p r i m a r y c a r e d i a b e t e s 9 ( 2 0 1 5 ) 179–183

Contents lists available at ScienceDirect

Primary Care Diabetes journal homepage: http://www.elsevier.com/locate/pcd

Original research

Lifestyle of metabolically healthy obese individuals Päivi E. Korhonen a,b,c,∗ , Pirkko Korsoff a , Tero Vahlberg d , Risto Kaaja a,e a

Satakunta Hospital District, 28100 Pori, Finland Central Satakunta Health Federation of Municipalities, 29200 Harjavalta, Finland c Institute of Clinical Medicine, Family Medicine, University of Turku, 20520 Turku, Finland d University of Turku, 20520 Turku, Finland e Institute of Clinical Medicine, Internal Medicine, University of Turku, 20520 Turku, Finland b

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Article history:

Aims: The aim of this study is to find factors associated with metabolic syndrome in obese

Received 30 May 2014

individuals and thus offer guidance to stay metabolically healthy if obese.

Received in revised form

Methods: A cardiovascular screening programme performed in Finland during the years

14 September 2014

2005–2007, identified 901 obese white individuals. Of them, 269 (30%) were metabolically

Accepted 22 September 2014

healthy according to the Harmonization criteria of metabolic syndrome.

Available online 18 October 2014

Results: In multivariate logistic regression analysis, male sex [odds ratio (OR) 1.44 (95% CI 1.01–2.07)], living alone [OR 1.77 (95% CI 1.18–2.65)], physical inactivity [OR 3.73 (95%

Keywords:

CI 1.24–11.24)], and use of betablockers [OR 2.63 (95% CI 1.75–3.95)] were associated with

Metabolic syndrome

metabolic syndrome.

Obesity

Conclusions: Even mild or occasional physical exercise is beneficial to health in obese indi-

Physical activity

viduals. Betablockers may not be the antihypertensive agents of choice when treating obese hypertensive individuals. © 2014 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

1.

Introduction

A subset of obese individuals without cluster of metabolic disturbances, known as “metabolically healthy obese” (MHO), appears to be protected to the development of diabetes or cardiovascular diseases [1,2]. Prevalence of MHO individuals depends on the definition used and for the time being, there is no standardized definition to identify MHO individuals for research protocols or in clinical practice. In Finland, the prevalence of MHO defined as obesity (body mass index ≥ 30 kg/m2 ) without metabolic syndrome (MetS) is estimated to be 2.0%

among men and 4.5% among women aged 45–74 years [3]. Successful prevention of MetS among these people would save substantial consequences from an individual perspective and costs from a societal perspective related to prevented or postponed comorbidities. It is currently not known why MHO individuals appear to be protected to the development of MetS. The present study characterized MHO individuals in a population-based screening programme and compared their lifestyle to that of “metabolically abnormal obese” (MAO) individuals in order to find factors associated with MetS in obese individuals.



Corresponding author at: Jokikatu 3, 29200 Harjavalta, Finland. Tel.: +358 40 7653257; fax: +358 2 6741180. E-mail addresses: paivi.e.korhonen@fimnet.fi (P.E. Korhonen), pirkko.korsoff@satshp.fi (P. Korsoff), tero.vahlberg@utu.fi (T. Vahlberg), risto.kaaja@utu.fi (R. Kaaja). http://dx.doi.org/10.1016/j.pcd.2014.09.006 1751-9918/© 2014 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

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p r i m a r y c a r e d i a b e t e s 9 ( 2 0 1 5 ) 179–183

2.

Methods

2.1.

Subjects and measurements

The study participants were drawn from a population survey, the Harmonica Project, which was carried out in the rural towns of Harjavalta and Kokemäki in southwestern Finland from autumn 2005 to autumn 2007. A cardiovascular risk factor survey, tape for the measurement of waist circumference, and type 2 diabetes risk assessment form (Finnish Diabetes Risk Score, FINDRISC, available from www.diabetes.fi/english), were mailed to all home-dwelling inhabitants aged 45–70 years (n = 6013) [4]. Out of the 4421 (74%) respondents, those having at least one cardiovascular risk factor (n = 3072) were invited for an enrolment examination performed by a public health nurse. Risk factors taken into account were waist circumference ≥80 cm in women and ≥94 cm in men, hypertension, history of gestational diabetes or hypertension, family history of premature cardiovascular disease, and ≥15 points in the FINDRISC (≥12 points in Harjavalta). Participation and all the tests included were free of charge for the subjects. Patients with known cardiovascular disease or previously diagnosed diabetes were excluded since they already had systematic follow-up in the health centres. The public health nurses examined 2752 risk study participants. Height and weight were measured with the subjects in standing position without shoes and outer garments. Height was recorded to the nearest 0.5 cm and weight to the nearest 0.1 kg Digital scales (Seca® 861, Germany) were used, and their calibration was monitored regularly. Body mass index (BMI) was calculated as weight (kg) divided by the square of height (m2 ). Waist circumference was measured at the level midway between the lower rib margin and the iliac crest. Blood pressure was measured with a calibrated mercury sphygmomanometer with subjects in a sitting posture, after resting at least 5 min Two readings taken at intervals of at least 2 min were measured, and the mean of these readings was used in the analysis.

2.2.

Laboratory tests

Laboratory tests were determined in blood samples which were obtained after at least 12 h of fasting. Oral glucose tolerance test was performed by measuring fasting plasma glucose and 2-h plasma glucose from capillary blood with HemoCue® Glucose 201+ system (Ängelholm, Sweden) after ingestion of a glucose load of 75 g anhydrous glucose dissolved in water. Glucose disorders were classified according to the World Health Organization 2006 criteria [5]. Total cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides were measured enzymatically (Olympus® AU640, Japan). Low-density lipoprotein (LDL) cholesterol was calculated according to the Friedewald’s formula.

2.3.

Definitions

MetS was diagnosed according to the Harmonization definition [6] (Table 1). MAO and MHO phenotypes were defined

Table 1 – Criteria for the 2009 Harmonization definition of metabolic syndrome [9]. The presence of any 3 of 5 risk factors constitutes a diagnosis of metabolic syndrome. Measure

Cut point

Elevated waist circumference Elevated triglycerides Reduced HDL-cholesterol

Females ≥80 cm, males ≥94 cm

Elevated blood pressure

Systolic ≥130 and/or diastolic ≥85 mmHg, or antihypertensive drug treatment in a patient with a history of hypertension ≥5.6 mmol/l, or drug treatment of elevated glucose

Elevated fasting glucose

≥1.7 mmol/l, or fibrate or nicotinic acid medication Females

Lifestyle of metabolically healthy obese individuals.

The aim of this study is to find factors associated with metabolic syndrome in obese individuals and thus offer guidance to stay metabolically healthy...
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