A Study On The Relation Between Obesity Related Metabolic Status And Chinese Medicine Constitution And Their Associations With Left Ventricular Function

Part 1 Study on the Relation between Obesity Related Metabolic Status and Chinese Medicine ConstitutionAims:This is a cross-sectional study based on the epidemiological study—"Danyang Study".The main objective of this part is to investigate the characteristics and distribution of Chinese medicine constitution in subjects grouped by body mass index(BMI)categories and metabolic health status,which might be helpful to the clinical treatment.Methods:The study subjects were recruited from Danyang county from 2017 to 2019.Obesity is defined by body mass index categories(normal weight,overweight,and obesity).Metabolic health is strictly defined as having neither any of the guidelines recommended metabolic syndrome components nor insulin resistance.Chinese medicine constitutions are mainly defined by the Chinese Medicine Constitution Classification and Assessment Scale and mixed constitutions are excluded from consideration.All data were collected for statistically analyses.Results:The 2757 participants(mean age ± standard deviation,52.7±11.7 years)include 1613(58.5%)women,999(36.2%)obese,2080(75.4%)metabolically unhealthy,and 93(3.4%)metabolic healthy obese(MHO)participants.Gentleness type is the main constitution among all groups.Compared to the distribution of Gentleness type among the six groups,only the distributions of yang-deficiency and phlegm-dampness were significant different among the six groups(P<0.0001).The proportion of yang-deficiency constitution decreased significantly(Ptrend<0.0001)from normal weight to obesity especially in metabolically unhealthy groups.However,regardless of metabolic status,the constitution of phlegm-dampness increased significantly from normal weight to obese groups(all Ptrend≤0.0013).Conclusions and significances:With the aggravation of obesity,the proportion of phlegm-dampness constitution increased while the proportion of yang-deficiency constitution reduced regardless the presence or absence of metabolic unhealthy although the reduction in proportion of yang-deficiency constitution seems to be more significant in metabolic abnormalities.Part 2 Study on the Relation between Obesity Related Metabolic Status and Left Ventricular FunctionAims:This is also a cross-sectional study based on the epidemiological study—"Danyang Study".The aim of this part is to examine the role of strictly defined metabolically healthy obese(MHO)with subclinical cardiac dysfunction in a Chinese population.Methods:The study subjects were also recruited from Danyang county from 2017 to 2019 and were divided into 6 groups as described above.Preclinical systolic(global longitudinal strain,GLS)and diastolic function were assessed by 2D speckle tracking,and transmitral and tissue Doppler imaging,respectively.Results:In a crude model,MHO participants have lower GLS(20.6%vs.22.1%)and e’(10.3 vs.11.5 cm/s)compared with controls(P<0.0001).However,MHO subjects have higher GLS(20.6%vs.19.9%)and faster e’(7.5 vs.9.0 cm/s)compared with the metabolically unhealthy obese(MUO)group(P≤0.001).After adjustment for covariates,the trend is similar for left ventricular ejection fraction(Ptrend>0.07)but significantly worse for.GLS,e’ and E/e’ ratio(Ptrend≤ 0.02)across the six groups or passing from normal weight to obese individuals irrespective of their metabolic status.Specifically,MHO participants still have significantly lower GLS(20.4%vs.21.4%)and e’(9.6 vs.10.6 cm/s)compared with controls(P<0.0001)but have similar GLS(20.4%vs.20.3%,P=0.47)compared with MUO individuals.Regardless of their obesity status,metabolically unhealthy participants have worse diastolic function compared with their metabolically healthy counterparts(P≤0.0004).Compared with metabolically healthy normal weight participants,MHO individuals are at higher risk of subclinical LV systolic dysfunction,(OR=3.44,95%CI=1.25-9.49;P=0.02)and this is even similar to the risk in MUO.These results are robust to various sensitivity analyses.Conclusions and significances:Regardless of the metabolic status,obesity was substantially associated with worse subclinical systolic function although early diastolic dysfunction seemed to be more accentuated in metabolic abnormalities.