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Older age, central fat distribution predict poor metabolic health in adults with obesity
Central fat distribution and older age, as well as an increase in fat-free mass index among women, were all predictive of adverse metabolic health among middle-aged Asian patients with obesity, according to researchers in Thailand.
“Skeletal mass plays an important role in glucose metabolism as it serves as an important organ for glucose disposal,” Pornpoj Pramyothin, MD, of the division of nutrition, department of medicine at Siriraj Hospital, Mahidol University, Bangkok, and colleagues wrote. “Skeletal muscle depletion in obese patients, or ‘sarcopenic obesity,’ has also been associated with metabolic abnormalities, including insulin resistance, hyperglycemia and [type 2 diabetes]. However, most of the existing literature has focused on patients who are mildly obese (BMI 25-29.9 kg/m2 for Asians and 30-35 kg/m2 for other ethnicities), while data on Asian adults with BMI of 30 kg/m2 or higher remains limited.”
The researchers reviewed data on 552 patients (67% women; median age, 40.5 years; median BMI, 38.3 kg/m2) who sought weight management at an academic medical center in Bangkok from 2007 to 2016.
Patients provided information on demographic data, concurrent treatments and medical comorbidities. Pramyothin and colleagues measured fat-free mass using bioelectrical impedance.
The researchers reported metabolically healthy obesity in 19% of patients. Metabolic syndrome occurred in 55.4% of patients, and 32.6% had type 2 diabetes.
Multivariate models showed that higher fat-free mass was independently associated with metabolically abnormal obesity (OR = 1.22; 95% CI, 1.09-1.37). In women, higher fat-free mass was also associated with an increased risk for metabolic syndrome (OR = 1.12; 95% CI, 1.03-1.22), but this did not hold true for men.
In both sexes, older age showed an independent association with metabolically abnormal obesity (OR = 1.06; 95% CI, 1.04-1.09 in women; OR = 1.06; 95% CI, 1.02-1.09 in men), the researchers wrote. Older age was also associated with metabolic syndrome (OR = 1.05; 95% CI, 1.03-1.06 in women; OR = 1.05; 95% CI, 1.02-1.07 in men) and with type 2 diabetes (OR = 1.07; 95% CI, 1.05-1.09 in women; OR = 1.06; 95% CI, 1.04-1.09 in men), according to Pramyothin and colleagues.
In men, waist to hip ratio was independently associated with metabolically abnormal obesity (OR = 1.08; 95% CI, 1.01-1.15), the researchers reported. In women, waist circumference was associated with type 2 diabetes (OR = 1.03; 95% CI, 1.01-1.05).
“In conclusion, we observed that older age, central fat distribution and, surprisingly, an increase in fat-free mass among women were independent predictors of abnormal metabolic phenotypes in this cohort of relatively young obese Asian adults,” Pramyothin and colleagues wrote. “Our findings require confirmation in larger studies with longitudinal study design. Whether interventions which aim at preserving muscle mass during weight loss with healthy lifestyle modification, pharmacotherapy or bariatric surgery in the obese would improve health outcomes remains unclear.” – by Andy Polhamus
Disclosures: The researchers report no relevant financial disclosures.