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Pujia R, Tarsitano MG, Arturi F, De Lorenzo A, Lenzi A, Pujia A, Montalcini T. Advances in Phenotyping Obesity and in Its Dietary and Pharmacological Treatment: A Narrative Review. Front Nutr 2022; 9:804719. [PMID: 35242796 PMCID: PMC8885626 DOI: 10.3389/fnut.2022.804719] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/21/2022] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- Roberta Pujia
- Department of Medical and Surgical Science Nutrition Unit, University Magna Grecia, Catanzaro, Italy
| | - Maria Grazia Tarsitano
- Department of Medical and Surgical Science Nutrition Unit, University Magna Grecia, Catanzaro, Italy
| | - Franco Arturi
- Department of Medical and Surgical Science Nutrition Unit, University Magna Grecia, Catanzaro, Italy
| | - Antonino De Lorenzo
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, University La Sapienza, Rome, Italy
| | - Arturo Pujia
- Department of Medical and Surgical Science Nutrition Unit, University Magna Grecia, Catanzaro, Italy
| | - Tiziana Montalcini
- Department of Clinical and Experimental Medicine, Nutrition Unit, University Magna Grecia, Catanzaro, Italy
- *Correspondence: Tiziana Montalcini
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Amaro-Gahete FJ, De-la-O A, Jurado-Fasoli L, Ruiz JR, Castillo MJ. Association of basal metabolic rate and fuel oxidation in basal conditions and during exercise, with plasma S-klotho: the FIT-AGEING study. Aging (Albany NY) 2019; 11:5319-5333. [PMID: 31390595 PMCID: PMC6710061 DOI: 10.18632/aging.102100] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/11/2019] [Indexed: 12/11/2022]
Abstract
S-klotho, the shed form of α-klotho, is thought to be an ageing suppressor with functions related to the physiology of energy metabolism. However, it remains unknown whether ageing biomarkers such as S-klotho and/or chronological ageing are associated in any way with basal metabolic rate (BMR) and fuel oxidation in basal conditions and during exercise. The present work investigates the association of BMR and fuel oxidation in basal conditions and during exercise, with plasma S-klotho in middle-aged, sedentary adults. BMR was measured by indirect calorimetry in 74 such subjects (53% women; age 53.7±5.1 years) following standard procedures, and their fuel oxidation estimated via stoichiometric equations. The maximal fat oxidation during exercise (MFO) and the intensity of exercise that elicits MFO (Fatmax) were determined using a walking graded exercise test. No relationship was seen between BMR and plasma S-klotho (P>0.1), although both basal fat oxidation and MFO showed positive associations with this protein (both P<0.001); these relationships persisted after controlling for age, sex and fat mass. However, no significant associations were seen between BMR, basal fat oxidation or MFO and chronological age (all P>0.1). The present findings suggest that basal fat oxidation and MFO are strongly associated with plasma S-klotho in middle-aged sedentary adults. These results support the idea that metabolic flexibility is a powerful predictor of biological ageing.
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Affiliation(s)
- Francisco J Amaro-Gahete
- EFFECTS-262 Research Group, Department of Medical Physiology, School of Medicine, University of Granada, Granada, Spain.,PROmoting FITness and Health through Physical Activity Research Group (PROFITH), Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Alejandro De-la-O
- EFFECTS-262 Research Group, Department of Medical Physiology, School of Medicine, University of Granada, Granada, Spain
| | - Lucas Jurado-Fasoli
- EFFECTS-262 Research Group, Department of Medical Physiology, School of Medicine, University of Granada, Granada, Spain
| | - Jonatan R Ruiz
- PROmoting FITness and Health through Physical Activity Research Group (PROFITH), Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Manuel J Castillo
- EFFECTS-262 Research Group, Department of Medical Physiology, School of Medicine, University of Granada, Granada, Spain
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Pujia A, Gazzaruso C, Ferro Y, Mazza E, Maurotti S, Russo C, Lazzaro V, Romeo S, Montalcini T. Individuals with Metabolically Healthy Overweight/Obesity Have Higher Fat Utilization than Metabolically Unhealthy Individuals. Nutrients 2016; 8:E2. [PMID: 26742056 PMCID: PMC4728616 DOI: 10.3390/nu8010002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/04/2015] [Accepted: 12/08/2015] [Indexed: 12/17/2022] Open
Abstract
The mechanisms underlying the change in phenotype from metabolically healthy to metabolically unhealthy obesity are still unclear. The aim of this study is to investigate whether a difference in fasting fat utilization exists between overweight/obese individuals with a favorable cardiovascular risk profile and those with Metabolic Syndrome and Type 2 diabetes. Furthermore, we sought to explore whether there is an association between fasting fat utilization and insulin resistance. In this cross-sectional study, 172 overweight/obese individuals underwent a nutritional assessment. Those with fasting glucose ≥ 126 mg/dL or antidiabetic treatment were considered to be diabetics. If at least three of the NCEP criteria were present, they had Metabolic Syndrome, while those with less criteria were considered to be healthy overweight/obese. An indirect calorimetry was performed to estimate Respiratory Quotient, an index of nutrient utilization. A lower Respiratory Quotient (i.e., higher fat utilization) was found in healthy overweight/obese individuals than in those with Metabolic Syndrome and Type 2 diabetes (0.85 ± 0.05; 0.87 ± 0.06; 0.88 ± 0.05 respectively, p = 0.04). The univariate and multivariable analysis showed a positive association between the Respiratory Quotient and HOMA-IR (slope in statistic (B) = 0.004; β = 0.42; p = 0.005; 95% Confidence interval = 0.001-0.006). In this study, we find, for the first time, that the fasting Respiratory Quotient is significantly lower (fat utilization is higher) in individuals who are metabolically healthy overweight/obese than in those with metabolically unhealthy obesity. In addition, we demonstrated the association between fat utilization and HOMA-IR, an insulin resistance index.
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Affiliation(s)
- Arturo Pujia
- Department of Medical and Surgical Science, University Magna Grecia, Catanzaro 88100, Italy.
| | | | - Yvelise Ferro
- Department of Medical and Surgical Science, University Magna Grecia, Catanzaro 88100, Italy.
| | - Elisa Mazza
- Department of Medical and Surgical Science, University Magna Grecia, Catanzaro 88100, Italy.
| | - Samantha Maurotti
- Department of Medical and Surgical Science, University Magna Grecia, Catanzaro 88100, Italy.
| | - Cristina Russo
- Department of Medical and Surgical Science, University Magna Grecia, Catanzaro 88100, Italy.
| | - Veronica Lazzaro
- Department of Health Science, University Magna Grecia, Catanzaro 88100, Italy.
| | - Stefano Romeo
- Department of Medical and Surgical Science, University Magna Grecia, Catanzaro 88100, Italy.
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg 40530, Sweden.
| | - Tiziana Montalcini
- Department of Medical and Surgical Science, University Magna Grecia, Catanzaro 88100, Italy.
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Siervo M, Lara J, Celis-Morales C, Vacca M, Oggioni C, Battezzati A, Leone A, Tagliabue A, Spadafranca A, Bertoli S. Age-related changes in basal substrate oxidation and visceral adiposity and their association with metabolic syndrome. Eur J Nutr 2015; 55:1755-67. [PMID: 26233884 DOI: 10.1007/s00394-015-0993-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/06/2015] [Indexed: 01/06/2023]
Abstract
PURPOSE Ageing is directly associated with visceral fat (VAT) deposition and decline of metabolically active cellular mass, which may determine age-related shifts in substrate oxidation and increased cardiometabolic risk. We tested whether VAT and fasting respiratory quotient (RQ, an index of macronutrient oxidation) changed with age and if they were associated with increased risk of metabolic syndrome (MetSyn). METHODS A total of 2819 adult participants (age range: 18-81 years; men/women: 894/1925) were included; we collected history, anthropometric measures, biochemistry, smoking habits, and physical activity. The body mass index range was 18.5-60.2 kg/m(2). Gas exchanges (VO2 and VCO2) were measured by indirect calorimetry in fasting conditions, and RQ was calculated. Body composition was measured by bioelectrical impedance. Abdominal subcutaneous fat and VAT were measured by ultrasonography. MetSyn was diagnosed using harmonised international criteria. Multivariate linear and logistic regression models were utilised. RESULTS VAT increased with age in both men (r = 0.31, p < 0.001) and women (r = 0.37, p < 0.001). Basal RQ was not significantly associated with age (p = 0.49) and VAT (p = 0.20); in addition, basal RQ was not a significant predictor of MetSyn (OR 3.31, 0.57-19.08, p = 0.27). VAT was the primary predictor of MetSyn risk in a fully adjusted logistic model (OR 4.25, 3.01-5.99, p < 0.001). CONCLUSIONS Visceral adiposity remains one of the most important risk factors for cardiometabolic risk and is a significant predictor of MetSyn. Post-absorptive substrate oxidation does not appear to play a significant role in age-related changes in body composition and cardiometabolic risk, except for a correlation with triglyceride concentration.
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Affiliation(s)
- Mario Siervo
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Campus for Ageing and Vitality, Newcastle on Tyne, NE4 5PL, UK. .,MRC Human Nutrition Research, Fulbourn Road, Cambridge, CB1 9NL, UK.
| | - Jose Lara
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Campus for Ageing and Vitality, Newcastle on Tyne, NE4 5PL, UK
| | - Carlos Celis-Morales
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Campus for Ageing and Vitality, Newcastle on Tyne, NE4 5PL, UK
| | - Michele Vacca
- MRC Human Nutrition Research, Fulbourn Road, Cambridge, CB1 9NL, UK
| | - Clio Oggioni
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Campus for Ageing and Vitality, Newcastle on Tyne, NE4 5PL, UK
| | - Alberto Battezzati
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Sandro Botticelli, 21, 20133, Milan, Italy
| | - Alessandro Leone
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Sandro Botticelli, 21, 20133, Milan, Italy
| | - Anna Tagliabue
- Human Nutrition and Eating Disorders Research Centre, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Bassi, 21, 27100, Pavia, Italy
| | - Angela Spadafranca
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Sandro Botticelli, 21, 20133, Milan, Italy
| | - Simona Bertoli
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Sandro Botticelli, 21, 20133, Milan, Italy
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