Metabolically Healthy and Unhealthy Obese Phenotypes among Arabs and South Asians: Prevalence and Relationship with Cardiometabolic Indicators.

Victor M Oguoma,Fahd Al-Mulla,Mark Daniel,Mohamed Abu-Farha,Faisal H Al-Refaei,Jehad Abubaker,Saad Alsharrah,Neil T Coffee

doi:10.3390/nu14050915

Abstract

Obesity is a public health crisis in Kuwait. However, not all obese individuals are metabolically unhealthy (MuHO) given the link between obesity and future cardiovascular events. We assessed the prevalence of the metabolically healthy obese (MHO) phenotype and its relationship with high sensitivity C-reactive protein (hs-CRP), serum alanine aminotransferase (ALT), and insulin resistance (HOMA-IR) in Arab and South Asian ethnic groups in Kuwait. The national cross-sectional survey of diabetes and obesity in Kuwait adults aged 18–60 years were analysed. The harmonised definition of metabolic syndrome was used to classify metabolic health. Multinomial logistic regression analysis was used to model the relationship between the MHO and MuHO phenotypes and hs-CRP, ALT and HOMA-IR levels. Overall, the prevalence of MHO for body mass index (BMI)- and waist circumference (WC)-defined obesity was 30.8% and 56.0%, respectively; it was greater in women (60.4% and 61.8%, respectively) than men (39.6% and 38.2%, respectively). Prevalence rates were also lower for South Asians than for Arabs. The MHO phenotype had hs-CRP values above 3 µg/mL for each age group category. Men compared to women, and South Asians compared to Arabs had a lower relative risk for the MHO group relative to the MuHO group. This study shows there is high prevalence of MHO in Kuwait.

Highlights

Introduction iationsGlobal estimates indicate steady and highly concerning increases in the burden of overweight and obesity
South Asians had a lower percentage of the metabolically healthy obese (MHO) phenotype than Arabs for body mass index (BMI)- and waist circumference (WC)-defined obesity: 33.5% and 37.9 versus 66.5% and 62.1%, respectively
In both BMI- and WC-defined obesity, our study found that the metabolically unhealthy obese (MuHO) phenotype has the highest mean or median high sensitivity C-reactive protein (hs-CRP), ALT, and homeostasis model assessment (HOMA)-IR values compared to other phenotypes

Summary

Introduction

Global estimates indicate steady and highly concerning increases in the burden of overweight and obesity. In 2016, over 1.9 billion and 650 million adults above 18 years were overweight and obese, respectively [1]. Obese individuals are at an increased risk for cardio-metabolic complications than healthy-weight individuals [2]. Cardiometabolic complications linked with obesity include type 2 diabetes mellitus (T2DM), hypertension, dyslipidaemia, coronary heart disease, stroke, and some cancers. Sims [3] initially proposed the concept of the metabolically healthy obese phenotype in 2001. The relevance of maintaining a healthy body weight to reduce the risk of cardiometabolic complications is well understood amongst health scientists. The recognition that disease risks might vary among obese individuals has led to more inquiry to delineate different phenotypes

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