Evaluation Of Health-related Quality Of Life In People With Different Obesity Phenotypes

Objective and purpose:It is generally believed that obesity is a chronic disease that affects people’s health and quality of life.Obesity leads to metabolic disorders that cause type 2 diabetes,dyslipidemia,hyperuricemia,and cardiovascular disease risk.As a risk factor for metabolic diseases,obesity has become focus point in health concern.From the change of obesity standard from body mass to body mass index to visceral fat rate,it can be seen that the research on obesity has not revealed the essence of metabolic disorders.At the same time,more and more studies have found that the risk of cardiovascular and cerebrovascular diseases in obese people is not exactly the same,and there are high-risk groups of obesity-related diseases in normal body weight people.It can be seen that the body weight and metabolic status of individuals may affect the risk of obesity-related diseases at the same time.Therefore,the concept of obesity phenotype has been proposed,and the study of obesity phenotype may be more helpful for people to understand the essence of metabolic disorders implied by obesity.The mainstream view in academia has always been that obesity can reduce health-related quality of life,but in recent years,studies on the relationship between overweight,obesity and health have shown contradictory conclusions,namely that overweight and mildly obese people have a lower risk of death and better survival prognosis and health-related quality of life,especially in the mental health field.This phenomenon is called the "obesity paradox".The specific mechanism of the "obesity paradox" is unclear.If stratified studies of obese people can explain this phenomenon to a certain extent?This study intends to differentiate the obesity phenotypes by obesity combined with metabolic status,and evaluate the health-related quality of life of people with different obesity phenotypes to explore the cause of the "obesity paradox".Methods:The 2492 examineesrecruited from cross-sectional field investigations(Preventive Treatment Center of Beijing Tongren Hospital,the First Affiliated Hospital of Anhui University of Chinese Medicine,and Zhuhai Branch,Guangdong Provincial Hospital of Traditional Chinese Medicine and "Systematic investigation of physiological parameters of pulse diagnosis of different physique of normal population"),the sociodemographic information(age,sex,marital status,the education level),daily habits(smoking habit,drinking habit,Light diet,Sleep time,and exercise habit),physical indexes(height,weight,waist circumference,blood pressure,fasting blood glucose,high density lipoprotein,triglycerides),past history of disease,family history of disease and the Medical OutcomesStudy 36-Item Short-Form Health Survey(SF-36)were included in the analysis.Body mass index(BMI)was calculated from height and weight(BMI=weight/height 2(kg/m2),BMI<25 is non-obese,BMI≥25 is obese;Waist circumference(WC):WC≥85 cm in males,WC≥80 cm in females are central obesity,Conversely non-obese obesity.Metabolic conditions:The four indicators in the National Cholesterol Eduacation Program Adults Treatment Panel Ⅲ(NCEPATP Ⅲ)were used for judgment.According to metabolic and obese phenotypes,they were divided into four groups:metabolically healthy non-obesity(MHNO),metabolically unhealthy non-obesity(MUN),metabolically healthy obesity(MHO),and metabolically unhealthy obesity(MUO).The SF-36 scale can comprehensively evaluate the physical and mental health of people from the physical component summary(PCS)and mental component summary(MCS).PCS includes physical function(PF),role-physical(RP),physical pain(BP)and general health(GH),MCS includes vitality(VT),social functioning(SF),role-emotional(RE)and mental health(MH).The specific statistical analysis methods were as follows:①X2 test was used to analyze the population characteristics of different obese phenotypes;②Comparing the HRQOL of people with different obesity phenotypes:Partial least squares regression was used to calculate the scores of SF-36 for different obesity phenotypes after controlling sociodemographic and behavioral factors and family history of disease,and Student’s t test was used for pairwise comparisons.③Logistic regression analysis was used to compare the effects of different obesity phenotypes on health-related quality of life.Results:①Population characteristics of different obesity phenotypes determined by BMI:The two groups with normal metabolism(MHNO and MHO)showed a higher proportion of women,18-39 years old,married,bachelor and above;In terms of daily behavior,people with different obesity phenotypes showed no smoking and drinking,non-light diet,6-8h sleep time,low level exercise of high proportion.A high proportion of those without family history of hyperlipidemia and diabetes,a slightly higher family history of hypertension in the MUO group.Population characteristics of different obesity phenotypes determined by WC:Different obesity phenotypes are female and married of high proportion;the metabolically normal group(MHNO and MHO)showed a high proportion of those aged 18-39 years old and bachelor and above;in terms of daily behaviors,people with different obesity phenotypes showed a high proportion of no smoking and drinking habits,non-light diet,6-8h sleep time,and low level exercise,A high proportion of those without family history of hyperlipidemia diabetes,a slightly higher family history of hypertension in the MUO group.②Health-related quality of life in individuals with different obesity phenotypes determined by BMI:Except for those over 60 years of age,the health-related quality of life of different obesity phenotypes determined by BMI was different.When the metabolic status is normal,the HRQOL of obese was not worse than that of the non-obese;when the metabolic status was unhealthy,the HRQOL of obese was only worse than that of the non-obese in PCS;in the obese group,the HRQOL of MHO was better than that of MUO in PCS;the HRQOL of MUNO in the non-obese group was not worse than that of MHNO;the MUO was only worse than that of MHNO in PCS.Health-related quality of life in individuals with different obesity phenotypes determined by WC:Generally,the results of different obese phenotypes determined by WC are consistent with BMI,but there were gender differences in health-related quality of life in different obesity phenotypes determined by WC.When the metabolic status was healthy,the HRQOL of female MHO was worse than that of MHNO,but only the difference in RP dimension was statistically significant.③The influence of different obesity phenotypes on HRQOL determined by BMI:Compared with MHNO,MHO had a protective effect on PCS(0.694,P=0.009),MCS(0.655,P=0.002),VT(0.728,P=0.021),SF(0.723,P=0.031),RE(0.624,P=0.001),and MH(0.733,P=0.022).MUO reduced the HRQOL of PF(1.435,P=0.010),but protectively promoted the health of MH(0.675,P=0.005).The influence of different obesity phenotypes on HRQOL determined by WC:Compared with MHNO,MHO had a protective effect on the health of RE(0.768,P=0.014);MUO reduced the HRQOL in the PCS field,especially in the PF(1.425,P=0.006);but in the field of MCS,it had a protective effect on HRQOL,especially in the MH(0.691,P=0.004),the differences were statistically significant.However,the difference was particularly obvious in different gender subgroups:compared with MHNO,MUO significantly reduced the HRQOL in PCS(1.702,P=0.002),PF(1.692,P=0.004),RP(1.498,P=0.026),BP(1.537,P=0.015)and GH(1.448,P=0.034)in female samples,but not significant in male samples.Conclusions:Obesity and metabolic unhealthy both affect the health-related quality of life.When the metabolic status is healthy,obesity has a protective effect on the quality of life,especially in the MCS field.When the metabolic status is unhealthy,obesity only reduced the PCS of HRQOL.At the same time,there are gender differences in the impact of different obesity phenotypes on HRQOL,and metabolically unhealthy obesity diminishes some dimensions of the PCS of HRQOL in female.This might help us gain a new understanding of obese people and " obesity paradox" to a certain extent,and provide a basis for hierarchical health management of obese people.