Are young Iranian women with metabolically healthy obesity at increased risk of CVD incidence?

Abstract Background The association between the Metabolically Healthy Obese (MHO) phenotype in the absence of metabolic syndrome and subsequent cardiovascular disease remains unclear. Objectives We examined the association between MHO and CVD risk in young Iranian women. Methods We studied 183 women aged 20-35 years from a population of 308 candidates. We classified participants into 4 phenotypes. We measured body composition, blood pressure, and biochemical factors in all participants. Results The Metabolically Healthy Normal Weight (MHNW) and Normal Weight Obese (NWO) phenotypes had no statistical differences in any biochemistry variables. FBS, TG, LDL/HDL, Cholesterol/HDL, hs-CRP, and atherogenic index of plasma (AIP) were all higher in Metabolically Unhealthy Obese (MUO) than MHO individuals, whereas HDL was higher in MHO than in MUO individuals. LDL/HDL and hs-CRP were higher in MHO participants than MHNW participants, whereas HDL-c was higher in MHNW than MHO. Conclusions Results of the present study demonstrate that young women displaying the MHO phenotype have a favorable metabolic profile as shown by lower FBS, TG, LDL-c/HDL, Cho/HDL, hs-CRP, and AIP and higher HDL levels than the MUO phenotype. However, MHO individuals were still at greater risk of CVD incidence (lower HDL and higher hs-CRP levels) than MHNW individuals.

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Abstract 13508: Obesity Phenotype and the Risk of Hypertension and Type 2 Diabetes: Does Cardiorespiratory Fitness Matter?

Circulation ◽

10.1161/circ.130.suppl_2.13508 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Sae Young Jae ◽

Mercedes Carnethon ◽

Won Hah Park ◽

Bo Fernhall

Keyword(s):

Type 2 Diabetes ◽

Body Mass Index ◽

Cardiorespiratory Fitness ◽

Normal Weight ◽

Incident Hypertension ◽

Metabolically Healthy Obese ◽

Increased Risk ◽

Healthy Obese ◽

Metabolically Healthy

There is conflicting evidence regarding the association between metabolically healthy obese (MHO) and metabolically unhealthy normal weight (MUNW) with incident hypertension and type 2 diabetes. The role of cardiorespiratory fitness on these associations has not been fully explored. We tested the hypothesis that obesity phenotypes predict incident hypertension and type 2 diabetes, but cardiorespiratory fitness modifies these associations in a prospective study of apparently healthy men. 3800 men (mean age 48±6 yrs, range 20-76 yrs) participated in two health examinations during 1998-2009. All subjects were free of hypertension and type 2 diabetes at baseline examination. MHO was defined as obesity (body mass index ≥ 25 kg/m2) with no more than one metabolic abnormality, and MUNW was defined as body mass index < 23 kg/m2) with two or more abnormalities. Cardiorespiratory fitness was directly measured by peak oxygen uptake during a treadmill test. Incident hypertension and type 2 diabetes were defined as blood pressure ≥140/90mmHg and as ≥6.5% of HbA1c or ≥126mg/dl of fasting glucose at second examination, respectively. During an average follow-up of 5 years (1-12 yrs), there were 371 (9.8%) men incident hypertension and 170 (4.5%) men incident type 2 diabetes. MHO and MUNW were present in 844 (22%) and 249 (6.6%) men. Compared with metabolically healthy normal weight men, MHO and MUNW men were at increased risk for hypertension (relative risk (RR) =1.82, 95% Confidence Interval (CI): 1.29-2.56 and 1.75, 1.11-2.74) and type 2 diabetes (RR=3.68, 1.92-7.07 and 5.35, 2.61-10.94), respectively. These risks in MHO and MUNW men were still persisted with adjustment for confounder variables and cardiorespiratory fitness (hypertension=1.57, 1.05-2.34 and 1.59, 1.01-2.51; type 2 diabetes=3.35, 1.63-6.89 and 4.76, 2.32-9.77). Metabolically healthy obese or metabolically unhealthy normal weight men were at increased risk of hypertension and type 2 diabetes compared with metabolically healthy normal weight men. However, these associations were not attenuated by cardiorespiratory fitness or other confounder factors.

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Obesity and Metabolic Phenotypes (Metabolically Healthy and Unhealthy Variants) Are Significantly Associated with Prevalence of Elevated C-Reactive Protein and Hepatic Steatosis in a Large Healthy Brazilian Population

Journal of Obesity ◽

10.1155/2015/178526 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 23

Author(s):

Sameer Shaharyar ◽

Lara L. Roberson ◽

Omar Jamal ◽

Adnan Younus ◽

Michael J. Blaha ◽

...

Keyword(s):

Hepatic Steatosis ◽

High Sensitivity ◽

Abdominal Ultrasound ◽

Normal Weight ◽

C Reactive Protein ◽

Cvd Risk ◽

Reactive Protein ◽

Metabolically Healthy Obese ◽

Metabolically Healthy ◽

Relationship Of

Background. Among the obese, the so-called metabolically healthy obese (MHO) phenotype is thought to confer a lower CVD risk as compared to obesity with typical associated metabolic changes. The present study aims to determine the relationship of different subtypes of obesity with inflammatory-cardiometabolic abnormalities.Methods. We evaluated 5,519 healthy, Brazilian subjects (43±10years, 78% males), free of known cardiovascular disease. Those with <2 metabolic risk factors (MRF) were considered metabolically healthy, and those with BMI ≥ 25 kg/m2and/or waist circumference meeting NCEP criteria for metabolic syndrome as overweight/obese (OW). High sensitivity C reactive protein (hsCRP) was measured to assess underlying inflammation and hepatic steatosis (HS) was determined via abdominal ultrasound.Results. Overall, 40% of OW individuals were metabolically healthy, and 12% normal-weight had ≥2 MRF. The prevalence of elevated CRP (≥3 mg/dL) and HS in MHO versus normal weight metabolically healthy group was 22% versus 12%, and 40% versus 8% respectively (P<0.001). Both MHO individuals and metabolically unhealthy normal weight (MUNW) phenotypes were associated with elevated hsCRP and HS.Conclusion. Our study suggests that MHO and MUNW phenotypes may not be benign and physicians should strive to treat individuals in these subgroups to reverse these conditions.

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Treatment of Rheumatoid Arthritis with Marine and Botanical Oils: Influence on Serum Lipids

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2011/827286 ◽

2011 ◽

Vol 2011 ◽

pp. 1-9 ◽

Cited By ~ 22

Author(s):

Barbara C. Olendzki ◽

Katherine Leung ◽

Susan Van Buskirk ◽

George Reed ◽

Robert B. Zurier

Keyword(s):

Rheumatoid Arthritis ◽

Cardiovascular Disease ◽

General Population ◽

Serum Lipids ◽

Hdl Cholesterol ◽

Atherogenic Index ◽

Cvd Risk ◽

Double Blind ◽

Meaningful Improvement ◽

Increased Risk

The gap in mortality between patients with rheumatoid arthritis (RA) and the general population (1.5–3.0 fold risk) is increasing. This disparity is attributable mainly to cardiovascular disease (CVD), as the CVD risk is comparable to patients with diabetes mellitus. The purpose of this study is to determine whether borage seed oil rich in gamma-linolenic acid, fish oil rich in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), or the combination of both oils are useful treatments for dyslipidemia in patients with RA. We randomized patients into a double blind, 18 month trial. Mixed effects models were used to compare trends over time in serum lipids. No significant differences were observed between the three groups: All three treatment groups exhibited similar meaningful improvement in the lipid profile at 9 and 18 months. When all groups were combined, these treatments significantly reduced total and LDL-cholesterol and triglycerides, increased HDL-cholesterol, and improved the atherogenic index. All improvements observed at 9 months persisted at 18 months (P<0.001verses baseline).Conclusion. Marine and botanical oils may be useful treatment for rheumatoid arthritis patients who are at increased risk for cardiovascular disease compared to the general population.

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Association between the metabolically healthy obese phenotype and the risk of myocardial infarction: results from the Kailuan study

Acta Endocrinologica ◽

10.1530/eje-18-0356 ◽

2018 ◽

Vol 179 (6) ◽

pp. 343-352 ◽

Cited By ~ 6

Author(s):

Yijie Xu ◽

Haibin Li ◽

Anxin Wang ◽

Zhaoping Su ◽

Guang Yang ◽

...

Keyword(s):

Myocardial Infarction ◽

Cox Model ◽

Normal Weight ◽

Metabolically Healthy Obese ◽

Increased Risk ◽

Confounding Variables ◽

History Of ◽

Healthy Obese ◽

Metabolically Healthy

Objective This study aimed to determine if the metabolically healthy obese (MHO) is associated with an increased risk of myocardial infarction (MI) in Chinese population. Design The Kailuan study is a community-based prospective cohort study. Methods BMI and metabolic syndrome (MetS) were assessed in 91 866 participants without a history of MI or stroke. Participants were categorised into six mutually exclusive groups according to the BMI-MetS status: normal weight (BMI: ≤ 18.5to < 24.0 kg/m2) without MetS (MH-NW), normal weight with MetS (MUH-NW), overweight (BMI: ≤ 24.0to < 28.0 kg/m2) without MetS (MH-OW), overweight with MetS (MUH-OW), obese (BMI ≥ 28.0 kg/m2) without MetS (MHO) and obese with MetS (MUO). The hazard ratio (HR) with 95% CI was calculated for the incidence of MI using a multivariable Cox model. Results A total of 6745 (7.34%) individuals were classified as MHO. During a median 8-year follow-up, 1167 (1.27%) participants developed MI. The MHO group had an increased risk of MI (HR: 1.76, 95% CI: 1.37–2.25) in comparison with the MH-NW group after adjusting for potential confounding variables. After a similar adjustment, the risk of MI was significantly elevated in the MUH-NW (HR: 1.62, 95% CI: 1.28–2.05), MUH-OW (HR: 1.98, 95% CI: 1.67–2.35) and MUO group (HR: 2.06, 95% CI: 1.70–2.49). Conclusions MHO subjects showed a substantially higher risk of MI in comparison with MH-NW subjects. That said, even without measurable metabolic abnormalities, obesity was associated with a higher risk of MI.

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Risk of incident ischemic stroke according to the metabolic health and obesity states in the Vascular-Metabolic CUN cohort

International Journal of Stroke ◽

10.1177/1747493016672083 ◽

2016 ◽

Vol 12 (2) ◽

pp. 187-191 ◽

Cited By ~ 17

Author(s):

Laura Sánchez-Iñigo ◽

David Navarro-González ◽

Alejandro Fernández-Montero ◽

Juan Pastrana-Delgado ◽

JA Martínez

Keyword(s):

Ischemic Stroke ◽

Hazard Analysis ◽

Normal Weight ◽

Metabolic Health ◽

Stroke Incidence ◽

Metabolically Healthy Obese ◽

Increased Risk ◽

Healthy Obese ◽

Metabolically Healthy

Background Whether obesity is a major risk factor for cardiovascular disease in the absence of metabolic comorbidities remains under debate. Indeed, some obese individuals may be at low risk of metabolic-related complications, while normal-weight individuals may not be “healthy.” Aims To assess the incidence of ischemic stroke according to the metabolic health and obesity states of 5171 participants from the Vascular-Metabolic CUN cohort. Methods A Cox proportional-hazard analysis was conducted to estimate the hazard ratio and their 95% confidence interval of stroke according to the metabolic health and obesity states based on TyG index and Adult Treatment Panel-III criteria, during 9.1 years of follow-up. Results After 50,056.2 person-years of follow-up, 162 subjects developed an ischemic stroke (incidence rate 3.23 per 1000 person-years). Metabolically healthy obese subjects did not show greater risk of stroke, while metabolically unhealthy participants, obese and non-obese, had an increased risk of stroke, compared with healthy non-obese. The hazard ratios for the multivariable adjusted model were 1.55 (95% CI: 1.36–1.77) and 1.86 (95% CI: 1.57–2.21), respectively. Conclusions Metabolically unhealthy individuals exhibited a greater risk of ischemic stroke than metabolically healthy obese individuals.

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Lipid Profile and Atherogenic Index of Plasma (AIP) in Vegetarians

Journal of Enam Medical College ◽

10.3329/jemc.v5i1.21494 ◽

2015 ◽

Vol 5 (1) ◽

pp. 30-33

Author(s):

AN Wahida Sultana ◽

Noortaj Begum ◽

Abu Sadique Abdullah ◽

Md Aminul Haque Khan ◽

Md Rezwanur Rahman ◽

...

Keyword(s):

Lipid Profile ◽

Total Cholesterol ◽

Fruits And Vegetables ◽

Oxidized Ldl ◽

Hdl Cholesterol ◽

Vegetarian Diet ◽

Atherogenic Index ◽

Atherogenic Index Of Plasma ◽

Increased Risk ◽

Control And Prevention

Background: Diet deficient in fresh fruits and vegetables are associated with an increased risk of coronary diseases. Low levels of vitamin C, vitamin E and other antioxidants may enhance the production of oxidized LDL and are important independent risk factors for coronary disease. Objective: To make a comparative evaluation of lipid profile and atherogenic index of plasma (AIP) between vegetarians and nonvegetarians. Materials and Methods: This case-control study was carried out in the Department of Biochemistry of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka between July 2011 to June 2012. Vegetarian and nonvegetarian subjects of male sex were the study population. Vegetarians were considered as cases while nonvegetarians as controls. After proper ethical consideration a total of 30 vegetarians and 40 nonvegetarians were consecutively included in the study based on predefined inclusion and exclusion criteria. Laboratory investigations were done in the Department of Biochemistry, BSMMU, Dhaka. Results: The vegetarians had significantly lower total cholesterol and LDLcholesterol than the nonvegetarians (p=0.000 and p=0.000 respectively). Serum HDL cholesterol was also lower among the vegetarians (p=0.002) and triglycerides were almost identical in both the groups (p=0.272). Conclusion: The study reveals lower level of total cholesterol, LDLcholesterol and HDL-cholesterol in vegetarians. No difference regarding triglycerides and AIP was found between the groups. So, the findings of this study do not indicate any superiority of vegetarian diet in control and prevention of cardiac diseases. DOI: http://dx.doi.org/10.3329/jemc.v5i1.21494 J Enam Med Col 2015; 5(1): 30-33

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Abstract 179: Vascular Inflammation and Hepatic Steatosis among the Overweight Metabolically Healthy Individuals and Normal Weight with Cardiometabolic Risk Factor Clustering

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.33.suppl_1.a179 ◽

2013 ◽

Vol 33 (suppl_1) ◽

Author(s):

Sameer Shaharyar ◽

Adil Karim ◽

Michael J Blaha ◽

Shozab S Ali ◽

Omar Jamal ◽

...

Keyword(s):

Hepatic Steatosis ◽

Vascular Inflammation ◽

High Sensitivity ◽

Abdominal Ultrasound ◽

Normal Weight ◽

Cvd Risk ◽

Reactive Protein ◽

Cardiometabolic Disorders ◽

Metabolically Healthy ◽

Hs Crp

BACKGROUND Emerging literature has elucidated a new phenotype, metabolically healthy overweight/obese (MHO) who have a similar CVD risk to normal weight individuals. The aim of the study was to compare the relative risk of both phenotypes with subclinical inflammatory-cardiometabolic disorders. METHODS We evaluated 6,464 healthy non diabetic Brazilian subjects (43±10 years, 79% males). Those with <2 metabolic risk factors (MRF)were considered metabolically healthy and those with BMI≥25 kg/m2 as overweight (OW). High sensitivity C reactive protein (hs-CRP) was measured to assess degree of underlying inflammation and hepatic steatosis (HS) was determined via abdominal ultrasound. RESULTS Overall, 52% OW individuals were metabolically normal, and 11% normal-weight had≥2 MRF. The respective prevalence for elevated CRP (≥ 3 mg/dl) was 28% vs 16%, p<0.0001) and 71% vs 28% for HS, respectively. As compared to those with normal weight/metabolically benign, the highest risk of elevated CRP & HS was noted among those with overweight/metabolically unhealthy individuals (table). Both MHO individuals & normal weight metabolically unhealthy participants had similar association with elevated CRP & HS. CONCLUSION Our study highlights that healthy overweight/obesity & normal weight metabolically unhealthy phenotypes are not entirely benign and efforts are needed to reverse these conditions.

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Circulating Adipokines in Healthy versus Unhealthy Overweight and Obese Subjects

International Journal of Endocrinology ◽

10.1155/2014/170434 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 18

Author(s):

Assim A. Alfadda

Keyword(s):

Hdl Cholesterol ◽

Metabolic Health ◽

Bioactive Substances ◽

Metabolically Healthy Obese ◽

Cholesterol Levels ◽

Increased Risk ◽

Obese Subjects ◽

Healthy Obese ◽

Metabolically Healthy

It is now well established that not all obese subjects are at increased risk of cardiometabolic complications; such patients are termed the metabolically healthy obese. Despite their higher-than-normal body fat mass, they are still insulin sensitive, with a favorable inflammatory and lipid profile and no signs of hypertension. It remains unclear which factors determine an individual's metabolic health. Adipose tissue is known to secrete multiple bioactive substances, called adipokines, that can contribute to the development of obesity-associated complications. The goal of this study was to determine whether the circulating adipokine profiles differs between metabolically healthy and metabolically unhealthy overweight and obese subjects, thereby obtaining data that could help to explain the link between obesity and its related cardiometabolic complications. We defined metabolic health in terms of several metabolic and inflammatory risk factors. The serum adiponectin levels were higher in the healthy group and showed a positive correlation with HDL cholesterol levels in the unhealthy group. There were no differences between the two groups in the levels of serum leptin, chemerin and orosomucoid. Accordingly, adiponectin might play a role in protecting against obesity-associated cardiometabolic derangements. More studies are needed to clarify the role of different chemerin isoforms in this system.

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Serum 25(OH)D Concentration and Cardiovascular Disease Risk Markers Among Middle-Aged Healthy and Type 2 Diabetic Subjects

Hormone and Metabolic Research ◽

10.1055/a-1534-2747 ◽

2021 ◽

Vol 53 (10) ◽

pp. 676-682

Author(s):

Yogita Dhas ◽

Joyita Banerjee ◽

Gauri Damle ◽

Neetu Mishra

Keyword(s):

Cardiovascular Disease ◽

Vitamin D ◽

Blood Viscosity ◽

Atherogenic Index ◽

Risk Markers ◽

Cvd Risk ◽

Atherogenic Index Of Plasma ◽

Hs Crp ◽

Fgf 23

AbstractVitamin D deficiency is a major widespread health concern and is linked to a high risk of cardiovascular disease (CVD). Thus, we have investigated the association of vitamin D with various CVD risk markers. The present study comprises 90 control and 90 type 2 diabetes mellitus (T2DM) subjects of both sexes (age range, 30–50 years). The 25 hydroxyvitamin D [25(OH)D] and CVD risk markers including high sensitive C-reactive protein (hs-CRP), monocyte chemoattractant protein-1 (MCP-1), intact parathyroid hormone (I-PTH), fibroblast growth factor (FGF)-23, erythrocyte sedimentation rate (ESR), and fibrinogen were measured by using standard assays. Blood viscosity and atherogenic index of plasma calculated using standard formulae. The ten-year cardiovascular risk was assessed using the Framingham risk score (FRS). 25(OH)D, hs-CRP, MCP-1, FGF-23, ESR, fibrinogen, atherogenic index of plasma and FRS were significantly different between control and T2DM groups (p<0.05). 25(OH)D showed a significant negative correlation with MCP-1, ESR, blood viscosity, atherogenic index of plasma and FRS among total study subjects. Further, logistics regression analysis showed an association of 25(OH)D with MCP-1, hematocrit, fibrinogen, and blood viscosity. The association between 25(OH)D and various CVD risk markers suggests that 25(OH)D might help in the prediction of CVD risk.

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Is normal body mass index a good indicator of metabolic health in Azar cohort population?

Journal of Cardiovascular and Thoracic Research ◽

10.15171/jcvtr.2019.09 ◽

2019 ◽

Vol 11 (1) ◽

pp. 53-60

Author(s):

Mohammd Hossein Somi ◽

Zeinab Nikniaz ◽

Alireza Ostadrahimi ◽

Amir Taher Eftekhar Sadat ◽

Elnaz Faramarzi

Keyword(s):

Public Health Problem ◽

Normal Weight ◽

Normal Body Mass Index ◽

Metabolic Abnormalities ◽

Regression Analyses ◽

Cvd Risk ◽

Important Public Health Problem ◽

Metabolically Healthy Obese ◽

Healthy Obese ◽

Metabolically Healthy

Introduction: Metabolic syndrome (Mets) has become most important public health problem in the world. We examined the association between Mets and different cardiometabolic phenotype in Azar cohort population. Methods: In the present study, the data of 13099 subjects who participated in Azar cohort study were cross-sectionally analyzed. Mets was defined according to the National Cholesterol Education Program’s Adult Treatment Panel III report (ATPIII) criteria. Participants were categorized into four cardiometabolic phenotypes including metabolically healthy Lean (MHL), metabolically unhealthy lean (MUHL), metabolically healthy Obese (MHO), metabolically unhealthy obese (MUHO) according to BMI cut–off point (25 kg/m2 ), and the presence of Mets. Results: Totally, the prevalence of Mets was 33.20% with the higher prevalence in women (40.1%). About 46.7% of participants were MHO and 1.6% of them were MHL. In both genders, MUHL had the highest prevalence of hyperglycemia, hypertrigliceridemia, hypo-HDL-cholestrolemia and Frahmingham 10-year CVD risk. In both MUHL and MUHO phenotypes, hypertriglyceridemia (OR: 31.97 [95% CI: 22.31, 45.81] and OR: 20.28 [95% CI: 17.32, 23.75]) and hypo-HDL cholestrolemia (OR:27.97 [95% CI: 17.35, 45.09] and OR:11.0 [95% CI: 9.62, 12.58]) are the strongest predictor of incidence of Mets. Also, the results of multinominal regression analyses indicated that in all cardiometabolic phenotypes, Framingham 10- year CVD risks had the lowest power for predicting of Mets incidence. Conclusion: Based on the results, in addition to obese individuals, multiple metabolic abnormalities were seen in normal weight individuals and these subjects are even at higher risk of developing Mets compared with metabolically obese individuals. So, it seems that decision on initiation of lifestyle interventions should not be only based on the BMI; rather metabolic status seems to be even more important.

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