Abstract
ObjectiveWe aimed to characterize metabolic status by body mass index (BMI) status.MethodsThe CRONICAS longitudinal study was performed in an age-and-sex stratified random sample of participants aged 35 years or older in four Peruvian settings: Lima (Peru’s capital, costal urban, highly urbanized), urban and rural Puno (both high-altitude), and Tumbes (costal semirural). Data from the baseline study, conducted in 2010, was used. Individuals were classified by BMI as normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (≥30 kg/m2), and as metabolically healthy (0–1 metabolic abnormality) or metabolically unhealthy (≥2 abnormalities). Abnormalities included individual components of the metabolic syndrome, high-sensitivity C-reactive protein, and insulin resistance.ResultsA total of 3088 (age 55.6±12.6 years, 51.3% females) had all measurements. Of these, 890 (28.8%), 1361 (44.1%) and 837 (27.1%) were normal weight, overweight and obese, respectively. Overall, 19.0% of normal weight in contrast to 54.9% of overweight and 77.7% of obese individuals had ≥3 risk factors (p<0.001). Among normal weight individuals, 43.1% were metabolically unhealthy, and age ≥65 years, female, and highest socioeconomic groups were more likely to have this pattern. In contrast, only 16.4% of overweight and 3.9% of obese individuals were metabolically healthy and, compared to Lima, the rural and urban sites in Puno were more likely to have a metabolically healthier profile.ConclusionsMost Peruvians with overweight and obesity have additional risk factors for cardiovascular disease, as well as a majority of those with a healthy weight. Prevention programs aimed at individuals with a normal BMI, and those who are overweight and obese, are urgently needed, such as screening for elevated fasting cholesterol and glucose.
Highlights
Obesity, commonly measured using body mass index (BMI), has been associated with a number of metabolic and cardiovascular disease (CVD) risk factors including an excess mortality risk [1]
Prevention programs aimed at individuals with a normal BMI, and those who are overweight and obese, are urgently needed, such as screening for elevated fasting cholesterol and glucose
Levels of overweight and obesity in Latin America have increased over time [2] and have approached levels found in higher-income countries, with a disproportionate increase in waist circumference compared to BMI over the past 20 years [3, 4]
Summary
Commonly measured using body mass index (BMI), has been associated with a number of metabolic and cardiovascular disease (CVD) risk factors including an excess mortality risk [1]. Prior studies in high-income settings have noted a high prevalence of individuals who are overweight and obese but display normal metabolic features despite their increased adiposity [6,7,8,9,10,11,12]. This metabolically healthy obese profile is controversial: whilst some evidence suggests these individuals are still at increased risk of developing diabetes [13, 14], CVD [15, 16] and have increased mortality [8], other studies have found an “obesity paradox” whereby there seems to be a protective effect of obesity from mortality and other chronic conditions [17]. No prior studies have estimated the prevalence of overweight and obese individuals and their metabolic risk factors and if these individuals are different with regards to socio-demographic and behavioral factors in a Latin American population
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