Metabolic health studies -
In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript. npj Metabolic Health and Disease is an online Open Access journal dedicated to publishing high-quality peer-reviewed content on all aspects of metabolism.
The journal welcomes submissions that explore basic mechanisms of metabolism and metabolic diseases, as well as pre-clinical and clinical studies focussing on novel diagnostic tools, effects of interventions for the prevention and treatment of metabolic pathophysiology, epidemiology, public health, and global health.
The journal also publishes Reviews, Perspectives, and Comments on the most relevant and recent developments in metabolism research. We routinely organize and commission collections covering specific topics and encourage open discussions and debates. If you are unsure about the suitability of your work for the journal, please submit a pre-submission inquiry to npjmetabhealth nature.
Our overarching goal is to develop and validate innovative diets to promote health and wellbeing, and deliver improved health outcomes to the community in a range of areas. For additional leads in this area of research, please contact Nutrition and Metabolic Health researchers.
We offer exciting opportunities for researchers at the honours, masters and PhD levels. Our research degrees are open to students from a broad range of backgrounds, and range from basic sciences to clinical research. The NHSPs collected information regarding hypertension, family history of diabetes, smoking status, alcohol consumption, and physical activity from self-reported questionnaires.
Smoking status was categorized as never smoker, former smoker, or current smoker. Current smokers were defined as individuals who answered "Yes, and I currently smoke cigarettes.
We categorized economic status into three groups by income-based insurance premium: low, 1—3rd deciles; middle, 4th—7th deciles; and high, 8th—10th deciles. Residential areas were categorized using residential area codes for metropolitan areas and other regions.
Seven cities were classified as metropolitan areas by adding Seoul, a special city, to the six metropolitan cities of Incheon, Daejeon, Gwangju, Daegu, Ulsan, and Busan. The endpoint of this study was to compare the occurrence rates of CVDs and all-cause mortality in the metabolic healthiness and obesity groups after enrollment — The composite outcome is sum of all-cause mortality and incidence of CVDs.
CVDs were defined when the main diagnosis II25 or II69 was recorded at least twice in outpatients or once in hospitalized patients. CVDs included IHD II25 and CbVDs II69 based on ICD codes.
CbVDs were further divided into ischemic, hemorrhagic, and other CbVDs according to the diagnosis code as follows: ischemic CbVDs were coded as I63 cerebral infarction , I65 occlusion and stenosis of precerebral arteries, not resulting in cerebral infarction , and I66 occlusion and stenosis of cerebral arteries, not resulting in cerebral infarction ; hemorrhagic CbVDs as I60 subarachnoid hemorrhage , I61 intracranial hemorrhage , and I62 other nontraumatic intracranial hemorrhage ; and other CbVDs as I64 stroke, not specified as hemorrhage or infarction , I67 other cerebrovascular diseases , I68 cerebrovascular disorders in diseases classified elsewhere , and I69 sequelae of cerebrovascular disease.
We conducted subgroup analyses for each IHDs, CbVDs, and all-cause mortality. The start date of the research was defined as the day of the first health examination between and For participants diagnosed with CVD between and , the research end date was the date of initial diagnosis of the disease.
In cases where the participant died before a diagnosis of diabetes was made, the end date was defined as the date of death. Similarly, in cases where the participants had not died or had not been diagnosed with diabetes during the study period, the end date was the latest date of the last outpatient clinic visit, last health screening, or last when the participants took the prescribed medication.
Analysis of variance ANOVA tests for continuous variables and chi-squared tests for categorical variables were used to check for group differences. To investigate the association between MetS, obesity, and composite outcomes all-cause mortality and incidence of CVDs , outcome-free survival rates were estimated and compared using the Kaplan—Meier method and log-rank test.
We built three Cox proportional hazard regression models after adjusting for age, smoking status, alcohol consumption status, physical activity, economic status, residence area, alanine aminotransferase ALT , and gamma-glutamyl transferase GGT.
We performed subgroup analysis for each outcome IHDs, CbVDs including ischemic and hemorrhagic CbVD, and all-cause deaths.
The outcome-free survival rates were estimated using the Kaplan—Meier method. Statistical analyses were performed using the statistical package SAS enterprise version 7. Not applicable. The ethics committee of National Health Insurance Service NHIS waived the need for informed consent because the data from the NHIS-HEALS were anonymized at all stages, including during data cleaning and statistical analysis.
The Institutional Review Board of the Chungbuk National University Hospital approved the present study CBNUH A total of , participants 85, men and 66, women included in this study, and the median follow-up duration was 9. Table 1 shows the baseline characteristics of the study population according to the combination of MetS and BMI.
Table 1 Within the same BMI category, the MH group was younger than the MUH group was. Waist circumference, SBP, fasting glucose, ALT, and GGT levels were lower in the MH group than in the MUH group. In both sexes, TG levels were higher in the MUH groups than the MH groups, while HDL-C and LDL-C levels tended to be higher in the MH groups than the MUH groups.
The proportion of current smokers was lower in the MH group than in the MUH group in both sexes. Among men, the MH group drank less alcohol and engaged in more regular physical activity than the MUH group.
Economic status was higher in the male MH group. However, females in the MUH group drank less alcohol and had a higher economic status than those in the MH group.
The incidence of DM, hypertension, and dyslipidemia was higher in the MUH group than in the MH group. Within each MH and MUH group, the more obese groups had higher SBP, total cholesterol, LDL-cholesterol, and ALT levels.
Figure 2 shows the estimated cumulative incidence of the composite outcomes based on the Kaplan—Meier survival curve. A total of 36, composite outcomes were observed, accounting for At the end of the follow-up period, the estimated cumulative incidences of composite outcomes were as follows: MHNW Cumulative incidents of composite outcome all-cause mortality and incidence of cardiovascular diseases according to metabolic healthy and obesity.
Figure 3 presents the results of the Cox proportional hazard regression models to examine the association between MetS, BMI category, and the incidence of composite outcomes. In the metabolically healthy group, the higher BMI group had the higher risk of composite outcomes.
The metabolically unhealthy group had a higher risk in any given BMI group. Cox proportional hazards regression models for composite outcome all-cause mortality and incidence of cardiovascular diseases.
Subgroup analysis was conducted to investigate the association between MetS, BMI category, and each outcome IHDs, CbVDs, ischemic CbVD, hemorrhagic CbVD, and all-cause mortality Fig.
The risk of hemorrhagic CbVDs was not significantly associated with the six MetS and BMI categories combined. Full-adjusted Cox proportional hazards regression models for incidence of ischemic heart diseases, cerebrovascular diseases, and all-cause mortality.
Apart from to Model 3, additional analysis was performed to check the marginal effect, which is how the composite outcome and each outcome change when the degree of obesity changes in the MH group and the MUH group Model 4, Supplementary Table 2.
In the MH group, the HRs increased according to the increase in BMI overweight in MH, 1. Based on the Korean NHIS-HEALS data, this retrospective study demonstrated that the risk of composite outcome increased in the MHOW, MHO, and MUH groups compared to the MHNW group.
In particular, after stratifying the composite outcome into IHD, CbVD, and all-cause death, all MUH groups showed an increased risk of IHD, CbVD, and ischemic CbVD incidence in both sexes compared to the MHNW group.
Recently, a few studies have shown that MHO did not increase the risk of CVD incidence more than MHNW 16 ; however, in our research, the risk of composite outcome, IHDs, CbVDs, and ischemic CbVDs in MHO was higher in MHNW. All-cause mortality is lower in MHO than in MHNW in men but not significantly different between the two groups in women.
The risk of all-cause mortality increased even in MUHNW in both sexes. In many cases, MetS and obesity coexist, and both can contribute to CVD Accordingly, through the results from analyses of the marginal effect conducted to confirm the interaction between MetS and obesity, the HRs for the composite outcome of the MUH group was found to be approximately 1.
These results are not significantly different from those of previous studies 18 , 19 , 20 ; the CVD risk in the MUH group increased by 1. Given these results, although additional research is needed, the effects of obesity on CVD outcomes may vary depending on metabolic health.
Previous studies have shown that various factors influence the occurrence of the MUH phenotype, and age, alcohol consumption status, low level of physical activity, low education level, and smoking are thought to be factors In addition, compared with MUHO, the MHO group had a better quality diet with a high intake of fruits, whole grains, meat, and beans In our study, men showed similar results.
In contrast, among women, the MH group showed a higher percentage of moderate alcohol consumption and lower economic status, and the MUH group had a relatively healthier lifestyle. These differences might be due to the MUH group's chance for early detection and treatment of the disease through regular check-ups or hospital visits according to the higher economic status and the possibility of healthy lifestyle changes to manage chronic conditions, such as refraining from alcohol consumption.
However, the mechanism by which metabolic unhealthiness or obesity influences CVD and death has not been elucidated. In a study by Kassi et al. Differences in fat distribution can also be explained as the cause of worse CVD outcomes in an MUH population.
In the case of the MUHNW population, there is little adipose tissue in the gluteo-femoral region that can store excess fat.
Instead, as trunk fat mass increases, previous studies have asserted that CVD risk increases independently In addition, recently, Single nucleotide polymorphisms SNPs related to lipid metabolism or insulin or glucose metabolism were observed in the MUHO or MUHNW groups, suggesting that they may be associated with CVD outcome at the gene level and the phenotype of obesity or MUH 23 , In our study, the risk of all-cause mortality tended to decrease with increasing BMI in both sexes in MH groups Overweight in MH, 0.
Although not statistically significant, this trend is also seen in the MUH groups. Recently, particularly in MHO, a mechanism has been suggested that intrinsic healthy adipose tissue allows excess adiposity without adipocyte dysfunction.
However, there is a limitation in that the cohort data used in this study did not include data on inflammatory markers such as interleukin-6 and high-sensitivity C-reactive protein, muscle mass, body fat distribution, diet, and SNP. Therefore, it was impossible to confirm a direct relationship between the following mechanisms and the results.
There was an age difference between each group of at least 1. Even though age was adjusted in all models, the residual effect of age-related hormonal change, metabolic derangement, and other risk factors should be considered as potential limitations when interpreting this study. In addition, since we did not consider the contribution of each factor involved in metabolic unhealthiness to the CVD outcome, the actual risk may differ from these results.
Furthermore, both MetS and obesity are likely to be transient at one point in time. This study estimated the risk of disease incidence and death according to MetS and obesity only at baseline. The possibility of risk changes according to status changes was not reflected due to cohort data limitations.
Some previous studies 28 , 29 showed that elevated fasting glucose and low HDL-C were associated with increased mortality, but the results did not include changes in the overall observation period. Since the definition of MetS or metabolic unhealthiness is not yet clear, even in previous studies, each researcher conducted the analysis using different criteria.
The results also differed depending on the criteria used. However, in our study, metabolic unhealthiness was defined by applying criteria for MetS that are familiar to the clinical field.
It has the strength of analyzing a long-term follow-up period of approximately 10 years for a group that can relatively represent Koreans. In addition, this study has the strength of subdividing and comparing groups according to the metabolic health of each obesity degree and additionally analyzing the interaction between obesity and metabolic health.
This study confirmed that metabolically unhealthy and increased BMI at a single time point could also affect the risk of CVD and death. Significantly, the risk of CVD and all-cause mortality was higher in metabolically unhealthy individuals with BMI within the normal range than in other groups.
Efforts in the clinical field are necessary for disease prevention and management. For composite outcome, high BMI and metabolic unhealthiness were associated with increased risk. However, in a specific risk of all-cause death result showed an inconsistency direction with the risk of CVD incidence.
In the same BMI group, the metabolically unhealthy group had a higher risk of all outcomes than the metabolically healthy group. Even in the metabolically healthy group, the overweight or obese group had a higher risk of the composite outcome and CVD incidence than the normal weight group.
Interestingly, patients with normal weight, if the metabolism is unhealthy, have an even higher risk of CVD and all-cause death than metabolically healthy obese patients, so attention should be paid to prevention.
The data that support the findings of this study are available from National Health Insurance Sharing Service but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available.
Data are however available from the authors upon reasonable request and with permission of National Health Insurance Sharing Service.
Roth, G. et al. Global burden of cardiovascular diseases and risk factors, — Update from the GBD study. Article PubMed PubMed Central Google Scholar. Grundy, S. American Heart Association, National Heart, Lung, and Blood Institute.
Circulation , — Després, J.
The effects of Glycemic load and glycemic variability quality Meabolic availability on metabolic processes Metabolic health studies only plays a significant role in the incidence of Metaboliv serious Hormonal imbalance signs, but can drastically influence our general health Metabollc wellbeing throughout our lives. The links between nutrition, metabolism Hormonal imbalance signs human health Metabolic health studies srudies, and our researchers—from basic scientists, human physiologists, clinicians Recovery aids for athletes population health specialists—are working to enhance shudies Hormonal imbalance signs of these links. Our researchers are investigating the associations between diet and sleep, pregnancy, foetal growth and mortality, and serious illnesses such as coronary heart disease, stroke, hypertension, atherosclerosis, obesity, cancer, type 2 diabetes, osteoporosis, dental caries, gall bladder disease, dementia and nutritional anaemias. Our overarching goal is to develop and validate innovative diets to promote health and wellbeing, and deliver improved health outcomes to the community in a range of areas. For additional leads in this area of research, please contact Nutrition and Metabolic Health researchers. We offer exciting opportunities for researchers at the honours, masters and PhD levels. Our research degrees are open to students from a broad range of backgrounds, and range from basic sciences to clinical research.
Sie hat der einfach prächtige Gedanke besucht
Ja, alles ist logisch
interessant, und das Analogon ist?
Ja, wirklich. So kommt es vor. Geben Sie wir werden diese Frage besprechen.
Ich meine, dass Sie sich irren. Geben Sie wir werden es besprechen. Schreiben Sie mir in PM, wir werden reden.