Normal Weight Central Obesity and its Impact on Type 2 Diabetes Mellitus.

The association between abdominal visceral adipose tissue and the risk of incident chronic kidney disease according to body mass index in the Asian population, remains unclear. We evaluated the impact of abdominal adiposity stratified by body mass index on the risk of incident chronic kidney disease. A cohort study included 11,050 adult participants who underwent health check-ups and re-evaluated the follow-up medical examination at a single university-affiliated healthcare center. Cross-sectional abdominal adipose tissue areas were measured using computed tomography. The primary outcome was progression to chronic kidney disease (estimated glomerular filtration rate <60 ml/min/1.73m2). The highest quartile of visceral adipose tissue was used for the cut-off of central obesity. During the mean of 5.6 follow-up years, 104 incident chronic kidney disease cases were identified. The risk for chronic kidney disease incidence was significantly increased in the 3rd and 4th quartile ranges of visceral adipose tissue [hazard ratio (95% confidence interval)]: 4.59 (1.48-14.30) and 7.50 (2.33-24.20), respectively. In the analysis stratified by body mass index, the chronic kidney disease incidence risk was increased in the highest quartile range of visceral adipose tissue in the normal weight group: 7.06 (1.35-37.04). However, there was no significant relationship between visceral adipose tissue and chronic kidney disease in the obese group. Compared to the subjects with normal weight and absent central obesity, the hazard ratio for chronic kidney disease incidence was 2.32 (1.26-4.27) among subjects with normal weight and central obesity and 1.81 (1.03-3.15) among subjects with obesity and central obesity. Visceral adipose tissue was a significant risk factor for subsequent chronic kidney disease progression, and the association was identified only in the normal weight group. Normal-weight central obesity was associated with excess risk of chronic kidney disease, similar to the risk in the group with obesity and central obesity.

Status and transition of normal-weight central obesity and the risk of cardiovascular diseases: A population-based cohort study in China

Central Obesity and Normal-Weight Central Obesity Among Adults Attending Healthcare Facilities in Buffalo City Metropolitan Municipality, South Africa: A Cross-Sectional Study

BackgroundCentral obesity is associated with an increased risk of hypertension in the general population. However, little is known regarding the potential relationship between central obesity and the risk of hypertension among adults with a normal body mass index (BMI). Our aim was to assess the risk of hypertension among individuals with normal weight central obesity (NWCO) in a large Chinese population.MethodsWe identified 10 719 individuals aged 18 years or older from the China Health and Nutrition Survey 2015. Hypertension was defined by blood pressure measurements, physician diagnosis, or the use of antihypertensive treatment. Multivariable logistic regression was used to assess the association of obesity patterns, defined by BMI, waist circumference (WC) and waist hip ratio (WHR), with hypertension after adjusting for confounding factors.ResultsThe patients’ mean age was 53.6 ± 14.5 years, and 54.2% were women. Compared with individuals with a normal BMI but no central obesity, subjects with NWCO had a greater risk of hypertension (WC: OR, 1.49, 95% CI 1.14–1.95; WHR: OR, 1.33, 95% CI 1.08–1.65). Overweight-obese subjects with central obesity demonstrated the highest risk of hypertension after adjustment for potential confounders (WC: OR, 3.01, 95% CI 2.59–3.49; WHR: OR, 3.08, CI 2.6–3.65). Subgroup analyses showed that the combination of BMI with WC had similar findings to the overall population except for female and nonsmoking persons; when BMI was combined with WHR, a significant association of NWCO with hypertension was observed only in younger persons and nondrinkers.ConclusionsCentral obesity, as defined by WC or WHR, is associated with an increased risk of hypertension in Chinese adults with normal BMI, highlighting the need to combine measures in obesity-related risk assessment.

Introduction Underweight (UW) and normal weight with central obesity (NWCO) groups are either underrepresented, excluded or merged to the normal weight category in data analysis of epidemiological studies. Purpose This is a local study conducted that explored the association of underweight versus normal weight central obesity in terms of cardiovascular risks and diseases among Filipinos. Methods The participants were Filipinos age 20 years old above who had participated and completed the desired data in the National Nutrition Survey II. The participants were categorized into the following groups: underweight (&amp;lt;18.5kg.m2) and normal weight with central obesity (WC ≥80cm or WHR ≥0.85 for females, WC ≥90cm or WHR ≥0.90 for males). This study compared the baseline profile of UW versus NWCO and determined its association with cardiovascular risks and diseases while using adjustment models for age and sex. Results A total of 3,009 participants were included in this study, 684 (22.7%) UW and 2,325 (77.3%) NWCO. The mean age was UW 47.8 versus NWCO 43.2, females 56.6% versus males 43.4%. In comparison to NWCO using adjustment models for age and sex, the ORs for hypertension (OR=1.498, 95% CI 1.23–1.82, p=.001), diabetes (OR=1.71, 95% CI 1.1–2.72, p=.023) and dyslipidemia (OR=1.8, 95% CI 1.5–2.16, p=.0001). Using age stratified model, CAD 25thP (31 years old) OR= 2, 95%Cl 1.5,2.6 p&amp;lt;.001), 50thP (43 years old), (OR=2.4, 95% CI 1.9,2.9, p&amp;lt;.001), 75thP (55 years old) (OR=1.9 95% CI 1.6,2.4 P&amp;lt;.001), CVA 75thP (OR=2.5,95% CI 1.1,5.6,p=.021), PAD 50thP (OR=3.4,95% CI 1.1,10.7,p=.03). Hypertension 25thP (OR=2.0,95%Cl 1.5,2.6 p&amp;lt;.001), 50thP (OR=2.4,95%Cl 1.9,2.9 p&amp;lt;.001), 75thP (OR=1.9,95%Cl 1.6,2.4 p&amp;lt;.001), Diabetes 25thP (OR=6.7,95% CI 2.8,15.9, p&amp;lt;.001), 75thP (OR=1.7,95% CI 1.1,2.5, p=.005) and Dyslipidemia 25thP (OR=1.2, 95%Cl, 1.1,1.6 p=.02) were significantly higher in UW. Conclusion Lipid and blood pressure parameters differed among male and female UW. A greater association in hypertension and coronary artery disease in all age groups, stroke among the older age group, and diabetes among the younger and older age group is seen among UW versus NWCO among Filipinos. Funding Acknowledgement Type of funding sources: None.

BackgroundIndividuals with normal weight obesity (NWO) are predisposed to having cardiometabolic disorders. This study aims to investigate the circulating levels of vaspin, leptin and their association with glycemic and lipid profiles in women with NWO.MethodsForty women with body mass index (BMI) = 18.5–24.9 kg/m2 and fat mass (FM) ≥ 30% were assigned in the NWO group. Thirty age-matched women with identical BMI range, and FM < 30% (normal weight non-obese; NWNO) were considered as a control group. In addition to anthropometric measurements, glycemic and lipid profiles and circulating levels of leptin and vaspin were measured.ResultsThe mean ± standard deviation (SD) age of participants was 28.76 ± 4.76 years in the NWO group and 29.23 ± 4.50 years in the control group. The NWO group had the higher mean serum levels of insulin (9.02 ± 4.75 vs. 6.24 ± 2.51, P = 0.009), leptin (17.31 ± 8.10 vs. 9.94 ± 4.30, P < 0.001) and homeostatic model assessment of insulin resistance (HOMA-IR) (33.77 ± 20.71 vs. 23.48 ± 10.03, P = 0.009) compared to the NWNO group. The serum level of vaspin was higher in the NWO group compared to the control group (34.82 pg/ml vs. 27.72 pg/ml, respectively, P = 0.12). In NWO group, the serum levels of leptin had positive correlation with FBS (r = 0.45, P = 0.02), insulin (r = 0.51, P = 0.008), and HOMA-IR (r = 0.46, P = 0.02) and vaspin concentration was associated with insulin (r = 0.36, P = 0.02) and HOMA-IR (r = 0.30, P = 0.06), positively.ConclusionIt is concluded that the concentration of insulin and HOMA-IR index were significantly higher in women with NWO compared to NWNO. Higher concentrations of leptin and vaspin in the NWO group were associated with glycemic profile.

Individuals with normal weight could suffer from obesity based on their body fat percentage (also known as normal weight obesity (NWO)), thus being at risk of significant morbidity and mortality compared to the general population. It seems that inflammatory pathways and chronic inflammation are significant contributors to the pathogenicity of NWO. This study aimed to assess and pool the association of proinflammatory and anti-inflammatory cytokines with NWO. In this systematic review and meta-analysis, online international databases (PubMed, Scopus, EMBASE, Web of Science, and Google Scholar) were searched until August 2022. All observational studies with an English full text comparing the mean levels of proinflammatory and anti-inflammatory cytokines (e.g., C-reactive protein (CRP), various types of interleukins (IL) s, tumor necrosis factor-alpha (TNF)) and white blood cell (WBC) count, in subjects with NWO and "normal weight non-obese (NWNO)" were included. Two researchers independently screened, reviewed and assessed the quality of included studies. The remaining articles' data were extracted post-screening. The heterogeneity between studies was assessed using the I2 and Cochran's Q tests. A random effect model meta-analysis was used to pool the standardized mean difference (SMD) as an effect size. From the initial 559 studies, 21 and 19 were included in the qualitative and quantitative synthesis, respectively. In the systematic review, 8 studies reported a significant association between various proinflammatory cytokines (CRP, IL6, IL1β, and TNFα) and NWO. According to random-effect meta-analysis, the association between NWO with CRP (SMD: 0.60, 95% CI: 0.30, 0.91) and IL6 (SMD: 0.90, 95%CI: 0.14, 1.66) was statistically significant. Moreover, the mean level of TNFα in subjects with NWO and NWNO did not differ significantly (SMD: 0.67, 95% CI: -0.36, 1.70). The findings of this study show that NWO was associated with high levels of CRP and IL6. Therefore, inflammatory pathways may play a role in the pathogenicity of NWO.

Aim: We aimed to underline the importance of “normal weight obesity concept”, prevent the overlooking of Normal Weight Obesity patients, administrate their treatments and explain them the risks regarding their future lives along with making emphasis on the necessity of change in polyclinical practices about the subject. Methods: We selected 200 female patients that were either normal or overweighted for this study. Patients have been divided into 4 groups with respect to their body mass index and body fat percent values. Differences of bioelectrical impedance analysis measurements between the groups, relation of the anthropometric and metabolic parameters and those parameters’ inner correlations have been inspected. Results: Serum levels of fasting plasma glucose, insulin, HOMA-IR, total cholesterol, LDL, triglyceride and TSH were higher in “Normal Weight Obesity” subjects than “Normal Weight Lean” subjects. The mean LDL levels were found to be higher in the Normal Weight Obesity group compared to the other groups and it was found to be statistically significant. Body fat percent was positively correlated to insulin, HOMA-IR, visceral fat rating, waist – hip circumferences, waist to height – hip to height ratios. Conclusion: The importance of measurement of body fat percent and not to overlook the Normal Weight Obesity patients should be emphasized once more. Therefore, in the primary care, during public screening and polyclinical assessment states, patients should be checked for obesity with not only measuring their weights and heights, but also detection of their detailed body composition. Keywords: obesity, body fat distribution, waist to height ratio

ObjectiveThis study aimed to determine the prevalence of Normal Weight Obesity (NWO) and evaluate its association with cardiometabolic risk factors among patients with Type 2 Diabetes Mellitus (T2DM) in Gujarat, India.MethodsThis cross-sectional study included 432 adults with T2DM attending a Non-Communicable Disease clinic. Anthropometric measurements, body composition analysis using bioelectrical impedance, and clinical parameters were assessed. NWO was defined as normal BMI (18.5–24.9 kg/m²) with high body fat percentage (≥ 25% for men, ≥ 32% for women). Cardiometabolic risk factors, including blood glucose, blood pressure, and lipid profile, were evaluated. Statistical analyses included descriptive statistics, correlation analysis, and multivariate logistic regression.ResultsThe prevalence of NWO was 33% among the study population. Significant discordance was observed between BMI classification and body fat percentage, with 91% of males and 51.8% of females with normal BMI having obese levels of body fat. Individuals with NWO demonstrated higher cardiometabolic risk profiles compared to non-obese counterparts, including elevated random blood glucose levels (290 ± 110 mg/dL vs. 180 ± 80 mg/dL, p < 0.001), higher systolic (148.8 ± 25.4 mmHg vs. 122.5 ± 19.5 mmHg, p < 0.001) and diastolic blood pressure (98.5 ± 55.6 mmHg vs. 78.6 ± 36.6 mmHg, p < 0.001), and increased prevalence of hypertension (61% vs. 15%, p < 0.001). A moderate positive correlation was found between body fat percentage and random blood sugar levels (r = 0.504, p < 0.001). Multivariate analysis identified age, duration of diabetes, blood glucose levels, and blood pressure as independent factors associated with NWO.ConclusionThe high prevalence of NWO and its significant association with adverse cardiometabolic risk factors in T2DM patients underscores the limitations of using BMI alone for obesity assessment. These findings highlight the need for incorporating body composition analysis in routine clinical practice to improve risk stratification and management strategies in T2DM patients, particularly in the Asian Indian population.

Normal weight obesity is associated with hypercholesterolemia and low muscle mass in persons living with HIV on antiretroviral treatment

BackgroundEvidence of probiotics effects on gut function, brain activity and emotional behaviour were provided. Probiotics can have dramatic effects on behaviour through the microbiome–gut–brain axis, through vagus nerve. We investigated whether chronic probiotic intake could modulate psychological state, eating behaviour and body composition of normal weight obese (NWO) and preobese–obese (PreOB/OB) compared to normal weight lean women (NWL).Methods60 women were enrolled. At baseline and after a 3-week probiotic oral suspension (POS) intake, all subjects underwent evaluation of body composition by anthropometry and dual X-ray absorptiometry, and psychological profile assessment by self-report questionnaires (i.e. EDI-2, SCL90R and BUT). Statistical analysis was carried out using paired t test or a non-parametric Wilcoxon test to evaluate differences between baseline and after POS intake, one-way ANOVA to compare all three groups and, where applicable, Chi square or t test were used to assess symptoms.ResultsOf the 48 women that concluded the study, 24% were NWO, 26% were NWL and 50% were PreOB/OB. Significant differences in body composition were highlighted among groups both at baseline and after a POS (p < 0.05). After POS intake, a significant reduction of BMI, resistance, FM (kg and %) (p < 0.05), and a significant increase of FFM (kg and %) (p < 0.05) were observed in all subjects in NOW and PreOB/OB. After POS intake, reduction of bacterial overgrowth syndrome (p < 0.05) and lower psychopathological scores (p < 0.05) were observed in NWO and PreOB/OB women. At baseline and after POS intake, all subjects tested were negative to SCL90R_GSI scale, but after treatment subjects positive to BUT_GSI scale were significantly reduced (8.33%) (p < 0.05) compared to the baseline (33.30%). In NWO and PreOB/OB groups significant differences (p < 0.05) in response to the subscales of the EDI-2 were observed. Significant improvement of the orocecal transit time was observed (p < 0.05) after POS intake. Furthermore, significant differences were observed for meteorism (p < 0.05) and defecation frequency (p < 0.05).ConclusionsA 3-week intake of selected psychobiotics modulated body composition, bacterial contamination, psychopathological scores of NWO and PreOB/OB women. Further research is needed on a larger population and for a longer period of treatment before definitive conclusions can be made.Trial registration ClinicalTrials.gov Id: NCT01890070

Purpose: Subjects with normal weight obesity (NWO), defined as normal BMI but high body fat (BF)%, are at increased cardiovascular risk. Factors contributing to NWO are not well studied. We hypothesized that NWO is associated with reduced physical activity and unhealthy eating patterns. Methods: We analyzed 5942 people ≥18 years with normal BMI (18.5-24.9 kg/m 2 ) from the NHANES III survey (1988-1994), a representative sample of the US population. Subjects were classified as NWO based on BF% (&gt;35% in women and &gt;25% in men). Leisure-time physical activity was measured with a standard survey. Subjects were stratified as INACTIVE (no physical activity reported), ACTIVE (3-6 METs for ≥ 5 times/week or &gt;6 METs, ≥3 times/week), or insufficiently active (those who were not INACTIVE but did not meet criteria for ACTIVE). Total activity was expressed in METs/hr/month, assuming an exercise duration of 30 minutes for each day reported. A Healthy Eating Index was based on 24-hour dietary recall data. Analyses were weighted for the complex study design. Results: Mean age was 43 years, 54.4% were men; 1170 people (19.7%) with normal BMI had NWO. Table shows demographics, physical activity and nutritional habits by group. After controlling for age, gender, poverty levels, smoking status and Healthy Eating Index, METs/hr/month was an independent predictor of NWO (OR per 100 MET/hours/month is 0.72(95%CI 0.60;0.88). People who were inactive and insufficiently active had higher odds of NWO as compared with active people (OR-1.47; 95%CI 1.10;1.96 and OR-1.60, 95% CI 1.25; 2.05, respectively). Also, strength training was independently associated with a decreased odds of NWO (0.63; 95%CI 0.44;0.89). Dietary pattern was not predictive of NWO. Conclusions: Physical activity, particularly resistance exercise, but not diet, was associated with NWO independently of potential confounders. Promoting physical activity may be an important interventional strategy in these patients.

To study whether normal-weight obesity in childhood is associated with increased cardiometabolic risk in early adulthood. This study assessed data for 236 girls followed from prepuberty to early adulthood. Growth chart data were obtained from birth to 18 years. Body composition was assessed by dual-energy x-ray absorptiometry and cardiometabolic risk by calculating continuous clustered risk score (at ages 11, 14, and 18). The association of body weight status with cardiometabolic risk from childhood to early adulthood was examined. Subjects with normal-weight obesity were virtually indistinguishable from their normal-weight lean peers in terms of relative body weight and BMI but had significantly higher fat mass (7.1-7.3 kg) and cardiometabolic risk already in childhood, and this difference persisted into early adulthood (P < 0.001 for all). Children and adolescents with normal body weight and high body fat percentage may be at increased risk for cardiometabolic morbidity in adulthood. Body fatness may be of utility in clinical practice to effectively identify children and adolescents at risk and to permit recommendation of lifestyle changes that could translate to lower risks of cardiovascular diseases in the future.

Normal weight obese (NWO) women: An evaluation of a candidate new syndrome

Objective To detect plasma progranulin (PGRN) level in subjects with newly diagnosed type 2 diabetes mellitus and to investigate the relationship of plasma PGRN level with glycolipid metabolism,inflammation,and insulin resistance.Methods Eighty patients with newly diagnosed type 2 diabetes (T2DM) and 88 subjects with normal glucose tolerance (NGT) were recruited in the study.Both of them were divided into normal weight (NW)subgroup and obesity (OB) subgroup.Obesity was defined as body mass index (BMI) ≥ 25 kg/m2 according to the World Health Organization-Western Pacific Region diagnostic criteria(2000).Body fat parameters were measured and BMI,waist-to-hip ratio were determined.Fasting plasma PGRN and interleukin-6 (IL-6) levels were determined by ELISA,fasting plasma glucose (FPG),2 h plasma glucose after glucose loading (2hPG),HbA1C,fasting insulin (FINS),and lipids were also detected.Insulin resistance and pancreas β cell function were assessed by homeostasis model assessment (HOMA-IR,HOMA-β).Results Plasma PGRN level was significantly higher in T2DM group than that in NGT group(P＜0.01).Within groups of T2DM and NGT,plasma PGRN level in OB subgroups was higher than that in NW subgroups [(225.22 ± 34.39 vs 195.59 ± 50.47 and 183.79 ± 61.63 vs 148.69 ± 55.27) ng/ml,P＜0.05].Bivariate correlation analysis showed that plasma PGRN level was positively correlated with weight,waist circumference,BMI,systolic blood pressure,FPG,2hPG,HbA1C,triglyceride(TG),IL-6,FINS,and HOMA-IR (P＜0.05 or P＜0.01),and was negatively correlated with HOMA-β (P＜0.05).Multiple linear regression analysis showed that BMI,HbA1C,IL-6,and TG were independently related to plasma PGRN level(P＜0.05).Conclusions Plasma PGRN level was increased in patients with type 2 diabetes as well as in obesity,and was closely related with glycolipid metabolism,inflammation,and insulin resistance. Key words: Dabetes mellitus, type 2 ; Obesity; Progranulin ; Insulin resistance