Abstract
BackgroundCardiometabolic disorders are frequently observed among those who have obesity as measured by body mass index (BMI). However, there is limited data available on the cardiometabolic profile of those who are non-obese by BMI but with a high body fat percentage (BFP), a phenotype frequently observed in the Indian population. We examined the prevalence of individuals with normal weight obesity (NWO) and the cardiometabolic profile of NWO individuals at high risk for type 2 diabetes(T2D) in a south Asian population.Material and methodsIn the Kerala Diabetes Prevention Program, individuals aged between 30 to 60 years were screened using the Indian Diabetes Risk Score(IDRS) in 60 rural communities in the Indian state of Kerala. We used data from the baseline survey of this trial for this analysis which included 1147 eligible high diabetes risk individuals(IDRS >60). NWO was defined as BMI within the normal range and a high BFP (as per Asia-pacific ethnicity based cut-off); Non-obese (NO) as normal BMI and BFP and overtly obese (OB) as BMI ≥25 kg/m2 irrespective of the BFP. Data on demographic, clinical and biochemical characteristics were collected using standardized questionnaires and protocols. Body fat percentage was assessed using TANITA body composition analyser (model SC330), based on bioelectrical impedance.ResultsThe mean age of participants was 47.3 ± 7.5 years and 46% were women. The proportion with NWO was 32% (n = 364; 95% CI: 29.1 to 34.5%), NO was 17% (n = 200) and OB was 51% (n = 583). Among those with NWO, 19.7% had T2D, compared to 18.7% of those who were OB (p value = 0.45) and 8% with NO (p value = 0.003). Among those with NWO, mean systolic and diastolic blood pressure were 129 ± 20; 78 ± 12 mmHg, compared to 127 ± 17; 78±11 mmHg among those with OB (p value = 0.12;0.94) and 120 ± 16; 71±10 mmHg among with NO (p value<0.001; 0.001), respectively. A similar pattern of association was observed for LDL cholesterol and triglycerides. After adjusting for other risk factors, the odds of having diabetes (OR:2.72[95% CI:1.46–5.08]) and dyslipidemia (2.37[1.55–3.64]) was significantly more in individuals with NWO as compared to non-obese individuals.ConclusionsAlmost one-third of this South Asian population, at high risk for T2D, had normal weight obesity. The significantly higher cardiometabolic risk associated with increased adiposity even in lower BMI individuals has important implications for recognition in clinical practice.
Highlights
Cardiometabolic disorders are one of the leading causes of death worldwide.[1]
The proportion with normal weight obesity (NWO) was 32% (n = 364; 95% CI: 29.1 to 34.5%), NO was 17% (n = 200) and OB was 51% (n = 583)
After adjusting for other risk factors, the odds of having diabetes (OR:2.72[95% CI:1.46–5.08]) and dyslipidemia (2.37[1.55–3.64]) was significantly more in individuals with NWO as compared to non-obese individuals
Summary
Cardiometabolic disorders are one of the leading causes of death worldwide.[1]. The conventionally described risk factors including unhealthy dietary patterns and physical inactivity in addition to underlying genetic predisposition are in part responsible for the increasing prevalence of obesity, which is often a forerunner of these cardiometabolic diseases.[2]. Asian Indians have a small body size but often have centripetal obesity as depicted by their high waist-to-hip ratio (WHR), waist circumference, visceral fat and posterior subcutaneous abdominal fat.[9,10] This unique phenotype called normal weight obesity (NWO), is defined as people with normal BMI and high body fat percentage This phenotype was first described in 1981 by Ruderman et al as metabolically obese normal weight and later termed as normal weight obesity in 2006, by De Lorenzo et al [11] it has not as yet percolated through clinical practice and there remains a rather large proportion of these apparently normal looking individuals with high metabolic risks who go unrecognised in the Indian setting.[5,12]. We examined the prevalence of individuals with normal weight obesity (NWO) and the cardiometabolic profile of NWO individuals at high risk for type 2 diabetes(T2D) in a south Asian population
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