There is metabolic heterogeneity in normal-weight individuals, however, there has been limited research in the Chinese population. This study aimed to investigate the prevalence, distribution and epidemiological determinants of metabolically obese but normal-weight (MONW) in a Chinese population. A total of 17,876 normal-weight individuals were recruited from 37,815 individuals in Zhejiang province in southeastern China. Normal-weight was defined as a body mass index (BMI) of 18.5–23.9 kg/m2. Metabolically abnormal traits were assessed by metabolic syndrome criteria from the International Diabetes Federation (IDF) in 2015. MONW was defined as individuals who had at least two metabolically abnormal trait but normal weight. Multiple logistic regression was used to investigate MONW risk factors, adjusting for potential confounders. The prevalence of metabolic abnormality was 34.1% in normal-weight individuals, and the overall prevalence of MONW was 16.1% in the general population. Different MONW distributions were found between men and women depending on age. Compared with women, men had a significantly higher MONW prevalence among those aged < 45 years old, and there was a lower prevalence for those aged ≥50 years old. Higher BMI or waist circumference (WC), central obesity, menopause, and family histories of hypertension, diabetes, and cardiovascular diseases, increased MONW risk. Higher education levels, regular alcohol drinking, and balanced or vegetarian food preferences reduced MONW risk. Normal-weight individuals have metabolic heterogeneity in China. The MONW distribution between men and women depends on age. BMI, WC, dietary factors, and family history of chronic diseases, are associated with metabolic status.

https://link.springer.com/content/pdf/10.1186/s12889-020-08630-8.pdf

Prevalence and epidemiological determinants of metabolically obese but normal-weight in Chinese population

People with the metabolically obese normal weight (MONW) phenotype are considered as an extremely high-risk group for unfavorable health consequences, but they are frequently undetected due to deceptive body mass index (BMI) and complex assessment. This study aimed to explore the clinical usefulness of cardiometabolic index (CMI) in identifying MONW individuals. This cross-sectional study involved a total of 47,683 normal-weight subjects aged ≥ 18 years. Participants underwent anthropometrics, routine biochemical tests, and questionnaires for a full evaluation of the metabolic profile. The odds ratio (OR) of CMI and MONW phenotype was determined by the Logistic regression models and the diagnostic accuracy of CMI was evaluated by the receiver operating characteristic (ROC) curve analysis. The prevalence of MONW phenotype was 11.0%. After multivariate adjustment, the ORs for MONW in the highest compared with the lowest quartile of CMI was 71.20 (95% CI 55.19–91.86), and 1-SD increment of CMI brought a 54% additional risk. In ROC analysis, compared with BMI and waist circumference, CMI showed superior performance for identifying MONW individuals with an AUC of 0.853 (95% CI 0.847–0.860) in men and 0.912 (95% CI 0.906–0.918) in women, respectively. Moreover, CMI exhibited the highest diagnostic accuracy in younger age groups (aged 18–34 for men; aged 18–34 and 35–44 for women), in which AUCs surpassed 0.9 in both sexes. CMI could be served as a valuable indicator to identify MONW phenotype of Chinese adults, particularly for young people.

Cardiometabolic index: a new tool for screening the metabolically obese normal weight phenotype.

The effective storage of lipids in white adipose tissue (WAT) critically impacts whole body energy homeostasis. Many genes have been implicated in WAT lipid metabolism, including tripartite motif containing 28 (Trim28), a gene proposed to primarily influence adiposity via epigenetic mechanisms in embryonic development. However, in the current study we demonstrate that mice with deletion of Trim28 specifically in committed adipocytes, also develop obesity similar to global Trim28 deletion models, highlighting a post-developmental role for Trim28. These effects were exacerbated in female mice, contributing to the growing notion that Trim28 is a sex-specific regulator of obesity. Mechanistically, this phenotype involves alterations in lipolysis and triglyceride metabolism, explained in part by loss of Klf14 expression, a gene previously demonstrated to modulate adipocyte size and body composition in a sex-specific manner. Thus, these findings provide evidence that Trim28 is a bona fide, sex specific regulator of post-developmental adiposity and WAT function.

/pdf/deletion-of-trim28-in-committed-adipocytes-promotes-obesity-w9y49mbfwl.pdf

Deletion of Trim28 in committed adipocytes promotes obesity but preserves glucose tolerance

Normal body mass index (BMI) is associated with lower risk for cardiometabolic diseases. However, there is a subset of individuals with BMI in this range who present with this metabolic abnormality (called metabolically unhealthy normal weight, MUHNW). Here we aimed to assess the adipose characteristics of people with MUHNW using dual-energy X-ray absorptiometry (DXA). This study included 3259 people with normal BMI who underwent health examinations from January 1, 2007 through December 31, 2016. Body fat percentage (%BF), android-gynoid percent fat ratio (AG ratio), and visceral adipose tissue (VAT) were measured simultaneously using DXA CoreScan software. Those with MUHNW comprised 12.67% of the sample. Among those with MUHNW, 71.6% of the women and 56.5% of the men showed high VAT amounts, but less than 40% of either showed high %BFs. Furthermore, considering the combined effects of fat amount and distribution, a normal BMI accompanied by high AG ratio and/or high VAT mass but low %BF presents a much higher risk for metabolic syndrome than when %BF is high, most predominantly in women. In conclusion, using DXA-measured abdominal fat, particularly VAT accumulation, is clinically more important than using %BF when assessing metabolic syndrome in those with normal BMI.

/pdf/dual-energy-x-ray-absorptiometry-assessed-adipose-tissues-in-20jo3z7fvj.pdf

Dual-energy X-ray absorptiometry-assessed adipose tissues in metabolically unhealthy normal weight Asians.

INTRODUCTION Insulin resistance is becoming an increasingly widespread problem worldwide. For its determination indirect indices of insulin resistance or insulin sensitivity have used. Those indices based on simultaneous measurements of blood glucose and insulin concentrations under fasting conditions or during the Oral Glucose Tolerance Test. OBJECTIVE The aim of the study was to estimate reliable reference values for the indices used in insulin resistance diagnosis. MATERIAL AND METHODS Materials and method. 191 selected participants, aged 18-31, were enrolled into the reference population. 130 participants from the reference population with fasting glucose ≤5.5 mmol/L, BMI<25 kg/m2, and without metabolic syndrome, were finally included in the reference group. The following insulin resistance indices were calculated: HOMA1-IR, HOMA2, HOMA2 from C-peptide, QUICKI, Matsuda Index and Insulin Secretion-Sensitive Index-2. Determination of reference intervals for indirect indices of insulin resistance was conducted in accordance with the C28-A3 procedure recommended by the Clinical & Laboratory Standards Institute (CLSI). RESULTS Results. The reference intervals for indirect insulin resistance indices examined according to CLSI protocol were: ≤4.00, ≤2.27, ≤4.10, ≥0.31 for HOMA1-IR, HOMA2, HOMA2 C-pep., and QUICKI, respectively. For insulin sensitivity, the value of the Matsuda Index was established as ≥3.19 and for beta cell pancreatic function ISSI-2 as ≥206. CONCLUSIONS Conclusions. Establishing a reference intervals for these indices enable the proper identification and differentiation of the types of insulin resistance in particular populations. The early detection of metabolic disorders allows for introduction of effective preventive action.

http://www.aaem.pl/pdf-109225-52227?filename=Estimation of reference.pdf

Estimation of reference intervals of insulin resistance (HOMA), insulin sensitivity (Matsuda), and insulin secretion sensitivity indices (ISSI-2) in Polish young people.

Objective
To analyze the effect of Chinese diabetes risk score in health checkup of elderly population and to explore the risk factors of abnormal glucose metabolism in the elderly patients.


Methods
Chinese diabetes risk score(C-DRs)screening, glucose tolerance test(OGTT), blood biochemical parameters and history collection were performed in 1 181 elderly people participating the health checkup.The area under the ROC curve(AUC)was used to evaluate the accuracy of the screening method.The effect of different cumulative C-DRs on screening target population was reflected by the Gordon index.Multivariate logistic regression analysis was used to analyze relevant risk factors for the glucose metabolic abnormalities.


Results
The AUC of screening for diabetes was 0.749(95%CI: 0.715-0.782), and the best cut-point value was 32.5 points.The sensitivity was 86.50%, the specificity was 60.84%, and the Gordon index was 0.47(P=0.000). The AUC of screening for the pre-diabetes was 0.760(95%CI: 0.733-0.787), and the best cut-point was 33.5 points.The sensitivity was 70.89%, the specificity was 68.72%, and the Gordon index was 0.40(P=0.000). The AUC of screening for MS was 0.797(95% CI: 0.772-0.823), and the best cut-point value was 32.5 points.The sensitivity was 83.62%, the specificity was 64.90%, and the Gordon index was 0.49(P=0.000). The AUC of screening for insulin resistance was 0.609(95%CI: 0.645-0.734), and the best cut-point value was 30.5 points.The sensitivity was 81.25%, the specificity was 44.81%, and the Gordon index was 0.26(P=0.000). Multiple logistic regression analysis showed that age over 80 years, abdominal obesity(waist circumference, male ≥ 90 cm, female ≥ 85 cm), hypertension, hypertriglyceridemia, family history of diabetes were risk factors for abnormality of glucose metabolism in the elderly.The odd ratio values of the above were 1.557, 1.543, 1.495, 1.569, 1.625, 1.715(all P<0.05).


Conclusions
Chinese diabetes risk score may be used to screen for diabetes, metabolic syndrome and insulin resistance in the elderly population.Old age, abdominal obesity, hypertension, hypertriglyceridemia and family history of diabetes are independent risk factors for abnormal glucose metabolism in the elderly population.


Key words: 
Diabetes Mellitus; Multiphasic screening; Risk factors

Evaluating the applied effectiveness of Chinese diabetes risk score in physical examination of elderly population

The aim of this study was to assess the prevalence of metabolic syndrome (MetS) in non-obese adults (body mass index (BMI) < 25 kg/m2) and the prevalence of obese adults (body mass index (BMI) ≥ 25 kg/m2) without MetS in Chinese Beijing urban subjects. A cross-sectional study was conducted and the subjects who came to the hospital to receive a health examination were enrolled randomly. Regardless of age stratification, men have a higher prevalence of MetS than women. Among the urban Beijing population, prevalence of metabolically obese but normal weight (MONW) is lower than metabolically healthy but obese (MHO) regardless of gender. Except for the underweight group, participants exhibit significant differences between MetS and non-MetS subgroups in all tested variables in normal weight and overweight groups, whereas MONW and MHO participants exhibit significant differences in all variables except for creatinine (CR), aspartate aminotransferase (AST), uric acid (UAC) and high-density lipoprotein cholesterol (HDL-C). Women tend to have a higher MONW prevalence but lower MHO prevalence than men. Accordingly, MetS happens more frequently among those 40-59 yr. Besides, sex, age, WC, SBP, DBP, ALT, FG, UAC, TG, HDL-C and LDL-C are risk factors for MetS after multivariate adjustment. In conclusion, the prevalence of MONW is lower than MHO regardless of gender. Women tend to have a higher MONW prevalence but lower MHO prevalence than men.

Prevalence of metabolically obese but normal weight (MONW) and metabolically healthy but obese (MHO) in Chinese Beijing urban subjects.

Objective In this systematic review and meta-analysis, we aimed to clarify the overall effects of functional foods and dietary supplements in non-alcoholic fatty liver disease (NAFLD) patients. Methods Randomized controlled trials (RCTs) published in PubMed, ISI Web of Science, Cochrane library, and Embase from January 1, 2000 to January 31, 2022 were systematically searched to assess the effects of functional foods and dietary supplements in patients with NAFLD. The primary outcomes were liver-related measures, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), and hepatic fibrosis and steatosis, while the secondary outcomes included body mass index (BMI), waist circumference (WC), triacylglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). These indexes were all continuous variables, so the mean difference (MD) was used for calculating the effect size. Random-effects or fixed-effects models were used to estimate the mean difference (MD). The risk of bias in all studies was assessed with guidance provided in the Cochrane Handbook for Systematic Reviews of Interventions. Results Twenty-nine articles investigating functional foods and dietary supplements [antioxidants (phytonutrients and coenzyme Q10) = 18, probiotics/symbiotic/prebiotic = 6, fatty acids = 3, vitamin D = 1, and whole grain = 1] met the eligibility criteria. Our results showed that antioxidants could significantly reduce WC (MD: −1.28 cm; 95% CI: −1.58, −0.99, P < 0.05), ALT (MD: −7.65 IU/L; 95% CI: −11.14, −4.16, P < 0.001), AST (MD: −4.26 IU/L; 95% CI: −5.76, −2.76, P < 0.001), and LDL-C (MD: −0.24 mg/dL; 95% CI: −0.46, −0.02, P < 0.05) increased in patients with NAFLD but had no effect on BMI, TG, and TC. Probiotic/symbiotic/prebiotic supplementation could decrease BMI (MD: −0.57 kg/m2; 95% CI: −0.72, −0.42, P < 0.05), ALT (MD: −3.96 IU/L; 95% CI: −5.24, −2.69, P < 0.001), and AST (MD: −2.76; 95% CI: −3.97, −1.56, P < 0.0001) levels but did not have beneficial effects on serum lipid levels compared to the control group. Moreover, the efficacy of fatty acids for treating NAFLD was full of discrepancies. Additionally, vitamin D had no significant effect on BMI, liver transaminase, and serum lipids, while whole grain could reduce ALT and AST but did not affect serum lipid levels. Conclusion The current study suggests that antioxidant and probiotic/symbiotic/prebiotic supplements may be a promising regimen for NAFLD patients. However, the usage of fatty acids, vitamin D, and whole grain in clinical treatment is uncertain. Further exploration of the efficacy ranks of functional foods and dietary supplements is needed to provide a reliable basis for clinical application. Systematic review registration https://www.crd.york.ac.uk/prospero, identifier: CRD42022351763.

/pdf/functional-foods-and-dietary-supplements-in-the-management-2zcyq51z.pdf

Functional foods and dietary supplements in the management of non-alcoholic fatty liver disease: A systematic review and meta-analysis

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Evaluating the applied effectiveness of Chinese diabetes risk score in physical examination of elderly population

Prevalence of metabolically obese but normal weight (MONW) and metabolically healthy but obese (MHO) in Chinese Beijing urban subjects.

Functional foods and dietary supplements in the management of non-alcoholic fatty liver disease: A systematic review and meta-analysis