Obesity, arterial function and arterial structure - a systematic review and meta-analysis

Q: What are the key findings of this study?

Obesity was associated with lower brachial flow-mediated dilatation and greater carotid intima-media thickness compared to healthy weight.

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Obesity (n=12554). Intervention: Obesity (defined by body mass index) vs. Healthy weight adults (defined by study-specific or WHO <25 kg/m² BMI cut-points). Primary outcome: Brachial artery flow-mediated dilatation (FMD, %) (MD -1.92%, 95% CI -2.92 to -0.92, p=0.0002).

Q: What does this research mean for the field?

Adults with obesity have significantly lower brachial flow-mediated dilatation and greater carotid intima-media thickness compared to healthy-weight individuals. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

J. Ne; Tommy Y. Cai; David S. Celermajer; Ian D. Caterson; Timothy Gill; Crystal Lee; Michael R. Skilton

doi:10.1002/osp4.108

March 31, 2017Obesity Science & PracticeOpen Access

Obesity, arterial function and arterial structure - a systematic review and meta-analysis

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Key result

Obesity is linked to ~1.9 percentage points lower flow-mediated dilatation compared to healthy weight.

MD -1.92%
95% CI -2.92 to -0.92
P=0.0002
n=12,554

Figures

Why the study?

Is obesity (defined by BMI) associated with impaired arterial endothelial function (brachial flow-mediated dilatation) and increased subclinical atherosclerosis (carotid intima-media thickness) compared with healthy weight in adults?

Study Design

Type

Meta-Analysis (n=12,554)

Structured PICO

Is obesity (defined by BMI) associated with impaired arterial endothelial function (brachial flow-mediated dilatation) and increased subclinical atherosclerosis (carotid intima-media thickness) compared with healthy weight in adults?

P

Population

12,554 adults (≥18 years) with obesity (defined by BMI) and healthy weight controls pooled across 19 brachial flow-mediated dilatation studies (n=2,733) and 19 carotid intima-media thickness studies (n=9,821).

E

Exposure

Obesity defined using study-specific or World Health Organization (≥30 kg/m²) body mass index (BMI) cut-points

C

Comparator

Healthy weight adults defined by study-specific or World Health Organization (<25 kg/m²) BMI cut-points

O

Outcome

Arterial endothelial function measured by brachial artery flow-mediated dilatation (FMD, %) and subclinical atherosclerosis measured by common carotid artery intima-media thickness (IMT, mm)surrogate

Main Result

Mean Difference: -1.92 (95% CI -2.92–-0.92)

p-value: p=0.0002

This meta-analysis quantifies the detrimental association of obesity with endothelial function (-1.92% brachial FMD) and subclinical atherosclerosis (+0.07 mm carotid IMT), providing benchmark effect sizes to evaluate vascular responses to weight loss interventions.

Limitations

Significant heterogeneity of results between studies (I² > 50%), possibly due to methodological differences in vascular assessment, varying BMI cut-points, and differing prevalence of cardiometabolic risk factors.
The majority of included studies were cross-sectional, preventing inference of causal relationships.
Obesity was defined solely by BMI, which lacks discriminatory power to differentiate between body fat and lean mass or between subcutaneous and visceral obesity.
Excluded studies that treated BMI as a continuous variable.
Cannot inform on progression over time or whether effects on FMD and IMT are reversible.
Subgroup analyses were derived from a subset of studies, which may have reduced statistical power.
Significant heterogeneity between studies (I² > 50%) likely related to lack of standardization in vascular assessment, varying BMI cut-points, and differing cardiometabolic risk factor prevalence.
Majority of included studies were cross-sectional, precluding causal inference.
Reliance on BMI to define obesity, which cannot differentiate between body fat and lean mass or subcutaneous and visceral adiposity.
Exclusion of studies treating BMI as a continuous variable.
Inability to assess progression over time or reversibility of vascular changes.
Reduced statistical power in subgroup analyses due to incomplete subgroup reporting across studies.

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Implication

Provides benchmark effect sizes for obesity-related vascular changes; extends evidence to inform weight-loss intervention trials.

Abstract

Objective Obesity is an established risk factor for cardiovascular disease. The mechanisms by which obesity affects cardiovascular risk have not been fully elucidated. This paper reports a comprehensive systematic review and meta-analysis on obesity and two key aspects of vascular health using gold-standard non-invasive measures – arterial endothelial function (brachial flow-mediated dilatation) and subclinical atherosclerosis (carotid intima-media thickness). Methods Electronic searches for ‘Obesity and flow-mediated dilatation’ and ‘Obesity and intima-media thickness’ were performed using Ovid Medline and Embase databases. A meta-analysis was undertaken for brachial flow-mediated dilatation and carotid intima-media thickness to obtain pooled estimates for adults with obesity and those with healthy weight. Results Of the 5,810 articles retrieved, 19 studies on flow-mediated dilatation and 19 studies on intima-media thickness were included. Meta-analysis demonstrated that obesity was associated with lower flow-mediated dilatation (−1.92 % [95% CI −2.92, −0.92], P = 0.0002) and greater carotid intima-media thickness (0.07 mm [95% CI 0.05, 0.08], P < 0.0001). Conclusions Obesity is associated with poorer arterial endothelial function and increased subclinical atherosclerosis, consistent with these aspects of vascular health at least partially contributing to the increased risk of cardiovascular events in adults with obesity. These estimated effect sizes will enable vascular health benefits in response to weight loss treatment to be put in greater perspective, both in the research setting and potentially also clinical practice.

Discussion

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Cite This Study

Ne et al. (2017) conducted a meta-analysis in Obesity (n=12,554). Obesity (defined by body mass index) vs. Healthy weight adults (defined by study-specific or WHO <25 kg/m² BMI cut-points) was evaluated on Brachial artery flow-mediated dilatation (FMD, %) (MD -1.92%, 95% CI -2.92 to -0.92, p=0.0002). Obesity was associated with lower brachial flow-mediated dilatation and greater carotid intima-media thickness compared to healthy weight.

synapsesocial.com/papers/6a81ba5f094b7c1224ee2604 https://doi.org/10.1002/osp4.108

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Obesity, arterial function and arterial structure - a systematic review and meta-analysis

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Obesity, arterial function and arterial structure - a systematic review and meta-analysis

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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