents. Methods: This nationwide cross-sectional study was conducted in the framework of the fifth survey of a national surveillance program, the CASPIAN study. Overall, 2,594 students aged 7-18 years were assessed for 25-hydroxyvitamin D status. Metabolic syndrome (MetS) was defined according to the ATP III criteria modified for the pediatric age group. Participants were classified into four metabolic phenotypes of obesity according to categories of the BMI and metabolic status: "metabolically healthy obese" (MHO), "metabolically non-healthy non-obese" (MNHNO), "metabolically non-healthy obese" (MNHO), and "metabolically healthy non-obese" (MHNO). Multinomial logistic regression analysis was performed for evaluating the association of 25-hydroxyvitamin D status with different metabolic phenotypes of obesity. Results: In this study, 85.2% of participants were classified as MHNO, 11.0 % as MHO, 2.5% as MNHNO, and 1.3% as MNHO. The frequency of hypovitaminosis D was more prevalent in MNHO (85.3%) than in other phenotypes (MHNO: 70%; MHO: 76.5%; MNHNO: 78.1%, respectively; p < 0.05). In the multivariate model, hypovitaminosis D significantly increased the odds of being MHO (OR: 1.46; 95% CI: 1.07-1.77) and MNHO (OR: 2.89; 1.05-8.31) compared to the healthy group. Likewise, in multivariate model, per each unit (ng/mL) increment in 25-hydroxyvitamin D concentration, the odds of MNHNO and MNHO decreased significantly by 7% (OR: 0.93; 0.91-0.96) and 6% (OR: 0.94; 0.91-0.98) respectively. Conclusion: Our results support the hypothesis that 25-hydroxyvitamin D concentration is associated with metabolic obesity phenotypes. Longitudinal studies are necessary to assess the clinical impacts of this finding.

Low vitamin D level was associated with metabolic syndrome and high leptin level in subjects with nonalcoholic fatty liver disease: a community-based study

Background

This study aimed to evaluate the association between serum vitamin D levels and nonalcoholic fatty liver disease (NAFLD) parameters, such as metabolic syndrome (MS), inflammatory cytokines (tumor necrosis factor, high sensitive C-reactive protein) and adipokines (adiponectin, leptin).

Methods

From August 2013 to August 2016, a community-based study was performed in the north-eastern region of Taiwan. All subjects received a demographic survey, blood testing and abdominal ultrasonography (US). The vitamin D level was evaluated by quartile divide or used the classification of deficiency (< 20 ng/ml), insufficiency (20–30 ng/ml) and sufficiency (> 30 ng/ml).

Results

Subjects were divided into NAFLD group and normal control (subjects number = 564 in each group) following abdominal US study and matching age and gender. The mean age was 57.1 years in NAFLD group and 57.5 in control group. Subjects in NAFLD group had a lower mean vitamin D than those in the control group (28.5 ± 9.5 ng/ml vs. 29.9 ± 10.2 ng/ml, P = 0.018). Subjects with serum vitamin D deficiency or insufficiency had higher odds for MS than those with sufficient vitamin D levels [deficiency vs. sufficiency, adjusted odds ratio (aOR) =1.860 (95% CI = 1.234–2.804), P = 0.003; insufficiency vs. sufficiency, aOR = 1.669 (95% CI = 1.237–2.251), P = 0.001]. Similarly, subjects in the lowest quartile of vitamin D had higher odds for MS than those in the highest quartile of vitamin D (aOR = 2.792, 95% CI = 1.719–4.538, P < 0.001). Vitamin D level was positively correlated with age and male, but negatively correlated with serum leptin level.

Conclusion

Subjects with low vitamin D level had higher odds for MS, but higher levels of leptin, compared to those with high vitamin D levels.

The relationship between vitamin D level and hepatosteatosis in obese children

OBJECTIVE:

The increasing incidence of obesity in children is a significant risk factor for nonalcoholic fatty liver disease and obesity-associated morbidity. In the present study, we aimed to explore the correlation between Vitamin D level and hepatosteatosis in obese children.

METHODS:

A total of 110 children aged 10–16 years who presented to pediatric endocrinology outpatient clinic for obesity were enrolled. The study was completed in a single season between September and November. Hepatosteatosis was diagnosed by ultrasonography. The patients were grouped into two groups: Group 1 comprised patients with hepatosteatosis and Group 2 consisted of patients without hepatosteatosis. 25 hydroxy (25-OH) Vitamin D levels were compared between patients with and without hepatosteatosis.

RESULTS:

No statistically significant difference was observed between 25-OH Vitamin D levels of patients with and without hepatosteatosis. When the effects of age and sex were kept constant, there was no significant correlation between Vitamin D level and aspartate aminotransferase, alanine aminotransferase, and body mass index values.

CONCLUSION:

Unlike the results of the previous studies, we were unable to detect any significant difference between Vitamin D levels of obese patients with and without hepatosteatosis. We think that obesity, rather than Vitamin D status, that is, in fact, independently associated with nonalcoholic fatty liver disease. Larger studies are needed to investigate the impact of Vitamin D in children with obesity with hepatosteatosis.

Serum Uric Acid Levels as an Indicator for Metabolically Unhealthy Obesity in Children and Adolescents

BACKGROUND

Metabolically healthy obesity (MHO) refers to those individuals who do not show cardiometabolic abnormalities. Our aim was to identify potential clinical and metabolic indicators that may help to distinguish between metabolically healthy and unhealthy individuals amongst overweight and obese children and adolescents.

METHODS

The study involved 246 overweight/obese and 212 normal-weight individuals enrolled in the LIFE Child study, aged between 6 and 18 years. Overweight/obese individuals without cardiovascular risk factors (fasting serum lipids, blood pressure, and glucose) were classified as MHO. Individuals meeting 1 or more criteria of cardiovascular risk factors were classified as metabolically unhealthy obesity (MUO).

RESULTS

Among the 246 overweight/obese individuals, 173 (70%) were MHO and 73 (30%) were MUO. The MHO individuals were younger, more likely to be male, and had lower BMI SDS. In the logistic regression models, uric acid (UA) SDS (OR 1.61, 95% CI 1.1-2.6, p = 0.004), waist circumference SDS (OR 2.50, 95% CI 1.2-6.4, p = 0.017), and C-peptide (OR 4.05, 95% CI 3.5-91, p = 0.003) were significant indicators of MUO.

CONCLUSION

Our results suggest that nearly one-third of overweight/obese children are already identified as MUO. Serum levels of UA can be used as an indicator of unhealthy obesity in youth, where lower levels of UA indicate a lower risk and higher levels suggest a higher risk of MUO. We note that the relevance of identifying potential indicators remains the first most important step in future clinical research.

Association of dietary inflammatory index with metabolic profile in metabolically healthy and unhealthy obese people

AIM

Obesity is an emerging public health problem, with its incidence on the rise. An abnormal metabolic profile is a risk factor for developing obesity. Dietary factors play a central role in the regulation of inflammation and obesity. The aim of the present study was to determine the prevalence of metabolically healthy obese and metabolically unhealthy obese (MUO) phenotypes, and their association with dietary inflammatory index (DII) among obese Iranian people.

METHODS

A cross-sectional study was conducted from July to October 2017 among 300 obese participants in southern Tehran. DII scores were computed based on the overall inflammatory properties of 32 dietary components using dietary intake assessed by food frequency questionnaire. MUO phenotype was defined as having three or more of these metabolic abnormalities: high blood glucose, high triglycerides, low high-density lipoprotein cholesterol, elevated blood pressure or abdominal obesity. The association was determined using logistic regression analysis.

RESULTS

The MUO phenotype (n = 176) was found in 63.5% of obese participants. Compared with participants in the first quartile, those in the fourth quartile of DII score (more pro-inflammatory diet) had higher odds of MUO phenotype (odds ratio, OR: 2.58 (95% CI: 1.19-5.59), P = 0.04), and there was a significant association between the continuous form of DII score and the odds of MUO phenotype (OR: 1.18 (95% CI: 1.01-1.37)) after adjusting for potential confounders.

CONCLUSIONS

Higher DII scores were positively associated with the MUO phenotype. A more pro-inflammatory diet is a potential risk factor for MUO phenotype.

Correlation between normal range of serum alanine aminotransferase level and metabolic syndrome: A community-based study

Serum alanine aminotransferase (ALT) is a biomarker of hepatocyte damage. However, the relationship between normal range of serum ALT level and metabolic syndrome (MetS) has not been completely understood. This study aimed to investigate the correlation between normal range of serum ALT level and MetS.A total of 2453 participants from the Beijing Community Pre-Diabetes study were enrolled. Multiple linear regression analysis was performed to calculate the regression coefficient. Normal serum ALT levels were divided into quartiles. Logistic regression model was used to compare the relative risk of MetS, and the receiver operating characteristic (ROC) curve to calculate the optimal ALT boundary value for predicting MetS.The frequency of MetS increased with the ALT level within the normal range. Compared with the first group, the risk of MetS was greater in the other quartiles of ALT level in males, the difference was significant for the fourth group. For females, the risk of MetS increased with ALT level within the normal range as well, with all differences showing statistical significance. The optimal ALT boundary value of the ROC curve for males and females was 24.5 and 14.5 U/L, respectively.ALT was related to metabolic factors and used as one of the indicators to assess the morbidity risk of metabolic diseases.

Association between Liver Enzymes with Metabolically Unhealthy Obese Phenotype

Background

Obesity could be classified into two phenotypes: metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUHO). This study investigated the ability of liver enzymes to identify obesity phenotype.

Methods

We conducted a cross-sectional study in 2197 obese adults (age > 40 years and BMI ≥25 kg/m²) in a rural area of central China.

Results

In this population, 75% of the participants have more than one cardiometabolic risk factor. Both GGT and ALT were strongly related to the MUHO phenotype. The association between the fourth quartile of GGT and MUHO risk was strong and independent of confounder risk factors in both genders (adjusted ORs, 1.73 (95%CI 1.03–2.92) for male and 1.82 (95%CI 1.29–2.57) for female). The association between the fourth quartile of ALT and MUHO risk was strong and independent in female, but not in male (adjusted ORs, 1.65 (95%CI 0.86–3.19) for male and 1.88 (95%CI 1.29–2.75) for female). Additionally, AST was not associated with MUHO phenotype.

Conclusions

Both GGT and ALT are effective markers for identifying MUHO in this population. Furthermore, the ability of GGT may be superior to ALT in male.

Relationship of Circulating Fetuin-A Levels with Body Size and Metabolic Phenotypes

BACKGROUND

Previous studies have suggested the existence of distinct body size subgroups according to metabolic health referred to as metabolically healthy obesity (MHO) and metabolically abnormal but normal weight (MANW) patients. Although nonalcoholic fatty liver disease (NAFLD) is strongly associated with obesity and metabolic syndrome, the relationship between these phenotypes and fetuin-A, a representative hepatokine, has not been explored.

METHODS

We examined the association between circulating fetuin-A levels, metabolic health phenotypes, cardiometabolic risk parameters, and subclinical atherosclerosis in 290 subjects who were randomly selected from an ongoing cohort study.

RESULTS

Fetuin-A concentrations were significantly associated with detrimental anthropometric and laboratory measurements, including increased waist circumference, blood pressure, alanine aminotransferase, fasting plasma glucose, and triglyceride levels. Furthermore, fetuin-A levels were significantly increased in the metabolically abnormal (MA) group compared to the metabolically healthy (MH) group in subjects without obesity (717.1 [632.1, 769.7] vs. 599.5 [502.0, 709.3], P = 0.001) and subjects with obesity (704.1 [595.5-880.9] vs. 612.2 [547.9-802.1], P = 0.016). In addition, brachial-ankle pulse wave velocity (baPWV), which reflects arterial stiffness, was higher in MA individuals compared to MH individuals. Multiple logistic regression analysis revealed that both individuals without obesity (P for trend = 0.017) and with obesity (P for trend = 0.028) in the higher tertiles of fetuin-A had an increased risk of MA than those in the lowest tertile.

CONCLUSIONS

This study demonstrates that fetuin-A levels are significantly associated with metabolic health phenotypes, such as MHO and MANW, in Korean adults.

The prevalence, metabolic risk and effects of lifestyle intervention for metabolically healthy obesity: a systematic review and meta-analysis: A PRISMA-compliant article

BACKGROUND

We conducted a systematic review and meta-analysis to firstly obtain a reliable estimation of the prevalence of metabolically healthy obese (MHO) individuals in obesity, then assessed the risk of developing metabolic abnormalities (MA) among MHO individuals. At last, we evaluated the effects of traditional lifestyle interventions on metabolic level for MHO subjects.

METHODS

A systematic review and meta-analysis (PRISMA) guideline were conducted, and original studies were searched up to December 31, 2016. The prevalence of MHO in obesity from each study was pooled using random effects models. The relative risks (RRs) were pooled to determine the risk of developing MA for MHO compared with metabolically healthy normal-weight (MHNW) subjects. For the meta-analysis of intervention studies, the mean difference and standardized mean differences were both estimated for each metabolic parameter within each study, and then pooled using a random-effects model.

RESULTS

Overall, 40 population-based studies reported the prevalence of MHO in obesity, 12 cohort studies and 7 intervention studies were included in the meta-analysis. About 35.0% obese individuals were metabolically healthy in the obese subjects. There were dramatic differences in the prevalence among different areas. However, 0.49 (95% confidence intervals [CI]: 0.38 to 0.60) of the MHO individuals would develop one or more MA within 10 years. Compared with MHNW subjects, the MHO subjects presented higher risk of incident MA (pooled RR = 1.80, 95%CI: 1.53-2.11). Following intervention, there was certain and significant improvement of metabolic state for metabolically abnormal obesity (MAO) subjects. Only diastolic blood pressure had reduced for MHO individuals after intervention.

CONCLUSIONS

Almost one-third of the obese individuals are in metabolic health. However, they are still at higher risk of advancing to unhealthy state. Therefore, it is still needed to advise MHO individuals to maintain or adopt a healthy lifestyle, so as to counterbalance the adverse effects of obesity.

Insulin sensitivity and its relation to hormones in adolescent boys and girls

BACKGROUND AND AIMS

A subset of obese individuals lacks cardiometabolic impairment. We aimed to analyze hormonal profiles of insulin-sensitive obese (ISO) and insulin-resistant obese (IRO) adolescents and determine hormonal predictors of homeostasis model of insulin resistance (HOMA-IR).

MATERIALS AND METHODS

A threshold of 3.16 of HOMA-IR was used to classify ISO (<3.16) IRO (≥3.16). In 702 individuals aged 13-18years (55.8% girls) anthropometric and laboratory [blood glucose, insulin, thyrotropin (TSH), free thyroxine (fT4), free triiodothyronine (fT3), sex hormone-binding globulin (SHBG), steroid hormones, luteinizing hormone, follicle stimulating hormone, prolactin, ghrelin, glucose-dependent insulinotropic polypeptide, glucagon-like-peptide 1glucagon, leptin, resistin, visfatin, leptin, adiponectin and adipsin] assessments were performed. Orthogonal projections to latent structures and Mann-Whitney tests with Bonferroni correction were applied for statistical analysis.

RESULTS

52.6% girls and 42.9% boys were insulin sensitive. In the predictive model of HOMA-IR thyroid function tests, adiponectin, ghrelin and leptin concentrations played an important role in both genders. Prolactin, testosterone and glucagon contributed to the model only in boys, while progesterone and dehydroepiandrosterone sulfate levels only in girls. After Bonferroni correction levels of leptin, adiponectin, leptin/adiponectin ratio, SHBG and fT4/TSH ratio in both genders, testosterone and glucagon levels in boys and levels of TSH and fT3 in girls were related to insulin sensitivity.

CONCLUSION

Metabolic health defined by HOMA-IR is partly predicted by various hormones. Some of them are gender specific. Free T4/TSH and leptin/adiponectin ratios are related to insulin sensitivity in both genders.

The Effect of Serum Vitamin D on Serum ALT Levels in Healthy Individuals

BACKGROUND

Several studies have examined the relationship between vitamin D (VD) and liver disease but none have explored this relationship in adults with normal liver enzymes. Our aim was to explore an independent association of VD with alanine aminotransferase (ALT) in a large sample of the US adults with liver enzymes in normal range (≤39 U/L).

METHODS

We used the continuous National Health and Nutrition Examination Survey from 2001 to 2006. We excluded individuals with serum ALT>39 U/L. We built linear regression models to estimate unadjusted and adjusted (age, sex, race, diabetes, hypertension, alcohol use, smoking, and body mass index) effect sizes, taking into account the complex probability survey design.

RESULTS

Of the 12,155 participants, 6635 (54.6%) were women, mean±SD age was 49.9±19.4 years, VD was 21.9±9.2 ng/mL, and ALT was 20.9±6.9 U/L. In unadjusted analysis, VD was significantly associated with serum ALT (0.02 U/L/ng/mL of VD, P=0.007). After adjustment for confounders, VD remained statistically significantly associated with serum ALT levels (0.04 U/L, P<0.001). Similarly, individuals in the highest quartile of VD had significantly higher serum levels of ALT than those in the lowest quartile (unadjusted difference=0.98 U/L, P<0.001; adjusted difference=1.21 U/L, P<0.001).

CONCLUSIONS

We found a positive association between VD and ALT after excluding individuals with suspected active liver injury (ALT>39 U/L). The underlying mechanisms for this association are not known and needs further study.

Metabolic health is more closely associated with prevalence of cardiovascular diseases or stroke than obesity: A cross-sectional study in Korean populations

Mounting evidence suggests that not all obese subjects are at increased cardiovascular risk. However, the relationship between the metabolically healthy obese (MHO) phenotype and cardiovascular diseases (CVDs) or stroke remains unclear. Therefore, we retrospectively investigated the prevalence of CVDs or stroke according to metabolic health with obese.We studied 3695 subjects (40-85 years) from the Fifth Korean National Health and Nutrition Examination Survey. Participants were divided into 2 groups and 6 subgroups based on the body mass index (BMI) and metabolic syndrome (MetS) components: healthy (exhibiting none of the 5 MetS components) with the followings: healthy-normal weight (BMI < 23 kg/m), healthy-overweight (BMI = 23-24.9 kg/m), and healthy-obese (BMI ≥ 25 kg/m); and unhealthy (exhibiting 2 or more MetS components) with the followings: unhealthy-normal weight, unhealthy-overweight, and unhealthy-obese.In the healthy group (n = 1726), there were 76 CVDs or stroke patients (4.4%), whereas in the unhealthy group (n = 1969), there were 170 (8.6%). The prevalence was significantly different between the 2 groups (P < 0.001). However, the prevalence was not significantly different among healthy subgroups (P = 0.4072). The prevalence in unhealthy subgroups also demonstrated no statistically significant difference (P = 0.3798).We suggest that the prevalence of CVDs or stroke is different between metabolically healthy and unhealthy phenotype. Furthermore, MHO did not reveal higher CVDs or stroke prevalence rather than metabolically healthy other groups. Additional cohort studies are needed to explain causality between CVDs or stroke incidence and subjects exhibiting the MHO phenotype.

Obesity, metabolic abnormality, and health-related quality of life by gender: a cross-sectional study in Korean adults

PURPOSE

This study sought to compare the association between health-related quality of life (HRQoL) and four body health types by gender.

METHODS

The study included 6217 men and 8243 women over 30 years of age chosen from a population-based survey. Participants were grouped by body mass index and metabolic abnormality into four types: metabolically healthy normal weight, metabolically abnormal but normal weight (MANW), metabolically healthy obesity (MHO), and metabolically abnormal obesity (MAO). HRQoL was measured using the EQ-5D health questionnaire. The outcomes encompassed five dimensions (mobility, self-care, usual activity, pain/discomfort, and anxiety/depression), and the impaired HRQoL dichotomized by the EQ-5D preference score. Complex sample multivariate binary logistic regression analyses were conducted to adjust for sociodemographic variables, lifestyle factors, and disease comorbidity.

RESULTS

Among men, those in the MANW group presented worse conditions on all dimensions and the impaired HRQoL compared to other men. However, no significant effect remained after adjusting for relevant covariates. For women, those in the MAO group had the most adversely affected HRQoL followed by those females in the MHO group. The domain of mobility and impaired HRQoL variable of the MAO and MHO groups remained significant when controlling for all covariates in the model.

CONCLUSIONS

The MANW is the least favorable condition of HRQoL for men, suggesting that metabolic health may associate with HRQoL more than obesity for males. In women, the MAO and MHO groups had the most adversely affected HRQoL, implying that MHO is not a favorable health condition and that obesity, in general, may be strongly associated with HRQoL in women.

Concentrations of the vitamin D metabolite 1,25(OH)2D and odds of metabolic syndrome and its components

AIM

Few epidemiological studies have investigated the association between circulating concentrations of the active vitamin D metabolite 1,25(OH)2D and metabolic syndrome. We sought to determine whether blood levels of 1,25(OH)2D are associated with metabolic syndrome and its individual components, including waist circumference, triglycerides, blood pressure, and glucose, and high-density lipoprotein. We also investigated these associations for the more abundant precursor vitamin D metabolite, 25(OH)D.

METHODS

Participants from two completed clinical trials of colorectal neoplasia with available metabolic syndrome data and blood samples for measurement of 1,25(OH)2D (n=1048) and 25(OH)D (n=2096) were included. Cross-sectional analyses of the association between concentrations of 1,25(OH)2D, 25(OH)D, metabolic syndrome, and its components were conducted.

RESULTS

A statistically significant inverse association was observed for circulating concentrations of 1,25(OH)2D and metabolic syndrome, with adjusted ORs (95% CIs) of 0.73 (0.52-1.04) and 0.52 (0.36-0.75) for the second and third tertiles of 1,25(OH)2D, respectively (p-trend <0.001). Significant inverse relationships were also observed between 1,25(OH)2D and high triglycerides (p-trend <0.001), and low high-density lipoprotein (p-trend <0.001). For 25(OH)D concentrations, significant inverse associations were found for metabolic syndrome (p-trend <0.01), high waist circumference (p-trend <0.04) and triglyceride levels (p-trend <0.01). Participants with 25(OH)D ≥30 ng/ml and in the highest tertile of 1,25(OH)2D demonstrated significantly lower odds of metabolic syndrome, with an OR (95% CI) of 0.38 (0.19-0.75) compared to those in the lowest category for both metabolites.

CONCLUSION

These results provide new evidence that the relatively rarely-studied active hormonal form of vitamin D, 1,25(OH)2D, is associated with metabolic syndrome and its components, and confirm prior findings for 25(OH)D. The finding that 1,25(OH)2D is related to high-density lipoprotein, while 25(OH)D is not, suggests that there may be an independent mechanism of action for 1,25(OH)2D in relation to metabolic dysregulation.

Vitamin D: A new player in non-alcoholic fatty liver disease?

Vitamin D through its active form 1a-25-dihydroxyvtamin D [1,25(OH)₂D] is a secosteroid hormone that plays a key role in mineral metabolism. Recent years have witnessed a significant scientific interest on vitamin D and expanded its actions to include immune modulation, cell differentiation and proliferation and inflammation regulation. As our understanding of the many functions of vitamin D has grown, the presence of vitamin D deficiency has become one of the most prevalent micronutrient deficiencies worldwide. Concomitantly, non-alcoholic fatty liver disease (NAFLD) has become the most common form of chronic liver disease in western countries. NAFLD and vitamin D deficiency often coexist and epidemiologic evidence has shown that both of these conditions share several cardiometabolic risk factors. In this article we provide an overview of the epidemiology and pathophysiology linking NAFLD and vitamin D deficiency, as well as the available evidence on the clinical utility of vitamin D supplementation in NAFLD.

Serum 25-hydroxyvitamin D levels and metabolic health status in extremely obese individuals

OBJECTIVE

Vitamin D deficiency is prevalent in obese individuals. 25-hydroxyvitamin D [25(OH)D] levels in metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO) adult individuals were examined and the relationship between 25(OH)D levels and other clinical parameters was evaluated.

METHODS

This is a retrospective chart review of outpatient medical records from the Nutrition and Weight Management Center at Boston Medical Center. Subjects were divided into two groups, MHO and MUO, using the homeostasis model assessment of insulin resistance criteria.

RESULTS

A total of 191 obese subjects were included in this analysis. The average body mass index (BMI) was 43.0 ± 9.2 kg/m(2) . Sixty-three subjects (33%) met criteria for MHO. MHO subjects had lower BMI and waist circumferences compared to MUO subjects. 25(OH)D levels were not significantly different between the two groups (P = 0.242). Overall, there were high prevalences of vitamin D deficiency (48.7%) and vitamin D insufficiency (33.0%). 25(OH)D levels were inversely correlated with BMI, body weight, waist circumferences, and HbA1c levels but not with blood pressure, total cholesterol, HDL, triglycerides, or LDL.

CONCLUSIONS

In extremely obese individuals, 25(OH)D levels were not related to metabolic health status or insulin resistance but correlated with the degree of adiposity.

The prevalence of metabolically healthy obesity: a systematic review and critical evaluation of the definitions used

We performed a systematic review of the prevalence of metabolically healthy obesity (MHO). Medline, Web of Science and EMBASE were searched for original articles from inception to November 2013. Only prospective and cross-sectional studies were included. After screening 478 titles, we selected 55 publications, of which 27 were population-based studies and were used in the narrative synthesis. From the 27 studies, we identified 30 definitions of metabolic health, mainly based on four criteria: blood pressure, high-density lipoprotein cholesterol, triglycerides and plasma glucose. Body mass index ≥30 kg m(-2) was the main indicator used to define obesity (74% of the studies). Overall, MHO prevalence ranged between 6% and 75%. In the studies that stratified the analysis by sex, prevalence was higher in women (seven out of nine studies) and in younger ages (all four studies). One-third of the studies (n = 9) reported the response rate. Of these, four reported a response rate of ≥70% and they showed MHO prevalence estimates between 10% and 51%. The heterogeneity of MHO prevalence estimates described in this paper strengthens calls for the urgent need for a commonly established metabolic health definition.

Circulating alanine transaminase (ALT) and γ-glutamyl transferase (GGT), but not fetuin-A, are associated with metabolic risk factors, at baseline and at two-year follow-up: the prospective Cyprus Metabolism Study

OBJECTIVE

To comparatively evaluate traditional liver tests and fetuin A as predictors of cardiometabolic risk, we studied associations between serum alanine transaminase (ALT), γ-glutamyl transferase (GGT), aspartate aminotransferase (AST) and fetuin-A and anthropometric, metabolic, and cardiovascular parameters cross-sectionally at baseline, and prospectively, after 2-years of follow-up.

RESEARCH DESIGN AND METHODS

616 randomly enrolled young healthy participants in the Cyprus Metabolism Study, including all 93 subjects who participated in the follow-up study 2 years after baseline assessment, were included in this study.

RESULTS

In the cross-sectional study, serum ALT and GGT were strongly correlated with anthropometric, cardiovascular, and metabolic variables, while serum AST was only correlated with waist circumference and waist-to-hip ratio. Fetuin-A was correlated with anthropometric variables, systolic blood pressure (SBP), insulin, and homeostasis model of assessment-insulin resistance (HOMA-IR) in the unadjusted model. In the fully adjusted model, both serum ALT and GGT levels remained positively correlated with total and low-density lipoprotein (LDL) cholesterol. GGT levels also remained correlated with triglycerides. ALT levels remained strongly positively correlated with insulin (r=0.17, p<.0001) and HOMA-IR (r=0.16, p=0.0001). Serum fetuin-A levels were no longer significantly correlated with any variables. Prospectively, ALT and GGT were predictors of anthropometric variables and LDL cholesterol, while baseline levels of AST and fetuin-A were not predictors of any variables at 2-year follow-up.

CONCLUSIONS

We confirmed associations of ALT and GGT levels but failed to demonstrate an independent association between fetuin-A and cardiometabolic risk factors in young healthy men. Traditional liver tests (LFTs) are thus better than fetuin-A predictors of metabolic risk factors cross-sectionally and prospectively in young healthy adults.

Differences in vitamin D concentration between metabolically healthy and unhealthy obese adults: associations with inflammatory and cardiometabolic markers in 4391 subjects

AIM

This study aimed to compare concentrations of serum 25-hydroxy vitamin D and inflammatory markers in metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO), and to determine whether the relationship between vitamin D levels and both cardiometabolic and inflammatory markers differs between MHO and MUO.

METHODS

This cross-sectional study comprised 4391 obese subjects aged>18 years. A panel of cardiometabolic and inflammatory markers, including anthropometric variables, glycaemic indices, lipid profiles, liver enzymes, homocysteine, C-reactive protein (CRP), fibrinogen and serum 25-hydroxy vitamin D levels, was investigated. All cardiometabolic and inflammatory markers in MHO and MUO as well as in vitamin D deficiency were compared.

RESULTS

Prevalence of MHO was 41.9% in our obese subjects using International Diabetes Federation criteria. Considering insulin resistance and inflammation, the prevalence of MHO was 38.4%. Individuals with MHO had significantly higher vitamin D concentrations compared with MUO, and this difference in vitamin D status persisted after accounting for BMI and waist circumference. Subjects with MHO had significantly better metabolic status, lower liver enzymes, lower inflammatory markers and higher serum 25-hydroxy vitamin D than those with MUO. Associations between vitamin D levels and inflammatory and cardiometabolic markers differed according to MHO/MUO status. Among MUO subjects, vitamin D deficiency was associated with higher liver marker and homocysteine levels. Serum vitamin D was negatively associated with fasting plasma glucose and HbA1c in MHO only.

CONCLUSION

Serum 25-hydroxy vitamin D levels were lower in MUO vs MHO, and reduced vitamin D concentrations were more strongly associated with cardiometabolic and inflammatory markers in MUO than in MHO subjects. These findings suggest that a deficiency in vitamin D could be a key component of MUO.

Association of metabolically abnormal but normal weight (MANW) and metabolically healthy but obese (MHO) individuals with arterial stiffness and carotid atherosclerosis

OBJECTIVE

Despite recent interest in differential impact of body size phenotypes on cardiovascular outcomes and mortality, studies evaluating the association between body size phenotypes and indicators of atherosclerosis are limited. This study investigated the relationship of metabolically abnormal but normal weight (MANW) and metabolically healthy but obese (MHO) individuals with arterial stiffness and carotid atherosclerosis in Korean adults without cardiovascular disease.

METHODS

A total of 1012 participants (575 men and 437 women, mean age 50.8 years), who underwent a health examination between April 2012 and May 2013 were prospectively enrolled based on inclusion and exclusion criteria. Study subjects were classified according to body mass index (BMI) and the presence/absence of metabolic syndrome.

RESULTS

The prevalence of metabolically healthy normal weight (MHNW), MANW, MHO, and metabolically abnormal obese (MAO) were 54.84%, 6.42%, 22.83%, and 15.91%, respectively. Individuals with MANW had significantly higher brachial-ankle pulse wave velocity and maximal carotid intima-media thickness values than those with MHO, after adjusting for age and gender (P = 0.026 and P = 0.018, respectively). The odds ratio (OR) of arterial stiffness and carotid atherosclerosis in the MANW group were significantly higher than in the MHNW group in unadjusted models. Furthermore, multivariable models showed that increased OR of carotid atherosclerosis in the MANW group persisted even after adjusting for confounding factors (OR = 2.98, 95% CI = [1.54, 5.73], P = 0.011).

CONCLUSIONS

Compared to MHNW or MHO subjects, Korean men and women with the MANW phenotype exhibited increased arterial stiffness and carotid atherosclerosis.

CLINICAL TRIALS NO

NCT01594710.

Predominance of small dense LDL differentiates metabolically unhealthy from metabolically healthy overweight adults in Korea

OBJECTIVE

The purposes of this study were (1) to determine the association between lipoprotein subfraction profiles and metabolically healthy overweight (MHO) phenotype, as defined by visceral adiposity; and (2) to identify the strongest predictor of metabolic health among the lipoprotein measurements.

MATERIALS/METHODS

This cross-sectional study was comprised of 462 overweight patients, who were classified as MHO or non-MHO based on their visceral adipose tissue (VAT) area to subcutaneous adipose tissue area (SAT) ratio (VAT/SAT ratio). Serum lipoprotein subfraction analyses and other metabolic parameters were measured.

RESULTS

Among the overweight participants, two hundred fifty-five individuals (53.7%) had the MHO phenotype. After adjusting for age, sex, medication, lifestyle factors, and confounding metabolic characteristics, the non-MHO group showed significantly higher lipid levels and a greater prevalence of unfavorable lipid profiles. LDL subclass pattern type B was the most significant predictor of the non-MHO phenotype (odds ratio 2.70; 95% CI 1.55-4.69), while serum LDL cholesterol level was not a significant predictor of the non-MHO phenotype.

CONCLUSIONS

Lipoprotein subfraction particle measurements were significantly associated with the non-MHO phenotype and a higher VAT/SAT ratio, with small dense LDL predominance being the most significant predictor of MHO phenotype. These findings will help identify MHO and non-MHO phenotypes and perhaps lead to a development of cost-effective individualized treatments.