| Objective:To investigate the difference of diagnostic methods of metabolically healthy obese(MHO)using different criteria of obesity,including the prevalence,clinical parameters and metabolic parameters;To analyze the heterogeneity of MHO,and to try to establish a new diagnostic criteria of MHO.Methods:5147 subjects were evaluated for routine health examination in People's Hospital of Hunan Province from April 2006 to January 2014.Data were collected including body height,body weight,waist circumference,Waist hip ratio,systolic blood pressure(SBP),diastolic blood pressure(DBP),triglyceride(TG),total cholesterol(TC),low density lipoprotein(LDL),high density lipoprotein(HDL),fast blood glucose(FBG),serum alanine aminotransferase(ALT),serum uric acid(UA),peripheral white blood cell count(WBCC)and abdominal B ultrasound.160 blood samples were preserved to detect C-reactive protein(CRP),fasting insulin(FINS),adiponectin(ADP),endothelin-1(ET-1).HOMA-IR was calculated.Metabolic Syndrome(MS)was diagnosed according to the critetia of Chinese Diabetes Society(CDS)in 2004.Body mass index(BMI),waist circum-ference(WC)and waist-to-hip ratio(WHR)was respectively used to diagnose MHO.To analyze the heterogeneity of MHO,and to try to establish a new diagnostic criteria of MHO.Results:1 The difference of diagnostic methods of MHO using different criteria of obesity:1.1 The prevalence of MHO using waist-to-hip ratio criteria was the highest to 40.81%.The prevalence of MHO using BMI criteria was the lowest to 25.20%.1.2 Compared with BMI diagnostic group,BMI,WC,SBP,DBP,ALT,UA were lower than in WC diagnostic group and WHR diagnostic group(P<0.05).Compared with WHR diagnostic group,BMI,WC,SBP were higher than in WC diagnostic group,but waist-to-hip ratio was lower(P<0.05).2 The heterogeneity analysis of MHO individuals:2.1 Metabolic status of different blood glucose levels in MHO:2.1.1 MHO Individuals were grouped into two groups according to FBG value of 5.6mmol/l as the cut-off point:group of FBG<5.6mmol/l(n=423)and group of 5.6mmol/l-FBG<6.1mmol/l(n=56).Compared with group of FBG<5.6mmol/l,the age was higher in group of 5.6mmol/l?FBG<6.1mmol/l(P<0.05),but proportion of male,BMI,SBP,DBP,TG?LDL,ALT,UA,WBCC were not significantly difference.2.1.2 MHO Individuals were grouped into four groups according to the quartile of FBG concentration:group B1(n=128):3.4mmol/l<FBG<4.6mmol/l;group B2(n=114):4.6mmol/l<FBG<4.93mmoI/l;group B3(n=118):4.93mmol/l?FBG<5.28mmol/l;B4(n=119)group B4:5.28mmol/l?FBG<6.1mmol/l.Compared with group B1,proportion of female and WBCC were higher in group B2 and B3,the age,UA and WBCC were higher in group B4(P<0.05).2.2 Metabolic status of different blood pressure levels in MHO:2.2.1 MHO Individuals were grouped into two groups according to blood pressure value of 130/85mmHg as the cut-off point:group of 90/60mmHg(BP<130/85mmHg(n=346)and group of 130/85mmHg?BP<140/90mmHg(n=133).Compared with group of 90/60mmHg?BP<130/85mmHg,the age and BMI were higher in group of 130/85mmHg?BP<140/90mmHg(P<0.05),but proportion of male,SBP,DBP,TG?LDL,ALT,UA,WBCC were not significantly difference.2.2.2 MHO Individuals were grouped into four groups according to the quartile of SBP and DBP values:group C1(n=77):BP:90-110/60-70mmHg;group C2(n=91):BP:111-120/71-76mmHg;group C3(n=117):BP:121-128/77-80mmHg;group C4(n=194):BP:129-139/80-89mmHg.Compared with group Cl and C2,BMI was higher in group C4(P<0.05).2.3 Metabolic status of different TG levels in MHO:MHO Individuals were grouped into four groups according to the quartile of TG concentration:group D1(n=120):TG?0.90mmol/l;group D2(n=120):0.90mmol/l<TG<1.14mmol/l;group D3(n=121):1.14 mmol/l<TG?1.40mmol/l;group D4(n=118):1.4mmol/l<TG<1.70 mmol/l.Compared with metabolically healthy normal weight group,TC of group D1 was lower,but FBG,LDL,HDL,WBCC were not significantly difference.Compared with metabolically healthy normal weight group,the age,BMI,SBP,DBP,ALT,FBG,LDL,UA,WBCC were higher in group D2,D3 and D4(HDL was lower)(P<0.05);Compared with group D1,TC was higher in group D2,D3 and D4(P<0.05),and LDL was higher in group D3 and D4(P<0.05),and HDLwas lower in group D4(P<0.05).2.4 Compared with MHO without NAFLD,age,BMI,SBP and FBG were higher than that in MHO with NAFLD(P<0.05).Compared with obesity with MS,age and BMI were not significantly difference,SBP and FBG was lower than that in obesity with MS,higher than that in MHO without NAFLD(P<0.05).2.5Metabolic status of different WBCC levels in MHO:MHO Individuals were grouped into four groups according to the quartile of WBCC concentration:group E1(n=120):WBCC ?5.48 × 109/L;group E2(n=120):5.48 × 109/L<WBCC ?6.49×109/L;group E3(n=120):6.49 ?109/L<WBCC ?7.52 × 109/L;group E4(n=119):WBCC>7.52 × 109/L.Compared with group El,the age,proportion of male,BMI,TG,LDL,ALT,UA,WBCC were higher in group E4,and HDL were lower than group E1(P<0.05).3 Introduction of new MHO criteria and comparison with the old diagnostic criteria:3.1 According to the analysis above,a new MHO diagnostic criteria was advised,including six indicators in the following:? Abdominal obesity:WC? 85cm(male),WC ? 80cm(female);?No history of diabetes,not taking hypoglycemic drugs,and fasting blood glucose<6.1 mmol/l;?No history of hypertension,not taking antihypertensive drugs,blood pressure<140/90mmHg;?No history of hyperlipemia,not taking lipid-lowing drugs,TC?0.9mmol/l and HDL?0.9mmol/l(male)or HDL?1.0mmol/L(female);?without NAFLD;?WBCC?7.52×109/L.3.2 On parameters including WC,BMI,SBP,DBP,TG,TC,LDL,ALT,UA and WBCC,those in new criteria for diagnosis of MHO were lower(proportion of female and HDL were higher)than the old diagnostic criteria(P<0.05).3.3 Fasting insulin,HOMA-IR,C-reactive protein,endothelin-1 were lower,and adiponectin was higher in new criteria for diagnosis of MHO(P<0.05).Conclusions:1 Different diagnostic criteria got different prevalence,The prevalence of MHO was 25%to 41%.2 Compared with BMI diagnostic group,WC diagnostic group and WHR diagnostic group had better metabolic condition.3 Heterogeneity was present in MHO diagnosed by present diagnosed criteria.4 Measuring from the definition of obese but metabolically healthy,new diagnostic criteria of MHO was more suitable to diagnose MHO. |
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