Associations between Normal-Weight Obesity and Disturbances in the Lipid Profile of Young Adults

Passos, Anna Flavia Ferreira; Santos, Acsa de Castro; Coelho, Alexandre Siqueira Guedes; Cominetti, Cristiane

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Arquivos Brasileiros de Cardiologia

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Original Article • Arq. Bras. Cardiol. 120 (9) • Sept 2023 • https://doi.org/10.36660/abc.20220914 copy

Associations between Normal-Weight Obesity and Disturbances in the Lipid Profile of Young Adults

Authorship SCIMAGO INSTITUTIONS RANKINGS

Central Illustration

: Associations between Normal-Weight Obesity and Disturbances in the Lipid Profile of Young Adults

Abstract

Background

Normal-weight obesity (NWO) is characterized by normal body mass index (BMI) but high body fat percentage (%BF) that increases the risks of cardiometabolic comorbidities. Accurate assessment and interpretation of body composition data are necessary to reduce these risks.

Objectives

To compare the cardiometabolic profile of individuals with NWO and normal %BF and evaluate the associated risk factors.

Methods

A cross-sectional study was conducted with 222 Brazilian adults from a university community, of whom 157 had NWO and 65 had normal BMI and %BF (non-NWO). All participants reported being asymptomatic and without underlying health conditions. Socioeconomic, lifestyle, food intake, anthropometry, body composition measures (using dual-energy radiological absorptiometry), and lipid and glycemic profiles were evaluated. A p < 0.05 was established as significant.

Results

The median age of the participants was 23 years (interquartile range: 21 to 25), and most were female (67.1%). No significant differences were found in blood pressure, age, or physical activity levels between the NWO and non-NWO groups. However, the frequency of lipid profile disturbances was higher in the NWO group (54%) compared to the non-NWO group (34%) (p < 0.006). Neck circumference, %BF, and lipid profile disturbances were positively associated with NWO.

Conclusion

Individuals with NWO have a worse cardiometabolic profile than those without NWO, and this condition is associated with important biomarkers. Addressing these outcomes is important for preventing long-term cardiometabolic complications. Accurate assessment and interpretation of body composition data, regardless of BMI, are crucial in this scenario.

Apolipoproteins; Body Composition; Dyslipidemias; Cardiovascular Diseases; Blood Glucose

Variables	Total (n = 222, 100.0%)	NWO (n = 157, 70.7%)	Non-NWO (n = 65, 29.3%)	p value
Sex				0.410
Male	73 (32.9)	49 (31.2)	24 (36.9)
Female	149 (67.1)	108 (68.8)	41 (63.1)
Skin color				0.522
White	84 (37.8)	64 (40.8)	20 (30.8)
Brown	94 (42.3)	63 (40.1)	31 (47.7)
Black	29 (13.1)	19 (12.1)	10 (15.4)
Asian	15 (6.8)	11 (7.0)	4 (6.2)
Marital status				0.522
Single	199 (89.6)	138 (87.9)	61 (93.8)
Married	22 (9.9)	18 (11.5)	4 (6.2)
Divorced	1 (0.5)	1 (0.6)	0 (0)
Education level				0.065
Higher incomplete	167 (75.2)	114 (72.6)	53 (81.5)
Higher complete	44 (19.8)	32 (20.4)	12 (18.5)
Graduation complete	11 (5.0)	11 (7.0)	0 (0)
Socioeconomic class				0.094
Higher	143 (64.4)	106 (67.5)	37 (56.9)
Intermediate	78 (35.1)	51 (32.5)	27 (41.5)
Lower	1 (0.5)	0 (0)	1 (1.5)
Age (years)	23.0 (21.0 – 25.0)	23.0 (21.0 – 26.0)	23.0 (21.0 – 24.0)	0.506
SBP (mmHg)	109.5 (100.0 – 115.8)	109.5 (100.0 – 116.0)	110.0 (100.0 – 115.0)	0.682
DBP (mmHg)	67.0 (60.1 – 74.0)	66.5 (60.0 – 74.0)	70.0 (62.0 – 74.0)	0.349
Weight (kg)	60.6 (55.0 – 66.6)	61.3 (56.0 – 66.7)	57.4 (53.0– 65.9)	0.026
Height (m)	1.7 (1.6 – 1.7)	1.7 (1.6 – 1.7)	1.7 (1.6 – 1.7)	0.719
BMI (kg/m ² )	21.8 (20.5 – 23.0)	22.1 (21.0 – 23.3)	20.8 (19.8 – 22.0)	<0.0001
PA level (MET min/week)	260.0 (131.2 – 409.8)	240.0 (100.0 – 415.0)	280 (180.0 – 409.0)	0.210
NC (cm)	32.4 (31.2 – 36.0)	32.5 (31.4 – 35.8)	32.1 (30.7 – 36.1)	0.490
WC (cm)	72.7 ± 5.5	73.8 ± 5.2	70.1 ± 5.4	<0.0001
%BF DXA	30.4 (23.4 – 36.4)	34.2 (28.8 – 37.7)	24.6 (15.4 – 28.1)	<0.0001
Android %BF	30.7 ± 9.6	34.7 ± 7.6	20.9 ± 6.4	<0.0001
Gynoid %BF	42.8 (34.2 – 48.4)	46.5 (38.1 – 49.5)	36.8 (23.2 – 41.0)	<0.0001
A:G	0.8 (0.7 – 0.9)	0.8 (0.7 – 0.9)	0.6 (0.6 – 0.8)	<0.0001
Glucose (mg/dL)	85.0 (80.2 – 89.8)	85.0 (81.0 – 90.0)	84.0 (80.0 – 89.0)	0.392
Insulin (pmol/L)	49.9 (38.9 – 66.6)	54.5 (42.4 – 71.8)	43.0 (35.2 – 54.5)	0.0001
HOMA-IR	1.4 (1.1 – 2.0)	1.6 (1.2 – 2.1)	1.2 (1.0 – 1.6)	0.0001
HOMA2-IR	0.9 (0.7 – 1.2)	1.0 (0.8 – 1.3)	0.8 (0.6 – 1.0)	0.0001
HOMA-beta	122.0 (87.9 – 170.1)	134.0 (95.1 – 176.1)	104.5 (78.9 – 149.6)	0.011
HbA _1c %	4.8 (4.6 – 5.0)	4.8 (4.6 – 5.0)	4.8 (4.6 – 5.0)	0.953
QUICKI Index	0.36 ± 0.02	0.36 ± 0.02	0.37 ± 0.02	<0.0001
TC (mg/dL)	175.7 ± 32.0	179.8 ± 33.1	165.8 ± 26.9	0.002
HDL-C (mg/dL)	55.0 (47.0 – 65.0)	55.0 (47.0 – 65.0)	56.0 (48.0 – 65.0)	0.782
LDL-C (mg/dL)	99.0 (82.0 – 117.8)	103.0 (83.0 – 118.0)	93.0 (74.0 – 107.0)	0.008
Non-HDL-C (mg/dL)	115.0 (96.2 – 136.0)	121.0 (100.0 – 140.0)	109.0 (90.0 – 121.0)	0.002
VLDL-C (mg/dL)	14.8 (10.6 – 20.8)	16.4 (11.4 – 21.8)	12.8 (9.6 – 16.6)	0.001
TG (mg/dL)	74.0 (53.2 – 104.0)	82.0 (57.0 – 109.0)	64.0 (48.0 – 83.0)	0.001
TC:HDL-C ratio	3.0 (2.6 – 3.6)	3.1 (2.7 – 3.8)	2.8 (2.5 – 3.3)	0.021
LDL-C:HDL-C ratio	1.8 (1.4 – 2.3)	1.8 (1.4 – 2.4)	1.7 (1.3 – 2.0)	0.050
Apo A1 (mg/dL)	151.0 (137.0 – 168.0)	151.5 (138.8 – 172.2)	149.0 (137.0 – 163.0)	0.246
Apo B (mg/dL)	76.0 (65.0 – 89.0)	80.4 ± 19.0	70.6 ± 14.8	0.0003
Apo B:Apo A1 ratio	0.5 (0.4 – 0.6)	0.5 (0.4 – 0.6)	0.5 (0.4 – 0.5)	0.031
TyG	3.5 ± 0.2	3.5 ± 0.2	3.4 ± 0.2	0.001
AI	1.0 (0.7 – 1.5)	1.0 (0.8 – 1.7)	0.9 (0.6 – 1.2)	0.022

Variables	Total sample (n=222)		NWO (n=157)		Non-NWO (n=65)		p value
Variables	n	%	n	%	n	%	p value
TEI > energy requirement	109	49.1	72	45.9	37	56.9	0.134
Protein > 15% of TEI	166	74.8	116	73.9	50	76.9	0.635
Carbohydrates > 60% of TEI	13	5.8	7	4.5	6	9.2	0.209
Dietary fiber < 25 g/day*	192	86.5	139	88.5	53	81.5	0.165
Lipids > 35% of TEI	121	54.5	93	59.2	28	43.1	0.028
SFA ≥ 10% of TEI	190	85.6	139	88.5	51	78.5	0.052
MUFA > 15% of TEI	42	18.9	33	21.0	9	13.8	0.214
PUFA > 10% of TEI	24	10.8	19	12.1	5	7.7	0.336

	Estimate (β)	SE	OR (95% CI)	z value	pr (>\|t\|)	p value
Intercept	-36.183098	9.713135	0.00 (0.00 – 0.00)	-3.725	0.000195	0.001
Variables
Female sex	-8.930783	1.948802	0.00 (0.00 – 0.01)	-4.583	<0.0001	0.001
Total %BF	1.112949	0.207149	3.04 (2.03 – 4.57)	5.373	<0.0001	0.001
Disturbances in lipid profile (≥1)	1.415612	0.699868	4.12 (1.04 – 16.24)	2.023	0.043106	0.050
Neck circumference	0.924465	0.297740	2.52 (1.41 – 4.52)	3.105	0.001903	0.010
BMI	-0.708130	0.340233	0.49 (0.25 – 0.96)	-2.081	0.037405	0.050
Mean carbohydrate intake	-0.012656	0.007977	0.99 (0.97 – 1.00)	-1.587	0.112615	1.000

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