Metabolic risks in individuals with normal body mass index and normal waist circumference

Frequency and risk factors of metabolic associated fatty liver disease among medical students in Egypt

Metabolic (dysfunction) associated fatty liver disease (MAFLD) is a growing global concern. This study assessed the frequency of hepatic steatosis and MAFLD, alongside their associated risk factors, among medical students at Suez University, Egypt. A cross-sectional study was conducted from November 2022 to April 2023 among 84 medical students aged ≥ 18 years. Data on anthropometric parameters, body composition, and lifestyle were collected through self-administered questionnaires, InBody analysis, and FibroScan. MAFLD diagnosis required steatosis (≥ 238 dB/m) with obesity, metabolic dysfunction, or both. Statistical analyses included chi-square tests, ANOVA, and logistic regression. Hepatic steatosis was present in 25% of participants, while MAFLD frequency was 13.1%. Participants with MAFLD exhibited higher body weight (82.34 ± 10.78 kg vs. 65.84 ± 10.61 kg, p < 0.001), BMI (29.05 ± 3.66 vs. 22.90 ± 3.23 kg/m2, p < 0.001), waist circumference (88.73 ± 8.73 cm vs. 78.10 ± 7.96 cm, p < 0.001), BMR (1566.09 ± 27.37 vs. 1429.86 ± 93.44 kcal/day, p < 0.001), and fat mass (32.74 ± 7.25% vs. 23.91 ± 8.60%, p < 0.001). Binary regression analysis revealed increased body weight, BMI, waist circumference, and BMR as significant risk factors for MAFLD. An elevated fat mass percentage with a reduced muscle mass percentage highlighted the sarcopenic obesity role in MAFLD progression. Extreme weight reduction can exacerbate hepatic fat accumulation. Poor sleep quality, a sedentary lifestyle, and an unhealthy diet are also significant predictors. The widespread frequency of steatosis and MAFLD highlights the pressing need to tackle this silent epidemic among young Egyptian adults.

Association Between the Visceral Adiposity Index and Homeostatic Model Assessment of Insulin Resistance in Participants With Normal Waist Circumference

We assessed the correlation between the visceral adiposity index (VAI; a useful indicator of adipose distribution and function) and homeostatic model assessment of insulin resistance (HOMA-IR) in participants with normal waist circumference. A cross-sectional study was conducted, which included 1834 Chinese adults. The blood pressure, anthropometric measurements, fasting and postprandial blood glucose, fasting insulin, and lipid profiles were measured. The VAI and HOMA-IR were calculated. Participants were divided into 4 groups according to the HOMA-IR level, and the correlation between the VAI and HOMA-IR was analyzed. The VAI gradually increased across the HOMA-IR quartiles ( P < .05), and a Pearson correlation analysis showed that VAI was positively related to the HOMA-IR ( P < .001) in males and females. After adjusting for the other covariates, VAI was independently correlated with the HOMA-IR. A logistic regression analysis indicated that VAI elevation was the main risk factor for the increased HOMA-IR in both genders. Overall, the VAI was closely correlated with the HOMA-IR in a population without central obesity.

No Obesity Paradox-BMI Incapable of Adequately Capturing the Relation of Obesity with All-Cause Mortality: An Inception Diabetes Cohort Study

Background. To reconcile "the obesity paradox," we tested if (1) the contribution of anthropometric measures to mortality was nonlinear and (2) the confounding of hip circumference contributed to the obesity paradox recently observed among diabetic patients. Methods. We analyzed data of diabetic patients attending a community-based prospective, "Tehran lipid and glucose study." In the mortality analysis, anthropometric measures-body mass index (BMI), waist, and hip circumference-were assessed using Cox models incorporating cubic spline functions. Results. During 12 990 person-years follow-up, BMI levels below 27 and those above 40 kg·m(-2) were associated with increased mortality. When we added waist circumference to the BMI in the multivariate-adjusted model, the steepness of BMI-mortality association curve slope for values below 27 kg·m(-2) increased, whereas the steepness of BMI-mortality association curve slope for values above this threshold decreased. Further adjusting the model for hip circumference, the steepness of the slopes of the association curve moved towards null on both extremes and no associations between BMI and all-cause mortality remained. Conclusion. BMI harbors intermixed positive and negative confounding effects on mortality of waist and hip circumference. Failing to control for the confounding effect of hip circumference may stymie unbiased hazard estimation and render conclusions paradoxical.

"Predictability of body mass index for diabetes: affected by the presence of metabolic syndrome?"

Background

Metabolic syndrome (MetS) and body mass index (BMI, kg.m^-2) are established independent risk factors in the development of diabetes; we prospectively examined their relative contributions and joint relationship with incident diabetes in a Middle Eastern cohort.

Method

participants of the ongoing Tehran lipid and glucose study are followed on a triennial basis. Among non-diabetic participants aged≥ 20 years at baseline (8,121) those with at least one follow-up examination (5,250) were included for the current study. Multivariate logistic regression models were used to estimate sex-specific adjusted odd ratios (ORs) and 95% confidence intervals (CIs) of baseline BMI-MetS categories (normal weight without MetS as reference group) for incident diabetes among 2186 men and 3064 women, aged ≥ 20 years, free of diabetes at baseline.

Result

During follow up (median 6.5 years); there were 369 incident diabetes (147 in men). In women without MetS, the multivariate adjusted ORs (95% CIs) for overweight (BMI 25-30 kg/m2) and obese (BMI≥30) participants were 2.3 (1.2-4.3) and 2.2 (1.0-4.7), respectively. The corresponding ORs for men without MetS were 1.6 (0.9-2.9) and 3.6 (1.5-8.4) respectively. As compared to the normal-weight/without MetS, normal-weight women and men with MetS, had a multivariate-adjusted ORs for incident diabetes of 8.8 (3.7-21.2) and 3.1 (1.3-7.0), respectively. The corresponding ORs for overweight and obese women with MetS reached to 7.7 (4.0-14.9) and 12.6 (6.9-23.2) and for men reached to 3.4(2.0-5.8) and 5.7(3.9-9.9), respectively.

Conclusion

This study highlights the importance of screening for MetS in normal weight individuals. Obesity increases diabetes risk in the absence of MetS, underscores the need for more stringent criteria to define healthy metabolic state among obese individuals. Weight reduction measures, thus, should be encouraged in conjunction with achieving metabolic targets not addressed by current definition of MetS, both in every day encounter and public health setting.