腹部内脏脂肪堆积可预测代谢健康的肥胖个体转变为不健康表型。
Visceral abdominal fat accumulation predicts the conversion of metabolically healthy obese subjects to an unhealthy phenotype.
作者信息
Hwang Y-C, Hayashi T, Fujimoto W Y, Kahn S E, Leonetti D L, McNeely M J, Boyko E J
机构信息
Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, USA.
Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
出版信息
Int J Obes (Lond). 2015 Sep;39(9):1365-70. doi: 10.1038/ijo.2015.75. Epub 2015 Apr 29.
BACKGROUND
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).
OBJECTIVES
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.
METHODS
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 m(-2). 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.
RESULTS
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-s.d. 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.
CONCLUSIONS
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.
背景
一部分肥胖受试者看似代谢健康（MHO），但对于MHO的自然病史以及预测其未来转变为代谢不健康肥胖（MUO）的因素却知之甚少。
目的
前瞻性地确定MHO转变为MUO的频率以及独立预测这种转变的临床变量，特别关注身体成分的作用。
方法
我们纳入了85名年龄在34 - 73岁（平均年龄49.8岁）的日裔美国人MHO患者（56名男性，29名女性），在入组后的2.5年、5年和10年进行随访，测量代谢特征、生活方式以及通过计算机断层扫描测量腹部和大腿脂肪面积。肥胖采用亚洲体重指数标准，即≥25 kg/m²来定义。代谢健康定义为符合美国国家胆固醇教育计划成人治疗小组第三次报告提出的5个代谢综合征组分中的≤2个，而代谢不健康定义为≥3个组分。
结果
在10年的随访中，55名MHO个体（64.7%）转变为MUO。转变的单因素统计学显著预测因素包括血脂异常、更高的胰岛素抵抗以及更大的内脏腹部（VAT）和皮下腹部脂肪面积（SAT）。在多因素分析中，VAT（每增加1个标准差的比值比（95%置信区间）为2.04（1.11 - 3.72），P = 0.021）、高密度脂蛋白（HDL）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）与未来转变为MUO显著相关。然而，SAT并非未来转变为MUO的独立预测因素。
结论
在该人群中，MHO是一种短暂状态，10年内近三分之二的人发展为MUO，转变为MUO的比例较高与VAT、女性性别、更高的空腹胰岛素水平以及更低的基线HDL胆固醇水平独立相关。
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