Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Jinan, China.
Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, China.
Ann Med. 2024 Dec;56(1):2403721. doi: 10.1080/07853890.2024.2403721. Epub 2024 Sep 18.
The relationship between serum calcium and occurrence of MHO (metabolically healthy obesity) and MUNO (metabolically unhealthy non-obesity) remains unclear, and distinguishing these two phenotypes is difficult within primary healthcare units. This study explores that relationship.
This survey included 28590 adults from the National Health and Nutrition Examination Survey (NHANES) 2001-2018. Obesity phenotypes were categorized based on BMI and presence or absence of metabolic syndrome components. Weighted multivariate logistic regression analyses were used to assess the association between serum calcium levels and the obesity phenotype. Restricted cubic spline analysis characterized dose-response relationships, and stratified analyses explored these relationships across sociodemographic and lifestyle factors.
The overall prevalence of MHO and MUNO were 2.6% and 46.6%, respectively. After adjusting for covariates, serum calcium exhibited a negative association with MHO [OR (95%): 0.49 (0.36,0.67), < 0.001], while exhibiting a positive association with MUNO [OR (95%): 1.48 (1.26,1.84), < 0.001]. Additionally, we found a non-linear association between serum calcium levels and the incidences of MHO and MUNO. Stratified analyses demonstrated a strong negative correlation between serum calcium levels and MHO occurrence across various subgroups. There was no significant interaction between calcium and stratified variables except sex; the association between calcium and the occurrence of MHO was remarkable in female patients. Meanwhile, the predictive ability of serum calcium level for the occurrence of MUNO among all patients was consistent across various subgroups. There was a significant interaction between calcium level and stratified variables based on age, sex, race, and smoking status; the association was remarkable in older (≥ 40 years old), white, none or less smoking, and female patients.
A significant correlation was identified between serum calcium levels and MHO or MUNO. The findings suggest that serum calcium levels may serve as an indicator for more accurate assessment and diagnosis of MUNO and MHO, especially among individuals with abdominal obesity.
血清钙与代谢健康肥胖（MHO）和代谢不健康非肥胖（MUNO）的发生之间的关系尚不清楚，并且在基层医疗机构中很难区分这两种表型。本研究对此进行了探讨。
本研究调查了 2001 年至 2018 年全国健康和营养检查调查（NHANES）中的 28590 名成年人。根据 BMI 和代谢综合征成分的存在与否，将肥胖表型进行分类。采用加权多变量逻辑回归分析评估血清钙水平与肥胖表型之间的关联。限制性三次样条分析描述了剂量反应关系，分层分析则在社会人口统计学和生活方式因素的基础上探讨了这些关系。
MHO 和 MUNO 的总体患病率分别为 2.6%和 46.6%。在调整了协变量后，血清钙与 MHO 呈负相关[比值比（95%置信区间）：0.49（0.36，0.67）， < 0.001]，而与 MUNO 呈正相关[比值比（95%置信区间）：1.48（1.26，1.84）， < 0.001]。此外，我们还发现血清钙水平与 MHO 和 MUNO 发生率之间存在非线性关系。分层分析表明，血清钙水平与 MHO 发生率之间存在强烈的负相关，且在各个亚组中均如此。除性别外，血清钙与分层变量之间没有显著的交互作用；在女性患者中，血清钙与 MHO 发生之间的关联显著。同时，血清钙水平对所有患者中 MUNO 发生的预测能力在各个亚组中是一致的。血清钙水平与年龄、性别、种族和吸烟状况等分层变量之间存在显著的交互作用；在年龄较大（≥40 岁）、白人、不吸烟或较少吸烟以及女性患者中，这种关联更为显著。
血清钙水平与 MHO 或 MUNO 显著相关。这些发现表明，血清钙水平可能是更准确评估和诊断 MUNO 和 MHO 的指标，尤其是在腹型肥胖患者中。
