Raaj Isha, Thalamati Manvitha, Gowda M N Vanitha, Rao Akshay
Department of Biochemistry, M. S. Ramaiah Medical College, Bengaluru, IND.
Department of Internal Medicine, M. S. Ramaiah Medical College, Bengaluru, IND.
Cureus. 2024 Nov 28;16(11):e74644. doi: 10.7759/cureus.74644. eCollection 2024 Nov.
Metabolic syndrome (MS), identified by abdominal obesity, insulin resistance, hypertension, and/or dyslipidemia, occurs across all BMI (body mass index) ranges and increases the risk of atherosclerotic cardiovascular (CV) diseases and type II diabetes. The Atherogenic Index of Plasma (AIP) and Castelli Risk Index (CRI) I & II are ratios that can be calculated from a simple lipid profile test. These ratios are independent risk factors for CV diseases and have been shown to be increased in angiographically confirmed coronary artery disease (CAD) patients. This study aimed to assess CV risk across the different subtypes of obesity: metabolically obese non-obese (MONO), metabolically healthy non-obese (MHNO), metabolically obese obese (MOO), and metabolically healthy obese (MHO) using AIP and CRI I & II and to study the association of AIP, CRI I & II with other CV risk factors such as total body fat percentage (BF%), visceral fat percentage (VF%), and BMI. Assessing CV risk in an individual based on the person's subtype of obesity using ratios calculated from simple lipid profile parameters may prove beneficial to developing better screening strategies.
A cross-sectional study was conducted on 128 adults with BMI ≥18.5 kg/m with and without MS, presenting to the General Medicine/Internal Medicine Outpatient Department in M S Ramaiah Medical College Hospital, Bangalore, Karnataka State, India. The sample size was calculated to be a minimum of 82 subjects based on a study that showed that AIP and CRI I & II had a positive association with BMI. After a detailed history, physical examination, anthropometric measurements (height, weight, and waist circumference), VF%, and BF% by bio-impedance were recorded. A blood sample was processed for lipid profile and fasting blood sugar on a Vitros 5600 auto-analyzer (Quidel Corporation and Ortho Clinical Diagnostics, San Diego, CA, USA). Subjects were divided into MONO (non-obese subjects with BMI < 25 kg/m having MS), MHNO (no obesity or MS), MOO (obese BMI ≥ 25 kg/m having MS), and MHO (obese BMI ≥ 25 kg/m not having MS) groups. AIP and CRI I & II were calculated. Statistical analysis was performed using the chi-square test, ANOVA, Pearson correlation coefficient, and receiver operating characteristic curve (ROC).
MONO, MHNO, MOO, and MHO constituted 26 (20.3%), 48 (37.5%), 28 (21.8%), and 26 (20.3%) of the 128 subjects, respectively. AIP ≥0.24 was found in 16 (61.5%) of MONO and in 16 (51.1%) of MOO subjects. CRI-I >4 was found in 19 (73.1%) and 16 (57.1%) subjects of the MONO and MOO groups, respectively. Eleven (42.3%) and 12 (42.9%) of MONO and MOO subjects, respectively, had CRI-II >3. Pearson's correlation revealed for AIP r=0.32, p=0.000 and r=0.43, p=0.000 with VF% and BMI, respectively. The area under the curve (AUC) for AIP and CRI I & II to detect the presence of MS were 0.84, 0.74, and 0.73, respectively.
CV risk, as assessed by AIP and CRI I & II in the different subtypes of obesity, was found to be highest in the MONO group, followed by the MOO group. With BMI and VF%, AIP showed a moderately positive linear correlation. API and CRI could be tools of low cost and moderate reliability in screening the general population for risk of CV disease.
代谢综合征（MS）以腹型肥胖、胰岛素抵抗、高血压和/或血脂异常为特征，在所有体重指数（BMI）范围内均有发生，并增加动脉粥样硬化性心血管（CV）疾病和II型糖尿病的风险。血浆致动脉粥样硬化指数（AIP）和卡斯泰利风险指数（CRI）I及II是可通过简单血脂检测计算得出的比率。这些比率是心血管疾病的独立危险因素，且在经血管造影证实的冠心病（CAD）患者中已显示升高。本研究旨在使用AIP和CRI I及II评估不同肥胖亚型：代谢性肥胖非肥胖者（MONO）、代谢健康非肥胖者（MHNO）、代谢性肥胖肥胖者（MOO）和代谢健康肥胖者（MHO）的心血管风险，并研究AIP、CRI I及II与其他心血管危险因素如全身脂肪百分比（BF%）、内脏脂肪百分比（VF%）和BMI之间的关联。基于简单血脂参数计算得出的比率，根据个体的肥胖亚型评估其心血管风险，可能有助于制定更好的筛查策略。
对印度卡纳塔克邦班加罗尔MS拉马亚医学院医院普通内科/内科门诊就诊的128名BMI≥18.5 kg/m²且有或无MS的成年人进行了一项横断面研究。根据一项显示AIP和CRI I及II与BMI呈正相关的研究，计算得出样本量至少为82名受试者。在详细询问病史、进行体格检查、测量人体测量学指标（身高、体重和腰围）后，通过生物阻抗记录VF%和BF%。采集血样在Vitros 5600自动分析仪（美国加利福尼亚州圣地亚哥的Quidel公司和奥森多临床诊断公司）上检测血脂谱和空腹血糖。受试者被分为MONO组（BMI<25 kg/m²的非肥胖MS患者）、MHNO组（无肥胖或MS）、MOO组（BMI≥25 kg/m²的肥胖MS患者）和MHO组（BMI≥25 kg/m²的肥胖非MS患者）。计算AIP和CRI I及II。使用卡方检验、方差分析、皮尔逊相关系数和受试者工作特征曲线（ROC）进行统计分析。
在128名受试者中，MONO、MHNO、MOO和MHO分别占26名（20.3%）、48名（37.5%）、28名（21.8%）和26名（20.3%）。在MONO组的16名（61.5%）和MOO组的16名（51.1%）受试者中发现AIP≥0.24。在MONO组的19名（73.1%）和MOO组的l6名（57.1%）受试者中发现CRI-I>4。MONO组和MOO组分别有11名（42.3%）和l2名（42.9%）受试者CRI-II>3。皮尔逊相关性显示AIP与VF%和BMI的r值分别为0.32，p=0.000和r=0.43，p=0.000。AIP和CRI I及II检测MS存在的曲线下面积（AUC）分别为0.84、0.74和0.73。
通过AIP和CRI I及II评估，发现不同肥胖亚型中的心血管风险在MONO组最高，其次是MOO组。AIP与BMI和VF%呈中度正线性相关。AIP和CRI可能是用于筛查普通人群心血管疾病风险的低成本且可靠性适中的工具。
