Clinical Characteristics And Significance Of Metabolically Healthy Obese Individuals

Chapter 1 The clinical characteristics of metabolically healthy obese individualsObjective:To investigate the prevalence of metabolically healthy obese(MHO)individuals in subjects of routine health examination in People’s Hospital of Hunan Province,and to explore the clinical characteristics of MHO individuals.Methods:4076 subjects were evaluated for routine health examination in People’s Hospital of Hunan Province from April 2006 to January 2010,2830 individuals were enrolled excluding those with missing data.1367 individuals were followed up during 1～3 years.Data were collected including body height,body weight,systolic blood pressure(SBP),diastolic blood pressure(DBP),triglyceride(TG),total cholesterol(TC),low density lipoprotein(LD),high density lipoprotein(HDL),fast blood glucose(FBG),serum alanine aminotransferase(ALT),serum uric acid(UA),peripheral white blood cell count(WBCC)and abdominal B ultrasound.Obesity was diagnosed according to the criteria of the Asia-Pacific region of international obesity task force(IOTF)in 2000.Metabolic Syndrome(MS)was diagnosed according to the critetia of Chinese Diabetes Society(CDS)in 2004.Compare the clinical and biochemistry parameters between MHO,Obesity with MS and normal controls.Results:1.The prevalence of obesity was 39.58%(1120/2830),and MHO was 23.30%(261/1120)in obesity.The proportion of MHO in female was higher than that in males(P<0.05).The proportion of MHO was decreased with the age in obese females(P<0.05).2.Parameters including age,proportion of male,SBP,DBP,FBG,TG,LDL,ALT,UA and WBCC,were lower(HDL,was higher)in MHO than those in obesity with MS,and higher(HDL,was lower)than those in normal controls(P<0.05).Conclusions:1.The prevalence of obesity was 40%,in which 1/4 was MHO.2.MHO shows an intermediate clinical features between obesity with MS and normal controls.Chapter 2 The risk of metabolic abnormal diseases in MHO individualsObjective:To investigate the prevalence and risk of metabolic abnormal diseases in MHO individuals,and to analyze the value of WBCC in normal range on predicting MS in obesity.Methods:The metabolic abnormal diseases include:1.abnormal glucose metabolism 2.hypertension 3.dyslipidemia 4.MS.The criteria of metabolic abnormal diseases was the same as each branch in the diagnosis of MS of CDS in 2004.MHO individuals(n=109)were followed up during 1 to 3 years,analyze the prognosis of MHO and the incidence of metabolic abnormal diseases in MHO,and investigate the risk of metabolic abnormal diseases in MHO.325 obesity without MS with normal WBCC were divided into four groups according to quartile of WBCC,following up for 1 to 3 years,compare to the risk of incident MS in different groups of quartile of WBCC.Results:1.Following up for 1 to 3 years,the incidence of metabolic abnormal diseases in MHO was 46.79%.2.Following up for 1 to 3 years,the incidence and the risk of abnormal glucose metabolism,hypertensionin,dyslipidemia and metabolic abnormal diseases in MHO was significantly higher than that in normal controls(P<0.05).3.325 obesity without MS with normal WBCC were divided into four groups according to quartile of WBCC,the incidence of MS in the highest quartile of WBCC was significantly increased(OR=2.712;95%CI:1.149-6.400,P<0.05).Conclusions:1.Following up for 1 to 3 years,about one half of MHO developed metabolic abnormal diseases.2.Following up for 1 to 3 years,the risk of abnormal glucose metabolism,hypertensionin,dyslipidemia and metabolic abnormal diseases in MHO was significantly increased.3.Even in the normal range,the elevated WBCC could predicte the risk of incident MS in obesity.Chapter 3 Study on the relation between MHO and nonalcoholic fatty liver diseaseObjective:To determine the proportion of nonalcoholic fatty liver disease(NAFLD)in MHO individuals,to investigate the risk of incident NAFLD,and to analysis the value of normal ALT on predicting the occurrence of NAFLD in MHO individuals.Methods:Ultrasonography was used to diagnose NAFLD.NAFLD was diagnosed according to the criteria of imaging diagnosis of Chinese Society of Hepatology in 2010.To analysis the proportion of NAFLD in MHO individuals.MHO individuals(n=109)were followed up during 1 to 3 years,to investigate the prevalence and risk of incident NAFLD.40 MHO individuals with normal ALT were divided into four groups according to the quartile of ALT,following up for 1 to 3 years,compare to the risk of incident NAFLD in different groups of quartile of ALT.Results:1.The proportion of NAFLD in MHO was significantly higher than that in normal controls(51.34%vs 5.02%,P<0.05).2.Compared with MHO without NAFLD,age,BMI and SBP were higher than that in MHO with NAFLD(P<0.05).Compared with obesity with MS,age and BMI were not significantly difference,SBP was lower than that in obesity with MS,higher than that in MHO without NAFLD(P<0.05).3.Following up for 1 to 3 years,the incidence of NAFLD in MHO was significantly higher than that in normal controls(44.44%vs 7.02%,OR=10.600;95%CI:4.873-23.058,P<0.05);the incidence of NAFLD in patients with obesity with MS was significantly higher than that in normal controls(47.37%vs 7.02%,OR=1.925;95%CI:5.280-26.932,P<0.05).4.40 MHO individuals with normal ALT were divided into four groups according to the quartile of ALT,the incidence of NAFLD in the highest quartile of ALT was significantly increased(OR=9.333;95%CI:1.193-72.991,P<0.05).Conclusio-ns:1.The proportion of NAFLD in MHO individuals was more than one half.2.The clinical features of MHO with NAFLD was closer to obesity with MS.3.The risk of incident NAFLD in MHO was significantly increased,and was similar to obesity with MS.4.Even in the normal range,the elevated ALT could predicte the risk of incident NAFLD in MHO.