背景:术语代谢健康肥胖(MHO)和代谢不健康肥胖(MUO)根据心脏代谢危险因素的存在或不存在对肥胖受试者进行分类。由于心脏代谢并发症的高风险,检测MUO表型至关重要,需要量身定制和密集的后续行动。然而,诊断MUO是耗时且昂贵的。因此,我们旨在研究地中海饮食(MD)在确定MHO/MUO表型中的作用,以及坚持MD是否可作为MUO表型的额外筛查工具.
方法:这项横断面观察研究的研究人群包括275名肥胖受试者。我们评估了他们的生活习惯(体力活动和吸烟习惯),人体测量(体重,高度,腰围,体重指数),血压,代谢参数,炎症标志物(高敏C反应蛋白水平),对MD的依从性(通过PREvenciónCONDIetaMEDiterránea(PREDIMED)问卷),和MHO/MUO表型。
结果:该研究包括275名肥胖个体(256F/19M;34.0±10.5岁;BMI38.3±5.95kg/m2)。其中,114(41.5%)表现为MHO表型,161人(58.5%)具有MUO表型。MHO表型表现出良好的人体测量和心脏代谢谱,以腰围较低(p<0.001)为特征,BMI(p<0.001),胰岛素抵抗(p<0.001),血压(p<0.001),炎症(p<0.001),和脂质水平(p<0.001)与MUO表型相比。值得注意的是,我们发现,MHO表型有较高的坚持MD(p<0.001)和消耗更多的特级初榨橄榄油(EVOO)(p<0.001),蔬菜(p<0.001),水果(p<0.001),豆类(p=0.001),鱼(p<0.001),葡萄酒(p=0.008),和坚果(p=0.001),虽然报告红色/加工肉类的摄入量较低(p<0.001),黄油,奶油,人造黄油(p=0.008),汽水饮料(p=0.006),和商业糖果(p=0.002)与MUO表型相比。坚持MD(p<0.001)和EVOO(p=0.015)摄入被认为是确定MUO/MHO表型存在的影响因素。此外,前评分<5被证明是预测MUO表型存在的最敏感和特异性的切点值(p<0.001)。
结论:对MD的高依从性与MHO表型相关。此外,我们建议,PREDIMED评分的特定截止值可能是区分MUO/MHO表型患者的一个指标,因此有助于识别需要特定饮食干预的心血管风险较高的患者.
The terms metabolically healthy obesity (MHO) and metabolically unhealthy obesity (
MUO) categorize subjects with obesity based on the presence or absence of cardio-metabolic risk factors. Detecting
MUO phenotype is crucial due to the high risk of cardio-metabolic complications, requiring tailored and intensive follow-up. However, diagnosing
MUO is time-consuming and costly. Thus, we aimed to investigate the role of Mediterranean diet (MD) in determining MHO/MUO phenotypes and whether adherence to MD could serve as an additional screening tool for
MUO phenotype.
The study population of this cross-sectional observational study consisted of 275 subjects with obesity. We assessed their lifestyle habits (physical activity and smoking habits), anthropometric measurements (weight, height, waist circumference, body mass index), blood pressure, metabolic parameters, inflammatory marker (high sensitivity C reactive protein levels), adherence to MD (by PREvención con DIetaMEDiterránea (PREDIMED) questionnaire), and MHO/MUO phenotypes.
The study included 275 individuals with obesity (256F/19M; 34.0 ± 10.5 years; BMI 38.3 ± 5.95 kg/m2). Among them, 114 (41.5%) exhibited MHO phenotype, while 161 (58.5%) had
MUO phenotype. MHO phenotype exhibited favorable anthropometric and cardio-metabolic profiles, characterized by lower waist circumference (p < 0.001), BMI (p < 0.001), insulin resistance (p < 0.001), blood pressure (p < 0.001), inflammation (p < 0.001), and lipid levels (p < 0.001) compared to MUO phenotype. Notably, we found that MHO phenotype had higher adherence to MD (p < 0.001) and consumed more extra virgin olive oil (EVOO) (p < 0.001), vegetables (p < 0.001), fruits (p < 0.001), legumes (p = 0.001), fish (p < 0.001), wine (p = 0.008), and nuts (p = 0.001), while reporting lower intake of red/processed meats (p < 0.001), butter, cream, margarine (p = 0.008), soda drinks (p = 0.006), and commercial sweets (p = 0.002) compared to MUO phenotype. Adherence to MD (p < 0.001) and EVOO (p = 0.015) intake were identified as influential factors in determining the presence of MUO/MHO phenotypes. Furthermore, a PREDIMED score < 5 proved to be the most sensitive and specific cut-point value for predicting the presence of MUO phenotype (p < 0.001).
High adherence to MD was associated with MHO phenotype. Moreover, we suggest that a specific cut-off of the PREDIMED score could be an indicator to discriminate patients with MUO/MHO phenotypes and therefore help in identifying patients at higher cardiovascular risk who will require specific dietary intervention.