Visceral abdominal fat accumulation predicts the conversion of metabolically healthy obese subjects to an unhealthy phenotype.
Visceral abdominal fat accumulation predicts the conversion of metabolically healthy obese subjects to an unhealthy phenotype.
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DOI：
10.1038/ijo.2015.75
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发表时间：
2015-09
期刊：
影响因子：
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通讯作者：
Boyko EJ
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文献类型：
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作者：
Hwang YC;Hayashi T;Fujimoto WY;Kahn SE;Leonetti DL;McNeely MJ;Boyko EJ
一部分肥胖受试者表现为代谢健康（MHO），但对MHO的自然史和预测其未来转化为代谢不健康肥胖（MUO）的因素知之甚少。目的是前瞻性地确定MHO向MUO转化的频率以及独立预测这种转化的临床变量，特别关注身体成分的作用。我们确定了85名患有MHO的日裔美国人（56名男性，29名女性），年龄34-73岁（平均年龄49.8岁），在入组后2.5年，5年和10年随访，测量代谢特征，生活方式以及通过计算机断层扫描测量的腹部和大腿脂肪面积。使用≥ 25 kg/m2的亚洲体重指数标准定义肥胖。代谢健康定义为存在国家胆固醇教育计划成人治疗小组III提出的5种代谢综合征组分中的≤ 2种，而代谢不健康定义为≥ 3种组分。在10年的随访中，55名MHO患者（64.7%）转为MUO。有统计学意义的单变量转换预测因子包括血脂异常、更高的胰岛素抵抗和更大的内脏腹部（VAT）和皮下腹部脂肪面积（SAT）。在多变量分析中，（每1个SD增量的比值比（95%置信区间）2.04（1.11 ~ 3.72），P=0.021），高密度脂蛋白胆固醇（0.24（0.11 - 0.53），P<0.001）、空腹血浆胰岛素（2.45（1.07 - 5.62），P=0.034）和女性性别（5.37（1.14 - 25.27），P=0.033）与将来转换为MUO显著相关。然而，SAT不是未来转换为MUO的独立预测因子。在该人群中，MHO是一种短暂状态，近三分之二的人在10年内发生MUO，较高的MUO转化率与VAT、女性性别、较高的空腹胰岛素水平和较低的基线HDL胆固醇水平独立相关。
A proportion of obese subjects appear metabolically healthy (MHO) but little is known about the natural history of MHO and factors predicting its future conversion to metabolically unhealthy obese (MUO). The aim was to determine prospectively the frequency of conversion of MHO to MUO and the clinical variables that independently predicted this conversion, with a particular focus on the role of body composition. We identified 85 Japanese Americans with MHO (56 men, 29 women), aged 34–73 years (mean age 49.8 years) who were followed at 2.5, 5, and 10 years after enrollment with measurements of metabolic characteristics, lifestyle, and abdominal and thigh fat areas measured by computed tomography. Obesity was defined using the Asian body mass index criterion of ≥ 25 kg/m2. Metabolically healthy was defined as the presence of ≤ 2 of 5 metabolic syndrome components proposed by the National Cholesterol Education Program Adult Treatment Panel III, while metabolically unhealthy was defined as ≥ 3 components. Over 10 years of follow-up, 55 MHO individuals (64.7%) converted to MUO. Statistically significant univariate predictors of conversion included dyslipidemia, greater insulin resistance, and greater visceral abdominal (VAT) and subcutaneous abdominal fat area (SAT). In multivariate analysis, VAT (odds ratio per 1 SD increment (95% confidence interval) 2.04 (1.11 – 3.72), P=0.021), high density lipoprotein (HDL) cholesterol (0.24 (0.11 – 0.53), P<0.001), fasting plasma insulin (2.45 (1.07 – 5.62), P=0.034), and female sex (5.37 (1.14 – 25.27), P=0.033) were significantly associated with future conversion to MUO. However, SAT was not an independent predictor for future conversion to MUO. In this population, MHO was a transient state, with nearly two-thirds developing MUO over 10 years, with higher conversion to MUO independently associated with VAT, female sex, higher fasting insulin level, and lower baseline HDL cholesterol level.