Evolution of Metabolic Phenotypes of Obesity in Coronary Patients after 5 Years of Dietary Intervention: From the CORDIOPREV Study.

Laura Martin-Piedra,Pablo Perez-Martinez,Jose D Torres-Peña,Jose Lopez-Miranda,Antonio P Arenas De Larriva,Juan L Romero-Cabrera,Francisco M Gutierrez-Mariscal,Juan F Alcala-Diaz,Raul M Luque,Javier Delgado-Lista,Javier Caballero-Villarraso

doi:10.3390/nu13114046

Abstract

Background: Obesity phenotypes with different metabolic status have been described previously. We analyzed metabolic phenotypes in obese coronary patients during a 5-year follow-up, and examined the factors influencing this evolution. Methods: The CORDIOPREV study is a randomized, long-term secondary prevention study with two healthy diets: Mediterranean and low-fat. All obese patients were classified as either metabolically healthy obese (MHO) or metabolically unhealthy obese (MUO). We evaluated the changes in the metabolic phenotypes and related variables after 5 years of dietary intervention. Results: Initially, 562 out of the 1002 CORDIOPREV patients were obese. After 5 years, 476 obese patients maintained their clinical and dietary visits; 71.8% of MHO patients changed to unhealthy phenotypes (MHO-Progressors), whereas the MHO patients who maintained healthy phenotypes (MHO-Non-Progressors) lost more in terms of their body mass index (BMI) and had a lower fatty liver index (FLI-score) (p < 0.05). Most of the MUO (92%) patients maintained unhealthy phenotypes (MUO-Non-Responders), but 8% became metabolically healthy (MUO-Responders) after a significant decrease in their BMI and FLI-score, with improvement in all metabolic criteria. No differences were found among dietary groups. Conclusions: A greater loss of weight and liver fat is associated with a lower progression of the MHO phenotype to unhealthy phenotypes. Likewise, a marked improvement in these parameters is associated with regression from MUO to healthy phenotypes.

Highlights

Obesity is a worldwide public concern due to the effects it has on health and its socioeconomic implications
Some publications suggest that impairments of insulin sensitivity and low-grade subclinical inflammation, both triggered by an abnormal body fat distribution, are the most important underlying mechanisms that induce the progression from metabolically healthy obese (MHO) to metabolically unhealthy obese (MUO) [8,9,13]
Some of the European cohorts report a proportion of MHO patients between 12% and 22%, to our findings (15.8%), despite the fact that they included the general population, not patients with cardiovascular disease (CVD) [33], these values are slightly lower than studies in Spanish populations, which range from 16.1% to 21.8% [22,34]

Summary

Introduction

Obesity is a worldwide public concern due to the effects it has on health and its socioeconomic implications. The other phenotype of obesity is “metabolically unhealthy obese” (MUO), which is characterized by its association with risk factors and complications of obesity (diabetes, hypertension, CVD and all-cause mortality) [10]. This has not been clearly stated, many authors consider that MUO is the final status of all obese patients [11,12]. After 5 years, 476 obese patients maintained their clinical and dietary visits; 71.8% of MHO patients changed to unhealthy phenotypes (MHO-Progressors), whereas the MHO patients who maintained healthy phenotypes (MHO-Non-Progressors) lost more in terms of their body mass index (BMI) and had a lower fatty liver index (FLI-score) (p < 0.05). A marked improvement in these parameters is associated with regression from MUO to healthy phenotypes

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