Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea.
Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
PLoS One. 2023 Dec 22;18(12):e0296073. doi: 10.1371/journal.pone.0296073. eCollection 2023.
We investigated the differences in quantity and quality of skeletal muscle between metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO) individuals using abdominal CT. One hundred and seventy-two people with morbid obesity who underwent bariatric surgery and 64 healthy control individuals participated in this retrospective study. We divided the people with morbid obesity into an MHO and MUO group. In addition, nonobese metabolic healthy people were included analysis to provide reference levels. CT evaluation of muscle quantity (at the level of the third lumbar vertebra [L3]) was performed by calculating muscle anatomical cross-sectional area (CSA), which was normalized to patient height to produce skeletal muscle index (SMI). Muscle quality was assessed as skeletal muscle density (SMD), which was calculated from CT muscle attenuation. To characterize intramuscular composition, muscle attenuation was classified into three categories using Hounsfield unit (HU) thresholds: -190 HU to -30 HU for intermuscular adipose tissue (IMAT), -29 to +29 HU for low attenuation muscle (LAM), and +30 to +150 HU for normal attenuation muscle (NAM). People with morbid obesity comprised 24 (14%) MHO individuals and 148 (86%) MUO individuals. The mean age of the participants was 39.7 ± 12.5 years, and 154 (65%) participants were women. MUO individuals had a significantly greater total skeletal muscle CSA than MHO individuals in the model that adjusted for all variables. Total skeletal muscle SMI, SMD, NAM index, LAM index, and IMAT index did not differ between MHO and MUO individuals for all adjusted models. Total skeletal muscle at the L3 level was not different in muscle quantity, quality, or intramuscular composition between the MHO and MUO individuals, based on CT evaluation. MHO individuals who are considered "healthy" should be carefully monitored and can have a similar risk of metabolic complications as MUO individuals, at least based on an assessment of skeletal muscle.
我们使用腹部 CT 研究了代谢健康肥胖（MHO）和代谢不健康肥胖（MUO）个体之间骨骼肌的数量和质量差异。172 名接受减重手术的病态肥胖患者和 64 名健康对照者参与了这项回顾性研究。我们将病态肥胖患者分为 MHO 和 MUO 组。此外，还纳入了非肥胖代谢健康人群进行分析，以提供参考水平。通过计算肌肉解剖横截面积（CSA），对肌肉量（第 3 腰椎 [L3] 水平）进行 CT 评估，该 CSA 经患者身高标准化后产生骨骼肌指数（SMI）。肌肉质量评估为骨骼肌密度（SMD），通过 CT 肌肉衰减值计算得出。为了描述肌内成分，使用亨氏单位（HU）阈值将肌肉衰减值分为三类：-190 HU 到-30 HU 为肌间脂肪组织（IMAT），-29 到+29 HU 为低衰减肌肉（LAM），+30 到+150 HU 为正常衰减肌肉（NAM）。病态肥胖患者包括 24 名（14%）MHO 个体和 148 名（86%）MUO 个体。参与者的平均年龄为 39.7±12.5 岁，154 名（65%）参与者为女性。在调整所有变量的模型中，MUO 个体的总骨骼肌 CSA 明显大于 MHO 个体。在所有调整模型中，MHO 和 MUO 个体之间的总骨骼肌 SMI、SMD、NAM 指数、LAM 指数和 IMAT 指数均无差异。基于 CT 评估，在 L3 水平的总骨骼肌的数量、质量或肌内组成方面，MHO 和 MUO 个体之间没有差异。考虑到“健康”的 MHO 个体应该被仔细监测，并且至少根据对骨骼肌的评估，他们可能与 MUO 个体具有相似的代谢并发症风险。
