Elsevier

Endocrine Practice

Volume 19, Issue 5, September–October 2013, Pages 758-768
Endocrine Practice

Original Article
Prevalence of Metabolically Discordant Phenotypes in a Mediterranean Population—the Imap Study

https://doi.org/10.4158/EP12355.ORGet rights and content

ABSTRACT

Objective

To study the prevalence and correlates of body size phenotypes in an adult Spanish population.

Methods

We undertook a cross-sectional analysis in a random sample of 2,270 individuals. We defined six body size phenotypes based on body mass index category (normal-weight, 18.5 to 24.9 kg/m2; overweight, 25 to 29.9 kg/m2; obese, ≥30.0 kg/m2) and the presence of ≤1 (meta- bolically healthy) or ≥2 (metabolically abnormal) cardio- metabolic abnormalities: metabolically healthy normal- weight (MHNW), metabolically abnormal normal-weight (MANW), metabolically healthy overweight (MHOW), metabolically abnormal overweight (MAOW), metaboli- cally healthy obese (MHO), and metabolically abnormal obese (MAO). We considered four cardiometabolic abnormalities: systolic and/or diastolic blood pressure ≥130/85 mm Hg, triglycerides ≥150 mg/dL, high-density-lipopro- tein cholesterol levels <40/<50 mg/dL in men/women, and elevated glucose (fasting plasma glucose ≥100 mg/dL or previous diabetes).

Results

Submitted for publication October 30, 2012 Accepted for publication April 1, 2013From the 1The prevalence of the MHO, MHOW, and MANW phenotypes was 2.2, 13.9, and 7.9%, respectively. Whereas 9.6% of obese and 32.6% of overweight individuals were metabolically healthy, 21.3% of the normal- weight subjects were metabolically abnormal. A multivariate regression model (adjusted for age, sex, and waist circumference) showed that age >40 years, male sex, and higher waist circumference were independently associated with the metabolically abnormal phenotype MANW, whereas younger age, female sex, and lower waist circumference were independently associated with the metabolically healthy phenotypes.

Conclusion

The prevalence of MHO in our population is low and is more common in women and younger people. In contrast, a high proportion of normal-weight individuals (mainly over 40 years of age) in our population show cardiometabolic abnormalities. (Endocr Pract. 2013;19:758-768)

Section snippets

INTRODUCTION

Recent studies have suggested that cardiometabolic risk may vary greatly among individuals with a similar body mass index (BMI), depending on their metabolic profile. A subset of obese individuals, denominated “metabolically healthy, obese” (MHO), despite having excessive body fatness, display a favorable metabolic profile characterized by high levels of insulin sensitivity, lower visceral adipose tissue content, less liver fat, normal blood pressure, and favorable lipid, inflammatory,

METHODS

We undertook a cross-sectional, analytical, epidemiologic study. The patients comprised a representative random sample of the adult population aged 18 to 80 years assigned to a health center in the Malaga District (N = 29,818) (Malaga, Spain). For sample size calculation, the prevalence rate of the metabolic syndrome (MS) (~20%) was used. Our sample size was calculated to have >80% power with a confidence level of 95% (a = 0.05) and losses of 15%. Accordingly, the minimum sample size required

RESULTS

A total of 27 subjects (1.6%) with a BMI <18.5 kg/ m2 were excluded. Thus, the final sample comprised 2,233 subjects, whose epidemiologic and metabolic phenotypes according to body size are summarized in Table 1.

The proportion of subjects who were normal-weight, overweight, or obese was 37, 38.4, and 22.9%, respectively. The population prevalence of MHO, MHOW, and MANW subjects was 2.2, 13.9, and 7.9%, respectively (Fig. 1). A total of 9.6% of the obese subjects were MHO, 32.6% of the

DISCUSSION

Our data show that, in absolute terms, the prevalence of both the MANW and MHO phenotypes is low (7.9% and 2.2%, respectively) in our population. Although more than one-fifth of normal-weight Spanish adults expressed cardiometabolic abnormalities, only 9.6% of obese people did not exhibit MS.

The prevalence of metabolic phenotypes depends mainly on the definition used (12) and the population studied. Many studies have involved clinic-based samples, which are not representative of the general

CONCLUSION

In conclusion, the prevalence of overweight and obesity among Spanish adults who are metabolically healthy is notably lower than that previously reported for most other populations. In our setting, a high BMI is a good indicator of cardiometabolic abnormalities, so that preventive measures should be recommended universally in the obese population. On the other hand, there is a high prevalence of metabolically obese individuals with the normal-weight phenotype in our population, especially in

ACKNOWLEDGMENT

CIBER Fisiopatología de la Obesidad y la Nutrición is an ISCIII Project. This work was supported by Consejería de Salud de la Junta de Andalucia (grant no. 283/06).

DISCLOSURE

The authors have no multiplicity of interest to disclose. Dr. Ricardo Gomez-Huelgas contributed to the study conception and design, analysis and interpretation of data, drafting, reviewing, and critically revising the manuscript for important intellectual content and gave final approval of the version to be published. Dr. Dariusz Narankiewicz contributed to drafting, reviewing, and critically revising the manuscript for important intellectual content and gave final approval of the version to be

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