Abstract
BackgroundSubjects with normal body mass index (BMI) but elevated amounts of body fat (normal-weight obesity; NWO) show cardiometabolic dysregulation compared to subjects with normal BMI and normal amounts of body fat (normal-weight lean; NWL). In this study, we aimed to evaluate whether NWO individuals have higher rates of subclinical atherosclerosis compared to NWL subjects.MethodsFrom a large-scale health checkup system, we identified 2078 normal weight (18.5 ≤ BMI < 25 kg/m2) subjects with no previous history of coronary artery disease who underwent analysis of atherosclerosis using coronary computed tomography angiography (CCTA) and pulse wave velocity (PWV). NWO was defined as normal BMI and highest tertile of body fat percentage by sex (men ≥25. 4 % and women ≥31.4 %). CCTA was performed using a 64-detector row CT. A plaque was defined as a structure >1 mm2 within and/or adjacent to the vessel lumen and classified according to the presence/proportion of intraplaque calcification.ResultsNWO subjects (n = 283) demonstrated metabolic dysregulation compared to NWL individuals (n = 1795). After adjusting for age, sex, and smoking, NWO individuals showed higher PWV values than NWL individuals (1474.0 ± 275.4 vs. 1380.7 ± 234.3 cm/s, p = 0.006 by ANCOVA). Compared with NWL subjects, NWO subjects had a higher prevalence of soft plaques even after age, sex, and smoking adjustment (21.6 % vs. 14.5 %, p = 0.039 by ANCOVA). The PWV value and the log{(number of segments with plaque) + 1} showed a positive correlation with numerous parameters such as age, systolic blood pressure, visceral fat, fasting glucose level, serum triglyceride level, and C-reactive protein (CRP) in contrast to the negative correlation with high-density lipoprotein-cholesterol level. The visceral fat was an independent determinant of log{(number of segments with plaque) + 1} (ß = 0.027, SE = 0.011, p = 0.016) even after adjustment for other significant factors. Most importantly, NWO was an independent risk factor for the presence of soft plaques (odds ratio 1.460, 95 % confidence interval 1.027–2.074, p = 0.035) even after further adjustment for multiple factors associated with atherosclerosis (blood pressure, blood glucose, lipid level, CRP, medication, smoking status, physical activity).ConclusionsNWO individuals carry a higher incidence of subclinical atherosclerosis compared with NWL individuals, regardless of other clinical risk factors for atherosclerosis.
Highlights
IntroductionSubjects with normal body mass index (BMI) but elevated amounts of body fat (normal-weight obesity; NWO) show cardiometabolic dysregulation compared to subjects with normal BMI and normal amounts of body fat (normal-weight lean; NWL)
Subjects with normal body mass index (BMI) but elevated amounts of body fat show cardiometabolic dysregulation compared to subjects with normal BMI and normal amounts of body fat
Considering that vascular inflammation is a major pathologic phenomenon leading to plaque rupture [13, 14], these findings suggest that normal-weight obesity (NWO) subjects may have more subclinical atherosclerosis, which may in the longterm lead to significant cardiovascular mortality or morbidity
Summary
Subjects with normal body mass index (BMI) but elevated amounts of body fat (normal-weight obesity; NWO) show cardiometabolic dysregulation compared to subjects with normal BMI and normal amounts of body fat (normal-weight lean; NWL). BMI can overestimate the degree of obesity in people with lower body fat percentage and higher lean body mass [5] or underestimate it in Asians with the opposite body composition [6]. Because of these limitations in BMI, subjects with so-called normal-weight obesity (NWO) have been a matter of investigation recently. NWO subjects have more cardiometabolic risk factors [7,8,9,10], impaired cardiac function [11], and are more likely to experience mortality [9] compared to normal-weight lean (NWL) subjects. No reports have looked into whether NWO subjects are really susceptible to atherosclerosis nor have any in-depth studies investigated the characteristics of atherosclerosis in these patients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
