Metabolic and behavioral characteristics of metabolically obese but normal-weight women

Preliminary quantitative analysis of renal sinus fat dysfunction in T2DM patients using MRI fat fraction and R2* mapping

Purpose

To quantitatively analyze renal sinus fat (RSF) dysfunction in type 2 diabetes mellitus (T2DM) patients using magnetic resonance imaging (MRI) fat fraction (FF) and R2* mapping.

Methods

The inpatients who underwent 1.5 T MRI examination (including MRI FF and R2* mapping) of the abdomen from January 2017 to December 2023 were enrolled. The RSF volume, FF and R2* of the right and left kidneys and the mean values were measured. Associations between mean FF and R2* value of RSF and T2DM were assessed with logistic regression. Receiver operating characteristic (ROC) curve was applied to calculate area under the curve (AUC) for the parameters to identify T2DM patients. Partial correlation coefficients after controlling for age, sex, and BMI were computed to analyze the correlations among the mean RSF volume, FF and R2*.

Results

A total of 186 participants were finally enrolled in this study including 38 patients in T2DM group and 148 patients in non-T2DM group. Univariate logistic regression analyses showed the significant correlations of mean RSF FF (OR: 1.111, 95%CI: 1.054 - 1.171), P < 0.001) and R2* (OR: 1.120, 95%CI: 1.013 - 1.237), P = 0.027) with T2DM. Multivariate analysis showed that mean RSF FF (OR: 1.231, 95% CI: 1.098 - 1.380) is independently associated with T2DM after adjusting for age, sex and BMI. The AUC of mean RSF FF was 0.701 (0.630 - 0.766) with the sensitivity and specificity of 57.89% and 75.68%, respectively, when using 34.40% as the cut-off value. The AUC of mean RSF R2* was 0.616 (0.542 - 0.686) with the sensitivity and specificity of 68.42% and 58.11%, respectively, when using 21.97 Hz as the cut-off value. Furthermore, mean RSF FF presents significantly higher diagnostic efficacy for T2DM than R2* (P < 0.05). And combining mean RSF FF and R2* improved the diagnostic performance (AUC = 0.729).

Conclusion

Mean RSF FF and R2* were significantly associated with T2DM, and mean RSF FF was the independent risk factor of T2DM. This finding indicates the hypertrophy of adipocytes and excessive iron deposition and hypoxia in RSF, which may represent dysfunction of RSF for T2DM.

Triglyceride-glucose index is capable of identifying metabolically obese, normal-weight older individuals

BACKGROUND

The concept of metabolically obese, normal weight (MONW) has emerged to describe individuals with a normal body mass index (BMI) who are at a relatively high risk of chronic diseases. However, BMI itself is a suboptimal index for the assessment of the health risks associated with visceral fat. The triglyceride-glucose (TyG) index is considered to be a reliable and cost-effective marker of insulin resistance. Therefore, in the present study, we aimed to determine the TyG index cut-off values that could be used to define MONW in older people and to determine the usefulness of these values for the prediction of chronic diseases.

METHODS

A total of 4,721 participants in the Korea National Health and Nutritional Examination Survey who were ≥ 60 years of age and did not have underweight or obesity were included. MONW was defined using the criteria for metabolic syndrome (MS), and the TyG index was calculated on the basis of the fasting plasma triglyceride and glucose concentrations. Chronic diseases, including T2DM, hypertension, and non-alcoholic fatty liver disease (NAFLD), were diagnosed.

RESULTS

The prevalence of MS increased from the lowest to the highest TyG index tertile. The cut-off values of the TyG index for MONW were calculated as 8.88 and 8.80 for males and females, respectively. MONW, defined using these cut-off values, was associated with high odds ratios for NAFLD, T2DM, and hypertension in both males and females.

CONCLUSIONS

The TyG index cut-off values calculated in the present study can be used to discriminate individuals with MONW from other older individuals without obesity and to predict the risk of chronic diseases. These findings show that the TyG index is an effective and cost-efficient method of assessing the risk of chronic diseases in people with MONW.

Characteristics of Normal Weight Insulin-Resistant Adults with Unfavorable Health Outcomes

Background: Insulin resistance can be present in otherwise healthy, normal weight adults. Whether there are phenotype/sex-differences between normal weight insulin-resistant (NWIR) and normal weight insulin-sensitive (NWIS) Caucasians and whether there are differences in adverse health outcomes are unknown. Our goal was to define phenotypes and intermediate-term health outcomes of NWIR versus NWIS Caucasian adults. Methods: We analyzed data from 227 healthy volunteers body mass index 18 to <25.0 kg/m2 who underwent insulin clamp studies between January 1987 and January 2017 at Mayo Clinic to identify those in the top (NWIS, n = 56) and bottom (NWIR, n = 56) quartiles of insulin action. We compared the phenotypical characteristics and were able to collect medical records data for 80% of NWIS and 88% of NWIR to identify time to onset of hypertension, hyperglycemia, coronary heart disease, cerebrovascular disease, peripheral vascular disease, and all cause death; the follow-up averaged 11 (4, 20) years. Results: Body fat was significantly greater and peak VO2 was significantly less in both NWIS than NWIR males and females. Only in females was abdominal subcutaneous fat by computed tomography significantly greater in NWIR than NWIS. In NWIR males high-density lipoprotein-cholesterol and fat free mass were significantly less, and fasting insulin was greater than NWIS males. For the entire NWIS population, Kaplan-Meier disease-free survival analysis showed longer times free of hypertension, hyperglycemia, and some cardiovascular diseases than for NWIR. Conclusions: There are sex-specific phenotypes of NWIR in Caucasian adults. NWIR may be associated with accelerated onset of some adverse medical outcomes.

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.

Macronutrient quality and the incidence of metabolically unhealthy phenotypes in adults with normal weight and overweight/obesity

OBJECTIVE

We aimed to investigate the associations of macronutrient quality indices with the incident metabolically unhealthy normal weight (MUNW) and metabolically unhealthy overweight/obesity (MUO) phenotypes.

METHODS

This prospective study included 512 metabolically healthy normal weight and 787 metabolically healthy overweight/obese adults from the third study examination of the Tehran Lipid and Glucose Study. The participants were followed through the sixth study examination. Diet was measured with a food frequency questionnaire. The macronutrient quality index (MQI), carbohydrate quality index (CQI), fat quality index (FQI), and healthy plate quality index (HPPQI) were calculated. Hazard ratio (HR) and 95 % confidence interval (95 % CI) were estimated for incident unhealthy phenotypes using Cox regression.

RESULTS

After controlling all possible confounding factors, a one-point higher HPPQI was linked to a 28 % lower risk of MUNW (HR = 0.72; 95 % CI = 0.59, 0.87). Compared to the lowest quartile, the incident MUNW was also lower in the two last quartiles of the HPPQI. A one-unit increase in MQI was associated with a 5 % lower incident MUO (HR = 0.95; 95 % CI = 0.92, 0.99). The incident MUO was also higher for the highest compared to the lowest MQI quartile. In quartiles 2-4 of the HPPQI, incident MUO was lower with respective HRs (95 % CI) of 0.71 (0.54, 0.93), 0.60 (0.45, 0.80), and 0.66 (0.50, 0.86) in the fully-adjusted model.

CONCLUSIONS

A higher overall macronutrient quality was independently associated with a lower incident MUO. A higher dietary protein quality was related to a lower risk for MUNW and MUO.

Metabolically defined body size and body shape phenotypes and risk of postmenopausal breast cancer in the European Prospective Investigation into Cancer and Nutrition

BACKGROUND

Excess body fatness and hyperinsulinemia are both associated with an increased risk of postmenopausal breast cancer. However, whether women with high body fatness but normal insulin levels or those with normal body fatness and high levels of insulin are at elevated risk of breast cancer is not known. We investigated the associations of metabolically defined body size and shape phenotypes with the risk of postmenopausal breast cancer in a nested case-control study within the European Prospective Investigation into Cancer and Nutrition.

METHODS

Concentrations of C-peptide-a marker for insulin secretion-were measured at inclusion prior to cancer diagnosis in serum from 610 incident postmenopausal breast cancer cases and 1130 matched controls. C-peptide concentrations among the control participants were used to define metabolically healthy (MH; in first tertile) and metabolically unhealthy (MU; >1st tertile) status. We created four metabolic health/body size phenotype categories by combining the metabolic health definitions with normal weight (NW; BMI < 25 kg/m2 , or WC < 80 cm, or WHR < 0.8) and overweight or obese (OW/OB; BMI ≥ 25 kg/m2 , or WC ≥ 80 cm, or WHR ≥ 0.8) status for each of the three anthropometric measures separately: (1) MHNW, (2) MHOW/OB, (3) MUNW, and (4) MUOW/OB. Conditional logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Women classified as MUOW/OB were at higher risk of postmenopausal breast cancer compared to MHNW women considering BMI (OR = 1.58, 95% CI = 1.14-2.19) and WC (OR = 1.51, 95% CI = 1.09-2.08) cut points and there was also a suggestive increased risk for the WHR (OR = 1.29, 95% CI = 0.94-1.77) definition. Conversely, women with the MHOW/OB and MUNW were not at statistically significant elevated risk of postmenopausal breast cancer risk compared to MHNW women.

CONCLUSION

These findings suggest that being overweight or obese and metabolically unhealthy raises risk of postmenopausal breast cancer while overweight or obese women with normal insulin levels are not at higher risk. Additional research should consider the combined utility of anthropometric measures with metabolic parameters in predicting breast cancer risk.

Are Women with Normal-Weight Obesity at Higher Risk for Cardiometabolic Disorders?

OBJECTIVES

This study aimed to evaluate the cardiometabolic abnormalities in women with normal-weight obesity (NWO) in comparison with lean, overweight, and obese women.

METHODS

This cross-sectional study evaluated the assessment of cardiometabolic abnormalities of women with NWO compared to lean, overweight, and obese women. NWO was defined as a BMI < 25 kg.m^-2 and a BFP higher than 30%. Anthropometric variables, cardiometabolic abnormality markers (fasting blood glucose (FBG), blood pressure (BP), lipid profile, insulin resistance, and high-sensitivity C-reactive protein (hs-CRP)), and liver enzymes were also examined.

RESULTS

Significant differences were observed in HDL concentrations between NWO, lean, and obese participants (p < 0.05). There were no significant differences in FBG, insulin resistance, liver enzymes, or cholesterol between groups (p > 0.05). The prevalence of the abnormal metabolic phenotype was higher in NWO compared to the lean group (4.0% and 24.1%, respectively; p < 0.05). Women with type 2 and 3 obesity had abnormal metabolic profiles (60.9% and 73.9%, respectively) compared to NWO participants (p < 0.01). The NWO group had a significantly higher incidence of cardiometabolic abnormalities compared to the lean participants (p < 0.05), while the type 2 and 3 obese individuals had significantly higher incidences compared to the NWO group (p < 0.001 and p < 0.001, respectively).

CONCLUSIONS

Individuals with NWO had a significantly higher incidence of cardiometabolic abnormalities when compared to lean participants. These abnormalities strongly relate to BFP and waist circumferences.

Association between metabolic body composition status and vitamin D deficiency: A cross-sectional study

This study aimed to investigate the risk of vitamin D deficiency in a relatively healthy Asian population, with (i) metabolically healthy normal weight (MHNW) (homeostasis model assessment-insulin resistance [HOMA-IR] < 2. 5 without metabolic syndrome [MS], body mass index [BMI] < 25), (ii) metabolically healthy obesity (MHO) (HOMA-IR < 2.5, without MS, BMI ≥ 25), (iii) metabolically unhealthy normal weight (MUNW) (HOMA-IR ≥ 2.5, or with MS, BMI < 25), and (iv) metabolically unhealthy obesity (MUO) (HOMA-IR ≥ 2.5, or with MS, BMI ≥ 25) stratified by age and sex. This cross-sectional study involved 6,655 participants aged ≥ 18 years who underwent health checkups between 2013 and 2016 at the Chang Gung Memorial Hospital. Cardiometabolic and inflammatory markers including anthropometric variables, glycemic indices, lipid profiles, high-sensitivity C-reactive protein (hs-CRP), and serum 25-hydroxy vitamin D levels, were retrospectively investigated. Compared to the MHNW group, the MHO group showed a higher odds ratio (OR) [1.35, 95% confidence interval (CI) 1.05-1.73] for vitamin D deficiency in men aged < 50 years. By contrast, in men aged > 50 years, the risk of vitamin D deficiency was higher in the MUO group (OR 1.44, 95% CI 1.05-1.97). Among women aged < and ≥ 50 years, the MUO group demonstrated the highest risk for vitamin D deficiency, OR 2.33 vs. 1.54, respectively. Our study revealed that in women of all ages and men aged > 50 years, MUO is associated with vitamin D deficiency and elevated levels of metabolic biomarkers. Among men aged < 50 years, MHO had the highest OR for vitamin D deficiency.

Metabolically Defined Body Size Phenotypes and Risk of Endometrial Cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC)

BACKGROUND

Obesity is a risk factor for endometrial cancer but whether metabolic dysfunction is associated with endometrial cancer independent of body size is not known.

METHODS

The association of metabolically defined body size phenotypes with endometrial cancer risk was investigated in a nested case-control study (817 cases/ 817 controls) within the European Prospective Investigation into Cancer and Nutrition (EPIC). Concentrations of C-peptide were used to define metabolically healthy (MH; <1st tertile) and metabolically unhealthy (MU; ≥1st tertile) status among the control participants. These metabolic health definitions were combined with normal weight (NW); body mass index (BMI)<25 kg/m2 or waist circumference (WC)<80 cm or waist-to-hip ratio (WHR)<0.8) and overweight (OW; BMI≥25 kg/m2 or WC≥80 cm or WHR≥0.8) status, generating four phenotype groups for each anthropometric measure: (i) MH/NW, (ii) MH/OW, (iii) MU/NW, and (iv) MU/OW.

RESULTS

In a multivariable-adjusted conditional logistic regression model, compared with MH/NW individuals, endometrial cancer risk was higher among those classified as MU/NW [ORWC, 1.48; 95% confidence interval (CI), 1.05-2.10 and ORWHR, 1.68; 95% CI, 1.21-2.35] and MU/OW (ORBMI, 2.38; 95% CI, 1.73-3.27; ORWC, 2.69; 95% CI, 1.92-3.77 and ORWHR, 1.83; 95% CI, 1.32-2.54). MH/OW individuals were also at increased endometrial cancer risk compared with MH/NW individuals (ORWC, 1.94; 95% CI, 1.24-3.04).

CONCLUSIONS

Women with metabolic dysfunction appear to have higher risk of endometrial cancer regardless of their body size. However, OW status raises endometrial cancer risk even among women with lower insulin levels, suggesting that obesity-related pathways are relevant for the development of this cancer beyond insulin.

IMPACT

Classifying women by metabolic health may be of greater utility in identifying those at higher risk for endometrial cancer than anthropometry per se.

Effects of two different exercise paradigms on cardiac function, BDNF-TrkB expression, and myocardial protection in the presence and absence of Western diet

Background

Brain-derived neurotrophic factor (BDNF) -tropomyosin-related kinase receptor B (TrkB) signaling is a vital regulator of myocardial performance. Here, we tested the impact of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on heart function, metabolic parameters, and serum/cardiac BDNF (with its TrkB receptor) in animals fed a Western (WD) or regular diet (ND). Further, myocardial expression of pro-inflammatory cytokine interleukin-18 (IL-18) and cardioprotective molecule heme oxygens-1 (HO-1) were monitored.

Methods

Wistar rats were divided into HIIT, MICT, and sedentary (SED), all fed a WD or ND, for 12 weeks. Heart function, protein expression, and serum factors were assessed via echocardiography, western blotting, and ELISA, respectively.

Results

WD plus SED caused insulin resistance, dyslipidemia, visceral fat deposition, serum BDNF depletion as well as cardiac upregulation of IL-18 and downregulation of HO-1, without affecting, heart function and BDNF-TrkB expression. The cardiometabolic risk factors, serum BDNF losses, and IL-18 overexpression were similarly obviated by HIIT and MICT, although HO-1 expression was boosted by HIIT exclusively (even in ND). HIIT enhanced heart function, regardless of the diet. HIIT augmented cardiac BDNF expression, with a significant difference between ND and WD. Likewise, HIIT instigated TrkB expression only in ND.

Conclusions

HIIT and MICT can cope with myocardial inflammation and cardiometabolic risk factors in WD consumers and, exclusively, HIIT may grant further protection by increasing heart function, BDNF-TrkB expression, and HO-1 expression. Thus, the HIIT paradigm should be considered as a preference for subjects who require heart function to be preserved or enhanced.

Perinatal Treatment with Leptin, but Not Celastrol, Protects from Metabolically Obese, Normal-Weight Phenotype in Rats

Perinatal nutrition has a well-known influence on obesity susceptibility. We previously demonstrated the protective anti-obesity effects of perinatal leptin administration. Celastrol is a natural compound acting as a leptin sensitizer with anti-obesity effects when administered in adult animals. Here, we aimed to determine if perinatal treatment with leptin, celastrol, or their combination was able to improve metabolic health in animals fed an isocaloric high-fat (HF) diet. Leptin and/or celastrol or their vehicle were administered orally to rats during the suckling period. After weaning, animals were chronically pair-fed with an HF diet provided isocaloric to the intake of a normal-fat diet by control animals to avoid obesity. Isocaloric HF feeding in vehicle-treated animals resulted in metabolic features characteristic of the metabolically obese, normal-weight (MONW) phenotype, i.e., obesity-related disturbances without increased body weight. Leptin treatment prevented liver fat deposition and insulin resistance, induced greater insulin and leptin signaling capacity, decreased gene expression of orexigenic signals at the hypothalamic level, and induced browning in retroperitoneal adipose tissue. However, celastrol treatment did not provide any protective effect and resulted in greater size of the retroperitoneal adipose depot, higher circulating glucose and insulin levels, and decreased leptin sensitivity capacity in adipose tissue. The co-administration of leptin ameliorated the negative effects of celastrol on the retroperitoneal depot, inducing browning and decreasing its size. In conclusion, the perinatal administration of leptin, but not celastrol, provided protection against the consequences of dietary unbalances leading to an MONW phenotype in adulthood.

Advances in Phenotyping Obesity and in Its Dietary and Pharmacological Treatment: A Narrative Review

In recent times, it has become evident that there are individuals who, from a metabolic point of view, are affected by obesity but have a normal body mass index. There are also metabolically healthy individuals with a high body mass index who are thus are considered as to be affected by obesity obese. Understanding that individuals with obesity are phenotypically heterogeneous is a relatively novel concept which, although present in the scientific literature, unfortunately has not yet had an impact in clinical practice. However, common dietary approaches are not effective in treating large numbers of obese patients with obesity. This narrative review, based on the material searched via PubMed and the Web of Science up to October 2021, proposes a downsizing of the role of the body mass index in identifying the individual with "true obesity" since it is only partially useful, and suggests a new approach which also integrates the body composition and assessment of metabolic parameters. This approach leads to personalized therapies that work best for each obesity phenotype in reducing the risk of non-communicable diseases.

Metabolic Obesity in People with Normal Body Weight (MONW)-Review of Diagnostic Criteria

Disorders of metabolic obesity with normal body weight (MONW) are widely recognized risk factors for the development of cardiovascular diseases and type 2 diabetes. Despite this, MONW is not diagnosed in clinical practice. There is no consensus on the definition of MONW, and measuring the degree of insulin resistance or obesity among apparently healthy, non-obese patients is not widely applicable. The awareness of the relationship between metabolic disorders such as MONW and a higher risk of mortality from cardiovascular causes and other related diseases prompts the need for action to be taken aimed at creating appropriate diagnostic models that will allow for the effective detection of those with metabolic abnormalities among people with normal body weight. Such actions are decisive in the prevention and treatment of diseases. Therefore, the purpose of this article is to review the MONW diagnostic criteria used over the years.

Effect of obesity and metabolic health on urolithiasis: A nationwide population-based study

Purpose

To investigate the risk of symptomatic urolithiasis requiring surgical treatment according to obesity and metabolic health status using a nationwide dataset of the Korean population.

Materials and Methods

Of the 5,300,646 persons who underwent health examinations between the year 2009 and 2016, within one year after the health examination, 35,137 patients who underwent surgical treatment for urolithiasis were enrolled. Participants were classified as “obese” or “non-obese” using a body mass index (BMI) cutoff of 25 kg/m². People who developed ≥1 metabolic disease component in the index year were considered “metabolically unhealthy”, while those with none were considered “metabolically healthy”.

Results

Out of 34,330 participants excluding 843 missing, 16,509 (48.1%), 4,320 (12.6%), 6,456 (18.8%), and 7,045 (20.5%) subjects were classified into the metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO) group, respectively. Mean BMI was 22.1±1.9 kg/m², 22.9±1.6 kg/m², 26.9±1.8 kg/m², and 27.9±2.4 kg/m² respectively. After adjusting the age and sex, the subjects in the MUNO group had an HR (95% CI) of 1.192 (1.120–1.268), those in the MHO group, 1.242 (1.183–1.305), and those in the MUO group, 1.341 (1.278–1.407) for either extracorporeal shockwave lithotripsy or surgery, compared to those in the MHNO group.

Conclusions

Metabolically healthy, obese individuals have a higher risk of developing symptomatic urolithiasis than non-obese, unhealthy, but have a lower risk than obese, unhealthy. It suggests that metabolic health and obesity have collaborative effects, independently affecting the development of symptomatic urinary stone diseases.

Association of Metabolic Health and Central Obesity With the Risk of Thyroid Cancer: Data from the Korean Genome and Epidemiology Study

BACKGROUND

It is unknown whether the risk of thyroid cancer differs among metabolically healthy/unhealthy, normal-weight, or obese women. We aimed to assess the association of metabolic health and obesity with thyroid cancer risk.

METHODS

The Korean Genome and Epidemiology Study is a population-based prospective cohort study. Data were obtained from 173,343 participants (age {greater than or equal to}40 years) enrolled from 2004 to 2013. Obese participants were those with body mass index (BMI) {greater than or equal to}25 kg/m2. Participants with abnormalities in three of these indices were considered metabolically unhealthy: triglycerides, blood pressure, high-density lipoprotein cholesterol (HDL-cholesterol), waist circumference (WC), and fasting glucose levels. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for thyroid cancer risk associated with metabolic health and obesity.

RESULTS

Compared to non-obese women without metabolic abnormalities, metabolically unhealthy women, either normal-weight or obese, had an increased risk of thyroid cancer (HR [95% CI]=1.57[1.02-2.40] and 1.71[1.21-2.41], respectively). Significant association was not observed in men. Thyroid cancer risk was higher among non-obese women with high WC ({greater than or equal to}85 cm; HR [95% CI]=1.62[1.03-2.56]) than in non-obese women with low WC, and in obese women with low HDL-cholesterol (<50 mg/dL; HR[95% CI]=1.75[1.26-2.42]) compared to non-obese women with high HDL-cholesterol.

CONCLUSIONS

Metabolically unhealthy women or women with central adiposity may be at an increased thyroid cancer risk despite normal BMI.

IMPACT

This study suggests that women with central obesity and metabolically abnormality despite normal BMI may constitute a target group for thyroid cancer prevention and control programs.

Sex differences in younger school age children’s body weight categories

The issue of inadequate or excessive children’s body weight, particularly in relation to their health, is also discussed by Czech experts in physical anthropology, auxology, paediatrics, endocrinology, etc. Overweight and obesity occur already at a younger school age, and some domestic and foreign sources report a higher prevalence in boys.

The objective of this study was to describe distribution range in body weight categories among Czech children of younger school age (6 to 11 years) taking into account age and sex.

Our research was carried out at 23 primary schools in 5 regions of the Czech Republic between 2014 and 2018. The research group consisted of 2,099 children aged 6 to 11 years (boys n = 1,015, 48.4%; girls n = 1,084, 51.6%). Probands were subjected to the standard anthropometric examination with body weight being assessed using the following assessment standards: the Czech national growth references, Nationwide Anthropological Survey of Czech Children and Adolescents (NAS), World Health Organisation (WHO) growth standards, and International Obesity Task Force (IOTF) references were used. Statistical tests were carried out at a significance level of p ≤ 0.05; residual analysis.

According to all three assessment standards, the highest prevalence of children with normal body weight was in both sexes; 45.8% of girls and 48.4% of boys, using the Czech assessment reference. Overweight and obesity were more predominant in boys (7.9% and 8.7%) than in girls (7.7% and 7.5%). One point seven percent of boys and girls were equally underweight, whereas the percentage of girls (22.3%) with reduced body weight was higher than in boys (20.3%). A significant difference between boys and girls was found in the category of reduced body weight in nine-year-old children. Using internationally recommended BMI references, more children fell into the category of normal body weight. Significant differences, in accordance with IOTF, between the number of severely underweight boys and girls were observed in 7-year-olds, slightly underweight in 9- and 11-year-olds, and overweight in 7-year-olds. In accordance with the WHO growth standards, significant differences appeared between eight-year-olds and eleven-year-olds obese boys and girls.

Our research study revealed the prevalence in younger school age children body weight categories. Different BMI references were used to classify body weight. Significant differences between the number of boys and girls were observed in certain weight categories in seven-year-old, eight-year-old, nine-year-old and eleven-year-old children. Thus, the study confirmed the presence of differences in the number of boys and girls in specific body weight categories.

Abdominal periaortic and renal sinus fat attenuation indices measured on computed tomography are associated with metabolic syndrome

OBJECTIVES

To investigate the association between abdominal periaortic (APA) and renal sinus (RS) fat attenuation index (FAI) measured on MDCT and metabolic syndrome in non-obese and obese individuals.

METHODS

Visceral, subcutaneous, RS, and APA adipose tissue were measured in preoperative abdominal CT scans of individuals who underwent donor nephrectomy (n = 84) or bariatric surgery (n = 155). FAI was defined as the mean attenuation of measured fat volume. Participants were categorized into four groups: non-obese without metabolic syndrome (n = 64), non-obese with metabolic syndrome (n = 25), obese without metabolic syndrome (n = 21), and obese with metabolic syndrome (n = 129). The volume and FAI of each fat segment were compared among the groups. Receiver operator characteristics curve analysis was used to assess the association between the FAIs and metabolic syndrome.

RESULTS

FAIs of all abdominal fat segments were significantly lower in the obese group than in the non-obese group (p < 0.001). RS, APA, and the visceral adipose tissue FAIs were significantly lower in participants with metabolic syndrome than in those without metabolic syndrome in the non-obese group (p < 0.001, p = 0.006, and p < 0.001, respectively). The area under the curve for predicting metabolic syndrome was significantly higher for APA FAI (0.790) than subcutaneous, visceral, and RS FAI in all groups (0.649, 0.647, and 0.655, respectively).

CONCLUSION

Both metabolic syndrome and obesity were associated with lower RS and APA adipose tissue FAI, and APA FAI performed best for predicting metabolic syndrome.

KEY POINTS

• The volume and FAI of RS, APA, and visceral adipose tissue showed opposite trends with regard to metabolic syndrome or obesity. • Both metabolic syndrome and obesity were associated with lower RS FAI and APA FAI. • APA FAI performed best for predicting metabolic syndrome among FAIs of abdominal fat segments.

Cancer Risk in Normal Weight Individuals with Metabolic Obesity: A Narrative Review

Obesity represents one of the most significant public health challenges worldwide. Current clinical practice relies on body mass index (BMI) to define the obesity status of an individual, even though the index has long been recognized for its limitations as a measure of body fat. In normal BMI individuals, increased central adiposity has been associated with worse health outcomes, including increased risks of cardiovascular disease and metabolic disorders. The condition leading to these outcomes has been described as metabolic obesity in the normal weight (MONW). More recent evidence suggests that MONW is associated with increased risk of several obesity-related malignancies, including postmenopausal breast, endometrial, colorectal, and liver cancers. In MONW patients, the false reassurance of a normal range BMI can lead to lost opportunities for implementing preventive interventions that may benefit a substantial number of people. A growing body of literature has documented the increased risk profile of MONW individuals and demonstrated practical uses for body composition and biochemical analyses to identify this at-risk population. In this review, we survey the current literature on MONW and cancer, summarize pathophysiology and oncogenic mechanisms, highlight potential strategies for diagnosis and treatment, and suggest directions for future research.

Metabolically healthy obesity and metabolically obese normal weight: a review

Despite the general relationship between obesity and its co-morbidities, there are both obese individuals who scarcely present the associated pathologies (metabolically healthy obese; MHO) and individuals who present obesity alterations despite having normal weight (metabolically obese normal weight; MONW). It is still difficult to define metabolically MHO and MONW individuals because different classifications have been used in the studies reported. Indeed, different inclusion criteria have been used to discriminate between metabolically healthy and metabolically unhealthy subjects. Due to this and other reasons, such as differences in ethnicity, genetics, and lifestyle of the populations, data concerning the prevalence of MHO and MONW are very variable. The main determinants of MHO are type of growth (hypertrophy or hyperplasia), anatomical location, inflammation of adipose tissue, ectopic fat accumulation, genetic factors, and lifestyles factors. In the case of MONW, the main determinants are genetic background and lifestyle factors. With regard to treatment, it is not clear whether MHO subjects would benefit from traditional lifestyle interventions, based on diet energy restriction and increased physical activity. For MONW subjects, there is still no specialized treatment, and the therapies are the same as those used in obese subjects.

Dissociation Between Insulin Resistance and Abnormalities in Lipoprotein Particle Concentrations and Sizes in Normal-Weight Chinese Adults

Insulin resistance in obesity coincides with abnormalities in lipid profile and lipoprotein subclass distribution and size even before abnormalities in glucose homeostasis manifest. We aimed to assess this relationship in the absence of obesity. Insulin sensitivity (3-h intravenous glucose tolerance test and minimal modeling) and lipoprotein particle concentrations and sizes (proton nuclear magnetic resonance spectroscopy) were evaluated in 15 insulin-resistant and 15 insulin-sensitive lean Asians of Chinese descent with normal glucose tolerance, matched on age, sex, and body mass index. Despite a ~50% lower insulin sensitivity index (Si) in insulin-resistant than in insulin-sensitive subjects, which was accompanied by significantly greater acute insulin response to glucose (AIRg) and fasting insulin concentration but not different fasting glucose concentration, there were no significant differences between groups in the blood lipid profile (p ≥ 0.44) or the lipoprotein subclass concentrations (p ≥ 0.30) and particle sizes (p ≥ 0.43). We conclude that, contrary to observations in subjects with obesity, insulin resistance is not accompanied by unfavorable changes in the plasma lipid profile and lipoprotein particle concentrations and sizes in lean Asians with normal glucose tolerance. Therefore, insulin resistance at the level of glucose metabolism is mechanistically or temporally dissociated from lipid and lipoprotein metabolism.

Trial Registration:clinicaltrials.gov, NCT03264001.

Optimal Threshold of Homeostasis Model Assessment of Insulin Resistance to Identify Metabolic Syndrome in a Chinese Population Aged 45 Years or Younger

BACKGROUND

Metabolic syndrome (MetS) is regarded as a major risk factor for diabetes mellitus and cardiovascular disease (CVD). The optimal threshold of the homeostasis model assessment of insulin resistance (HOMA-IR) has been established for predicting MetS in diverse populations and for different ages. This study assessed the serum HOMA-IR level in a healthy Chinese population aged ≤45 years to determine its relationship with metabolic abnormalities.

METHODS

Cross-sectional study data were collected from health checkup records of Chinese adults aged ≥18 years between 2013 and 2016 at Xiamen Chang Gung Hospital. Participants completed a standardized questionnaire, which was followed by a health examination and blood sample collection. Exclusion criteria were as follows: history of known CVDs; liver, kidney, or endocrine diseases or recent acute illness; hypertension; hyperlipidemia; and pregnancy or lactation.

RESULTS

The clinical and laboratory characteristics of 5954 men and 4185 women were analyzed. Significant differences were observed in all assessed variables (all P < 0.05). The optimal cutoff point of HOMA-IR for predicting MetS was 1.7 in men and 1.78 in women.

CONCLUSIONS

We aimed to determine the optimal cutoff point of HOMA-IR for predicting MetS in a healthy Chinese population aged ≤45 years. The findings of this study would provide an evidence-based threshold for evaluating metabolic syndromes and further implementing primary prevention programs, such as lifestyle changes in the target population.

Cardiometabolic Risk Factor in Obese and Normal Weight Individuals in Community Dwelling Men

The aim of this study was to investigate the cardiometabolic risk factors (CRFs) in community dwelling men based on a combination of body mass index (BMI) and waist circumference (WC). This cross-sectional study was based on 867 males between the ages of 20 and 71 years. Subjects were categorized into 4 groups by BMI and WC (Group 1, BMI < 25 kg/m2 and WC < 90 cm; Group 2, BMI < 25 kg/m2 and WC > 90 cm; Group 3, BMI > 25 kg/m2 and WC < 90 cm; and Group 4 BMI > 25 kg/m2 and WC > 90 cm). The proportion of subjects with a normal weight with high WC was 3.2%. Among normal weight men with the high range of WC, significantly high Odds ratios (ORs) and 95% CI were found for hypertriglyceridemia (3.8, 1.8-8.2) and high blood glucose (3.2, 1.5-6.9). The probability that the general obesity group (Group 3) had one CRF was around twice that of the reference group (Group 1) (1.9 to 2.1 times), but Group 2 had probability more than 4 times higher (4.3 to 4.6 times). In community dwelling adult men, normal weight with high waist circumference was associated with the highest cardiometabolic risk. In conclusion, follow-up screening of those with high WC may be necessary to detect and prevent cardiometabolic diseases, particularly for men with a normal weight.

Cardiorespiratory Fitness, Body Mass Index, and Markers of Insulin Resistance in Apparently Healthy Women and Men

BACKGROUND

Insulin resistance may be present in healthy adults and is associated with poor health outcomes. Obesity is a risk factor for insulin resistance, but most obese adults do not have insulin resistance. Fitness may be protective, but the association between fitness, weight, and insulin resistance has not been studied in a large population of healthy adults.

METHODS

A cross-sectional analysis of cardiorespiratory fitness, body mass index, and markers of insulin resistance was performed. Study participants were enrolled at the Cooper Clinic in Dallas, Texas. The analysis included 19,263 women and 48,433 men with no history of diabetes or cardiovascular disease. Cardiorespiratory fitness was measured using exercise treadmill testing. Impaired fasting glucose (100-125 mg/dL) and elevated fasting triglycerides (≥150 mg/dL) were used as a markers of insulin resistance.

RESULTS

Among individuals with normal weight, poor fitness was associated with 2.2-fold higher odds of insulin resistance in women (1.4-3.6; P = .001) and 2.8-fold higher odds in men (2.1-3.6; P <.001). The impact of fitness remained significant for overweight and obese individuals, with the highest risk group being the unfit obese. Among obese women, the odds ratio for insulin resistance was 11.0 for fit women (8.7-13.9; P <.001) and 20.3 for unfit women (15.5-26.5; P <.001). Among obese men, the odds ratio for insulin resistance was 7.4 for fit men (6.7-8.2; P < .001) and 12.9 for unfit men (11.4-14.6; P < .001).

CONCLUSIONS

Independent of weight, poor fitness is associated with risk of insulin resistance. Obese individuals, particularly women, may benefit from the greatest absolute risk reduction by achieving moderate fitness.

Metabolic Health, Obesity, and the Risk of Developing Open-Angle Glaucoma: Metabolically Healthy Obese Patients versus Metabolically Unhealthy but Normal Weight Patients

BACKGROUND

This study sought to investigate the associations between metabolic health status, obesity, and incidence of primary open-angle glaucoma (POAG).

METHODS

In this nationwide, population-based, longitudinal prospective cohort study conducted using the Korean National Health Insurance System, we categorized all subjects based on presence and severity of metabolic syndrome and obesity. Insurance claims data were used to identify POAG development. Then, Cox regression was applied to calculate the hazard of developing POAG in people with various components of metabolic syndrome, obesity, or their combination.

RESULTS

Of the total 287,553 subjects, 4,970 (1.3%) developed POAG. High fasting glucose, blood pressure, and total cholesterol levels were all associated with increased risk of developing POAG. Regarding obesity level, people with body mass index (BMI) greater than 30 kg/m² were more likely to develop POAG than those with normal BMI. Also, people with greater number of metabolic syndrome components showed a greater POAG incidence. People who are metabolically unhealthy and obese (adjusted hazard ratio [HR], 1.574; 95% confidence interval [CI], 1.449 to 1.711) and those who are metabolically unhealthy nonobese (MUNO: adjusted HR, 1.521; 95% CI, 1.405 to 1.645) but not those who are metabolically healthy obese (MHO: adjusted HR, 1.019; 95% CI, 0.907 to 1.144) had an increased hazard of developing POAG compared with metabolically healthy nonobese (MHNO) subjects.

CONCLUSION

Metabolic health status and obesity were significantly associated with increased risk of POAG incidence. MUNO subjects but not MHO subjects showed a higher risk of POAG development than did MHNO subjects, suggesting that metabolic status is more important than obesity in POAG.

Dietary intakes of flavonoids and carotenoids and the risk of developing an unhealthy metabolic phenotype

This study was designed to investigate prospective associations between dietary habitual intakes of flavonoids and carotenoids and the development of an unhealthy metabolic phenotype. In this study 1114 adults, who had a healthy metabolic phenotype in the third examination cycle (2005-2008) participated. Dietary intakes of flavonoids and carotenoids were estimated using valid food frequency questionnaires evaluated during the study. Joint Scientific Statement criteria were used to define a metabolic unhealthy phenotype as meeting at least two criteria. During a median follow-up of 5.4 years, one standard deviation increase in total flavonoids reduced the risk of developing an unhealthy phenotype by 50% (95% CIs: 0.42-0.59), and inverse associations were observed for individual classes except anthocyanins, being the strongest for flavan-3-ols. Among carotenoid classes, a significant inverse association was only observed between lutein + zeaxanthin (HRs: 0.87, 95% CIs: 0.77-0.98) and the occurrence of an unhealthy phenotype. When data were stratified by baseline BMI, total flavonoids and individual classes of flavan-3-ols, flavonols, and flavones among both normal weight and overweight/obese individuals, isoflavones in those with excess weight and anthocyanins in normal weight individuals were inversely associated with the development of an unhealthy phenotype. Total carotenoids, β-carotene and lutein + zeaxanthin were significantly associated with the lower likelihood of the occurrence of an unhealthy phenotype, only among normal weight individuals. Higher intakes of flavonoids and their individual classes may contribute to the lower risk of a metabolic unhealthy phenotype in both normal weight and overweight/obese adults. Flavonoids may have more favorable metabolic health effects than carotenoids.

Increased incidence of bladder cancer with metabolically unhealthy status: analysis from the National Health Checkup database in Korea

We assessed the association between metabolic health status and the incidence of bladder cancer using nationally representative data from the National Health Insurance System and National Health Checkups (NHC) databases in South Korea. Data for 11,781,768 men who participated in the NHC between 2009 and 2012 were analysed. The normal-weight and physically obese categories were defined as body mass indexes (BMI) < 25 and ≥25 kg/m², respectively. Metabolically obese was defined as the presence of ≥3 components of metabolic syndrome. The participants were stratified into metabolically healthy, normal-weight (MHNW); metabolically obese, normal-weight (MONW); metabolically healthy, obese (MHO); metabolically obese, obese (MOO). Multivariate-adjusted Cox regression analysis was conducted to examine the association between metabolic health status and the incidence of bladder cancer. The study participants included 17,777 men newly registered with bladder cancer. Analysis according to metabolic health status classification revealed a higher multivariable-adjusted hazard ratio in the MOO, MONW group than in the MHO group (1.307 [95% CI: 1.258–1.358], 1.183 [95% CI: 1.137–1.231] and 1.066 [95% CI: 1.017–1.119], respectively; hazard ratios given relative to MHNW group) We found an association between metabolic health status and the incidence of bladder cancer, with an increasing risk according to the number of metabolic health status components.

Prevalence and epidemiological determinants of metabolically obese but normal-weight in Chinese population

BACKGROUND

There is metabolic heterogeneity in normal-weight individuals, however, there has been limited research in the Chinese population. This study aimed to investigate the prevalence, distribution and epidemiological determinants of metabolically obese but normal-weight (MONW) in a Chinese population.

METHODS

A total of 17,876 normal-weight individuals were recruited from 37,815 individuals in Zhejiang province in southeastern China. Normal-weight was defined as a body mass index (BMI) of 18.5-23.9 kg/m2. Metabolically abnormal traits were assessed by metabolic syndrome criteria from the International Diabetes Federation (IDF) in 2015. MONW was defined as individuals who had at least two metabolically abnormal trait but normal weight. Multiple logistic regression was used to investigate MONW risk factors, adjusting for potential confounders.

RESULTS

The prevalence of metabolic abnormality was 34.1% in normal-weight individuals, and the overall prevalence of MONW was 16.1% in the general population. Different MONW distributions were found between men and women depending on age. Compared with women, men had a significantly higher MONW prevalence among those aged < 45 years old, and there was a lower prevalence for those aged ≥50 years old. Higher BMI or waist circumference (WC), central obesity, menopause, and family histories of hypertension, diabetes, and cardiovascular diseases, increased MONW risk. Higher education levels, regular alcohol drinking, and balanced or vegetarian food preferences reduced MONW risk.

CONCLUSIONS

Normal-weight individuals have metabolic heterogeneity in China. The MONW distribution between men and women depends on age. BMI, WC, dietary factors, and family history of chronic diseases, are associated with metabolic status.

Dietary determinants of unhealthy metabolic phenotype in normal weight and overweight/obese adults: results of a prospective study

We aimed to investigate associations of dietary intakes with unhealthy metabolic phenotype development, in normal weight and overweight/obese adults separately. A total of 1114 individuals, aged ≥19 years, with healthy phenotype in the third examination cycle of Tehran Lipid and Glucose Study were followed until the fifth examination. Dietary intakes were estimated using the food frequency questionnaires, collected during the study. The participants were grouped as normal weight and overweight/obese according to the baseline body mass index (BMI). Unhealthy metabolic status was determined as having more than one component of metabolic syndrome using the Joint Interim Statement. Regardless of BMI, higher intakes of magnesium, dairy products, poultry, apples/pears, citrus fruits, and tea/coffee decreased the risk of developing unhealthy phenotype, while higher intakes of fast foods, organ meats, and potatoes increased the risk. Food intake can influence the transition to unhealthy phenotype in metabolically healthy adults, irrespective of the BMI status.

Physiological and Lifestyle Traits of Metabolic Dysfunction in the Absence of Obesity

PURPOSE OF REVIEW

Individuals with metabolically unhealthy normal weight (MUNW) have an adverse cardiometabolic risk factor profile in the absence of excess body weight, and increased risk for diabetes and heart disease. We critically review some physiological traits and lifestyle characteristics of the MUNW phenotype.

RECENT FINDINGS

The prevalence of MUNW varies considerably around the world and among ethnicities, partly because of different definitions; on average, this phenotype affects about ~ 30% of normal weight persons globally. Most studies have recruited MUNW subjects who, although within the normal weight range, are significantly "more obese" than their metabolically healthy lean peers (greater body mass index or total body fat); hence one cannot ascertain whether observed differences are true traits of the MUNW phenotype of simply secondary to greater relative adiposity within the normal range. Carefully matched studies have indicated that MUNW can exist in the absence of excess total body fat. These subjects have a preferential accumulation of fat in the upper body (abdominal subcutaneous and visceral adipose tissues) and the liver, but not skeletal muscle; perhaps surprisingly, this predominantly "android" fat distribution does not translate into increased waist circumference. The MUNW phenotype is associated with lower aerobic fitness and muscle mass and strength, but whether this is simply due to inadequate regular physical activity is not entirely clear. Likewise, no consistent associations have been found between any dietary factors and the development of MUNW phenotype, but diet-induced modest weight loss facilitates its resolution. Delineating the mechanisms leading to metabolic dysfunction in the absence of increased body weight and body fat will likely reveal important targets for improving metabolic health and eventually for reducing the burden of cardiometabolic disease, not only in individuals with normal body weight but also in people with obesity.

Relationship of age at menarche and serum leptin with the metabolically unhealthy phenotype in adolescents

Introduction

Objective: to analyze the relationship of age at menarche and leptin with the metabolically healthy (MH) and metabolically unhealthy (MUH) phenotypes in adolescent girls in different body mass index (BMI) categories. Method: an observational and cross-sectional study consisting of 139 female adolescents attended to at the Adolescent Reference Center in Macaé, Rio de Janeiro. Menarche was classified as early (EM) when the first menstruation occurred at or before 11 years of age; normal menarche (NM) was categorized at ages 12 to 14; menarche was considered late (LM) when it occurred at age 15 or older. The factors required to ascertain the subjects' phenotype, as well as their leptin levels, weight, and height, were measured and their BMIs were calculated. The girls were classified as MH or MUH based on the NCEP-ATP III criteria as adapted for children and adolescents. Results: 82 % (n = 114) of the girls were classified as MH and 18 % (n = 25) as MUH. Mean age at menarche was 11.79 ± 1.39 years. There was a higher prevalence of MUH amongst the girls who had EM (p = 0.04). A higher inadequacy of serum leptin concentrations was found in girls who had EM (p = 0.05) and in those classified as MUH (p = 0.01). The adolescents who were severely obese exhibited inadequate leptin levels (p < 0.01) and had gone through EM (p = 0.02). A total of 8.1 % (n = 7) of the normal-weight girls were classified as MUH, and 29.4 % (n = 5) of those who were severely obese were classified as MH (p < 0.01). Conclusion: early menarche and high serum leptin concentrations are related with the MUH phenotype in adolescent girls in different BMI categories.

Prevalence of Metabolic Syndrome in Iranian Hemodialysis Patients: A Systematic Review and Meta-analysis

Introduction: Metabolic syndrome as one of the risk factors for cardiovascular diseases has recently been the focus of clinical studies. This study was conducted to determine the prevalence of metabolic syndrome in hemodialysis patients in Iran. Methods: The present systematic review was done using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Case-control, cohort and crosssectional studies conducted in Iran were included. Clinical trials, case reports, letters to editors, systematic reviews, study protocols, narrative reviews, and case series were excluded. Subgroup analysis was conducted for determining the heterogeneity based on the participants as well as their gender. Meta-analysis was conducted using STATA version 14.0. Results: The prevalence of metabolic syndrome among 799 patients was 50% (95% CI: 47.0, 53.0, I2=50.6). The analysis of subgroups was conducted for determining the heterogeneity based on the participants as well as their gender. Based on the analysis of the subgroups using a random effects model, the prevalence of metabolic syndrome was found to be 44% and 55% in Iranian men and women undergoing hemodialysis, respectively. Conclusion: Given the high prevalence of metabolic syndrome in hemodialysis patients, it is advisable and logical that patients with chronic renal failure should be regularly evaluated for metabolic syndrome and cardiovascular risk factors both at the diagnosis time and afterwards.

Differential glucose metabolism in weight restored women with anorexia nervosa

Women with anorexia nervosa (AN) develop visceral adiposity associated with insulin resistance after partial weight restoration, but little is known about the glucose homeostasis after full weight restoration. In this investigation, we studied glucose homeostasis in twenty-four women with AN before (AN) and after weight restoration (WR) at a single institution, with both restricting and binge-purge subtypes (>70% binge-purge), compared to gender-, age- and BMI-matched healthy controls (HC). Participants underwent fasting plasma hormone analysis, oral glucose tolerance test (OGTT), and body composition analysis. Glucose homeostasis was assessed by the homeostasis model assessment (HOMA) and OGTT, and parameters were analyzed for association with body composition. We observed that a subset of the WR patients (21%) had metabolically unhealthy HOMA insulin resistance estimates (HOMA-IR), while this was not seen in the control group. Overall mean HOMA-IR between groups were not significantly different. Mean glucose reactivity was higher in the WR group than HC women (p = 0.008, Hedges' g = 0.811), and time-adjusted glucose reactivity in the WR group was inversely associated with visceral adiposity (r = -0.559, p = 0.006), but not with fat mass (r = -273, p = 0.208) or lean mass (r = -0.002, p = 0.994). Our findings suggest that glucose response during the OGTT in women with AN is altered in association with visceral adiposity acutely after full weight restoration, but that they do not develop overt insulin resistance. Glucometabolic profiling could offer novel insights to energy homeostasis acutely after weight restoration.

Association between metabolic body composition status and risk for impaired renal function: A cross-sectional study

BACKGROUND

The risk for obesity-related disorders is proportional to the visceral region and had been observed to be highly related with impaired renal function. In the current study, we aimed to evaluate renal function impairment, according to sex, age, and different status of metabolic body composition.

METHODS

We retrospectively collected from the medical records the basic information and metabolic titers of Chinese adults (13,373 men and 10,175 women) who underwent health checkup from 2013 to 2016. The population was divided into four groups, according to metabolic body composition, including metabolic healthy norms-weight (MHNW), metabolic healthy obesity (MHO), metabolic unhealthy norms-weight (MUNW), and metabolic unhealthy obesity (MUO). The categorical data were compared among the groups and logistic regression analyses were conducted to investigate the association between metabolic body composition status and risk for renal function impairment.

RESULTS

Across all ages in both sexes, the odds ratios (OR) for renal function impairment were higher in the MHO, MUNW, and MUO groups than in the MHNW group, except for women <45 years old in the MUNW group. However, after adjustment, the trend was no longer significant in all groups under 45 years old. For individuals >45 years old, the relatively high risk for renal function impairment remained significantly associated with the MUNW group (OR 2.95, 95% CI 2.02-4.30 in men and OR 1.95, 95% CI 1.35-2.82 in women) and MUO group (OR 2.33, 95% CI 1.82-3.00 in men and OR 2.67, 95% CI 2.04-3.48 in women).

CONCLUSION

Impaired renal function was independently associated with the status of metabolic obesity. However, the trend was only observed in individuals >45 years old, with significant sex difference.

Determinants of new onset cardiometabolic risk among normal weight children

OBJECTIVE

To identify determinants for the development of "normal weight metabolically unhealthy" (NWMU) profiles among previously metabolically healthy normal weight children.

METHODS

The QUALITY cohort comprises youth 8-10 years of age with a parental history of obesity (n = 630). Of these, normal weight children with no metabolic risk factors were identified and followed up 2 years later (n = 193). Children were classified as NWMU if they remained normal weight but developed at least one cardiometabolic risk factor. They were classified as normal weight metabolically healthy otherwise. Multivariable logistic regression models were used to identify whether adiposity (anthropometrics and DXA), lifestyle habits (physical activity, screen time, vegetables, and fruit- and sugar-sweetened beverages intake), fitness, and family history of cardiometabolic disease were associated with new onset NWMU.

RESULTS

Of the 193 normal weight and metabolically healthy children at baseline, 45 (23%) became NWMU 2 years later (i.e., 48% had elevated HDL cholesterol, 13% had elevated triglycerides, and 4% had impaired fasting glucose). Changes in adiposity between baseline and follow-up were associated with an increased risk of NWMU for all adiposity measures examined (e.g., for ∆zBMI OR = 3.95; 95% CI: 1.76, 8.83). Similarly, a 2-year change in screen time was associated with incident NWMU status (OR = 1.24; 95% CI 1.04, 1.49).

CONCLUSIONS

Children who increase their adiposity levels as they enter puberty, despite remaining normal weight, are at risk of developing cardiometabolic risk factors. Studies examining long-term consequences of NWMU profiles in pediatrics are needed to determine whether changes in screening practice are warranted.

Fasting triglycerides and glucose index is more suitable for the identification of metabolically unhealthy individuals in the Chinese adult population: A nationwide study

AIMS/INTRODUCTION

Metabolic unhealth can be defined by the components of metabolic syndrome, which is closely connected to insulin resistance. We aimed to determine a simple index to identify metabolic unhealth in the Chinese adult population.

MATERIALS AND METHODS

A total of 30,291 individuals were screened from the China National Diabetes and Metabolic Disorders Study carried out from June 2007 to May 2008. Metabolic unhealth was defined using components of metabolic syndrome, except waist circumference. We compared the three surrogate indices of insulin resistance: the product of fasting triglycerides and glucose (TyG), triglycerides divided by high-density lipoprotein cholesterol and the metabolic score for insulin resistance for the evaluation of metabolic status.

RESULTS

All indices had high sensitivity and specificity for the identification of metabolic unhealth, especially the TyG index with an area under the curve of 0.863 for men and 0.867 for women. Participants were divided into subgroups for further analysis. The TyG index also showed high diagnostic values, especially for younger individuals and men with normal waist circumference. Sex-specific cut-offs for three indices were also used to define metabolic unhealth. The TyG index showed the highest agreement with κ values of 0.603 and 0.605 for men and women between the components of metabolic syndrome and three indices.

CONCLUSIONS

We propose that the TyG index, just read in one blood laboratory test report, is simpler and more suitable for the identification of metabolically unhealthy individuals as well as who have high risk of cardiometabolic diseases of the Chinese adult population.

STRONG-D: Strength training regimen for normal weight diabetics: Rationale and design

BACKGROUND

Currently, there is a lack of data on effective lifestyle recommendations for normal-weight diabetics (NWD), who can represent up to 1 in 5 individuals with Type II Diabetes Mellitus (T2DM). NWD is especially prevalent in Asian populations and the elderly. Specific exercise treatment recommendations are needed for patients with normal-weight diabetes (NWD), as those in this category face higher mortality rates than overweight and obese diabetics. Standard T2DM treatment recommends aerobic training; however, performing aerobic training alone may not be appropriate for NWD and strength training may be a more effective treatment recommendation.

OBJECTIVE

While it is known that strength and aerobic training are beneficial in obese diabetics, there is currently insufficient evidence to recommend this regimen in NWD. The Strength Training Regimen for Normal Weight Diabetics (STRONG-D) study aims to determine the best exercise regimen for NWD and address the current lack of appropriate physical activity recommendations for this population. The primary goal of this study is to determine whether strength training aids glycemic control better than aerobic training in NWD.

STUDY DESIGN

STRONG-D is a three-arm randomized controlled trial designed to compare the clinical effectiveness of structured strength training only, aerobic training only, and combination (strength + aerobic) training sessions, modeled after the intervention in the Health Benefits of Aerobic and Resistance Training in T2DM patients (HART-D) study. Potential participants meeting eligibility criteria of HbA1c values of 6.5% to 13.0% and BMI of 18.5 kg/m2 to 25 kg/m2 will be enrolled. After randomization, participants will begin a 9-month exercise intervention. The primary outcomes will be HbA1c levels. The secondary endpoints will include physical fitness, body composition measured by Dual X-Ray Absorptiometry (DXA) scans, and leg strength and endurance measured by Biodex testing. Initial follow-up visits will occur at 3 months, 6 months, and 9 months. To determine the long-term effects of the exercise intervention, passive follow-up will continue via electronic health records (EHR) until a 24-month follow-up visit. A total of 282 participants will be randomized into the three study arms determine the clinically significant differences between strength-only, aerobic-only and combination regimens.

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

BACKGROUND

We assessed the association between metabolic health status and incidence of prostate cancer using the National Health Check-ups (NHC) database of Korea.

METHODS

A total of 11,771,252 men who participated in the NHC between 2009 and 2012 and 56,552 men who were newly diagnosed with prostate cancer were analyzed. Normal-weight and obesity were defined as body mass index (BMI) < 25 kg/m² and ≥ 25 kg/m², respectively. Metabolic obesity was defined as the presence ≥ 3 components of the metabolic syndrome. Participants were stratified into 4 groups: metabolically healthy, normal-weight; metabolically obese, normal-weight (MONW); metabolically healthy, obese (MHO); and metabolically obese, obese. Multivariate Cox regression analysis was performed to examine the relationship between metabolic health status and incidence of prostate cancer.

RESULTS

During a mean 5.4 ± 1.1 years of follow-up, 56,552 patients were registered with a diagnosis of prostate cancer. When analyzed according to metabolic health status classification, the multivariable-adjusted hazard ratio (HR) was 1.143 for the MONW group, 1.097 for the MHO group, showing the HR for the MONW group was higher than that for the MHO group. As the number of metabolic syndrome components increased, HR increased significantly. When stratified based on BMI, metabolically obese patients showed significantly higher HR than metabolically healthy patients in all BMI groups.

CONCLUSION

This population-based nationwide study revealed an association between metabolic health status and the incidence of prostate cancer, and the risk increased according to the number of components of the metabolic syndrome.

The relationship between occupational stress, health status, and temporary and permanent work disability among security guards in Serbia

Purpose. This study aimed to examine the influence of occupational stress on health status and work disability among security guards in Serbia. Methods. Three hundred and ninty nine male security guards (aged 25-65 years) were examined during regular medical preventive check-ups at the Institute of Occupational Health. Data on their health status and permanent and temporary work disability were obtained, and correlations with the levels of occupational stress (measured by occupational stress index [OSI] questionnaire) were analysed. Results. A high prevalence of health impairments, including diabetes (38.8%), dyslipidaemia (82.7%), hypertension (69.9%) and metabolic syndrome (77.7%), was found. Highly significant correlations were shown between reported levels of total stress at work (total OSI score) and measured values of glucose, lipids, blood pressure, heart rate, Framingham cardiovascular risk scale, occurrence of diabetes and impaired fasting glucose, dyslipidaemia, hypertension, metabolic syndrome, coronary heart disease, cerebrovascular insults, degenerative eye-fundus changes, and temporary and permanent work disability. All of these correlations remained significant even after adjustments for age, body mass index and smoking status. Regression analysis confirmed the independent effect of occupational stress on the analysed parameters. Conclusions. There is a significant independent impact of occupational stress on development of health impairments and work disability among security guards.

Predictors of nonalcoholic steatohepatitis and significant fibrosis in non-obese nonalcoholic fatty liver disease

AIMS

We compared (a) demographic and clinical characteristics and (b) determinants of nonalcoholic steatohepatitis and significant fibrosis in non-obese and obese nonalcoholic fatty liver disease.

METHODS

A cross-sectional study of 664 Asian subjects (mean age 53.1 years; men 50.3%) with biopsy-proven nonalcoholic fatty liver disease and controls was conducted. Subjects were divided by their body mass index into obese (body mass index ≥25 kg/m2 ) and non-obese (body mass index <25 kg/m2 ).

RESULTS

Observations in subjects with non-obese nonalcoholic fatty liver disease were in between non-obese controls and subjects with obese nonalcoholic fatty liver disease for body mass index, sagittal abdominal diameter, aminotransferase levels, insulin resistance and abdominal visceral adipose tissue area. There was no significant difference in histology between non-obese and obese subjects with nonalcoholic fatty liver disease except for lower grade of hepatic steatosis in nonobese nonalcoholic fatty liver disease and higher severity of hepatic fibrosis in nonobese nonalcoholic steatohepatitis. Predictors of nonalcoholic steatohepatitis in nonobese subjects included females (odds ratio 2.49), higher alanine aminotransferase (odds ratio 1.03), lower high-density lipoprotein cholesterol (odds ratio 0.96), higher prevalence of diabetes (odds ratio 3.65) and higher visceral adipose tissue area (odds ratio 1.63 per standard deviation increase of visceral adipose tissue area) while age (odds ratio 1.04), higher aspartate aminotransferase (odds ratio 1.02), diabetes (odds ratio 2.76) and higher visceral adipose tissue area (odds ratio 1.57 per standard deviation increase) were associated with significant fibrosis in the non-obese. Sagittal abdominal diameter was independently associated with nonalcoholic steatohepatitis or significant fibrosis among subjects with non-obese nonalcoholic fatty liver disease.

CONCLUSION

While there were a few phenotypic differences from obese subjects, non-obese subjects with nonalcoholic fatty liver disease displayed a similar severity of histological liver damage. Potential factor(s) beyond obesity may play a role as non-obese nonalcoholic fatty liver disease advances to more severe disease.

Metabolic health is more closely associated with decrease in lung function than obesity

Objective

Previous studies have evaluated the link between metabolic syndrome and obesity with impaired lung function, however findings have been controversial. We aimed to compare lung function among subjects with different metabolic health and obesity status.

Methods

Total 10,071 participants were evaluated at the Health Promotion Center in Seoul St. Mary’s Hospital between January 2012 and December 2014. Being metabolically healthy was defined as having fewer than three of the following risk factors: high blood pressure, high fasting blood glucose, high triglyceride, low high-density lipoprotein cholesterol and abdominal obesity. Obesity status was defined as body mass index (BMI) higher than 25 kg/m². Analyses of pulmonary function were performed in four groups divided according to metabolic health and obesity: metabolically healthy non-obese (MHNO), metabolically health obese (MHO), metabolically unhealthy non-obese (MUHNO), and metabolically unhealthy obese (MUHO).

Results

Metabolically unhealthy subjects were more prone to decreased lung function compared with their metabolically healthy counterparts, regardless of obesity status. When multinomial logistic regression analysis was performed according to quartiles of forced vital capacity (FVC) or forced expiratory volume in 1 second (FEV₁) (% pred), after adjusting for age, sex, and smoking status, odds ratio (OR) for the lowest FVC and FEV₁ (% pred) quartiles were significantly higher in MUHO subjects (1.788 [95% CI, 1.531–2.089] and 1.603 [95% CI, 1.367–1.881]) and lower in MHO subjects (0.768 [95% CI, 0.654–0.902] and 0.826 [95% CI, 0.700–0.976]) with MHNO group as the reference, when OR for highest FVC and FEV₁ quartiles were considered as 1.0

Conclusion

Metabolic health is more closely associated with impaired lung function than obesity.

Genes that make you fat, but keep you healthy

Obesity prevalence continues to rise worldwide, posing a substantial burden on people's health. However, up to 45% of obese individuals do not suffer from cardiometabolic complications, also called the metabolically healthy obese (MHO). Concurrently, up to 30% of normal-weight individuals demonstrate cardiometabolic risk factors that are generally observed in obese individuals, the metabolically obese normal weight (MONW). Besides lifestyle, environmental factors and demographic factors, innate biological mechanisms are known to contribute to the aetiology of the MHO and MONW phenotypes, as well. Experimental studies in animal models have shown that adipose tissue expandability, fat distribution, adipogenesis, adipose tissue vascularization, inflammation and fibrosis, and mitochondrial function are the main mechanisms that uncouple adiposity from its cardiometabolic comorbidities. We reviewed current genetic association studies to expand insights into the biology of MHO/MONW phenotypes. At least four genetic loci were identified through genome-wide association studies for body fat percentage (BF%) of which the BF%-increasing allele was associated with a protective effect on glycemic and lipid outcomes. For some, this association was mediated through favourable effects on body fat distribution. Other studies that characterized the genetic susceptibility of insulin resistance found that a higher susceptibility was associated with lower overall adiposity due to less fat accumulation at hips and legs, suggesting that an impaired capacity to store fat subcutaneously or a preferential storage in the intra-abdominal cavity may be metabolically harmful. Clearly, more work remains to be done in this field, first through gene discovery and subsequently through functional follow-up of identified genes.

Regulation of glucose metabolism in nondiabetic, metabolically obese normal-weight Asians

Type 2 diabetes in Asia occurs largely in the absence of obesity. The metabolically obese normal-weight (MONW) phenotype refers to lean subjects with metabolic dysfunction that is typically observed in people with obesity and is associated with increased risk for diabetes. Previous studies evaluated MONW subjects who had greater body mass index (BMI) or total body fat than respective control groups, making interpretation of the results difficult. We evaluated insulin sensitivity (hyperinsulinemic-euglycemic clamp); insulin secretion (mixed meal with oral minimal modeling); intra-abdominal, muscle, and liver fat contents (magnetic resonance); and fasting and postprandial glucose and insulin concentrations in 18 MONW subjects and 18 metabolically healthy controls matched for age (43 ± 3 and 40 ± 3 yr; P = 0.52), BMI (both 22 ± 1 kg/m²; P = 0.69), total body fat (17 ± 1 and 16 ± 1 kg; P = 0.33), and sex (9 men and 9 women in each group). Compared with controls, MONW subjects had an approximately twofold greater visceral adipose tissue volume and an approximately fourfold greater intrahepatic fat content (but similar muscle fat), 20-30% lower glucose disposal rates and insulin sensitivity, and 30-40% greater insulin secretion rates (all P < 0.05). The disposition index, fasting glucose, and HbA1c concentrations were not different between groups, whereas postprandial glucose and insulin concentrations were ~15% and ~65% greater, respectively, in MONW than control subjects (both P < 0.05). We conclude that the MONW phenotype is associated with accumulation of fat in the intra-abdominal area and the liver, profound insulin resistance, but also a robust β-cell insulin secretion response that compensates for insulin resistance and helps maintain glucose homeostasis.

Nonalcoholic Fatty Liver Disease and Metabolic Syndrome

Nonalcoholic fatty liver disease (NAFLD) and metabolic syndrome (MS) are highly prevalent, affecting approximately one-third of the US population. The relationship between NAFLD and MS is complex and may be bidirectionally associated. NAFLD is strongly associated with MS, the components of which include abdominal obesity, hyperglycemia, hypertension, and dyslipidemia. NAFLD associated with certain genetic factors such as the PNPLA3 G allele variant is not accompanied by insulin resistance and MS. Lifestyle modification, including diet and physical activity targeting visceral adiposity, remains the standard of care for patients with NAFLD and MS.

Obesity phenotypes and their paradoxical association with cardiovascular diseases

The pro-inflammatory state of the visceral adipose tissue (VAT) is supposed to accelerate cardiovascular (CV) and metabolic diseases in obese subjects. Some studies have recently reported an improved CV prognosis in certain obese and overweight patients as compared with leaner ones. This phenomenon, known as the "obesity paradox" (OP), has been described in many chronic diseases. This narrative review is based on the material searched for and obtained via PubMed and Web of Science up to May 2017. The search terms we used were: "obesity, paradox, adipose tissue" in combination with "cardiovascular, coronary heart disease, heart failure, arrhythmias". Using the current Body Mass Index (BMI)-based obesity definition, individuals with different clinical and biochemical characteristics are gathered together in the same category. Emerging evidence point to the existence of many "Obesity phenotypes" with different association with CV risk, accordingly to physical and life-style features. In this narrative review, we discussed if obesity phenotypes may be associated with a different CV risk, potentially explaining the OP. As a globally accepted definition of obesity is still lacking, we emphasized the need of a new approach, which should consider the heterogeneity of obesity. Better defining "obesities" and related CV risk is critical to markedly improve the classical BMI-based definition of obesity.

Prevalence of the Metabolic Syndrome in Hemodialysis

Background

Recently, the concept of the metabolic syndrome (MS) has emerged in an effort to group and study as a whole several cardiovascular risk factors. The definition of the metabolic syndrome requires the presence of 3 or more of the following parameters: high blood pressure (≥30/85), waist circumference >102 cm in men and >88 cm in women, HDL<50 mg/dL in men and <40 mg/dL in women, serum triglycerides >150 mg/dL and fasting blood glucose ≥110 mg/dL. Objectives: To investigate the prevalence of the MS and the specific patient characteristics in a cohort of hemodialysis patients.

Mterials and Methods

102 stable patients on maintenance hemodialysis (63 male/39 female with a mean time on dialysis of 57.19 ± 47.16 months) were studied for 12 months.

Results

The prevalence of the MS is high (56.25%) during the first year on dialysis and gradually declines (44.8% from 2–5 years and 29.7% for >5 years). In total 41/102 patients had MS (40.19%); 28/41 were men (68.29%) and 13/41 women (31.7%). The prevalence of MS in males was 44.4% (28/63) and 33.3% (13/39) in females, while the most frequent combination of risk factors in MS patients was high blood pressure-high waist circumference-high levels of serum triglycerides (36.58%). Serum triglycerides >150 mg/dL is the most frequent component of the MS both in well-nourished patients and according to the duration of dialysis (58.53% for 0–5 years and 19.51% for >5 years on dialysis). MS patients had a better nutritional status and were on dialysis for less time than their non-MS (NMS) counterparts. Actual or anamnestic cardiovascular events and infections did not differ between the 2 groups.

Conclusions

Our study provides new data concerning the prevalence of the MS and the specific patient characteristics in a hemodialysis population. The prevalence of MS in hemodialysis patients is high (40.19%) and seems to reflect a state of good nutrition compared to patients without the MS. Furthermore, the MS is more common in the first years of dialysis (42.46±34.29 months) than later on (67.25±52.15 months) probably reflecting the long term consequences of the hemodialysis treatment. Our results also indicate that although patients in the MS group were well-nourished and for a shorter time on dialysis, they were not protected from cardiovascular disease and infections. Our study provides new data concerning both the prevalence of the MS and a variety of patient characteristics in a hemodialysis population. Further research and a larger number of patients are required in order to clarify the precise role of this syndrome in patients on MHD.

Evidence of genetic predisposition for metabolically healthy obesity and metabolically obese normal weight

Obesity has evolved into a global pandemic that constitutes a major threat to public health. The majority of obesity-related health care costs are due to cardiometabolic complications, such as insulin resistance, dyslipidemia, and hypertension, which are risk factors for Type 2 diabetes and cardiovascular disease. However, many obese individuals, often called metabolically healthy obese (MHO), seem to be protected from these cardiometabolic complications. Conversely, there is a group of individuals who suffer from cardiometabolic complications despite being of normal weight; a condition termed metabolically obese normal weight (MONW). Recent large-scale genomic studies have provided evidence that a number of genetic variants show an association with increased adiposity but a favorable cardiometabolic profile, an indicator for the genetic basis of the MHO and MONW phenotypes. Many of these loci are located in or near genes that implicate pathways involved in adipogenesis, fat distribution, insulin signaling, and insulin resistance. It has been suggested that a threshold for subcutaneous adipose tissue expandability may be at play in the manifestation of MHO and MONW, where expiry of adipose tissue storage capacity could lead to ectopic lipid accumulation in non-adipose tissues such as liver, muscle, heart, and pancreatic beta cells. Understanding the genetic aspects of the mechanisms that underpin MHO and MONW is crucial to define appropriate public health action points and to develop effective intervention measures.

Normal weight obesity among young adults in Trinidad and Tobago: prevalence and associated factors

BACKGROUND

Patients with normal weight obesity (NWO) have a normal body mass index (BMI) but elevated body fat percentage (BF%), thereby increasing their risk of cardiovascular and metabolic disorders. The purpose of this research was to determine the prevalence of NWO and its associated factors in a sample of young adults in Trinidad and Tobago (T&T).

METHODS

A cross sectional study involving a convenience non-voluntary sample of participants with a normal BMI of 18.5-24.9 kg/m2 was conducted. The following information was collected: history, basic anthropometric measurements, including BF% via the Tanita Ironman Body Composition Analyzer (BC554), physical examination and basic blood investigations. Participants were divided into two groups; normal BF% (<23.1% males, <33.3% females) and elevated BF% (≥23.1% males, ≥33.3% females).

RESULTS

Two hundred and thirty-six students participated, F:M (2.1:1), aged 18-28 years [Mean 21.33 (SD 2.5)], mean BMI 21.66 (SD 1.9). A response rate of 80.3%. The prevalence of NWO for this population was 19.9% [95% confidence interval (CI) 15.1-25.7]. Males 14.4% (95% CI 10.3-19.7) and females 5.5% (95% CI 3.1-9.5). Variables with a statistically significant association with NWO included gender, waist circumference, waist-to-hip ratio (WHR), systolic blood pressure (BP), the ratio of total cholesterol (TC) to high density lipoprotein and in females, the presence of polycystic ovarian syndrome (PCOS) (p<0.05). Binary logistic regression revealed that predictors of NWO were male gender and waist circumference.

CONCLUSIONS

One in five of this young adult population was found to have NWO. Long-term studies are recommended to study the full implications of these findings.