Healthy Obesity Research Articles

Indicators of Glucose Metabolism in Children and Adolescents Characterized as Having “Metabolically Healthy” and “Metabolically Unhealthy” Obesity

Background/Objectives: Some individuals with obesity may exhibit fewer metabolic disturbances and face a lower long-term risk of complications; however, the existence of this so-called “metabolically healthy obesity” (MHO) compared to “metabolically unhealthy obesity” (MUO) remains controversial. We hypothesized that children with MHO might have a more favorable profile than children with MUO. Markers of glucose metabolism and insulin sensitivity were compared between children and adolescents diagnosed with MHO and MUO. Methods: This study recruited prospectively 104 children and adolescents (aged 6–16 years, 47 boys) with obesity. All participants underwent an oral glucose tolerance test (OGTT), and a comparative analysis was performed on HOMA-IR, QUICKI, insulin sensitivity index (ISI), insulinogenic index (IGI), disposition index (DI), and oral disposition index (oDI). Glucose metabolism indices were compared in these subgroups according to pubertal status. Results: Forty-seven children (45.2%) were diagnosed with MHO. The whole-body ISI differed significantly between the MHO and MUO groups (4.02 vs. 2.7, p < 0.01). The IGI was statistically lower in the MHO group compared to MUO (1.26 vs. 1.54, p < 0.01), while neither the DI nor the oDI differed significantly. A higher ISI (4.5 vs. 3.9, p < 0.01) was observed in prepubertal MHO individuals compared to MHO adolescents. Conclusions: Children classified as MHO according to the more recent criteria exhibit a more favorable metabolic profile than those with MUO. However, a completely healthy profile was not demonstrated in the MHO group, as many crucial metabolic profile parameters were comparable to those observed in the MUO group. The findings of this study indicate that all children with obesity, irrespective of whether they are categorized as having MUO or MHO, necessitate close monitoring.

Finding ways to correct nonspecific vaginitis in menopausal women with obesity

Objective — to increase the effectiveness of treatment of nonspecific vaginitis in menopausal women with excess body weight and obesity through long-term lifestyle modification. Materials and methods. 1178 patients aged 45—55 years were examined, including 317 with nonspecific vaginitis, who were divided into 3 study groups: with a healthy body weight, overweight and obesity. Each group was divided into three subgroups of comparison with standard therapy and three study groups that applied long-term lifestyle modification (actively and systematically used behavioral therapy, physical activity and a low-calorie diet) for 6 months. The control group consisted of 72 volunteers. Results and discussion. In the study subgroups of women who used long-term lifestyle modification, recurrences of nonspecific vaginitis were less frequent than in the corresponding comparison subgroups. Thus, after 6 months, in subgroups of women with a healthy body weight, the difference in the frequency of relapses after treatment was 40 % greater (34.2 vs 20.5 %), with excess body weight — 31.1 % (41.2 vs 28.4 %), with obesity — 29.8 % (55.1 vs 38.7 %). A significant deterioration in the state of the microbiota in menopausal patients with increased body weight and the effectiveness of the use of long-term lifestyle modification on its condition were established. It was proven that excess body weight and obesity in women negatively affected the frequency of nonspecific vaginitis, clinical picture, decreased quality of life, and frequency of relapses. Active and systematic use of behavioral therapy, physical activity, and a low-calorie diet in patients with nonspecific vaginitis in menopause had significant advantages in preventing relapses, compared to standard therapy, and in preserving and improving the quality of life of obese patients. Conclusions. Overweight and obese women are more likely than healthy women to suffer from nonspecific vaginitis, which is more severe and recurrent, accompanied by a decrease in quality of life and a disruption of the vaginal and skin biotope. After 6 months in obese postmenopausal women, the use of long-term lifestyle modification contributes to the restoration of the vaginal and skin microbiome, a decrease in the frequency of recurrences of nonspecific vaginitis and an improvement in quality of life compared with subgroups. with standard therapy. The best effect of treatment was observed in women with a healthy body weight, and the worst in the presence of obesity.

Metabolic Profile of Gut Microbiota and Levels of Trefoil Factors in Adults with Different Metabolic Phenotypes of Obesity

Obesity is associated with changes in the gut microbiota, as well as increased permeability of the intestinal wall. In 130 non-obese volunteers, 57 patients with metabolically healthy obesity (MHO), and 76 patients with metabolically unhealthy obesity (MUHO), bacterial DNA was isolated from stool samples, and the 16S rRNA gene was sequenced. The metabolic profile of the microbiota predicted by PICRUSt2 (https://huttenhower.sph.harvard.edu/picrust/) was more altered in patients with MUHO than MHO. Obesity, especially MUHO, was accompanied by an increase in the ability of the gut microbiota to degrade energy substrates, produce energy through oxidative phosphorylation, synthesize water-soluble vitamins (B1, B6, B7), nucleotides, heme, aromatic amino acids, and protective structural components of cells. Such changes may be a consequence of the microbiota adaptation to the MUHO-specific conditions. Thus, a vicious circle is formed, when MUHO promotes the depletion of gut microbiome, and further degeneration of the latter contributes to the pathogenesis of metabolic disorders. The concentration of the trefoil factor family (TFF) in the serum of the participants was also determined. In MHO and MUHO patients, TFF2 and TFF3 levels were increased, but we did not find significant associations of these changes with the metabolic profile of the gut microbiota.

The impact of body mass index on rehabilitation outcomes after lower limb amputation.

To determine the effect of obesity on physical function and clinical outcome measures in patients who received inpatient rehabilitation services for lower extremity amputation. A retrospective review was performed on patients with lower extremity amputation (n = 951). Patients were stratified into five categories adjusted for limb loss mass across different levels of healthy body mass index (BMI), overweight, and obesity. Outcomes included the Inpatient Rehabilitation Facility Patient Assessment Instrument functional scores (GG section), discharge home, length of stay (LOS), therapy time, discharge location, medical complications and acute care readmissions. Deep learning neural networks (DLNNs) were developed to learn the relationships between adjusted BMI and discharge home. The severely obese group (BMI > 40 kg/m2) demonstrated 7%-13% lower toileting hygiene functional scores at discharge compared to the remaining groups (p < .001). The severely obese group also demonstrated 8%-9% lower sit-to-lying and lying-to-sitting bed mobility scores than the other groups (both p < .001). Sit-to-stand scores were 16%-21% worse and toilet transfer scores were 12%-20% worse in the BMI > 40 kg/m2 group than the other groups (all p < .001). Walking 50 ft with two turns was most difficult for the BMI > 40 kg/m2 group, with mean scores 7%-27% lower than the other BMI groups (p = .011). Wheelchair mobility scores for propelling 150 ft were worst for the severely obese group (4.9 points vs. 5.1-5.5 points for all other groups; p = .021). The LOS was longest in the BMI > 40 group and shortest in the BMI < 25 group (15.0 days vs. 13.3 days; p = .032). Logistic regression analysis indicated that BMI > 40 kg/m2 was associated with lower odds risk (OR) of discharge-to-home (OR = 0.504 [0.281-0.904]; p < .022). DLNNs found that adjusted BMI and BMI category were ranked 11th and 12th out of 90 model variables in predicting discharge home. Patients with severe obesity (>40 kg/m2) achieved lower functional independence for several tasks and are less likely to be discharged home despite higher therapy volume than other groups. If a patient is going home, obesity will pose unique demands on the caregivers and resources can be put in place to help reintegrate the patient into life.

Obesity, Metabolic Health, and Diabetic Complications in People With Type 1 Diabetes.

The concept of metabolically healthy obesity (MHO) has not been studied in type 1 diabetes (T1D). By analysing datasets from the DCCT/EDIC study, we compared the development of diabetic complications by obesity and metabolic health over 30 years of follow up. Insulin resistance was calculated by estimated glucose disposal rate (eGDR). The participants (n = 1127) were then divided into four groups based on time-weighted mean body mass index and mean eGDR: metabolically healthy non-obesity (MHN, n = 874), metabolically unhealthy non-obesity (MUN, n = 66), MHO (n = 146) and metabolically unhealthy obesity (MUO, n = 41). Diabetic complications and cardiovascular events were compared across the four groups. MUO and MUN groups had significantly higher risk for peripheral neuropathy (p = 0.001 in MUO and p <0.001 in MUN vs. MHN), cardiac autonomic neuropathy (p <0.001 in both MUO and MUN vs. MHN), retinopathy (p = 0.001 in MUO and p <0.001 in MUN vs. MHN) and microalbuminuria (p <0.001 in both MUO and MUN vs. MHN) than MHN group. Moreover, MUO and MUN groups had significantly higher risks (HR [95%CI]) in any cardiovascular events (2.78 [1.51-5.11] and 1.88 [1.05-3.36]) and major atherosclerotic cardiovascular events (2.72 [1.16-6.37] and 2.31 [1.05-5.10]) compared to MHN group. However, the risk of these complications and cardiovascular events (except peripheral neuropathy and cardiac autonomic neuropathy) in MHO group was not different from that in MHN group. This study highlights the importance of metabolic health represented by insulin resistance in the development of diabetic complications and cardiovascular events in T1D beyond their weight status.

Early-day Protein Intake Influences the Transition of Metabolic Health Phenotypes Among Adults with Obesity

Metabolically healthy obesity (MHO) represents a subset of obesity characterized by a lower risk of cardiometabolic syndrome than individuals with metabolically unhealthy obesity (MUO). This study aimed to (1) describe the transition of metabolic health phenotypes in adults with obesity and (2) identify the differentiating factors associated with this transition following the 12-week weight reduction program. This study recruited 91 adults with obesity (Age: 39.6±6.3 years; 74.7% women; body mass index (BMI): 31.2±4.5 kg/m2). The weight reduction intervention incorporates multiple lifestyle domains, including dietary modifications, physical activity, behavioural strategies, and chrono-nutrition, which encompasses temporal eating patterns, meal timing and sleep. At pre-intervention, 55% of participants (n=50) were classified as MHO: BMI≥25kg/m2 with fewer than three metabolic abnormalities, while 45% (n=41) were classified as MUO: BMI≥25kg/m2 with three or more metabolic abnormalities. Post-intervention, about 24% of the participants (n=22) exhibited positive changes, transitioning from MUO to MHO or from MUO/MHO to metabolically healthy normal weight (MHN). The MUO proportion decreased to 31% (n=28), and 45% (n=41) remained as MHO. Participants who demonstrated positive changes were characterized with highest increase in energy intake from protein sources (+5.2% vs +1.1%, p=0.004), particularly during the earlier part of the day (+4.3% vs +1.1%, p=0.029), greater body weight loss (-7.0% vs -3.2%, p=0.022), body fat loss (-3.4% vs -1.3%, p=0.013) and visceral fat loss (-1.3 vs -0.5, p=0.013) as well as a higher proportion of morning chronotype (72.7% vs 35.7%, p=0.033), than the participants who showed negative changes. These results imply that, the timing of protein intake and chronotype may play significant roles in mitigating the risk of cardiometabolic syndrome among adults with obesity, in addition to weight reduction.

Unveiling adipose populations linked to metabolic health in obesity.

Precision medicine is still not considered as a standard of care in obesity treatment, despite a large heterogeneity in the metabolic phenotype of individuals with obesity. One of the strongest factors influencing the variability in metabolic disease risk is adipose tissue (AT) dysfunction; however, there is little understanding of the link between distinct cell populations, cell-type-specific transcriptional programs, and disease severity. Here, we generated a comprehensive cellular map of subcutaneous and visceral AT of individuals with metabolically healthy and unhealthy obesity. By combining single-nucleus RNA-sequencing data with bulk transcriptomics and clinical parameters, we identified that mesothelial cells, adipocytes, and adipocyte-progenitor cells exhibit the strongest correlation with metabolic disease. Furthermore, we uncovered cell-specific transcriptional programs, such as the transitioning of mesothelial cells to a mesenchymal phenotype, that are involved in uncoupling obesity from metabolic disease. Together, these findings provide valuable insights by revealing biological drivers of clinical endpoints.

Associations of Metabolically Healthy Obesity and Retinal Age Gap.

We investigated the association between metabolically healthy obesity (MHO) and retinal age gap and explored potential sex differences in this association. This study included 30,335 participants from the UK Biobank. Body mass index (BMI) was classified into normal weight, overweight, and obesity. Metabolic health (MH) was defined as meeting the following criteria: systolic blood pressure of <130 mmHg, no antihypertensive drugs, waist-to-hip ratio of <0.95 for women or 1.03 for men, and the absence of diabetes. Participants were categorized as MH normal weight (MHN), MH overweight (MHOW), MHO, metabolically unhealthy normal weight, metabolically unhealthy (MU) overweight, and MU obesity. Retinal age gap was defined as the difference between retinal age and chronological age. Linear regression models were used to investigate the association of metabolic phenotypes of obesity with retinal age gap. Compared with MHN, individuals with MHOW (β, 0.17; 95% confidence interval [CI], 0.01-0.32; P = 0.039) and MHO (β, 0.23; 95% CI, 0.02-0.44; P = 0.031) were associated with increased retinal age gap. Furthermore, individuals classified as metabolic unhealthy were also associated with higher retinal age gap, irrespective of body mass index categories (β for MU normal weight, 0.23; 95% CI, 0.08-0.38; P = 0.003; β for MU overweight: 0.31; 95% CI, 0.18-0.45; P < 0.001; β for MU obesity, 0.50; 95% CI, 0.36-0.65; P < 0.001). No significant sex difference was observed in the association between metabolic phenotypes of obesity and retinal age gap (all P for interaction > 0.05). MHOW and MHO were associated significantly with an increased retinal age gap compared with MHN individuals. Weight management should be recommended for individuals who are overweight or obese, even in the absence of metabolic unhealth. Retinal age gap provides a simple tool for identifying early health risks for MHOW and MHO individuals.

Concentration and composition of circulating vesicles of adipocytic origin in patients with colon polyps and colorectal cancer

Extracellular vesicles (EVs) are a heterogeneous population of membrane particles less than 1 μm in size, secreted by various cell types. Most EVs circulating in human blood are particles of platelet, leukocyte, erythrocyte and endothelial origin. The composition of circulating adipocyte EVs in various pathological conditions has been virtually unknown. Small EVs from the blood plasma of patients with colorectal cancer (CRC) and colon polyps with obesity or metabolic syndrome were isolated by ultrafiltration with double ultracentrifugation. To study the composition of adipocyte EVs, immunoprecipitation in combination with Western blotting and flow cytometry were used. Vesicle fractions (FABP4- and CD11b-immunoprecipitated EVs, as well as EVs contained in the supernatant after removal of CD11b-positive EVs) contained a complex of adipocyte markers (FABP4, PPAR-γ and perilipin 1). EVs of monocyte-macrophage origin precipitated on CD11b-coated particles in CRC patients without obesity were characterized by combined overexpression of FABP4 and perilipin 1, while such overexpression was not typical for CRC patients with metabolic syndrome or obesity. The fraction of truly adipocyte vesicles (supernatant after removal of CD11b-positive EVs) was characterized by the presence in all patients of a complex of adipocyte markers with predominant expression of FABP4 in both patients with metabolic syndrome/metabolically healthy obesity and patients without metabolic disorders. To correctly characterize circulating EVs of patients without obesity, it is first necessary to remove the fraction of CD11b-positive monocyte-macrophage EVs from EV preparations by immunoprecipitation or similar methods, and in the supernatant after removal/sorption of precipitated EVs, the composition of adipocyte vesicles can be studied using a set of markers (FABP4, PPAR-γ, perilipin 1, etc.). Moreover, in patients with metabolic disorders, taking into account the insignificant expression of FABP4 in CD11b-immunoprecipitated EVs, preliminary depletion of vesicle preparations is apparently not so necessary.

Lifestyle intervention improves cardiometabolic profiles among children with metabolically healthy and metabolically unhealthy obesity

BackgroundIn recent years, there has been a surge of interest in the metabolic phenotype among children with obesity characterized by the absence of associated cardiometabolic risk factors (CRFs), known as metabolically healthy obesity (MHO), as opposed to those with metabolically unhealthy obesity (MUO). This study investigated the effect of lifestyle intervention on CRFs among children with MHO and MUO.MethodsA total of 102 school-aged children with obesity (54 girls and 48 boys) aged 8–16 years completed a 16-week school-based lifestyle modification intervention program, MyBFF@school Phase I. The intervention consisted of physical activity, healthy eating promotion, and psychological empowerment. MHO and MUO statuses were defined based on the 2018 consensus-based criteria. Fasting venous blood collection, body composition measurement, clinical assessment and physical fitness testing were conducted at baseline and at the end of week 16.ResultsAfter the intervention, the CRFs of the children with MUO improved with significant decreases in systolic (p < 0.001) and diastolic (p = 0.01) blood pressure and a significant increase in high-density lipoprotein cholesterol (HDL-C) (p = 0.005), while the CRFs of the children with MHO had a significant decrease in uric acid (p = 0.04). Additionally, 51.6% of the children with MHO transitioned to the MUO, while 26.8% of the children with MUO crossed over to the MHO at the end of the intervention. Furthermore, the odds of having high systolic blood pressure among children with MUO were 59% lower at week-16 than at baseline (OR = 0.41 (95% CI = 0.18, 0.92), p = 0.03).ConclusionsOur findings demonstrated that CRFs improved more prominently among children with MUO following the intervention. More importantly, our findings indicate that MHO in children is transient, hence, strategies to protect children against MUO are warranted.Trial registration: ClinicalTrials.gov NCT02212873.

Factors Associated with Metabolically Unhealthy Obesity and Its Relation to Food Insecurity in Korean Adults with Obesity.

The association between food insecurity and metabolically unhealthy obesity (MUO) in the population with obesity is unclear. We evaluated factors associated with MUO and the relationship between food insecurity and MUO in individuals with obesity. We analyzed data from 5191 adults with obesity (body mass index ≥ 25 kg/m2) from the 8th Korea National Health and Nutrition Examination Survey 2019-2021. MUO was defined when participants with obesity had any of the following: (1) triglycerides ≥ 150 mg/dL, (2) High-density lipoprotein-cholesterol < 40 mg/dL (men), <50 mg/dL (women), (3) systolic blood pressure ≥ 135 mmHg, diastolic blood pressure ≥85 mmHg or on treatment for hypertension, (4) fasting glucose ≥ 100 mg/dL, or on treatment for diabetes. The odds ratios (ORs) and 95% confidence intervals (CIs) for MUO according to food security status, sociodemographic characteristics, and lifestyle factors were calculated using multivariate logistic regression analysis. The prevalence of MUO and metabolically healthy obesity (MHO) among the participants was 85.4% and 14.6%, respectively. In the multivariate model, the OR (95% CIs) for MUO in the food insecurity group was 1.87 (1.03-3.43). The odds for MUO were higher among participants with older age, higher BMI, <12 years of education, lower fat intake, non-manual work, and moderated and low physical activity than among their counterparts. Food insecurity, older age, higher BMI, lower educational level, lower fat intake, non-manual workers, and lower physical activity were associated with MUO. Therefore, targeted interventions and policies are needed for vulnerable groups.

Relationship of different metabolic obesity phenotypes with reflux esophagitis: a propensity score matching analysis

BackgroundObesity is associated with an increased risk of reflux esophagitis (RE). Metabolic abnormalities have been implicated in the pathogenesis of RE. However, the role of metabolic status in the risk of RE among individuals with varying degrees of obesity remains unclear. Therefore, our study aimed to assess the association between metabolic obesity phenotypes and the risk of RE.MethodsThis study included a cohort of 24,368 participants aged 18 years and older who underwent upper gastrointestinal endoscopy at the First Affiliated Hospital of Dalian Medical University during health checkups between January 1, 2008, and December 31, 2021. Among these participants, a total of 9,947 individuals were classified into four groups based on their obesity phenotype: metabolically healthy normal weight (MHNW), metabolically healthy obesity (MHO), metabolically unhealthy normal weight (MUNW), and metabolically unhealthy obesity (MUO). To account for potential confounding factors, multivariate logistic regression analysis was applied to examine the association between metabolic obesity phenotypes and the risk of RE, with stratification by sex and age.ResultsAmong all participants, the MUNW, MHO, and MUO groups demonstrated a higher risk of RE when compared to the MHNW group. After controlling for all confounding factors, the MUO group exhibited the highest risk, with an odds ratio (OR) of 3.723 (95% CI: 2.751–5.040) in males and 5.482 (95% CI: 4.080–7.367) in females. The prevalence of RE increased in proportion to the number of metabolic risk factors. Subgroup analyses, which accounted for all confounders, revealed that the MHO, MUNW, and MUO phenotypes were associated with an elevated risk of RE in individuals under 60 years old as well as those over 60 years old. Interestingly, a more comprehensive analysis indicated that obesity may have a greater effect on the risk of RE than metabolic disorders.ConclusionsBoth metabolic disorders and obesity were associated with an increased risk of RE. The effect of obesity on RE prevalence may be stronger than that of metabolic disorders, emphasizing the significance of obesity regardless of metabolic health status. Clinical interventions should address not only obesity but also metabolic disorders in order to reduce the risk of RE.

Glucagon-like peptide-1 agonists in cardiovascular diseases: a bibliometric analysis from inception to 2023.

In recent years, glucagon-like peptide-1 (GLP-1) agonists have garnered increasing attention for their potential cardiovascular benefits beyond glycemic control in patients with diabetes. Understanding the research landscape surrounding GLP-1 agonists and cardiovascular diseases (CVDs) is crucial for informing clinical practice and guiding future research endeavors. This bibliometric analysis aimed to comprehensively assess the scholarly output and trends in this field, shedding light on the evolving landscape of GLP-1 agonists' role in cardiovascular health. The publications concerning GLP-1 agonists in CVDs were gathered from the Web of Science Core Collection, and visualizations were created utilizing Excel 2019, Cite Space, and VOS viewer software. Using bibliometric and visual methods, the research hotspots and trends regarding GLP-1 agonists in cardiovascular diseases were pinpointed. Additionally, a thriving interest in GLP-1 agonists research within cardiovascular medicine was observed, with a notable surge in publications from 2016 onwards. The analysis revealed that the United States and China are the leading contributors, accounting for over 50% of the total publications. The University of Copenhagen and the University of Toronto emerged as the most prolific institutions in this field. Co-citation analysis highlighted the influential role of landmark clinical trials, such as the LEADER, ELIXA, and EXSCEL. Keyword trend analysis identified the emergence of newer GLP-1 agonists, such as tirzepatide and semaglutide, as well as a growing focus on topics like 'healthy obesity' and chronic kidney disease. These findings suggest that the research landscape is evolving, with a focus on expanding the therapeutic applications of GLP-1 agonists beyond glycemic control. Overall, this bibliometric analysis provided insights into the current state and future directions of research on GLP-1 agonists and their impact on cardiovascular health, guiding future research endeavors, and informing clinical practice.

Preconception health inequalities in Northern Ireland: a focus on obesity and folic acid supplement use from 255,117 pregnancies

Obesity prevalence is rising globally. Living with obesity can lead to increased reproductive challenges and compromise preconception health, defined as the overall health of non-pregnant individuals of childbearing age (15-49 years)(1). Folic acid supplement use, considered a key preconception health behaviour, is pivotal for the prevention of neural tube defects in offspring(2). Guidelines suggest women with obesity take a higher dose (5mg/day) to reduce the risk of fetal complications(3). This research explored trends in Body Mass Index (BMI) in the preconception and early pregnancy period in Northern Ireland (NI) and the prevalence of folic acid supplement use across BMI categories, exploring differences based on deprivation.Anonymised national data collected in the Northern Ireland MATernity System (NIMATS) were accessed via the UK Secure eResearch Platform Data, provided by the HSC Honest Broker Service. The NI Multiple Deprivation Measure (NIMDM) (2017) aggregates the rankings of seven specific domains into a single ranking, used to categorise deprivation into quintiles for comparison (Q1 highest deprivation vs Q5 least deprivation). Healthy weight, overweight, and obesity were classified as BMI 18.5–24.99kg/m2, 25.00–29.99kg/m2 and ≥30kg/m2, respectively. Folic acid supplement use was self-reported. Multiple linear regressions explored trends in BMI between 2011 and 2021 and χ2 tests explored associations between BMI categories and folic acid supplement use from 2014-2021. The ‘Healthy Reproductive Years’ Patient and Public Involvement and Engagement (PPIE) advisory panel (aged 18-45 years), were involved throughout the study.The analyses included a total of 255,117 pregnancies, with missing data addressed per variable.The percentage of women entering pregnancy with a healthy BMI decreased between 2011 and 2021 (48.65%, n = 12,144, and 39.55%, n = 4,316, respectively), while the percentage of women with obesity increased over the same period (18.11%, n = 4,520, and 27.36%, n = 2,986, respectively). Regression models suggested an average increase of ∼1 unit of BMI per calendar year in women entering pregnancy (p&lt;0.001). There were higher proportions of pregnancies conceived by women with overweight or obesity in the highest deprivation quintile (Q1, 53.57%) compared to the least deprivation (Q5, 46.37%). Folic acid supplement use was mostly initiated after conception (59.03%) rather than before (37.54%), as recommended. Among women living with obesity, preconception supplement use of 5mg of folic acid was low (8.74%, n = 2,990). Lower proportions were observed for preconception supplement use of 400mcg among women in the quintile of greatest deprivation (Q1, 21.41%) versus least deprivation (Q5, 44.06%).Analyses demonstrated an increased number of women entering pregnancy with an elevated BMI and suboptimal preconception folic acid supplement use, particularly for women with obesity. It highlights significant health inequalities according to NIMDM regarding obesity and folic acid supplement use. There is a need to address modifiable preconception health risks, particularly for those from lower socioeconomic groups.

Central and Peripheral Sensitivity to Thyroid Hormones Correlate to Metabolically Obesity Phenotypes in Chinese Euthyroid Adults: A Cross-Sectional Study.

Thyroid hormones impact lipid metabolism and glucose homoeostasis through both central and peripheral regulation; however, little research has delved into the association between thyroid hormone sensitivity and metabolically obese phenotypes. We aimed to investigate the correlation between indices of central and peripheral sensitivity to thyroid hormones and metabolically obese phenotypes in euthyroid Chinese adults. This cross-sectional study included 20,084 euthyroid individuals. Central thyroid hormone sensitivity was assessed using the thyroid feedback quantile-based index (TFQI), parametric thyroid feedback quantile-based index (PTFQI), thyroid-stimulating hormone index (TSHI), and thyrotropin thyroxine resistance index (TT4RI), while peripheral thyroid hormone sensitivity was measured by FT3/FT4. Metabolically obesity phenotypes included metabolically healthy non-obesity (MHNO), unhealthy non-obesity (MUNO), metabolically healthy obesity (MHO), and unhealthy obesity (MUO). Multinomial logistic regression and restricted cubic spline analyses were conducted to investigate the association between thyroid hormone sensitivity indices and metabolically obese phenotypes risk. Subgroup analysis was also performed to examine this association stratified by sex and age. Mediation analysis was performed to estimate direct and indirect effects of BMI. Prevalence of MHNO, MUNO, MHO and MUO was 66.1% (n=13,273), 21.3% (n=4271), 5.3% (n=1055), and 7.4% (n=1485) respectively. After adjustment for potential confounders, the odds ratios (ORs) (95% CI) for MUNO and MUO were increased with all elevated thyroid hormones sensitivity indices (per SD increase) [MUNO: TFQI 1.14(1.09-1.19), PTFQI 1.18(1.23-1.23); TSHI 1.26(1.19-1.33), TT4RI 1.41, (1.31-1.53), FT3/FT4 1.20(1.14-1.25) and [MUO: TFQI 1.20(1.11-1.31), PTFQI 1.26(1.16-1.37), TSHI 1.39 (1.26-1.54), TT4RI 1.70(1.48-1.95), FT3/FT4 1.26 (1.16-1.37)] (p value<0.001), and only TSHI and TT4RI (per SD increase) significantly increased the risk of MHO (TSHI: OR=1.12, 95% CI 1.01-1.24; TT4RI: OR=1.25, 95%CI 1.08-1.4) (p value<0.05). Non-linear relationships were observed between central thyroid hormones sensitivity indices and MUNO and MUO(p for nonlinearity<0.05). Conversely, a linear relationship between FT3/FT4 and metabolically obese phenotypes was noted in all subjects (p for nonlinearity>0.05). Besides, subgroup analysis indicated that this association remained consistent among sex and age (p for interaction>0.05). The proportions mediated by BMI on the association of TFQI, PTFQI, TSHI, TT4RI, FT3/FT4 and risk of metabolically unhealthy conditions were 13.73%, 25.38%, 22.75%, 17.94% and 62.28%, respectively. In euthyroid adults, central and peripheral sensitivity to thyroid hormones indices are positively associated with metabolically obese phenotypes risk, especially MUNO and MUO phenotypes.

Reverse epidemiology of obesity paradox: Fact or fiction?

Obesity paradox refers to the clinical observation that when acute cardiovascular decompensation occurs, patients with obesity may have a survival benefit. This apparently runs counter to the epidemiology of obesity, which may increase the risk for non-communicable diseases (NCDs). The scientific community is split on obesity paradox, with some supporting it, while others call it BMI paradox. This review: (a) defines the obesity paradox, and its proposed role in overall mortality in NCDs; (b) delineates evidence for and against obesity paradox; (c) presents the importance of using different indices of body mass to assess the risk in NCDs; (d) examines the role of metabolically healthy obesity in obesity paradox, and emerging importance of cardio-respiratory fitness (CRF) as an independent predictor of CVD risk and all-cause mortality in patients with/without obesity. Evidence suggests that the development of obesity and insulin resistance are influenced by genetic (or ethnic) make up and dietary habits (culture) of the individuals. Hence, this review presents lean diabetes, which has higher total CVD and non-CVD mortality as compared to diabetics with obesity and the possibility of maternal factors programming cardiometabolic risk during fetal development, which may lead to a paradigm shift in our understanding of obesity.

Body Mass Index and Postacute Sequelae of SARS-CoV-2 Infection in Children and Young Adults

Obesity is associated with increased severity of COVID-19. Whether obesity is associated with an increased risk of post-acute sequelae of SARS-CoV-2 infection (PASC) among pediatric populations, independent of its association with acute infection severity, is unclear. To quantify the association of body mass index (BMI) status before SARS-CoV-2 infection with pediatric PASC risk, controlling for acute infection severity. This retrospective cohort study occurred at 26 US children's hospitals from March 2020 to May 2023 with a minimum follow-up of 179 days. Eligible participants included children and young adults aged 5 to 20 years with SARS-CoV-2 infection. Data analysis was conducted from October 2023 to January 2024. BMI status assessed within 18 months before infection; the measure closest to the index date was selected. The BMI categories included healthy weight (≥5th to <85th percentile for those aged 5-19 years or ≥18.5 to <25 for those aged >19 years), overweight (≥85th to <95th percentile for those aged 5-19 years or ≥25 to <30 for for those aged >19 years), obesity (≥95th percentile to <120% of the 95th percentile for for those aged 5-19 years or ≥30 to <40 for those aged >19 years), and severe obesity (≥120% of the 95th percentile for those aged 5-19 years or ≥40 for those aged >19 years). To identify PASC, a diagnostic code specific for post-COVID-19 conditions was used and a second approach used clusters of symptoms and conditions that constitute the PASC phenotype. Relative risk (RR) for the association of BMI with PASC was quantified by Poisson regression models, adjusting for sociodemographic, acute COVID severity, and other clinical factors. A total of 172 136 participants (mean [SD] age at BMI assessment 12.6 [4.4] years; mean [SD] age at cohort entry, 13.1 [4.4] years; 90 187 female [52.4%]) were included. Compared with participants with healthy weight, those with obesity had a 25.4% increased risk of PASC (RR, 1.25; 95% CI, 1.06-1.48) and those with severe obesity had a 42.1% increased risk of PASC (RR, 1.42; 95% CI, 1.25-1.61) when identified using the diagnostic code. Compared with those with healthy weight, there was an increased risk for any occurrences of PASC symptoms and conditions among those with obesity (RR, 1.11; 95% CI, 1.06-1.15) and severe obesity (RR, 1.17; 95% CI, 1.14-1.21), and the association held when assessing total incident occurrences among those with overweight (RR, 1.05; 95% CI, 1.00-1.11), obesity (RR, 1.13; 95% CI, 1.09-1.19), and severe obesity (RR, 1.18; 95% CI, 1.14-1.22). In this cohort study, elevated BMI was associated with a significantly increased PASC risk in a dose-dependent manner, highlighting the need for targeted care to prevent chronic conditions in at-risk children and young adults.

Metabolically healthy obesity and cardiovascular outcomes

Abstract Obesity increases cardiovascular risk through a deterioration of the metabolic profile. However, obesity is not always accompanied by a worsening metabolic profile. This longitudinal study aimed to determine whether obesity with a normal metabolic profile, i.e. metabolically healthy obesity, increases the risk of cardiovascular disease. We analyzed a health insurance data of Shizuoka prefecture resident. This data includes data from annual health check-ups performed for insured persons. This study analyzed data from 168,699 individuals aged &amp;lt;65 years. Obesity was defined as ≥ 25 kg/m2 body mass index. Metabolically healthy was defined as ≤ 1 metabolic risk factors (high blood pressure, low high-density lipoprotein cholesterol, high low-density lipoprotein cholesterol, or high hemoglobin A1c). Incidence rate of cardiovascular diseases (stroke and myocardial infarction), and all-cause mortality identified from the insurance data were compared between clinical profile-matched metabolically healthy obesity and non-obesity groups (n = 8,644 each). Clinical parameters, namely systolic blood pressure (standard mean difference = 0.03), HDL cholesterol (0.01), LDL cholesterol (0.01), and hemoglobin A1c (0.01) did not differ among the metabolically healthy obesity and non-obesity groups. The incident rate of stroke (obesity: 9.2 per 10,000 person-years; non-obesity: 10.5; log-rank test P = 0.595), myocardial infarction (obesity: 3.7; non-obesity: 3.1; P = 0.613), and all-cause mortality (obesity: 26.6; nonobesity: 23.2; P = 0.304) also did not differ significantly among the groups even when abdominal obesity was considered in the analysis, though the population with metabolically healthy obesity reported negligibly worse metabolic profiles than the population with nonobese at the 5.6-year follow-up. Obesity, when accompanied by a healthy metabolic profile, did not increase the risk of cardiovascular outcomes and all-cause mortality. Key messages • Metabolically healthy obesity did not increase cardiovascular disease risks. • Metabolically healthy obesity was associated with worse metabolic profiles after a few years later.

Association of obesity and metabolic health status with cerebral small vessel disease in stroke-free individuals

Abstract Background It remains unclear whether obesity itself or metabolic abnormalities coexisting with obesity, are associated with stroke. Purpose We aimed to investigate the association of obesity and metabolic health status with cerebral small vessel disease (SVD) in stroke-free participants from a brain health check-up. Methods We conducted a cross-sectional study of 6088 stroke-free participants who underwent brain magnetic resonance imaging at a brain check-up between 2013 and 2020. Participants were categorised according to sex-specific waist circumference and metabolic health status. A metabolically healthy status was defined as the absence of components of metabolic syndrome other than a large waist circumference, such as high blood pressure, hyperglycaemia, and dyslipidaemia. The total SVD score was derived from four magnetic resonance imaging markers: silent lacunar infarcts, cerebral microbleeds, moderate-to-severe white matter hyperintensities, and enlarged perivascular spaces. Results The mean age of the participants was 55±12 years and 46% were women. The prevalence of metabolically healthy obesity was 650 (11%) and the proportion of metabolically healthy obesity among individuals with obesity was 24%. The prevalence of metabolically unhealthy obesity was 2043 (34%), and the proportion of metabolically unhealthy obesity among individuals with metabolically unhealthy individuals was 58%. The prevalence of moderate-to-severe SVD scores (≥2) was 348 (6%), which was higher in metabolically unhealthy individuals, regardless of obesity status. Compared with the metabolically healthy non-obesity group, the metabolically unhealthy non-obesity (odds ratio 2.22 [95% CI, 1.44–3.42]) and metabolically unhealthy obesity (odds ratio, 2.76 [95% CI, 1.80–4.24]) groups had a significantly higher multivariable-adjusted risk for a total SVD score of ≥2. Further sensitivity analyses using BMI-defined obesity instead of waist circumference-defined obesity yielded similar results. Conclusions Abdominal and general obesity alone are not associated with higher total SVD scores in stroke-free individuals. Unhealthy metabolic components, especially high blood pressure and hyperglycaemia, are important risk factors for SVD.

Systemic Inflammation Across Metabolic Obesity Phenotypes: A Cross-Sectional Study of Korean Adults Using High-Sensitivity C-Reactive Protein as a Biomarker.

Chronic systemic inflammation is a hallmark of obesity. This cross-sectional study aimed to investigate the association between metabolic obesity phenotypes and inflammatory markers in Korean adults (N = 21,112; mean age: 50.9 ± 16.6). Metabolic obesity phenotypes were categorized into metabolically healthy non-obesity (MHNO), metabolically unhealthy non-obesity (MUNO), metabolically healthy obesity (MHO), and metabolically unhealthy obesity (MUO) based on body mass index and the presence of any metabolic abnormalities. High-sensitivity C-reactive protein (hs-CRP) levels were measured. Multiple linear regression was used to determine the association between obesity phenotypes and hs-CRP levels. In the male sample, compared to the MHNO type, the MUNO, MHO, and MUO types were associated with a 22.3% (95% confidence interval; CI: 14.7-30.3%), 15.8% (95% CI: 2.6-30.7%), and 12.5% (95% CI: 3.0-22.9%) increase in the hs-CRP levels, respectively. The association between metabolic obesity types and hs-CRP levels was stronger among the female sample; compared to the MHNO type, the MUNO, MHO, and MUO types were associated with a 30.2% (95% CI: 22.8-38.2%), 16.0% (95% CI: 6.5-26.4%), and 22.8% (95% CI: 13.6-32.8%) increase in the hs-CRP levels, respectively. Our findings indicate a varying profile of systemic inflammation across different metabolic obesity phenotypes.