Key result
The metabolically healthy but obese phenotype was associated with greater left atrial diameter (MD 2.73 mm; 95% CI 1.35-4.11) and left ventricular mass index compared to normal weight individuals.
Why the study?
It is unclear whether metabolically healthy, but obese individuals differ from metabolically healthy, normal weight individuals regarding preconditions for cardiovascular diseases.
Does the metabolically healthy but obese phenotype associate with adverse echocardiographic parameters and inflammatory biomarkers compared to metabolically healthy normal weight individuals?
Cohort (n=1,412)
Does the metabolically healthy but obese phenotype associate with adverse echocardiographic parameters and inflammatory biomarkers compared to metabolically healthy normal weight individuals?
Mean Difference: 2.73 (95% CI 1.35–4.11)
The metabolically healthy but obese phenotype is associated with subclinical cardiac remodeling and increased inflammation, suggesting that obesity without metabolic syndrome is not entirely benign.
MHO links to larger LA/LVMI and inflammation; hypothesis-generating for whether it confers excess CV risk.
Introduction: The research on heterogeneity among obese individuals has identified the metabolically healthy, but obese (MHO) phenotype as a distinct group that does not experience the typical cardiovascular-related diseases (CVD). It is unclear if this group differs with regard to preconditions for CVDs. Our aim was to assess differences in echocardiographic parameters and inflammatory biomarkers between MHO and metabolically healthy, normal weight individuals (MHNW). Methods: The analyses used data from 1412 elderly participants from a German population-based cohort study (CARLA), which collected detailed information on demographic, biochemical, and echocardiographic variables. Participants were subdivided into four groups (MHNW, MHO, MUNW (metabolically unhealthy, normal weight) and MUO (metabolically unhealthy, obese)) based on BMI≥ 30 kg/m 2 (obese or normal weight) and presence of components of the metabolic syndrome. The clinical characteristics of the 4 groups were compared with ANOVA or Chi-Square test, in addition to two linear regression models for 16 echocardiographic parameters. The difference in inflammatory biomarkers (hsCRP, IL-6 and sTNF-RI) between the groups was examined with a multinomial logistic regression model. Results: The MHO individuals were on average 64.2± 8.4 years old, with a higher proportion of women (71.6%), low percentage of smokers, larger waist circumference (109.3± 10.5 cm vs 89.1± 10.8 cm, p< 0.0001) and higher odds ratios for hsCRP, IL-6 and sTNF-RI compared to MHNW individuals. Linear regression models revealed greater left atrial (LA) diameter (2.73 (95% CI: 1.35– 4.11) mm), LA volume (7.86 (95% CI: 2.88– 12.83) mL), and left ventricular mass index (LVMI) (11.82 (95% CI: 4.43– 19.22) g/m 1.7 ) in the MHO group compared to the MHNW group. Conclusion: The MHO phenotype is associated with echocardiographic markers of cardiac remodeling (LA diameter, volume and LVMI) and higher odds ratios for inflammatory biomarkers.
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Efremov et al. (2020) conducted a cohort in Metabolically healthy obesity (n=1,412). Metabolically healthy, but obese (MHO) phenotype vs. Metabolically healthy, normal weight (MHNW) phenotype was evaluated on Left atrial (LA) diameter (MD 2.73, 95% CI 1.35-4.11). The metabolically healthy but obese phenotype was associated with greater left atrial diameter (MD 2.73 mm; 95% CI 1.35-4.11) and left ventricular mass index compared to normal weight individuals.
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