Obesity Severity and Duration Are Associated With Incident Metabolic Syndrome: Evidence Against Metabolically Healthy Obesity From the Multi-Ethnic Study of Atherosclerosis

Context:Although the health risks of obesity compared to normal weight have been well studied, the cumulative risk associated with chronic obesity remains unknown. Specifically, debate continues about the importance of recommending weight loss for those with metabolically healthy obesity.Objective:We hypothesized that relatively greater severity and longer duration of obesity are associated with greater incident metabolic syndrome.Design, Setting, Participants, and Measures:Using repeated measures logistic regression with random effects, we investigated the association of time-varying obesity severity and duration with incident metabolic syndrome in 2,748 Multi-Ethnic Study of Atherosclerosis participants with obesity (body mass index ≥30 kg/m2) at any visit. Obesity duration was defined as the cumulative number of visits with measured obesity and obesity severity by the World Health Organization levels I–III based on body mass index. Metabolic syndrome was defined using Adult Treatment Panel III criteria modified to exclude waist circumference.Results:Higher obesity severity (level II odds ratio [OR], 1.32 [95% confidence interval, 1.09–1.60]; level III OR, 1.63 [1.25–2.14] vs level I) and duration (by number of visits: two visits OR, 4.43 [3.54–5.53]; three visits OR, 5.29 [4.21–6.63]; four visits OR, 5.73 [4.52–7.27]; five visits OR, 6.15 [4.19–9.03] vs one visit duration of obesity) were both associated with a higher odds of incident metabolic syndrome.Conclusion:Both duration and severity of obesity are positively associated with incident metabolic syndrome, suggesting that metabolically healthy obesity is a transient state in the pathway to cardiometabolic disease. Weight loss should be recommended to all individuals with obesity, including those who are currently defined as metabolically healthy.

Download Full-text

Sex hormones, inflammation and the metabolic syndrome: a population-based study

Acta Endocrinologica ◽

10.1530/eje.0.1490601 ◽

2003 ◽

pp. 601-608 ◽

Cited By ~ 280

Author(s):

DE Laaksonen ◽

L Niskanen ◽

K Punnonen ◽

K Nyyssonen ◽

TP Tuomainen ◽

...

Keyword(s):

Cardiovascular Disease ◽

Metabolic Syndrome ◽

Body Mass Index ◽

Body Mass ◽

Sex Hormones ◽

Free Testosterone ◽

Population Based ◽

World Health ◽

Inverse Association ◽

The Metabolic Syndrome

OBJECTIVE: Mild hypoandrogenism in men is associated with features of the metabolic syndrome, but the association with the metabolic syndrome itself using an accepted definition has not been described. DESIGN: Men with the metabolic syndrome were identified and testosterone and sex hormone-binding globulin (SHBG) levels were determined in a population-based cohort of 1896 non-diabetic middle-aged Finnish men. RESULTS: Calculated free testosterone and SHBG were 11% and 18% lower (P<0.001) in men with the metabolic syndrome (n=345, World Health Organisation definition). After categorisation by tertiles and adjusting for age and body mass index, total and free testosterone and SHBG were inversely associated with concentrations of insulin, glucose, triglycerides, C-reactive protein (CRP) and CRP-adjusted ferritin and positively associated with high-density lipoprotein cholesterol. Men with free testosterone levels in the lowest third were 2.7 (95% confidence interval (CI) 2.0-3.7) times more likely to have the metabolic syndrome in age-adjusted analyses, and 1.7 (95% CI 1.2-2.4) times more likely even after further adjusting for body mass index. Exclusion of men with cardiovascular disease did not alter the association. The inverse association of SHBG with the metabolic syndrome was somewhat stronger. CONCLUSIONS: Low testosterone and SHBG levels were strongly associated not only with components of the metabolic syndrome, but also with the metabolic syndrome itself, independently of body mass index. Furthermore, sex hormones were associated with inflammation and body iron stores. Even in the absence of late-stage consequences such as diabetes and cardiovascular disease, subtle derangements in sex hormones are present in the metabolic syndrome, and may contribute to its pathogenesis.

Download Full-text

Natural course of metabolically healthy phenotype and risk of developing Cardiometabolic diseases: a three years follow-up study

BMC Endocrine Disorders ◽

10.1186/s12902-021-00754-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Daniel Elías-López ◽

◽

Arsenio Vargas-Vázquez ◽

Roopa Mehta ◽

Ivette Cruz Bautista ◽

...

Keyword(s):

Metabolic Syndrome ◽

Body Mass Index ◽

Body Mass ◽

Continuous Process ◽

Incidence Rates ◽

Metabolic Health ◽

History Of ◽

Metabolically Healthy ◽

Over Time

Abstract Background Whether the metabolically healthy obese (MHO) phenotype is a single, stable or a transitional, fluctuating state is currently unknown. The Mexican-Mestizo population has a genetic predisposition for the development of type 2 diabetes (T2D) and other cardiometabolic complications. Little is known about the natural history of metabolic health in this population. The aim of this study was to analyze the transitions over time among individuals with different degrees of metabolic health and body mass index, and evaluate the incidence of cardiometabolic outcomes according to phenotype. Methods The study population consisted of a metabolic syndrome cohort with at least 3 years of follow up. Participants were apparently-healthy urban Mexican adults ≥20 years with a body mass index (BMI) ≥20 kg/m2. Metabolically healthy phenotype was defined using the criteria of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) metabolic syndrome criteria and the subjects were stratified into 4 groups according to their BMI and metabolic health. For cardiometabolic outcomes we estimated the incidence of cardiometabolic outcomes and standardized them per 1, 000 person-years of follow-up. Finally, to evaluate the risk for transition and development of cardiometabolic outcomes, we fitted Cox Proportional Hazard regression models. Results Amongst the 5541 subjects, 54.2% were classified as metabolically healthy and 45.8% as unhealthy. The MHO prevalence was 39.3%. Up to a third of the population changed from their initial category to another and the higher transition rate was observed in MHO (42.9%). We also found several novel factors associated to transition to metabolically unhealthy phenotype; socioeconomic status, number of pregnancies, a high carbohydrate intake, history of obesity and consumption of sweetened beverages. Similarly, visceral adipose tissue (VAT) was a main predictor of transition; loss of VAT ≥5% was associated with reversion from metabolically unhealthy to metabolically healthy phenotype (hazard ratio (HR) 1.545, 95%CI 1.266–1.886). Finally, we observed higher incidence rates and risk of incident T2D and hypertension in the metabolically unhealthy obesity (MUHO) and metabolically unhealthy lean (MUHL) phenotypes compared to MHO. Conclusions Metabolic health is a dynamic and continuous process, at high risk of transition to metabolically unhealthy phenotypes over time. It is imperative to establish effective processes in primary care to prevent such transitions.

Download Full-text

Metabolic Phenotyping Using Metabolic Syndrome Criteria and Cardiometabolic Disabilities Criteria in Bangladeshi Adult Population

Bangladesh Journal of Medical Biochemistry ◽

10.3329/bjmb.v11i1.39762 ◽

2019 ◽

Vol 11 (1) ◽

pp. 1-8

Author(s):

S Naher ◽

SS Sejooti ◽

MM Hoque ◽

MS Zaman ◽

H Imam ◽

...

Keyword(s):

Metabolic Syndrome ◽

Body Mass Index ◽

Body Mass ◽

Adult Population ◽

Normal Weight ◽

Cross Sectional ◽

Global Epidemic ◽

Metabolic Phenotypes ◽

Metabolically Healthy ◽

Medical University

Obesity has become a global epidemic and has been found to be associated with numerous comorbidities. Body mass index (BMI) based classification of obesity is simple but co-morbidities do not affect all obese and overweight people. The present study was aimed to find out the frequency of metabolic phenotypes in different BMI groups using metabolic syndrome (MetS) criteria and cardiometabolic disabilities (CA) criteria and also to find out an appropriate method for defining metabolic health among adult population attending out patient department of Bangabandhu Sheikh Mujib Medical University (BSMMU). This cross-sectional analytical study was carried out in the Department of Biochemistry, Bangabandhu Sheikh Mujib Medical University (BSMMU) from March 2016 to February 2017. By non probability sampling, a total of 1023 study subjects were selected from apparently healthy adult individuals attending outpatient department of BSMMU. The study subjects were grouped into three body mass index classes and also further categorized into six groups according to metabolically unhealthy or healthy phenotypes by presence or absence of metabolic syndrome (MetS) criteria as well as cardiometabolic disabilities (CA) criteria respectively. Then agreement among different metabolic phenotypes based on these two criteria were observed. Frequency of different metabolic phenotypes i,e metabolically healthy normal weight (MHNW), metabolically obese normal weight (MONW), metabolically healthy over weight (MHOW), metabolically obese over weight (MOOW), metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO) were 12.3%, 6.9%, 21.4%, 27.7%, 7.7%, 23.9% by MetS criteria and 7.7%, 11.5%, 11.6%, 37.4%, 6.1%, 25.6% by CA criteria respectively. MOOW followed by MUO were found to be predominant among all phenotypes. Fare agreement was found between two criteria in case of normal weight and overweight groups and good agreement was found in case of obese groups. From this study, it may be concluded that, attention should be given to the metabolically obese phenotypes in different BMI classes to reduce co-morbidities. Bangladesh J Med Biochem 2018; 11(1): 1-8

Download Full-text

Body fat has stronger associations with bone mass density than body mass index in metabolically healthy obesity

PLoS ONE ◽

10.1371/journal.pone.0206812 ◽

2018 ◽

Vol 13 (11) ◽

pp. e0206812 ◽

Cited By ~ 3

Author(s):

Yuan-Yuei Chen ◽

Wen-Hui Fang ◽

Chung-Ching Wang ◽

Tung-Wei Kao ◽

Yaw-Wen Chang ◽

...

Keyword(s):

Body Mass Index ◽

Bone Mass ◽

Body Mass ◽

Body Fat ◽

Mass Density ◽

Bone Mass Density ◽

Metabolically Healthy Obesity ◽

Metabolically Healthy

Download Full-text

Comparison of Body Mass Index Percentiles to Detect Metabolic Syndrome Using the Korean, United States Centers for Disease Control and Prevention, and World Health Organization References in Korean Children Aged 10–16 Years

Metabolic Syndrome and Related Disorders ◽

10.1089/met.2018.0126 ◽

2019 ◽

Vol 17 (4) ◽

pp. 210-216 ◽

Cited By ~ 1

Author(s):

Kayoung Lee

Keyword(s):

United States ◽

Metabolic Syndrome ◽

Body Mass Index ◽

Disease Control ◽

World Health Organization ◽

Body Mass ◽

World Health ◽

Korean Children ◽

Control And Prevention ◽

Health Organization

Download Full-text

Letter to the Editor: Obesity Severity and Duration Are Associated With Incident Metabolic Syndrome: Evidence Against Metabolically Healthy Obesity From the Multi-Ethnic Study of Atherosclerosis

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2016-3196 ◽

2016 ◽

Vol 101 (12) ◽

pp. L112-L113

Author(s):

Wahyu Wulaningsih ◽

Johnathan Watkins ◽

Rebecca Hardy

Keyword(s):

Metabolic Syndrome ◽

Metabolically Healthy Obesity ◽

Ethnic Study ◽

Letter To The Editor ◽

Metabolically Healthy

Download Full-text

Youth to adult body mass index trajectories as a predictor of metabolically healthy obesity in adulthood

European Journal of Public Health ◽

10.1093/eurpub/ckz109 ◽

2019 ◽

Cited By ~ 1

Author(s):

Kylie J Smith ◽

Costan G Magnussen ◽

Katja Pahkala ◽

Juha Koskinen ◽

Matthew A Sabin ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Metabolically Healthy Obesity ◽

Adult Body Mass ◽

Adult Body ◽

Metabolically Healthy ◽

Adult Body Mass Index ◽

Body Mass Index Trajectories

Download Full-text

Successful Weight Reduction in Metabolic Syndrome with a Hypocaloric Plant-Based Diet (Lacto-ovo-vegetarian Diet) with Exercise During an Educational Hospitalization: Report of Three Cases

10.21926/obm.icm.2101006 ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Mitsuro Chiba ◽

◽

Masafumi Komatsu ◽

Satomi Watanabe ◽

Yoko Daimon

Keyword(s):

Metabolic Syndrome ◽

Body Mass Index ◽

Inflammatory Bowel Disease ◽

Weight Loss ◽

Body Weight ◽

Body Mass ◽

Bowel Disease ◽

Vegetarian Diet ◽

Visceral Fat Area ◽

Inflammatory Bowel

The high prevalence of obesity is a global concern. However, obesity and inflammatory bowel disease have similarities in epidemiology, diet, and gut microbial dysbiosis. An omnivorous (westernized) diet replacement with a plant-based diet in inflammatory bowel disease achieved better outcomes in both the induction and quiescent phases. Educational hospitalization providing a plant-based diet was found effective in suppressing flare-up in ulcerative colitis. This case report was designed to assess whether a plant-based diet can reduce body weight in patients with obesity during educational hospitalization for a short period of two weeks. Three men with metabolic syndrome (55, 61, and 65 years old) were included in the study with body mass index ranging from 27.0 to 31.2 kg/m2 and visceral fat area between 94.7 and 128 cm2. In Japan, a body mass index of ≥25 is defined as obesity. A lacto-ovo-vegetarian diet with brown rice (1400 or 1100 kcal/day), a plant-based diet, was provided during hospitalization for around two weeks. Patients walked for about 1 h in a park daily during the hospitalization. All three patients showed weight loss: 2.9%, 6.1%, and 6.6% at discharge. A decrease in body mass index, waist circumference, and the visceral fat area was also observed. Restriction in total calories in the form of a plant-based diet and daily 1-hour walks through an educational hospitalization for two weeks effectively reduced body weight and improved obesity-related parameters. Thus, a plant-based diet could be an effective weight-loss diet.

Download Full-text