Metabolically healthy overweight/obesity are associated with increased risk of cardiovascular disease in adults, even in the absence of metabolic risk factors: A systematic review and meta-analysis of prospective cohort studies

Association between metabolically healthy obesity and atrial fibrillation: A systematic review and meta-analysis of longitudinal studies

INTRODUCTION

Obesity is not a single diagnosis, and the association of 'metabolically unhealthy' obesity with cardiovascular disease is well-described. However, the relationship between metabolically healthy obesity (MHO) and atrial fibrillation (AF) is still debated.

OBJECTIVE

Our objective is to investigate the association between MHO and the risk of AF.

METHODS

A comprehensive search of databases, including PubMed, EMBASE, Web of Science, and the Cochrane Library regarding longitudinal studies of MHO and risk of AF was performed. Random effects were used to pool the effect estimates.

RESULTS

Nine cohort studies comprising 4,250,557 participants were included. The pooled results revealed that individuals with MHO were associated with a greater incidence of AF than those with a metabolically healthy normal weight (HR: 1.34, 95 % CI: 1.26 to 1.42) with moderate certainty according to the Grading of Recommendations Assessment, Development, and Evaluation assessment. Individuals with MHO were associated with a lower risk of AF compared with participants with metabolically unhealthy obesity (RR: 0.48, 95 % CI: 0.36 to 0.64). Individuals with MHO were not significantly associated with the risk of AF as compared to metabolically unhealthy normal weight (HR: 1.04, 95 % CI: 0.89 to 1.22).

CONCLUSION

MHO is associated with a greater incidence of AF, highlighting the importance of weight reduction in individuals without metabolic disorders in reducing the risk of AF.

REGISTRATION

PROSPERO - registration number CRD42023432195.

Pronounced effects of the sepsis-obesity paradox in elderly and male individuals without septic shock and the role of immune-inflammatory status: an analysis of MIMIC-IV data

BACKGROUND

Obesity has been shown to reduce short-term mortality in sepsis patients, but the main subgroups and its role in immune-related inflammatory status require further research. The aim of this study was to identify the primary beneficiaries of the sepsis-obesity paradox and to investigate the involvement of immune-inflammatory status.

METHODS

In this study, we analyzed data from 6602 sepsis patients from the MIMIC-IV database. Body mass index (BMI) was divided into quartiles, and mortality rates were assessed for each interval. Logistic trend tests and subgroup and restricted cubic spline (RCS) analyses were performed. Blood biochemical indicators were compared across different BMI ranges and between survivors and non-survivors. The receiver operating characteristic (ROC) curve for 28-day mortality was also evaluated.

RESULTS

The 28-day mortality of sepsis patients followed a U-shaped pattern with increasing BMI. Trend analysis confirmed that BMI was a significant risk factor for 28-day mortality (p < 0.05). Subgroup analysis revealed an interactive effect of BMI on 28-day mortality in elderly (≥ 65 years old), male, and non-septic shock individuals (p < 0.05). A higher BMI was associated with an increased lymphocyte proportion and decreased neutrophil proportion, neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) (p < 0.05). Compared with survivors, non-survivors had lower lymphocyte proportions and higher neutrophil proportions, NLRs, and SIIs. ROC analysis revealed that the lymphocyte and neutrophil proportions, NLR, and SII had predictive value for 28-day mortality. Subgroup and RCS analyses revealed that increased BMI was associated with reduced 28-day mortality in sepsis patients, mainly in elderly, male, and septic shock individuals, with protective BMIs ranging from 27.8 ~ 41.7 kg/cm2, 28.4 ~ 37.7 kg/cm2, and > 28.6 kg/cm2, respectively.

CONCLUSIONS

The sepsis-obesity paradox significantly affects elderly (≥ 65 years old), male, and non-septic shock individuals, displaying a U-shaped pattern for 28-day mortality. BMI may mediate this phenomenon by influencing the body's immune-inflammatory status.

The association between metabolically healthy obesity and risk of depression: a systematic review and meta-analysis

This review aimed to explore the association between metabolically healthy obesity (MHO) and the risk of depression. Databases (EMBASE, PubMed, Web of Science, Cochrane Library) were searched up to 20 June 2024. Observational studies were included if they compared groups with MHO, metabolically unhealthy nonobesity, and metabolically unhealthy obesity to groups with metabolically healthy nonobesity for the risk of depression. The random-effect model was used to calculate the pooled odds ratios (ORs). Subgroup analyses and meta-regressions were conducted according to age, study design, definition of MHO, BMI cut-off value, depression assessment method, geographic location, ethnicity, development status, and gender to explore the sources of heterogeneity. Three cohorts and 9 cross-sectional studies (N = 1,277,267 participants) were included in this review. Individuals with MHO (OR 1.08 [95% CI 1.04, 1.12], I² = 88.3%), metabolically unhealthy nonobesity (OR 1.15 [95% CI 1.04, 1.28], I² = 99.6%), and metabolically unhealthy obesity (OR 1.30 [95% CI 1.12, 1.51], I² = 99.8%) had an increased risk of depression than individuals with metabolically healthy nonobesity. The association between MHO and risk of depression was stronger in women (OR = 1.14; 95% CI: 1.08-1.20) and populations from North America (OR = 1.26; 95% CI: 1.01-1.58) and Europe (OR = 1.23; 95% CI: 1.07-1.41). Inconsistencies in MHO definitions and BMI cutoff values across studies were important sources of heterogeneity (subgroup analysis: PQ = 29.87, p = 0.001; meta-regression: p = 0.015, R² = 100%). MHO was associated with an increased risk of depression, particularly among women and populations from North America and Europe. These high-risk groups need personalized interventions. Standardizing definition for MHO could enhance comparability across studies. Future prospective cohort studies are needed to validate our findings by including populations from developing nations and employing rigorous definitions.

Individual and joint associations of obesity and metabolic health parameters on arterial stiffness: Evidence from the UK Biobank

AIMS

There is conflicting evidence regarding whether excess adiposity without metabolic abnormalities reflects a truly benign phenotype. This study evaluated the independent and joint associations of the presence of excess adiposity and metabolic abnormalities on arterial stiffness.

MATERIALS AND METHODS

Participants in UK Biobank with body mass index (BMI) and arterial stiffness index (ASI) recorded between 2006 and 2010, free from cardiovascular diseases and not underweight (BMI <18.5 kg/m2) were included. The primary outcome was severity of ASI analysed using multivariate-adjusted linear regression.

RESULTS

Of 162 590 participants, 42.5% were overweight and 24.4% were obese. Within the normal BMI strata, 50.7% had ≥1 metabolic abnormality. Compared to individuals with normal BMI and no metabolic abnormality (reference group), increased BMI or metabolic abnormalities were similarly associated with higher ASI: normal BMI with metabolic abnormalities (adjusted β-coefficient and 95% CI, 0.35; 0.30-0.40); overweight without metabolic abnormalities (0.32; 0.26-0.37). Individuals with obesity and no metabolic abnormality had higher ASI (0.65; 0.57-0.74) but was lower than individuals with overweight and metabolic abnormalities (0.80; 0.75-0.84). Individuals with obesity and metabolic abnormalities had the highest ASI (1.07; 1.02-1.12) among all six metabolic combinations, p < 0.001 for each versus reference group. Sensitivity analysis suggested higher ASI with increasing number of metabolic abnormalities within BMI categories and higher ASI in the presence of abdominal obesity within metabolic categories.

CONCLUSIONS

Excess adiposity and metabolic abnormalities are independently associated with increased arterial stiffness to a similar degree, suggesting that metabolically healthy individuals with overweight and obesity are not benign groups. This reinforces the need to prevent excess adiposity and consider primary prevention strategies even before metabolic abnormalities emerge.

Association of novel metabolic status with asymptomatic intracranial arterial stenosis: A cross-sectional study

OBJECTIVES

To investigate the association of metabolic status newly defined or obesity with asymptomatic intracranial arterial stenosis (aICAS) among populations in rural China.

METHODS

The cross-sectional study is based on the Rose asymptomatic IntraCranial Artery Stenosis (RICAS) cohort, which enrolled 2005 participants aged 40 years or older without a history of clinical stroke or transient ischemic attack. Metabolically healthy status (MH) was defined by a newly proposed criterion: (1) systolic blood pressure (SBP) < 130 mmHg and without antihypertensive medication; (2) a waist-to-hip ratio (WHR) below 1.03 for men and below 0.95 for women; (3) no diabetes. All participants were categorized based on their metabolic status and obesity. Multivariate logistic regression models were used to investigate the association between metabolic status or obesity and aICAS.

RESULTS

Among 2005 participants, 1597 (79.65%) were defined as metabolically unhealthy status (MU) according to the new criterion. MU was significantly associated with aICAS (OR 2.02, 95% CI 1.11-3.68, P = 0.021), especially moderate-to-severe aICAS (OR 2.43, 95% CI 1.04-5.72, P = 0.042). The prevalence of aICAS increased with the numbers of metabolic disorders (P for linear trend <0.001). Both metabolically unhealthy normal-weight (MUN) (OR 2.11, 95% CI 1.10-4.03, P = 0.025) and metabolically unhealthy obesity (MUO) (OR 3.30, 95% CI 1.64-6.64, P = 0.001) were significantly correlated with aICAS, but not metabolically healthy obesity (MHO). Subgroup analysis further confirmed the association between MU and aICAS risk only in men (P for interaction = 0.042).

CONCLUSIONS

MU defined by the new criterion was significantly associated with aICAS, especially with moderate-to-severe aICAS. This novel criterion effectively identifies individuals with a high prevalence of aICAS among populations with obesity, which could be crucial for stroke prevention.

A Bayesian network analysis of the probabilistic relationships between metabolically healthy obesity and cardiovascular disease risk under new diagnostic criteria

BACKGROUND

The relationship between metabolically healthy obesity (MHO) and cardiovascular disease (CVD) risk remains debated. The critical point may be the lack of consensus on MHO's definition and diagnostic criteria.

OBJECTIVE

This study aimed to investigate the association of MHO status with arteriosclerosis-CVD (ASCVD) risk in Chinese under new diagnostic criteria.

METHODS

Participants aged 35-79 in the 2009 China Health and Nutrition Survey cohort were included. The 10-year ASCVD risk was predicted by the prediction for ASCVD risk in China, and participants with a predicted risk of ⩾ 10% were classified into the high-risk group. The Bayesian network (BN) models were constructed to characterize the multivariable probabilistic connections between metabolically obesity phenotypes and ASCVD risk.

RESULTS

The 10-year ASCVD risk score and the proportion of individuals at ASCVD high risk were significantly different between metabolically obesity phenotypes (P< 0.001). BN reasoning results showed that MHO individuals were not significantly associated with a 10-year ASCVD risk. Among metabolically unhealthy individuals, the conditional probability of high ASCVD risk increased with the Body Mass Index (BMI), with the conditional probability of high ASCVD risk was 24.63% (95% CI: 22.81-26.55%), 32.97% (95% CI: 30.75-35.27%) and 40.2% (95% CI: 36.64-43.86%) for metabolically unhealthy normal weight (MUNW), metabolically healthy overweight weight (MHOW), and metabolically unhealthy obesity (MUO) group, respectively. Subgroup analysis showed that MHO individuals were at increased risk of CVD compared with metabolically healthy normal weight (MHNW) individuals only in females.

CONCLUSION

These results showed that there was no significant increase in ASCVD risk of MHO phenotype based on the new diagnostic criteria, suggesting that MHO is in a relatively healthy state.

The vices and virtues of medical models of obesity

Despite numerous public health organizations supporting the pathologization of obesity and considering recent obesity rates a health crisis, many researchers in the humanities, social sciences, and even in the health sciences remain unconvinced. In this paper, we address a set of arguments coming from these academic fields that criticize medical models of obesity for their supposedly flawed diagnostic categories that shift focus onto individuals and support moralizing judgements. Clarifying some key claims in these models and explicating the view of obesity in terms of energy dysregulation, we aim to tease apart misunderstandings and argue that not only do these models not say what they are often accused of saying, but their apparent vices may actually be virtues in helping to combat stigma. Building on the social psychology of stigma and disease labeling, we then suggest that current medical models are largely supportive of many moral and political aims promoted by critics of these models.

Effects of Increasing Farmed Salmon Intake to the Recommended Fish-Intake Amounts on Lipid Profile in Young Women: An 8-Week Intervention Study

BACKGROUND/OBJECTIVES

Habitual dietary changes that could help reduce the potential consequences of excessive body mass, such as hyperlipidemia and increased cardiovascular disease risk, are needed. The aim of this study is to assess the impact of a farmed-salmon-based dietary intervention on lipid profile parameters in young women with excessive body mass.

METHODS

The 8-week intervention involved 38 pair-matched women aged 18-30 years with excessive body weight defined as BMI ≥ 25.0 kg/m2. Participants were randomly assigned to the intervention (200 g of smoked salmon weekly) or the control group. Lipid profile parameters (total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TAG)), as well as atherogenic indices (Atherogenic Index of Plasma (AIP), Atherogenic Coefficient (AC), Cholesterol Index (Cholindex), Castelli Risk Index 1 (CRI-1), Castelli Risk Index 2 (CRI-2) and the TAG/HDL ratio) were assessed before, during, and after the intervention.

RESULTS

At baseline, 47% of participants had at least one of the lipid profile parameters outside the recommended range. No statistically significant differences were observed in the TC, HDL, non-HDL, LDL, or TAG concentrations or in the various atherogenic indices between the intervention and the control group after the 8-week-long intervention. However, differences in the change of the LDL concentration were noted, with a decrease of 8.2 ± 20.7 mg/dL in the intervention group compared to an increase of 9.5 ± 20.0 mg/dL in the control group (p = 0.011), as well as in the change of the Cholindex for which a median decrease of 4.4 mg/dL was noted in the intervention group, while a median increase of 0.8 mg/dL in the control group was observed (p = 0.040). Additionally, across participants with a waist-to-height ratio (WHtR) greater than 0.5, an increase of 50.0 ± 68.3 mg/dL in the intervention group and a decrease of 8.6 ± 56.6 mg/dL in the control group was noted for the TAG concentration change (p = 0.040).

CONCLUSIONS

Concerning the observed beneficial influence of increasing farmed salmon intake to the recommended fish-intake amounts on decreasing LDL and Cholindex in young women with excessive body weight after 8 weeks, it seems that such a diet alteration might be recommended for this group to decrease their risk of cardiovascular disease in the future. Nonetheless, regarding the diverse influence on TAG, further studies are needed to assess the influence of increasing the intake of fatty fish available on the market at present on human health.

Metabolically healthy obesity: from epidemiology and mechanisms to clinical implications

The concept of metabolic health, particularly in obesity, has attracted a lot of attention in the scientific community, and is being increasingly used to determine the risk of cardiovascular diseases and diabetes mellitus-related complications. This Review assesses the current understanding of metabolically healthy obesity (MHO). First, we present the historical evolution of the concept. Second, we discuss the evidence for and against its existence, the usage of different definitions of MHO over the years and the efforts made to provide novel definitions of MHO. Third, we highlight epidemiological data with regard to cardiovascular risk in MHO, which is estimated to be moderately elevated using widely used definitions of MHO when compared with individuals with metabolically healthy normal weight, but potentially not elevated using a novel definition of MHO. Fourth, we discuss novel findings about the physiological mechanisms involved in MHO and how such knowledge helps to identify and characterize both people with MHO and those with metabolically unhealthy normal weight. Finally, we address how the concept of MHO can be used for risk stratification and treatment in clinical practice.

Synergistic effects of glucose tolerance and BMI on cardiovascular events and all-cause mortality in a healthy population: CA.ME.LI.A study 7 years follow-up

The CA.ME.LI.A (CArdiovascular risks, MEtabolic syndrome, LIver and Autoimmune disease) epidemiological study was conducted in Abbiategrasso (Milan, Italy) to identify risk factors for metabolic and cardiovascular disease in an apparently healthy population of northern Italy. The population (n = 2,545, 1,251 men, 1,254 women) was stratified according to body mass index [normal body weight (NBW): <25 kg/m2; overweight-obese (OWO): ≥25 kg/m2] and according to fasting blood glucose [normal fasting glucose: <100 mg/dL; impaired fasting glucose (IFG): 100-125 mg/dL; diabetes mellitus (DM): ≥126 mg/dL]. The incidence of cardiovascular (CV) events and overall mortality were studied by the Kaplan-Meier method using the log rank test. Univariate analysis was conducted with time-dependent Cox models. During the 7-yr follow-up period, 80 deaths and 149 CV events occurred. IFG [hazard ratio (HR): 2.81; confidence interval (CI): 1.37-5.77; P = 0.005], DM (HR: 4.88; CI: 1.47-16; P = 0.010), or OWO (HR: 2.78; CI:1.68-4.59; P < 0.001) all produced significant increases in CV events and deaths. In the combination IFG/OWO (HR: 5.51; CI: 3.34-9.08; P < 0.001), there was an apparent additive effect of the two conditions, whereas in the combination DM/OWO (HR: 12.71; CI: 7.48-22; P < 0.001), there was an apparent multiplicative effect on the risk for CV events and deaths. In males, the DM/NBW group had a higher incidence of cardiovascular events and deaths than the IFG/OWO group. In contrast, in females, the IFG/OWO group had a higher incidence of cardiovascular events and deaths than the DM/NBW group. In women, there was a greater incidence of CV events in the IFG/OWO group (HR: 6.23; CI: 2.88-13; P < 0.001) than in men in the same group (HR: 4.27; CI: 2.15-8.47; P < 0.001). Consistent with these data, also all-cause mortality was progressively increased by IFG/DM and OWO, with an apparently exponential effect in the combination DM/OWO (HR: 11.78; CI: 6.11-23; P < 0.001). IFG/DM and OWO, alone or in combination, had major effects in increasing mortality for all causes and CV events. The relative contributions of hyperglycemia and overweight/obesity on cardiovascular events and deaths were apparently, to a certain extent, sex dependent. Females were more affected by overweight/obesity either alone or combined with IFG, as compared with males.NEW & NOTEWORTHY For the first time, the combined effects of glucose tolerance and BMI have been investigated in an apparently healthy large population sample of a city in the north of Italy. We found that there are synergistic effects of glucose levels with BMI to increase not only cardiovascular events and deaths but also cancer-related deaths and all-cause mortality.

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.

A twin-driven analysis on early aging biomarkers and associations with sitting-time and physical activity

BACKGROUND

Current physical activity guidelines may be insufficient to address health consequences in a world increasing in sedentary behavior. Physical activity is a key lifestyle factor to promote healthy aging, but few studies examine activity in conjunction with sitting. We examine how activity intensity and sitting behavior influence health and the extent to which physical activity might counter sitting.

METHODS

We analyzed data from the Colorado Adoption/Twin Study of Lifespan behavioral development and cognitive aging (CATSLife) in adults aged 28-49 years (M = 33.16, SD = 4.93). We fit a linear mixed-effect model for body mass index (BMI) and total cholesterol/high-density lipoprotein ratio (TC/HDL). Leveraging the co-twin control approach, we explore the trade-off between sitting and physical activity.

RESULTS

Across established adulthood, TC/HDL and BMI demonstrated increasing age trends with prolonged sitting and vigorous activity inversely associated. Moreover, after considering sitting time, we found an age-equivalent benefit of vigorous exercise where those performing 30 minutes daily had expected TC/HDL and BMI estimates that mirrored sedentary individuals 5 and 10 years younger, respectively. Co-twin control analysis suggests partial exposure effects for TC/HDL, indicating greater vigorous activity may counter sitting-health effects but with diminishing returns.

CONCLUSIONS

Our findings support the counteracting influence of prolonged sitting and physical activity on indicators of cardiovascular and metabolic health. A compensating role of vigorous activity on sitting health links is indicated while reducing sitting time appears paramount. Public health initiatives should consider sitting and vigorous activity in tandem in guidelines to promote health maintenance and combat accelerated aging.

Complete genome sequence and anti-obesity potential of Lactiplantibacillus plantarum HOM2217 in 3T3-L1 cells and high-fat diet-fed rats

The global prevalence of obesity is rising year by year, which has become a public health problem worldwide. Many animal and clinical studies have shown that Lactiplantibacillus plantarum is considered an ideal probiotic and potential supplement for the treatment of obesity. In this study, we aimed to complete the genome sequence of L. plantarum HOM2217, which was isolated from human milk, and study its physiological characteristics and anti-obesity effects in 3T3-L1 cells and rats fed a high-fat diet (HFD) to determine its potential as a starter for functional food products. Whole-genome analysis demonstrated that HOM2217 contained a single circular chromosome of 3,267,529 bp with a GC content of 44.5% and one plasmid (62,350 bp) with a GC content of 38.5%. Compared to the reference strains, HOM2217 demonstrated superior tolerance to gastrointestinal conditions, higher adhesion to intestinal epithelial cell lines, potent antimicrobial activity against Enterobacter cloacae ATCC 13047, and effective cholesterol removal ability in vitro. Treatment with heat-killed HOM2217 significantly reduced lipid accumulation and intracellular triglyceride production in 3T3-L1 adipocytes. Daily treatment of HFD-fed rats with HOM2217 for 7 weeks decreased body weight, body weight gain, and body fat without changes in food intake. HOM2217 also significantly increased the serum high-density lipoprotein cholesterol (HDL-C) level, decreased the serum tumor necrosis factor (TNF-α) and increased short-chain fatty acid (SCFA) (formic acid, acetic acid, and butyric acid) levels in the cecum. Thus, HOM2217 could potentially prevent obesity in rats by inhibiting inflammatory responses and regulating lipid metabolism and SCFAs expression. Therefore, HOM2217 has potential as an alternative treatment for obesity.

The combined effect of handgrip strength and obesity phenotype on the risk of stroke in Chinese middle-aged and elderly: A cohort study

OBJECTIVE

The aim of this study was to investigate the combined effect of handgrip strength (HGS) and obesity phenotype on the risk of stroke in Chinese middle-aged and elderly people.

METHODS

The data was used from the China Health and Retirement Longitudinal Study (CHARLS). Middle-aged and older adults who participated in surveys between 2011 and 2018 were included in the study. They were divided into 4 different types of obesity phenotypes based on obesity and metabolic status: metabolically healthy non-overweight/obesity (MHNO), metabolically healthy overweight/obesity (MHO), metabolically abnormal non-overweight/obesity (MANO), and metabolically abnormal overweight/obesity (MAO). The HGS level was divided into low and high groups according to the median values. Cox proportional risk regression model was used to analyze the joint effect of HGS and obesity phenotype on the risk of stroke among participants.

RESULTS

A total of 7904 participants aged 58.89±9.08 years were included in this study. After adjusting for potential confounders, high HGS&MHO (HR=1.86, 95 % CI=1.12-3.09), high HGS&MANO (HR=2.01, 95 %CI=1.42-2.86), high HGS&MAO (HR=2.01, 95 % CI=1.37-2.93), low HGS&MHNO (HR=1.57, 95 % CI=1.00-2.46), low HGS&MHO (HR=2.09, 95 % CI=1.29-3.38), low HGS&MANO (HR=2.02, 95 % CI=1.35-3.03), and low HGS&MAO (HR=2.48, 95 % CI=1.72-3.58) group had significantly higher risks of stroke than the high HGS&MHNO group.

CONCLUSION

The coexistence of metabolically unhealthy and low HGS can synergistically increase the risk of stroke in Chinese middle-aged and elderly people.

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.

Prevalence and factors associated with unhealthy metabolic status according to body mass index: analysis of a national nutritional survey

INTRODUCTION

Although obesity substantially influences public health owing to related comorbidities, it has been discovered that the incidence of such issues is not directly related to obesity but to the patient's unhealthy metabolic status (MUS) independent of the body mass index (BMI).

OBJECTIVES

To describe the prevalence of UMS overall and according to BMI and determine the factors associated with it.

METHODS

A cross-sectional analytical study was used based on the analysis of secondary databases called the Life Stage Nutritional Surveillance Survey (VIANEV). Participants were selected in two stages, finally obtaining 885 participants. UMS was defined based on the criteria of the Adult Treatment Panel III used to define metabolic status in a set of 5 parameters, if the subject presented two or more alterations it was considered UMS. Six groups were formed according to BMI: metabolically healthy, average weight (MHNW) and unhealthy (MUNW), metabolically healthy, overweight (MHOW) and unhealthy (MUOW), metabolically healthy, obese (MHO) and unhealthy (MUO).).

RESULTS

The total prevalence of UMS was 73.11%, with MUNW, MUOW, and MUO being 47.90%, 80.34%, and 96.44%, respectively. Only 5.31% did not present any metabolic alteration. The multivariable analysis found variations globally according to sex, age, marital status, geographical region, smoking habit, and altitude.

CONCLUSIONS

A high prevalence of UMS was observed in Peru, indicating that BMI alone is not a sufficient indicator of metabolic status. These findings suggest that strategies should be prioritized to address the growing problem of UMS, considering the particularities of each subpopulation and using a multifaceted approach that addresses modifiable and non-modifiable risk factors.

Association between metabolically healthy obesity and carotid intima-media thickness in Korean adolescents with overweight and obesity

PURPOSE

Data regarding the association between metabolically healthy obesity (MHO) and preclinical atherosclerosis in childhood are lacking. Carotid intima-media thickness (cIMT) is a noninvasive method used to assess cardiovascular risk. This study examined the relationships among cIMT, metabolic phenotypes, and cardiometabolic risk factors (CMRFs) in overweight and obese adolescents.

METHODS

Anthropometric, biochemical, and cIMT data were collected. The study participants were categorized as MHO or metabolically unhealthy obesity (MUO) based on insulin resistance. CMRFs were assessed using blood pressure (BP); levels of triglycerides, high-density lipoprotein cholesterol (HDL-C), and fasting plasma glucose; or a diagnosis of diabetes mellitus. Differences in cIMT values were evaluated according to the metabolic phenotype and factors associated with cIMT.

RESULTS

Among the 111 participants (80 boys, 72.1%), 23 (20.7%) were classified as MHO and 88 (79.3%) as MUO. The MHO group exhibited lower glycated hemoglobin and triglyceride levels and higher HDL-C levels compared to those exhibited by the MUO group (all P<0.01). The cIMT values did not differ significantly between the MHO and MUO groups. The high cIMT tertile group revealed higher systolic BP compared to that exhibited by the low cIMT tertile group (123.7±2.1 mmHg vs. 116.9±1.6 mmHg, P=0.028). Mean cIMT was positively correlated with age (β=0.009) and body mass index (BMI) (β=0.033) after adjusting for covariates (both P<0.05).

CONCLUSION

In overweight and obese Korean adolescents, cIMT was associated with age and BMI but not with metabolic phenotype or CMRFs. Further research is warranted to determine the relationship between cIMT during adolescence and cardiovascular outcomes during adulthood.

Association of Anthropometric Indices With Midlife Cardiovascular Risk in Young Individuals Without Obesity and Traditional Risk Factors

BACKGROUND

The aim of this study was to assess how early-adulthood body mass index (BMI) and waist circumference (WC) relate to long-term cardiovascular structure, function, and prognosis in individuals without obesity and with low cardiovascular risk factor (CVRF) burden.

METHODS AND RESULTS

A total of 2024 participants aged 18 to 30 from the CARDIA (Coronary Artery Risk Development in Young Adults) study, without obesity and with low CVRFs defined as the absence of cardiovascular disease (CVD), diabetes, hypertension, current smoking, and dyslipidemia were included. A CVRF-optimal subgroup was also defined, with blood pressure<120/80 mm Hg, fasting glucose <100 mg/dL, total cholesterol <200, low-density lipoprotein cholesterol <130, and women with high-density lipoprotein cholesterol ≥50 mg/dL. Coronary artery calcification, carotid intima-media thickness, left ventricular mass, left ventricular ejection fraction, longitudinal peak systolic strain, and diastolic function were assessed in midlife. Cox regression was used to calculate hazard ratios of BMI and WC for all-cause death and CVD events. Logistic regression was used to estimate odds ratios for subclinical CVD. Over 33.9 years (median follow-up), 5.2% (n=105) died, and 2.6% (n=52) had CVD events. Each 1-SD BMI increase was associated with 27% (95% CI, 1.10-1.47), 24% (1.08-1.43), 42% (1.20-1.68), 28% (1.05-1.57), 51% (1.20-1.90), and 49% (1.10-2.02) higher odds of coronary artery calcification presence, increased carotid intima-media thickness, left ventricular hypertrophy, reduced left ventricular ejection fraction, low longitudinal peak systolic strain, and diastolic dysfunction, respectively, in the CVRF-low group. Generally, similar associations were found for WC and in the CVRF-optimal subgroup. No significant associations between BMI and WC with CVD and death were found.

CONCLUSIONS

Elevations in BMI and WC among young low-risk individuals, even within the nonobesity range, are associated with midlife cardiovascular health.

MASLD and MASH at the crossroads of hepatology trials and cardiorenal metabolic trials

Steatotic liver disease (SLD) is a worldwide public health problem, causing considerable morbidity and mortality. Patients with SLD are at increased risk for major adverse cardiovascular (CV) events, type 2 diabetes mellitus and chronic kidney disease. Conversely, patients with cardiometabolic conditions have a high prevalence of SLD. In addition to epidemiological evidence linking many of these conditions, there is evidence of shared pathophysiological processes. In December 2022, a unique multi-stakeholder, multi-specialty meeting, called MOSAIC (Metabolic multi Organ Science Accelerating Innovation in Clinical Trials) was convened to foster collaboration across metabolic, hepatology, nephrology and CV disorders. One of the goals of the meeting was to consider approaches to drug development that would speed regulatory approval of treatments for multiple disorders by combining liver and cardiorenal endpoints within a single study. Non-invasive tests, including biomarkers and imaging, are needed in hepatic and cardiorenal trials. They can be used as trial endpoints, to enrich trial populations, to diagnose and risk stratify patients and to assess treatment efficacy and safety. Although they are used in proof of concept and phase 2 trials, they are often not acceptable for regulatory approval of therapies. The challenge is defining the optimal combination of biomarkers, imaging and morbidity/mortality outcomes and ensuring that they are included in future trials while minimizing the burden on patients, trialists and trial sponsors. This paper provides an overview of some of the wide array of CV, liver and kidney measurements that were discussed at the MOSAIC meeting.

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.

The transition of metabolic phenotypes and cardiovascular events: Panasonic cohort study 16

OBJECTIVE

The study objective was to investigate whether changes in metabolic phenotype affect the risk of cardiovascular events.

METHODS

All 117,589 participants were included in this retrospective cohort study. The metabolic phenotypes of the participants were assessed at two points (the second evaluation was set 2 years after the first evaluation), and the incidence rate of cardiovascular events was observed for 11 years. The main outcome was 3-point major adverse cardiac events (MACE), which comprises cardiovascular death, nonfatal coronary artery disease, and nonfatal stroke incidence.

RESULTS

Of the participants, 2748 (2.3%) cases of 3-point MACE were identified during follow-up. The stable metabolically healthy obesity group had a higher risk of 3-point MACE than those with stable metabolically healthy nonobesity (MHNO). Additionally, the change from metabolically healthy obesity to MHNO for 2 years decreased the risk of 3-point MACE (hazard ratio [HR], 1.12: 95% CI: 0.84-1.47) to the same level as stable MHNO. However, the change from metabolically abnormal nonobesity and metabolically abnormal obesity to MHNO for 2 years maintained a higher risk of 3-point MACE (HR, 1.66 [95% CI: 1.36-2.01]; HR, 1.91 [95% CI: 1.22-2.81]) than those with stable MHNO.

CONCLUSIONS

Change in metabolic phenotype is associated with incident 3-point MACE.

Impaired Remodeling of White Adipose Tissue in Obesity and Aging: From Defective Adipogenesis to Adipose Organ Dysfunction

The adipose organ adapts and responds to internal and environmental stimuli by remodeling both its cellular and extracellular components. Under conditions of energy surplus, the subcutaneous white adipose tissue (WAT) is capable of expanding through the enlargement of existing adipocytes (hypertrophy), followed by de novo adipogenesis (hyperplasia), which is impaired in hypertrophic obesity. However, an impaired hyperplastic response may result from various defects in adipogenesis, leading to different WAT features and metabolic consequences, as discussed here by reviewing the results of the studies in animal models with either overexpression or knockdown of the main molecular regulators of the two steps of the adipogenesis process. Moreover, impaired WAT remodeling with aging has been associated with various age-related conditions and reduced lifespan expectancy. Here, we delve into the latest advancements in comprehending the molecular and cellular processes underlying age-related changes in WAT function, their involvement in common aging pathologies, and their potential as therapeutic targets to influence both the health of elderly people and longevity. Overall, this review aims to encourage research on the mechanisms of WAT maladaptation common to conditions of both excessive and insufficient fat tissue. The goal is to devise adipocyte-targeted therapies that are effective against both obesity- and age-related disorders.

Impact of obesity on airway remodeling in asthma: pathophysiological insights and clinical implications

The prevalence of obesity among asthma patients has surged in recent years, posing a significant risk factor for uncontrolled asthma. Beyond its impact on asthma severity and patients' quality of life, obesity is associated with reduced lung function, increased asthma exacerbations, hospitalizations, heightened airway hyperresponsiveness, and elevated asthma-related mortality. Obesity may lead to metabolic dysfunction and immune dysregulation, fostering chronic inflammation characterized by increased pro-inflammatory mediators and adipocytokines, elevated reactive oxygen species, and reduced antioxidant activity. This chronic inflammation holds the potential to induce airway remodeling in individuals with asthma and obesity. Airway remodeling encompasses structural and pathological changes, involving alterations in the airway's epithelial and subepithelial layers, hyperplasia and hypertrophy of airway smooth muscle, and changes in airway vascularity. In individuals with asthma and obesity, airway remodeling may underlie heightened airway hyperresponsiveness and increased asthma severity, ultimately contributing to the development of persistent airflow limitation, declining lung function, and a potential increase in asthma-related mortality. Despite efforts to address the impact of obesity on asthma outcomes, the intricate mechanisms linking obesity to asthma pathophysiology, particularly concerning airway remodeling, remain incompletely understood. This comprehensive review discusses current research investigating the influence of obesity on airway remodeling, to enhance our understanding of obesity's role in the context of asthma airway remodeling.

Metabolically healthy obesity and health risks - a review of meta-analyses

OBJECTIVE

This article briefly summarizes the results of existing research on metabolically healthy obesity in the context of health risks.

METHODS

The PubMed database was searched for relevant meta-analyses addressing metabolically healthy obesity in the context of health risks.

RESULTS

We included a total of 17 relevant meta-analyses in this review. The results of the studied meta-analyses showed that metabolically healthy obesity may be only a transient condition associated with an increased risk of developing metabolic abnormalities in the future. People with obesity without metabolic abnormalities have an increased risk of type 2 diabetes, cardiovascular disease, cancer, chronic kidney disease, and depressive syndrome. In addition, all people with obesity are at risk of pathogenesis resulting from the mechanical stress caused by presence of abnormal adipose tissue, such as sleep apnoea syndrome or skin problems.

CONCLUSION

Based on the results of meta-analyses, we recommend motivating all obese patients to change their lifestyle regardless of the presence of metabolic defects.

Effect of a Very Low-Calorie Diet on Oxidative Stress, Inflammatory and Metabolomic Profile in Metabolically Healthy and Unhealthy Obese Subjects

The purpose of the study was to determine the impact of weight loss through calorie restriction on metabolic profile, and inflammatory and oxidative stress parameters in metabolically healthy (MHO) and unhealthy (MUHO) obese individuals. A total of 74 subjects (34 MHO and 40 MUHO) received two cycles of a very low-calorie diet, alternating with a hypocaloric diet for 24 weeks. Biochemical, oxidative stress, and inflammatory markers, as well as serum metabolomic analysis by nuclear magnetic resonance, were performed at baseline and at the end of the intervention. After the diet, there was an improvement in insulin resistance, as well as a significant decrease in inflammatory parameters, enhancing oxidative damage, mitochondrial membrane potential, glutathione, and antioxidant capacity. This improvement was more significant in the MUHO group. The metabolomic analysis showed a healthier profile in lipoprotein profile. Lipid carbonyls also decrease at the same time as unsaturated fatty acids increase. We also display a small decrease in succinate, glycA, alanine, and BCAAs (valine and isoleucine), and a slight increase in taurine. These findings show that moderate weight reduction leads to an improvement in lipid profile and subfractions and a reduction in oxidative stress and inflammatory markers; these changes are more pronounced in the MUHO population.

Metabolically healthy obese individuals are still at high risk for diabetes: Application of the marginal structural model

AIM

To assess the effect of obesity phenotype on the incidence of diabetes, considering phenotype as a time-varying exposure.

METHODS

We used community-based cohort data from the Korean Genome and Epidemiology Study, with a 16-year follow-up period. Obesity phenotype was determined using body mass index and metabolic syndrome criteria. The influence of obesity phenotype on the occurrence of diabetes was evaluated using a Cox proportional hazard model and a marginal structural model (MSM).

RESULTS

Obesity phenotypes were defined in 6265 individuals, with diabetes identified in 903 (14.4%) during the follow-up period. Individuals with metabolically healthy obesity (MHO) exhibited a higher risk of diabetes compared to those with metabolically healthy normal weight (MHNW), with a hazard ratio (HR) of 1.48 (95% confidence interval [CI] 1.15-1.90). This association remained significant after applying the MSM (HR 1.49, 95% CI 1.01-2.20). Moreover, various sensitivity analyses consistently demonstrated a higher risk of diabetes in individuals with MHO compared to those with MHNW.

CONCLUSIONS

Even when obesity phenotype was treated as a time-varying exposure, individuals with MHO were still at higher risk for developing diabetes than those with MHNW. Consequently, such individuals should aim to avoid transitioning to a metabolically unfavourable state and strive to reduce their body weight to a normal range.

Risk of incident chronic kidney disease in metabolically healthy obesity and metabolically unhealthy normal weight: A systematic review and meta-analysis

Studies have reported inconsistent results about the risk of incident chronic kidney disease (CKD) in people with metabolically healthy obesity (MHO). We designed this systematic review and meta-analysis to evaluate the risk of developing CKD in people with MHO and metabolically unhealthy normal weight (MUNW). We used a predefined search strategy to retrieve eligible studies from multiple databases up to June 20, 2022. Random-effects model meta-analyses were implied to estimate the overall hazard ratio (HR) of incident CKD in obesity phenotypes. Eight prospective cohort studies, including approximately 5 million participants with a median follow-up ranging between 3 and 14 years, were included in this meta-analysis. Compared to the metabolically healthy normal weight (MHNW), the mean differences in cardiometabolic and renal risk factors in MHO, MUNW, and metabolically unhealthy obesity (MUO) were evaluated with overall HR of 1.42, 1.49, and 1.84, respectively. Compared to MHNW, the mean estimated glomerular filtration rate (eGFR) and high-density lipoprotein (HDL) were significantly lower, and low-density lipoprotein (LDL), blood pressure, blood glucose, and triglycerides were higher in MHO and MUNW. In conclusion, MHO and MUNW are not benign conditions and pose a higher risk for incident CKD. Obesity, whether in the presence or absence of metabolic health, is a risk factor for CKD.

Association of obesity with cardiovascular disease in the absence of traditional risk factors

BACKGROUND

The association between obesity and cardiovascular disease (CVD) in people without traditional CVD risk factors is unclear. This study aimed to investigate the association of obesity with CVD and its subtypes in people without traditional CVD risk factors.

METHODS

Based on the Kailuan cohort study, the included participants were divided into different groups according to levels of body mass index (BMI) and waist height ratio (WHtR), respectively. Multivariate Cox proportional hazard models were used to evaluate the associations.

RESULTS

This study included 31,955 participants [men 63.99%; mean age (48.14 ± 3.33) years]. During a median follow-up period of 12.97 (interquartile range: 12.68-13.17) years, 1298 cases of CVD were observed. Compared with the normal BMI group, the hazard ratios (HRs) for CVD, stroke, and myocardial infarction (MI) in the BMI obese group were 1.31 (95% confidence interval [CI] 1.11-1.55), 1.21 (95%CI 1.01-1.46), 1.62 (95%CI 1.13-2.33), respectively. Compared with the WHtR non-obese group, the HRs for CVD, stroke, and MI in the obese group were 1.25(95%CI 1.11-1.41), 1.18 (95%CI 1.03-1.34), 1.57 (95%CI 1.18-2.09), respectively. There was an interaction between age and WHtR (P for interaction was 0.043). The association between WHtR and CVD was stronger in people under 60 years old, with a HR of 1.44 (95%CI 1.24-1.67).

CONCLUSION

We found that obesity increased the risk of CVD in people without traditional CVD risk factors. The association of WHtR with CVD was stronger in people under 60 years old.

Inflammatory profile of patients with different weight diagnoses and similar periodontal condition: A systematic review

Background

This study aimed to systematically review the literature regarding the inflammatory profiles, measured by cytokines and chemokines, of individuals with different diagnoses of weight, but with the similar periodontal condition.

Materials and Methods

Searches were performed in five databases (Scopus, EMBASE, PubMed, Web of Science, and Cochrane-Central). Studies that compared the inflammatory profile of normal-weight individuals to those with obesity and evaluated the same cytokine, collection method, and periodontal diagnosis (periodontal health, gingivitis, or periodontitis) were included. Cross-sectional studies underwent evaluation by independent researchers using the Joanna Briggs Institute Critical Appraisal Checklist. The GRADE (Grades of Recommendation, Assessment, Development and Evaluation) system assessed evidence certainty.

Results

Twelve studies were included. The diagnosis of obesity was done on the basis of body mass index, waist circumference, and waist-hip ratio. Pro-inflammatory cytokines (interleukin-6 [IL-6], tumor necrosis factor-α [TNF]-α, IL-1β, IL-31, and IL-34) were analyzed in serum, saliva, gingival crevicular fluid (GCF), and plasma. Periodontal diagnoses varied across studies. TNF-α expression was significantly higher in individuals with obesity and periodontal health or periodontitis. Serum IL-1β levels showed mixed results, but salivary IL-1β levels were elevated in obese individuals. IL-6 levels were higher in obese individuals, regardless of periodontal status. IL-34 and IL-10 showed no significant differences across groups. Monocyte chemoattractant protein-4 (MCP-4) levels were higher in obese individuals with periodontitis or periodontal health. IL-31 and IL-34 in GCF showed no significant differences between obese and nonobese individuals, without periodontitis.

Conclusions

Heterogeneous results were noted for IL-6, IL-1β, IL-31, IL-34, TNF-α, and MCP-4, hindering conclusions on weight's impact on inflammatory profiles in periodontal patients.

[Effectiveness of using preventive and personalized technologies for obesity correction]

The epidemic of overweight and obesity, which has reached the proportions of a total crisis in health care in recent years, affects more than 1 billion people worldwide, of whom 2.8 million die annually. The polymodal nature of the pathogenesis of obesity, manifested by the participation of multiple pathological processes, allows us to consider the complex use of physiotherapeutic effects as the most effective therapeutic strategy, the implementation of which allows us to achieve a high clinical result due to the synergistic interaction of therapeutic physical factors.

OBJECTIVE

Development and evaluation of the effectiveness of preventive and personalized technologies based on the predominant use of therapeutic physical factors that have a pathogenetic effect on key patterns of metabolically unhealthy obesity.

MATERIAL AND METHODS

The studies were conducted at the Scientific and Clinical Center 1 of the Russian Scientific Center of Surgery named after academician B.V. Petrovsky with the participation of 157 patients (89 men and 68 women) aged 30 to 70 years. A prospective, controlled, comparative, randomized study was performed. Using the simple fixed randomization method, all patients were divided into 2 groups: control (77 patients) and experimental (80 patients). In the main group, patients received a course of complex exposure to therapeutic physical factors aimed at correcting their metabolic profile (thermotherapy, oxygen and aromatherapy, vibration massage of the back and lower extremities, relaxation music therapy, pressotherapy, dry carbon dioxide baths and general air cryotherapy). The course of complex physiotherapeutic exposure was carried out twice with an interval of 6-8 months. Patients in the control group did not undergo correction of the metabolic profile. The design of the study provided for a three-fold examination of patients in the main and control groups: before the complex program of physiotherapeutic correction of the metabolic profile, after the first and second courses.

RESULTS

Conducting a complex course of physiotherapy had a reliable corrective effect on the parameters of the metabolic profile of patients with obesity, including a reliable decrease in anthropometric indices, improvement of the lipid spectrum of the blood, a decrease in insulin resistance, a decrease in the level of leptin and the severity of sluggish systemic inflammation. Conducting a comparative assessment of the effectiveness of a course of complex physiotherapeutic intervention in the main group compared to the control group, performed using the correlation adaptometry algorithm, made it possible to establish a reliable decrease in the weight of the correlation graph in the main group, which indicates an increase in functional reserves. To implement a personalized approach to the use of a complex of physiotherapeutic interventions, an algorithm for identifying predictor biomarkers that allow predicting the expected clinical effectiveness was used. As a result, informative indicators were identified for predicting the effectiveness of using the developed physiotherapeutic complex to reduce body mass index and insulin resistance.

CONCLUSION

Using the correlation adaptometry method, the effectiveness of using the developed technologies based on the complex use of therapeutic physical factors affecting the main clinical and metabolic manifestations of obesity was proven. The identified predictors of the effectiveness of physiotherapeutic correction of obesity have criterion significance for forming a prognosis of the expected clinical effect at the initial stage (before the start of therapy).

Tirzepatide reduces the predicted risk of atherosclerotic cardiovascular disease and improves cardiometabolic risk factors in adults with obesity or overweight: SURMOUNT-1 post hoc analysis

AIM

To assess the effect of tirzepatide on long-term risk of atherosclerotic cardiovascular disease (ASCVD) among people with obesity or overweight without diabetes from SURMOUNT-1.

MATERIALS AND METHODS

SURMOUNT-1, a phase 3 trial, evaluated the efficacy and safety of tirzepatide in adults with body mass index ≥30 or ≥27 kg/m2 and at least one weight-related complication, excluding diabetes. Participants were randomly assigned to tirzepatide (5/10/15 mg) or placebo. Changes from baseline in cardiometabolic variables were assessed. The predicted 10-year ASCVD risk scores were calculated (American College of Cardiology/American Heart Association risk engine) at baseline, week 24, and week 72 in SURMOUNT-1 participants without a history of ASCVD. Percent change in risk scores from baseline to weeks 24 and 72 was compared between tirzepatide and placebo using mixed model for repeated measures analysis. Analyses were also conducted in participants with intermediate to high risk at baseline.

RESULTS

Tirzepatide-treated groups demonstrated reductions in cardiometabolic variables over 72 weeks. In participants without a history of ASCVD (N = 2461), the baseline median risk score was low and did not differ across groups (1.5%-1.6%). Relative change in risk from baseline to week 72 was greater for tirzepatide (-23.5% to -16.4%) than placebo (12.7%; P < 0.001). Relative change among participants with intermediate-to-high baseline risk was significantly greater for tirzepatide (P < 0.05). Intermediate-to-high-risk participants demonstrated similar relative change but greater absolute risk reduction compared to the overall population.

CONCLUSION

Tirzepatide treatment significantly reduced the 10-year predicted risk of ASCVD versus placebo in patients with obesity or overweight without diabetes.

Risk factors for metabolic syndrome in self-identified and questioning sexual minority women

OBJECTIVE

Studies have shown sexual minority women (SMW) have a higher incidence of obesity, but the risk of metabolic syndrome (MetS) in SMW is unclear. We examined the association between sexual orientation and MetS and its components.

METHODS

Data were extracted from the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2016 examining women aged 20 to 59 years. Participants were divided into three categories: heterosexual, self-identified SMW, and questioning SMW. Logistic regression was used to analyze the association between sexual orientation and MetS.

RESULTS

Of 12,755 women, 708 (5.6%) were self-identified SMW, and 365 (2.9%) were questioning SMW. The incidence of MetS was not significantly different across the groups. Logistic regression demonstrated that self-identified SMW had significantly higher odds of large waist circumference (odds ratio [OR] 1.39; 95% CI: 1.14-1.71) and obesity (OR 1.53; 95% CI: 1.24-1.90), while questioning SMW had significantly higher odds of low levels of high-density lipoprotein (OR 1.5; 95% CI: 1.13-1.98) compared with heterosexual women.

CONCLUSIONS

Self-identified and questioning SMW did not have an increased incidence of MetS compared with heterosexual women, but they had higher odds of large waist circumference and low high-density lipoprotein, respectively. Further studies are needed to identify the gaps in social determinants of health in SMW.

Influence of body composition and cardiorespiratory fitness on plasma HSP72, norepinephrine, insulin, and glucose responses to an acute aerobic exercise bout performed in the fed state

Being overweight is already considered a metabolic risk factor, which can be overcome by increasing cardiorespiratory fitness (CRF). Acute exercise is known to induce changes in plasma hormones and heat shock proteins release. However, there is a lack of studies investigating the impact of body composition and CRF on these variables following acute aerobic exercise. To assess the influence of body composition and cardiorespiratory fitness on plasma heat shock protein 72 kDa (HSP72), norepinephrine (NE), insulin, and glucose responses to an acute aerobic exercise bout in the fed state. Twenty-four healthy male adults were recruited and allocated into three groups: overweight sedentary (n = 8), normal weight sedentary (n = 8), and normal weight active (n = 8). The volunteers performed an acute moderate exercise session on a treadmill at 70% of VO2 peak. Blood samples were drawn at baseline, immediately post-exercise, and at 1-h post-exercise. The exercise session did not induce changes in HSP72 nor NE but changes in glucose and insulin were affected by body mass index. Also, subjects with elevated CRF maintain reduced NE through exercise. At baseline, the overweight sedentary group showed elevated NE, insulin, and glucose; these last two impacting the HOMA-IR index. Thirty minutes of aerobic exercise at 70% VO2 peak, in the fed state, did not change the levels of plasma NE and HSP72. Elevated body composition seems to impact metabolic profile and increase sympathetic activity. Conversely, subjects with increased cardiorespiratory fitness seem to have attenuated sympathetic activity.

Obesity, cardiovascular risk, and lifestyle: cross-sectional and prospective analyses in a nationwide Spanish cohort

AIMS

To assess whether overweight and obesity are independently associated with cardiometabolic health [as categorized based on the presence/absence of cardiovascular disease (CVD) risk factors (diabetes, hypercholesterolaemia, or hypertension)], and the role of lifestyle on this association.

METHODS AND RESULTS

A nationwide cohort of Spanish adults (18-64 years) was studied using a cross-sectional design and prospective observational design. Lifestyle-related factors (physical activity, sleeping characteristics, alcohol drinking, and smoking) were registered, and participants were classified as having an 'unhealthy' or 'healthy' cardiometabolic status attending to the presence or absence, respectively, of ≥1 CVD risk factor. A number of 596 111 participants (44 ± 9 years, 67% male) were studied at baseline, with prospective analyses in a subcohort [n = 302 061; median follow-up, 2 years (range, 2 to 5)]. Compared to normal weight, overweight and obesity were associated with a higher prevalence [odds ratio, 1.67 (95% confidence interval, 1.61-1.67) and 2.70 (2.69-2.78), respectively] and incidence [1.62 (1.59-1.67) and 2.70 (2.63-2.78)] of an unhealthy cardiometabolic status. Meeting physical activity guidelines reduced the odds of an unhealthy cardiometabolic status at baseline [0.87 (0.85-0.88)] among individuals with overweight/obesity, as well as of transitioning from a healthy status to an unhealthy status during the follow-up [0.87 (0.84-0.94)]. No significant associations were found for the remainder of lifestyle factors.

CONCLUSION

Overweight and obesity are independently associated with an unhealthy cardiometabolic status. Regular physical activity attenuates not only the prevalence but also the incidence of CVD risk factors.

Obesity phenotypes and cardiovascular risk: From pathophysiology to clinical management

Obesity epidemic reached the dimensions of a real global health crisis with more than one billion people worldwide living with obesity. Multiple obesity-related mechanisms cause structural, functional, humoral, and hemodynamic alterations with cardiovascular (CV) deleterious effects. A correct assessment of the cardiovascular risk in people with obesity is critical for reducing mortality and preserving quality of life. The correct identification of the obesity status remains difficult as recent evidence suggest that different phenotypes of obesity exist, each one associated with different degrees of CV risk. Diagnosis of obesity cannot depend only on anthropometric parameters but should include a precise assessment of the metabolic status. Recently, the World Heart Federation and World Obesity Federation provided an action plan for management of obesity-related CV risk and mortality, stressing for the instauration of comprehensive structured programs encompassing multidisciplinary teams. In this review we aim at providing an updated summary regarding the different obesity phenotypes, their specific effects on CV risk and differences in clinical management.

Normal-weight central obesity: implications for diabetes mellitus

Background

Current guidelines for obesity prevention and control focus on body mass index (BMI) and rarely address central obesity. Few studies have been conducted on the association between normal-weight central obesity and the risk of diabetes mellitus (DM).

Methods

26,825 participants from the National Health and Nutrition Examination Survey (NHANES) were included in our study. A weighted multivariate logistic regression model was used to analyze the relationship between different obesity patterns and the risk of DM.

Results

Our results suggest that normal-weight central obesity is associated with an increased risk of DM (OR: 2.37, 95% CI: 1.75-3.23) compared with normal-weight participants without central obesity. When stratified by sex, men with normal-weight central obesity, obesity and central obesity were found to have a similar risk of DM (OR: 3.83, 95% CI: 2.10-5.97; OR: 4.20, 95% CI: 3.48-5.08, respectively) and a higher risk than all other types of obesity, including men who were overweight with no central obesity (OR: 1.21, 95% CI: 0.96-1.51) and obese with no central obesity (OR: 0.53, 95% CI: 0.30-0.91).

Conclusion

Our results highlight the need for more attention in people with central obesity, even if they have a normal BMI.

Association of metabolically unhealthy non-obese and metabolically healthy obese individuals with arterial stiffness and 10-year cardiovascular disease risk: a cross-sectional study in Chinese adults

BACKGROUND

The relationship between metabolically healthy obese individuals (MHO) and cardiovascular disease (CVD) risk is disputed. This study investigated the association of metabolically unhealthy non-obese(MUNO) individuals and MHO with arterial stiffness and 10-year CVD risk.

METHODS

A total of 13,435 participants were enrolled and further divided into the metabolically healthy non-obese (MHNO) phenotype (n = 4927), MUNO phenotype (n = 1971), MHO phenotype (n = 2537) and metabolically unhealthy obese (MUO) phenotype (n = 4000) according to body mass index (BMI) and metabolic status. We used brachial ankle pulse wave velocity (baPWV) to measure arterial stiffness and the Framingham risk score (FRS) to evaluate the 10-year CVD risk.

RESULTS

The MUO and MUNO phenotypes had higher mean baPWV values than the MHO and MHNO phenotypes, regardless of age (1446.19 ± 233.65 vs. 1423.29 ± 240.72 vs. 1283.57 ± 213.77 vs. 1234.08 ± 215.99 cm/s, P < 0.001). Logistic regression analysis indicated that the MUNO and MUO phenotypes were independently correlated with elevated baPWV and 10-year CVD risk, while the MHO phenotype was independently associated with only the 10-year CVD risk. In metabolically healthy subjects, BMI showed a dose-dependent increase in the risk of elevated baPWV, with an adjusted OR of 1.007 (95% CI 1.004-1.010, P < 0.001). However, in metabolically unhealthy participants, the estimate for the relationship between elevated baPWV and BMI was nonsignificant.

CONCLUSIONS

The MUNO phenotype exhibits increased arterial stiffness and 10-year CVD risk. However, BMI is positively and dose-dependently correlated with arterial stiffness only in metabolically healthy subjects. We speculate that metabolic status may be a strong confounder in the obesity-elevated baPWV association.

Associations of obesity phenotypes with weight change, cardiometabolic benefits, and type 2 diabetes incidence during a lifestyle intervention: results from the PREVIEW study

BACKGROUND/OBJECTIVES

Some individuals with overweight/obesity may be relatively metabolically healthy (MHO) and have a lower risk of cardiovascular disease than those with metabolically unhealthy overweight/obesity (MUO). We aimed to compare changes in body weight and cardiometabolic risk factors and type 2 diabetes incidence during a lifestyle intervention between individuals with MHO vs MUO.

METHODS

This post-hoc analysis included 1012 participants with MHO and 1153 participants with MUO at baseline in the randomized trial PREVIEW. Participants underwent an eight-week low-energy diet phase followed by a 148-week lifestyle-based weight-maintenance intervention. Adjusted linear mixed models and Cox proportional hazards regression models were used.

RESULTS

There were no statistically significant differences in weight loss (%) between participants with MHO vs MUO over 156 weeks. At the end of the study, weight loss was 2.7% (95% CI, 1.7%-3.6%) in participants with MHO and 3.0% (2.1%-4.0%) in those with MUO. After the low-energy diet phase, participants with MHO had smaller decreases in triglyceride (mean difference between MHO vs MUO 0.08 mmol·L-1 [95% CI, 0.04-0.12]; P < 0.001) but similar reductions in fasting glucose and HOMA-IR than those with MUO. However, at the end of weight maintenance, those with MHO had greater reductions in triglyceride (mean difference -0.08 mmol·L-1 [-0.12--0.04]; P < 0.001), fasting glucose, 2-hour glucose (difference -0.28 mmol·L-1 [-0.41--0.16]; P < 0.001), and HOMA-IR than those with MUO. Participants with MHO had smaller decreases in diastolic blood pressure and HbA1c and greater decreases in HDL cholesterol after weight loss than those with MUO, whereas the statistically significant differences disappeared at the end of weight maintenance. Participants with MHO had lower 3-year type 2 diabetes incidence than those with MUO (adjusted hazard ratio 0.37 [0.20-0.66]; P < 0.001).

CONCLUSIONS

Individuals with MUO had greater improvements in some cardiometabolic risk factors during the low-energy diet phase, but had smaller improvements during long-term lifestyle intervention than those with MHO.

Executive Attentional Dyscontrol as a Core Cognitive and Behavioral Feature of Individuals with Obesity and Cardiovascular Disease: A Cross-Sectional Investigation

Executive attention as a frontal domain ability that is effective in potentially blocking distracting information, reconciling conflicts among simultaneous attentional demands, and regulating impulsive behavior may be impaired in individuals with obesity and cardiovascular disease (CVD). This study aimed (i) to explore the presence of selected cognitive (global cognitive impairment, sensitivity to interference, and attention) and psychological (quality of life, depression, anxiety, and impulsivity) dimensions and (ii) to examine the interactive relationship between attentional dyscontrol-both as a psychological and as a cognitive measure-and the above-mentioned variables in a sample of patients with CVD attending a cardiac rehabilitation program across different body mass index (BMI) levels. Clinical information of 104 patients with CVD was retrospectively collected. Participants were classified into three groups according to their BMI as follows: normal weight (NW = 30), overweight (OW = 19), and obese (OB = 55). Individuals with CVD and a higher BMI showed problems in controlling executive attention-through both neuropsychological and behavioral measures. Specifically, OB patients demonstrated reduced sensitivity to cognitive interference, lower capabilities in divided attention during visual-tracking tasks, and greater impulsivity compared to NW patients. This behavioral characteristic was also found to be correlated with higher levels of anxiety and depression and a lower quality of life. Implications for cognitive rehabilitation were discussed to offer directions for better management of patients with CVD and obesity.

Investigating Adiposity-Related Metabolic Health Phenotypes in Patients with Hidradenitis Suppurativa: A Cross-Sectional Study

BACKGROUND

Obesity and hidradenitis suppurativa (HS) are related through meta-inflammation and are both associated with increased cardiometabolic risk. Notwithstanding, cardiometabolic pathology is not uniform in obesity and a subset of individuals with excess adiposity exhibit a healthy metabolic profile. Whilst the incidence of cardiometabolic endpoints and transitions across different adiposity-related body composition phenotypes within several populations and across different ethnicities have been investigated, data regarding metabolic health (MetH) and body composition phenotypes in individuals with HS are lacking. The objective of this study was to evaluate the relationship between different body composition phenotypes in individuals with HS.

METHODS

This was a cross-sectional study of 632 individuals with and without HS from a population with a high prevalence of both obesity and HS. A total of four body composition phenotypes were generated based on BMI and metabolic status (defined using either the metabolic syndrome definition or the homeostasis model of insulin resistance (HOMA-IR)): metabolically healthy overweight/obese (MHOWOB), metabolically unhealthy overweight/obese (MUOWOB), metabolically healthy normal weight (MHNW), and metabolically unhealthy normal weight (MUNW).

RESULTS

Generally, subjects with HS exhibited a worse metabolic profile with higher levels of indices of central adiposity measures (including Visceral Adiposity Index and waist circumference), systolic blood pressure and markers of insulin resistance, as well as a higher prevalence of the metabolic syndrome. Moreover, when sub-stratified into the different body composition phenotypes, individuals with HS typically also demonstrated adverse metabolic characteristics relative to controls matched for both adiposity and metabolic health, particularly in the normal weight category and despite being classified as metabolically healthy. Being metabolically unhealthy in addition to being overweight/obese increases an individual's risk of HS.

CONCLUSIONS

Metabolic risk-assessment should be prioritized in the clinical management of individuals with HS even in those who are lean. Patients attending HS clinics provide a valuable opportunity for targeted cardiovascular risk reduction with respect to the management of both obesity and metabolic health.

Cognitive behavioural therapy for adults with overweight or obesity

This is a protocol for a Cochrane Review (intervention). The objectives are as follows:

To assess the effects of cognitive behavioural therapy for weight management in adults with overweight or obesity.

The healthful plant-based diet index as a tool for obesity prevention-The healthy lifestyle community program cohort 3 study

Background

World-wide the prevalence of obesity is high, and promoting a shift toward more healthful and more plant-based dietary patterns appears to be one promising strategy to address this issue. A dietary score to assess adherence to a healthy plant-based diet is the healthful plant-based diet index. While there is evidence from cohort studies that an increased healthful plant-based diet index is associated with improved risk markers, evidence from intervention studies is still lacking.

Methods

A lifestyle intervention was conducted with mostly middle-aged and elderly participants from the general population (n = 115). The intervention consisted of a 16-month lifestyle program focusing on a healthy plant-based diet, physical activity, stress management, and community support.

Results

After 10 weeks, significant improvements were seen in dietary quality, body weight, body mass index, waist circumference, total cholesterol, measured and calculated low-density lipoprotein (LDL) cholesterol, oxidized LDL particles, non-high-density lipoprotein cholesterol, remnant cholesterol, glucose, insulin, blood pressure, and pulse pressure. After 16 months, significant decreases were seen in body weight (-1.8 kg), body mass index (-0.6 kg/m2), and measured LDL cholesterol (-12 mg/dl). Increases in the healthful plant-based diet index were associated with risk marker improvements.

Conclusions

The recommendation of moving toward a plant-based diet appears acceptable and actionable and may improve body weight. The healthful plant-based diet index can be a useful parameter for intervention studies.

Rate of Cardiovascular Events and Safety Outcomes Seven Years Following Gastric Bypass Versus Sleeve Gastrectomy

Objective

The study aimed to assess major adverse cardiovascular events (MACEs), complications requiring revision surgery, and bariatric conversion surgery 7 years after gastric bypass (GB) and sleeve gastrectomy (SG) using real-world data.

Background

GB and SG both result in weight loss and improved cardiometabolic health. Whether the long-term rate of MACE differs between the 2 bariatric procedures is unclear.

Methods

In this population-based retrospective cohort study, we used inhospital National Health Registry data from January 2012 to December 2018. Patients undergoing GB were 1:1 propensity score-matched with patients who had SG. The primary outcome was the incidence of MACE, defined as acute myocardial infarction, ischemic stroke, cardiac arrest, or hospitalization for heart failure. Secondary outcomes encompassed individual MACE components, postoperative complications, and the need for bariatric conversion surgery.

Results

Among 5240 propensity score-matched pairs, the incidence rate per 1000 person-years of MACE was 2.8 among patients undergoing GB and 3.2 among those undergoing SG (hazard ratio [HR], 0.92; 95% confidence interval [CI], 0.62-1.37). Single components of MACE were not different between both groups. Patients after GB had a higher risk of long-term postoperative complications requiring a revision surgery compared with those after SG (HR, 3.53 [95% CI, 2.78-4.49]). Bariatric conversion surgery was less frequently performed among patients undergoing GB compared with patients undergoing SG (HR, 0.09 [95% CI, 0.06-0.13]).

Conclusions

In this study, the performance of GB versus SG was associated with a similar risk of MACE. While postoperative complications were more frequent among patients undergoing GB, patients following SG had a higher probability of bariatric conversion surgery.

Metabolic health and cardiometabolic risk clusters: implications for prediction, prevention, and treatment

Among 20 leading global risk factors for years of life lost in 2040, reference forecasts point to three metabolic risks-high blood pressure, high BMI, and high fasting plasma glucose-as being the top risk variables. Building upon these and other risk factors, the concept of metabolic health is attracting much attention in the scientific community. It focuses on the aggregation of important risk factors, which allows the identification of subphenotypes, such as people with metabolically unhealthy normal weight or metabolically healthy obesity, who strongly differ in their risk of cardiometabolic diseases. Since 2018, studies that used anthropometrics, metabolic characteristics, and genetics in the setting of cluster analyses proposed novel metabolic subphenotypes among patients at high risk (eg, those with diabetes). The crucial point now is whether these subphenotyping strategies are superior to established cardiometabolic risk stratification methods regarding the prediction, prevention, and treatment of cardiometabolic diseases. In this Review, we carefully address this point and conclude, firstly, regarding cardiometabolic risk stratification, in the general population both the concept of metabolic health and the cluster approaches are not superior to established risk prediction models. However, both subphenotyping approaches might be informative to improve the prediction of cardiometabolic risk in subgroups of individuals, such as those in different BMI categories or people with diabetes. Secondly, the applicability of the concepts by treating physicians and communication of the cardiometabolic risk with patients is easiest using the concept of metabolic health. Finally, the approaches to identify cardiometabolic risk clusters in particular have provided some evidence that they could be used to allocate individuals to specific pathophysiological risk groups, but whether this allocation is helpful for prevention and treatment still needs to be determined.

A novel criterion of metabolically healthy obesity could effectively identify individuals with low cardiovascular risk among Chinese cohort

Background and objective

Obesity has become a serious public health problem and brings a heavy burden of cardiovascular disease. Metabolically healthy obesity (MHO) is defined as individuals with obesity with no or only minor metabolic complications. Whether individuals with MHO have a lower cardiovascular risk remains controversial. In this study, a new criterion was used to define MHO and assess its predictive value for cardiovascular events and death. At the same time, the new criterion and the traditional criterion are compared to analyze the differences between different diagnostic criteria.

Methods

A prospective cohort was established in northeast rural China from 2012 to 2013. Follow-up was conducted in 2015 and 2018 to investigate the incidence of cardiovascular events and survival. Subjects were grouped according to the metabolic health and obesity status. Kaplan-Meier curves were drawn to describe the cumulative risk of endpoint events in the four groups. Cox regression analysis model was constructed to evaluate the risk of endpoint events. Analysis of variance and post hoc analyses were used to calculate and compare differences in metabolic markers between MHO subjects diagnosed by novel and traditional criteria.

Results

A total of 9345 participants 35 years of age or older without a history of cardiovascular disease were included in this study. After a median follow-up of 4.66 years, the data showed that participants in the MHO group had no significant increase in the risk of composite cardiovascular events and stroke, but had a 162% increase in the risk of coronary heart disease (HR: 2.62; 95%CI: 1.21-5.67). However, when using conventional criteria for metabolic health, mMHO group had a 52% increase in combined CVD risk (HR: 1.52; 95%CI: 1.14-2.03). By comparing the differences of metabolic indicators between MHO subjects diagnosed by the two criteria, MHO subjects diagnosed by the new criterion had higher WC, WHR, TG, FPG, and lower HDL-C levels except for lower blood pressure, showing more exposure to cardiovascular risk factors.

Conclusions

The risk of combined CVD and stroke was not increased in MHO subjects. The new metabolic health criterion is superior to the traditional criterion and can effectively identify individuals with obesity with a lower risk of combined CVD. Blood pressure levels may be responsible for the inconsistent risk of combined CVD in MHO subjects diagnosed with both criteria.

U-shaped association between the triglyceride-glucose index and atrial fibrillation incidence in a general population without known cardiovascular disease

OBJECTIVE

The triglyceride-glucose (TyG) index has been shown to be a new alternative measure for insulin resistance. However, no study has attempted to investigate the association of the TyG index with incident atrial fibrillation (AF) in the general population without known cardiovascular diseases.

METHODS

Individuals without known cardiovascular diseases (heart failure, coronary heart disease, or stroke) from the Atherosclerosis Risk in Communities (ARIC) cohort were recruited. The baseline TyG index was calculated as the Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. The association between the baseline TyG index and incident AF was examined using Cox regression.

RESULTS

Of 11,851 participants, the mean age was 54.0 years; 6586 (55.6%) were female. During a median follow-up of 24.26 years, 1925 incidents of AF cases (0.78/per 100 person-years) occurred. An increased AF incidence with a graded TyG index was found by Kaplan‒Meier curves (P < 0.001). In multivariable-adjusted analysis, both < 8.80 (adjusted hazard ratio [aHR] = 1.15, 95% confidence interval [CI] 1.02, 1.29) and > 9.20 levels (aHR 1.18, 95% CI 1.03, 1.37) of the TyG index were associated with an increased risk of AF compared with the middle TyG index category (8.80-9.20). The exposure-effect analysis confirmed the U-shaped association between the TyG index and AF incidence (P = 0.041). Further sex-specific analysis showed that a U-shaped association between the TyG index and incident AF still existed in females but not in males.

CONCLUSIONS

A U-shaped association between the TyG index and AF incidence is observed in Americans without known cardiovascular diseases. Female sex may be a modifier in the association between the TyG index and AF incidence.

Metabolically healthy obesity: Misleading phrase or healthy phenotype?

Obesity is a heterogenous condition with multiple different phenotypes. Among these a particular subtype exists named as metabolically healthy obesity (MHO). MHO has multiple definitions and its prevalence varies according to study. The potential mechanisms underlying the pathophysiology of MHO include the different types of adipose tissue and their distribution, the role of hormones, inflammation, diet, the intestinal microbiota and genetic factors. In contrast to the negative metabolic profile associated with metabolically unhealthy obesity (MUO), MHO has relatively favorable metabolic characteristics. Nevertheless, MHO is still associated with many important chronic diseases including cardiovascular disease, hypertension, type 2 diabetes, chronic kidney disease as well as certain types of cancer and has the risk of progression into the unhealthy phenotype. Therefore, it should not be considered as a benign condition. The major therapeutic alternatives include dietary modifications, exercise, bariatric surgery and certain medications including glucagon-like peptide-1 (GLP-1) analogs, sodium-glucose cotransporter-2 (SGLT-2) inhibitors and tirzepatide. In this review, we discuss the significance of MHO while comparing this phenotype with MUO.

Medical Nutrition Therapy Interventions Provided by Dietitians for Adult Overweight and Obesity Management: An Academy of Nutrition and Dietetics Evidence-Based Practice Guideline

Overweight and obesity affect most adults living in the United States and are causally linked to several adverse health outcomes. Registered dietitian nutritionists or international equivalents (dietitians) collaborate with each client and other health care professionals to meet client-centered goals, informed by the best available evidence, and translated through a lens of clinical expertise and client circumstances and preferences. Since the last iteration of the Academy of Nutrition and Dietetics guideline on adult weight management in 2014, considerable research has been conducted and circumstances confronting dietitians have evolved. Thus, updated guidance is needed. The objective of this evidence-based practice guideline is to provide recommendations for dietitians who deliver medical nutrition therapy behavioral interventions for adults (18 years and older) with overweight and obesity to improve cardiometabolic outcomes, quality of life, and weight outcomes, when appropriate for and desired by the client. Recommendations in this guideline highlight the importance of considering complex contributors to overweight and obesity and individualizing interventions to client-centered goals based on specific needs and preferences and shared decision making. The described recommendations have the potential to increase access to care and decrease costs through utilization of telehealth and group counseling as effective delivery methods, and to address other barriers to overweight and obesity management interventions. It is essential for dietitians to collaborate with clients and interprofessional health care teams to provide high-quality medical nutrition therapy interventions using the nutrition care process to promote attainment of client-centered outcomes for adults with overweight or obesity.

Lack of association between metabolic phenotype and food consumption by degree of food processing: results from the Study of Workers' Health (ESAT)

Introduction

Introduction: an increase in the consumption of processed and ultra-processed foods may predispose to metabolic abnormalities. Objective: to verify the association of food consumption with metabolic phenotype in workers from a quaternary hospital in Rio de Janeiro, Brazil. Methods: workers of both sexes aged > 18 years were eligible. A food frequency questionnaire and the NOVA classification were used in the food consumption analysis. Metabolic phenotype considered the presence of at least one metabolic alteration (blood glucose, serum lipids, and blood pressure) combined with BMI (eutrophic or excess weight) as follows: 1) metabolically healthy eutrophic (MHE); 2) metabolically unhealthy eutrophic (MUE); 3) metabolically healthy excess weight (MHEW); 4) metabolically unhealthy excess weight (MUEW). Results: from the included 160 participants (mean age, 45.2 ± 1.1 years; 59.4 %, women), 21.9 % self-reported arterial hypertension and 4.4 % diabetes. Most presented excess weight (74.6 %), with approximately 40 % being obese. The MUEW phenotype had higher body fat percentage and central adiposity represented by higher WC and VFA in comparison to the other phenotypes. The lean body mass was similar between the groups. The median of ultra-processed foods was 32.4 % for eutrophic, 32.7 % for overweight, and 34.3 % for obese subjects. No significant associations were observed between ultra-processed food consumption and metabolically unhealthy eutrophic (OR: 1.01; 95 % CI: 0.96-1.06), metabolically healthy excess weight (OR: 1.03; 95 % CI: 0.98-1.08), and metabolically unhealthy excess weight (OR: 1.00; 95 % CI: 0.96-1.05) in comparison to metabolically healthy eutrophic. Conclusion: consumption of ultra-processed food was high. In this cross-sectional analysis, no association of metabolic phenotypes with consumption of food groups according to degree of food processing were observed.

Overweight or obesity increases the risk of cardiovascular disease among older Australian adults, even in the absence of cardiometabolic risk factors: a Bayesian survival analysis from the Hunter Community Study

OBJECTIVE

To estimate the risk of cardiovascular disease (CVD) in older adults with overweight or obesity without metabolic risk factors using a Bayesian survival analysis.

DESIGN

Prospective cohort study with median follow-up of 9.7 years.

SETTING

Newcastle, New South Wales, Australia.

PARTICIPANTS

A total of 2313 community-dwelling older men and women.

INTERVENTION/EXPOSURE

Participants without known CVD and with a body mass index (BMI) ≥ 18.5 kg m² were stratified by BMI and metabolic risk to create six BMI-metabolic health categories. Metabolic risk was defined according to the International Diabetes Federation criteria for metabolic syndrome. 'Metabolically healthy' was defined as absence of metabolic risk factors. Bayesian survival analysis, incorporating prior information from a previously published meta-analysis was used to assess the effect of BMI-metabolic health categories on time from recruitment to CVD.

MAIN OUTCOME

Incident physician-diagnosed CVD, defined as fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, angina, or coronary revascularisation procedure, was determined by linkage to hospital admissions records and Medicare Australia data. Secondary outcomes were cardiovascular mortality and all-cause mortality.

RESULTS

From 2313 adults with complete metabolic health data over a median follow-up of 9.7 years, 283 incident CVD events, 58 CVD related deaths and 277 deaths from any cause occurred. In an adjusted Bayesian survival model of complete cases with informative prior and metabolically healthy normal weight as the reference group, the risk of CVD was increased in metabolically healthy overweight (HR = 1.52, 95% credible interval 0.96-2.36), and in metabolically healthy obesity (HR = 1.86, 95% credible interval 1.14-3.08). Imputation of missing metabolic health and confounding data did not change the results.

CONCLUSION

There was increased risk of CVD in older adults with overweight or obesity, even in the absence of any metabolic abnormality. This argues against the notion of 'metabolically healthy' overweight or obesity.