Factors of Obesity and Metabolically Healthy Obesity in Asia

Temporal trends in obesity and its prognostic impact in Korean patients with inflammatory bowel disease

BACKGROUND

To assess the changes in body mass index (BMI) among Korean patients with inflammatory bowel disease (IBD) over a 14-year period and to explore how BMI at diagnosis impacts prognosis.

METHODS

We retrospectively collected BMI and laboratory data from patients with IBD who visited the Asan Medical Center between 2008 and 2021 (Cohort 1). Clinical outcomes, including intestinal resection and medication use, were analyzed in patients with a recorded BMI at diagnosis who were followed up in a prospectively maintained cohort (Cohort 2).

RESULTS

Among 11,216 IBD patients (Cohort 1), the median BMI increased over the study period, and the disparity in the prevalence of obese individuals (BMI ≥ 25 kg/m2) between those with IBD and the general population narrowed. Serum glucose and lipid profiles showed an upward trend during the study period. In patients with recorded BMI at the time of diagnosis (Cohort 2), the odds of intestinal resection and the use of biologics/small molecules were comparable or even lower in Crohn's disease (CD) and ulcerative colitis patients who were obese compared to patients with a normal BMI. Obesity (≥ 25 kg/m2) was inversely associated with the risk of thiopurine use in CD patients (adjusted hazard ratio: 0.61, 95% confidence interval: 0.48-0.78, p < 0.001).

CONCLUSIONS

During a 14-year period, Korean IBD patients showed increasing trends in the prevalence of obese individuals and metabolic syndrome-associated laboratory results. CD patients with high BMI at diagnosis exhibited a similar or lower likelihood of undergoing intestinal resection and medication use compared to those with a normal BMI.

Association Between Abdominal Obesity, Body Mass Index, and Hypertension in India: Evidence From a Large Nationally Representative Data

Hypertension prevalence is rising among individuals with abdominal obesity in Southeast Asia, including India, but the relationship between abdominal obesity, body mass index (BMI), and hypertension remains underexplored. This study examines the association between these factors in a nationally representative Indian population aged 20-54 years (males: N = 78 832; females: N = 559 059). We analyzed data from the National Family Health Survey 2019-21 (NFHS-5). Hypertension was defined as a systolic blood pressure (SBP) ≥ 140 mm Hg, diastolic blood pressure (DBP) ≥ 90 mm Hg, or use of blood pressure-lowering medication. Abdominal obesity was defined by waist-hip ratio (>0.90 for men, >0.85 for women). BMI categories were underweight (<18.5 kg/m2), normal (18.5-<25.0 kg/m2), overweight (25.0-<30.0 kg/m2), and obese (≥30.0 kg/m2). Multivariable logistic regression adjusted for demographic and lifestyle factors was used to assess the link between BMI, abdominal obesity, and hypertension. Individuals with both obesity and abdominal obesity had significantly higher odds of hypertension, with males having 3.3 times (95% confidence interval [CI]: 2.9-3.7) and females 2.8 times (95% CI: 2.6-2.9) odds compared to those with normal BMI and no abdominal obesity. Both genders showed increased SBP and DBP by 3.0-5.0 mm Hg when abdominal obesity was present, regardless of BMI. Indian health programs should emphasize the risks of high BMI and abdominal obesity to reduce hypertension.

The association between vitamin D deficiency and childhood obesity and its impact on children's serum calcium, alkaline phosphatase, and bone age

OBJECTIVE

The research aimed to investigate the Association between Vitamin D deficiency and childhood obesity and its Impact on children's serum calcium, alkaline Phosphatase, and bone Age.

METHODS

The study analyzed clinical data from 159 school-aged children who underwent medical examinations. The children were divided into a 25-(OH)D3 deficiency group and a non-25-(OH)D3 deficiency group based on their serum 25-hydroxy Vitamin D3 levels. The two groups were compared regarding BMI, TC, TG, FBG, HbA1c, Ca, ALP, and bone age differences.

RESULTS

Individuals with a deficiency in 25-(OH)D3 exhibited higher levels of BMI, TC, TG, and ALP, and lower levels of Ca and bone age than those without the deficiency. These differences were statistically significant (P<0.05). Further analysis revealed a negative association between 25-(OH)D3 levelsa positive correlation between Ca and bone age, and a positive correlation with, BMI, TC, TG, and ALP.

CONCLUSION

The deficiency of 25-(OH)D3 in school-aged children is linked to obesity and impacts bone growth. Monitoring vitamin D levels is crucial for clinical practitioners.

Association of dietary insulin index (DII) and dietary insulin load (DIL) with circadian rhythm and quality of sleep among overweight and obese women: a cross-sectional study

BACKGROUND

Obesity is a global issue, with over 1.9 billion adults overweight. Disruption of circadian rhythms (CR) leads to obesity and metabolic disorders. Dietary nutrition significantly impacts sleep disorders and disruption in CR, influencing hormones and inflammation, which can contribute to insomnia. The dietary insulin index (DII) and dietary insulin load (DIL) are important factors in determining sleep quality. The current study aims to investigate the association between DII and DIL with CR and sleep quality among with overweight and obesity women.

METHODS

A case-control study involved 280 overweight/obese women aged 25-40 from Tehran University Medical Science. They were assessed for dietary intake, physical activity, and sleep using validated questionnaires. The study also assessed body composition, bioelectrical impedance analysis, biochemical components, anthropometric components, and blood pressure. Socio-demographic and lifestyle characteristics, such as age, educational level, physical activity, and smoking habits, were also assessed through questionnaires.

RESULT

In the crude and adjustment models, high adherence of DII compared with lower adherence increased the odds of poor sleep quality index among participants. This significant association remained even after adjustment for confounding variables (P < 0.05), such that the odds of poor sleep quality index was 1.92 times higher.

CONCLUSION

This study showed high adherence to DII and DIL may cause CR disruption. Furthermore, higher adherence to DII lead to poor sleep quality in women.

Analyzing the infertility burden of polycystic ovarian syndrome in China: A comprehensive age-period-cohort analysis with future burden prediction (1990-2030)

OBJECTIVE

Polycystic ovarian syndrome (PCOS) is a common but complex endocrine disorder widely linked to infertility and miscarriage. This study assessed the correlation between PCOS and infertility.

METHODS

Using the latest data from the Global Burden of Disease 2019 database, we conducted an in-depth assessment of the disease burden attributed to PCOS in China. This analysis was performed using the joinpoint regression, age-period-cohort, and autoregressive integrated moving average (ARIMA) models.

RESULTS

Between 1990-2019, an upward trend was observed in the age-standardized prevalence of PCOS-related female infertility in China. Joinpoint regression analysis revealed an increasing trend in the age-standardized prevalence of PCOS-related female infertility burden indicators as well as the average annual percentage change and annual percentage change across all age groups in China. In terms of the cohort effect, the period rate ratios associated with the age-standardized prevalence of PCOS-related infertility increased steadily over time. The ARIMA model predicted a relatively swift upward trend in the age-standardized prevalence of PCOS-related infertility in China from 2020-2030.

CONCLUSION

The age-standardized prevalence of PCOS-related female infertility in China has increased between 1990-2019. The ARIMA model predicted that the age-standardized prevalence of this disease may continue to increase over the next decade. This study can increase the public's attention, improve women's health awareness, and have a certain significance for reducing female infertility related to PCOS.

The association of vitamin D insufficiency with the prevalence of obesity in children: implications for serum calcium levels, alkaline phosphatase activity, and bone maturation

Background

Vitamin D deficiency has been identified as a potential risk factor for various adverse health outcomes. However, its specific role in metabolic regulation and skeletal development in school-aged children is not fully understood. This study aimed to explore the correlation between vitamin D deficiency and childhood obesity rates, and its impact on serum calcium, alkaline phosphatase, and bone age in children.

Methods

The study analyzed clinical data from 159 school-aged children who underwent medical examinations. Participants were divided into the 25-hydroxyvitamin D3 (25(OH)D3) deficiency group and the 25(OH)D3 normal group based on their serum levels. We compared body mass index (BMI), total cholesterol (TC), triglycerides (TG), Ca, ALP, bone age, fasting blood glucose (FBG), and hemoglobin A1c (HbA1c) between the two groups. Logistic regression and Spearman correlation analyses were performed to further investigate relationships between 25(OH)D3 levels and metabolic and bone-related markers.

Results

This study showed that the 25(OH)D3 deficiency cohort exhibited significantly higher BMI, TC, TG, and ALP levels, with lower Ca levels and delayed bone age compared to the normal group. Logistic regression analysis identified Ca, ALP, and bone age as significant predictors of 25(OH)D3 deficiency. Subgroup analysis showed that in the 25(OH)D3 deficient group, children with higher BMI had elevated TC, ALP levels, and delayed bone age, while Ca levels were lower. Correlation analysis confirmed the predictive value of these markers for 25(OH)D3 deficiency.

Conclusion

Our findings demonstrate that 25(OH)D3 deficiency is strongly associated with obesity in school-aged children and may negatively affect normal skeletal development. Regular monitoring of 25(OH)D3 levels in school-aged children is essential for ensuring proper growth and development, especially in those at risk for obesity.

Metabolic Syndrome in Reproductive Age Women of Various Ethnic Groups. Neuroendocrine Status and Lipid Peroxidation System

We analyzed the state of neuroendocrine regulation and LPO-antioxidant defense systems in reproductive age women with metabolic syndrome (MetS), representatives of the Russian and Buryat ethnic groups. Compared to the corresponding control groups, women from the Russian ethnic group with MetS had elevated levels of thyroid-stimulating hormone and free androgen index (FAI) and reduced levels of sex hormone-binding globulin, while women from the Buryat ethnic group had increased levels of prolactin and FAI. Changes in the LPO system in women of the Russian ethnic group with MetS consisted in an increase in the levels of substrates with double bonds, TBA-reactive substances, and fat-soluble vitamins. Buryat women with MetS had a higher content of primary oxidation products and reduced levels of glutathione. The results of the study indicate a hyperandrogenic shift in the neuroendocrine regulation system, as well as compensatory influences from different parts of the antioxidant defense system in women of reproductive age with MetS, depending on their ethnicity. These findings indicate the need for assessing and monitoring the levels of these metabolites in women with MetS, considering their ethnicity.

Association of hypertriglyceridemic waist phenotype with metabolic syndrome traits and its diagnostic potential to predict metabolic syndrome in adults with excess body weight: A community-based cross-sectional study

BACKGROUND

The hypertriglyceridemic waist (HTGW) phenotype is a simple measure to identify individuals at increased risk of metabolic syndrome (MetS) traits. The present study aimed to describe the HTGW prevalence, and its associations with MetS traits, and also determine the diagnostic potential of the mirror indices of HTGW phenotype to predict MetS and its components in community-dwelling adults with overweight or obesity in Southern, Sri Lanka.

METHODS

In a cross-sectional study, 300 adults with excess body weight (body mass index >23 kg/m2) were enrolled and examined for the HTGW phenotype (fasting plasma triglyceride concentration ≥1.695 mmol/L and waist circumference >90 and >85 cm in males and females, respectively).

RESULTS

One in five adults with excess body weight had the HTGW phenotype. Phenotype-positive adults had significantly higher fasting plasma glucose (FPG) (p = 0.010), low-density lipoprotein cholesterol (HDL-C) (p < 0.001), total cholesterol (p < 0.001), atherogenic index (p < 0.001), coronary risk index (p = 0.001), triglyceride glucose index (p = 0.040), bioimpedance visceral fat (p = 0.041) and significantly lower HDL-C (p = 0.001) and cardioprotective index (p = 0.009) than those without the HTGW phenotype. Adults with excess body weight and the HTGW phenotype had an increased risk of FPG (odds ratio [OR] = 1.294; 95% confidence interval [CI] 1.051-1.594), atherogenic index (OR = 3.138; 95% CI = 1.559-6.317) and triglyceride glucose index (OR = 3.027; 95% CI = 1.111-8.249). The HTGW phenotype was strongly associated with MetS traits (OR = 16.584; 95% CI = 6.230-44.147). The cut-off values for the product of waist circumference × triglyceride, to identify the risk of having MetS and dyslipidemia among adults with excess body weight were 158.66 and 160.15 cm × mmol/L, respectively.

CONCLUSIONS

The readily available and inexpensive measures of the HTGW phenotype could serve as a clinically useful marker to identify MetS traits in adults with excess body weight.

Gut microbiome signatures associated with type 2 diabetes in obesity in Mongolia

Mongolian people possess a unique dietary habit characterized by high consumption of meat and dairy products and fewer vegetables, resulting in the highest obesity rate in East Asia. Although obesity is a known cause of type 2 diabetes (T2D), the T2D rate is moderate in this population; this is known as the "Mongolian paradox." Since the gut microbiota plays a key role in energy and metabolic homeostasis as an interface between food and body, we investigated gut microbial factors involved in the prevention of the co-occurrence of T2D with obesity in Mongolians. We compared the gut microbiome and metabolome of Mongolian adults with obesity with T2D (DO: n = 31) or without T2D (NDO: n = 35). Dysbiotic signatures were found in the gut microbiome of the DO group; lower levels of Faecalibacterium and Anaerostipes which are known as short-chain fatty acid (SCFA) producers and higher levels of Methanobrevibacter, Desulfovibrio, and Solobacterium which are known to be associated with certain diseases. On the other hand, the NDO group exhibited a higher level of fecal SCFA concentration, particularly acetate. This is consistent with the results of the whole shotgun metagenomic analysis, which revealed a higher relative abundance of SCFA biosynthesis-related genes encoded largely by Anaerostipes hadrus in the NDO group. Multiple logistic regression analysis including host demographic parameters indicated that acetate had the highest negative contribution to the onset of T2D. These findings suggest that SCFAs produced by the gut microbial community participate in preventing the development of T2D in obesity in Mongolians.

Exploring metabolically healthy obesity: prevalence, characteristics, and cardiovascular risk in the Iranian population based on the STEPS 2021

Background

Regarding the rapidly increasing prevalence of obesity throughout the globe, it remains a serious public health concern. A subgroup of obesity that does not meet metabolic syndrome criteria is called metabolically healthy obesity (MHO). However, whether the MHO phenotype increases cardiovascular disease (CVD) risk is controversial. This study aimed to evaluate the prevalence of MHO and its 10-year CVD risk in Iranian populations.

Methods

Based on the STEPS 2021 project in Iran, we collected data on 18119 Iranians 25 years and older from all 31 provinces after applying many statistical factors. Using the Framingham score, we evaluated the 10-year cardiovascular risk associated with the various MHO definition criteria for Iranian populations.

Results

The prevalence of MHO was 6.42% (5.93-6.91) at the national level according to the AHA-NHLBI definition, and 23.29% of obese women and 24.55% of obese men were classified as MHOs. Moreover, the MHO group was younger than the metabolically unhealthy obesity (MUO) group based on all definitions (p < 0.001). The odds ratio of MUO individuals being classified as high-risk individuals by the Framingham criteria for CVD was significantly higher than that of MHO individuals by all definitions, with a crude odds ratio of 3.55:1 based on AHA-NHLBI definition.

Conclusion

This study reveals a significant prevalence of MHO in the Iranian population, with approximately 25% of obese individuals classified as MHO. While MHO is associated with a lower risk of cardiovascular disease compared to MUO, MHO carries the potential for transitioning to an unhealthy state.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01364-5.

Antiobesity effect of healthy food crops and functional foods: A systematic review of their mechanisms

Diet is a modifiable risk factor in the prevention and management of obesity, and various foods have the potential to aid in obesity management by modulating different pathways involved in the disease's pathology. We performed a systematic review of literature, using CINAHL, PubMed, and Google Scholar, focusing on the antiobesity potential of foods crops and functional food products, and their mechanisms of action and clinical evidence. Sixty-four articles were identified, of which 41 investigated food crops, while 23 investigated functional products. Food crops, such as cereals, vegetables, fruits, mushrooms, seaweeds, legumes, herbs, spices, and cocoa seeds, have antiobesity effects through mechanisms such as altering the metabolism of glucolipids by inhibiting enzymes like α-amylase and α-glucosidase, stimulating the bioenergetics of thermogenic fat, modulating gut microbiota, and inhibiting lipogenesis and storage. In addition, developed functional teas, beverages, and yoghurt have antiobesity effects through similar or different mechanisms, such as enhancing energy expenditure and satiety, suppressing adipogenesis and lipolysis, improving glucose and lipid metabolism, and altering hormonal secretion. This review reemphasized the significance of food in the control of obesity, and highlights the distinct methods these explored foods exert their antiobesity effects. In conclusion, foods are safe and effective means of combating obesity without the side effects of conventional drugs, which can help inform dietary choices, assist professionals in providing more accurate advice, and also lead to better understanding of food and its effect on overall health of the public. This approach will eradicate global diseases, especially if more underutilized and indigenous food crops are extensively researched.

The Ongoing Impact of COVID-19 on Pediatric Obesity

In the developed world, pediatric obesity (PO) has been a major health concern since the last century, and this condition may lead to detrimental life-long physical and mental comorbidities. Currently, its prevalence has increased in low- and middle-income countries and in many high-income countries. Thus, the provision of effective and tailored care for children and their families has become vital. The social consequences of the COVID-19 pandemic are known everywhere, and among these, it has been argued that the COVID-19 pandemic has had a major impact on PO. Overall, the growth of PO over the last decade has been enhanced by the pandemic. During the COVID-19 pandemic, children, adolescents and young adults gained weight as the pediatric population dealt with sedentary lifestyles and changes in food habits. In this review, we want to highlight the impact that the COVID-19 pandemic had on PO.

Associations between the Genetic Heritability of Dyslipidemia and Dietary Patterns in Korean Adults Based on Sex Differences

Dyslipidemia can be defined as an abnormality in serum lipid levels that is substantially linked to genetic variations and lifestyle factors, such as diet patterns, and has distinct sex-specific characteristics. We aimed to elucidate the genetic impact of dyslipidemia according to sex and explore the associations between genetic variants and dietary patterns in large-scale population-based cohorts. After performing genome-wide association studies (GWASs) in male, female, and entire cohorts, significant single nucleotide polymorphisms (SNPs) were identified in the three groups, and genetic risk scores (GRSs) were calculated by summing the risk alleles from the selected SNPs. After adjusting for confounding variables, the risk of dyslipidemia was 2.013-fold and 2.535-fold higher in the 3rd quartile GRS group in the male and female cohorts, respectively, than in the 1st quartile GRS group. While instant noodle and soft drink intake were significantly associated with GRS related to hyperlipidemia in male cohorts, coffee consumption was substantially related to GRS related to hyperlipidemia in female cohorts. Considering the influence of genetic factors and dietary patterns, the findings of this study suggest the potential for implementing sex-specific strategic interventions to avoid dyslipidemia.

Metabolically Healthy Obesity: Are Interventions Useful?

PURPOSE OF REVIEW

This review aims to detail the current global research state of metabolically healthy obesogenesis with regard to metabolic factors, disease prevalence, comparisons to unhealthy obesity, and targeted interventions to reverse or delay progression from metabolically healthy to unhealthy obesity.

RECENT FINDINGS

As a long-term condition with increased risk of cardiovascular, metabolic, and all-cause mortality risks, obesity threatens public health on a national level. The recent discovery of metabolically healthy obesity (MHO), a transitional condition during which obese persons carry comparatively lower health risks, has added to confusion about the true effect of visceral fat and subsequent long-term health risks. In this context, the evaluation of fat loss interventions, such as bariatric surgery, lifestyle changes (diet/exercise), and hormonal therapies require re-evaluation in light of evidence that progression to high-risk stages of obesity relies on metabolic status and that strategies to protect the metabolism may be useful in the prevention of metabolically unhealthy obesity. Typical calorie-based exercise and diet interventions have failed to reduce the prevalence of unhealthy obesity. Holistic lifestyle, psychological, hormonal, and pharmacological interventions for MHO, on the other hand, may at least prevent progression to metabolically unhealthy obesity.