Visceral Adiposity, Pro-Inflammatory Signaling and Vasculopathy in Metabolically Unhealthy Non-Obesity Phenotype

Meng-Ting Tsou; Chun-Ho Yun; Jiun-Lu Lin; Kuo-Tzu Sung; Jui-Peng Tsai; Wen-Hung Huang; Chia-Yuan Liu; Charles Jia-Yin Hou; I-Hsien Tsai; Cheng-Huang Su; Chung-Lieh Hung; Ta-Chuan Hung

doi:10.3390/diagnostics11010040

Visceral Adiposity, Pro-Inflammatory Signaling and Vasculopathy in Metabolically Unhealthy Non-Obesity Phenotype

Diagnostics (Basel). 2020 Dec 29;11(1):40. doi: 10.3390/diagnostics11010040.

Authors

Meng-Ting Tsou^{1

2}, Chun-Ho Yun^{3

4}, Jiun-Lu Lin⁵, Kuo-Tzu Sung^{3

6}, Jui-Peng Tsai^{3

6}, Wen-Hung Huang^{3

6}, Chia-Yuan Liu^{3

7}, Charles Jia-Yin Hou^{3

6}, I-Hsien Tsai⁸, Cheng-Huang Su^{3

6}, Chung-Lieh Hung^{3

6

9}, Ta-Chuan Hung^{2

3

6}

Affiliations

¹ Department of Family Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan.
² Department of Nursing, Mackay Junior College of Medicine, Nursing and Management, New Taipei 25245, Taiwan.
³ Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan.
⁴ Department of Radiology, MacKay Memorial Hospital, Taipei 10449, Taiwan.
⁵ Division of Endocrinology and Metabolism, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan.
⁶ Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan.
⁷ Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan.
⁸ Nutritional Medicine Center, MacKay Memorial Hospital, Taipei 10449, Taiwan.
⁹ Institute of Biomedical Sciences, Mackay Medical College, New Taipei 25245, Taiwan.

Abstract

The debate regarding the actual cardiovascular burden in metabolically healthy obese or metabolically unhealthy non-obesity individuals is ongoing. Accumulating data have suggested a unique pathophysiological role of pro-inflammatory cytokines in mediating metabolic and cardiovascular disorders by dysregulated visceral adiposity. To compare the burden of visceral adiposity, the inflammatory marker high-sensitivity C-reactive protein (hs-CRP) and the prevalent atherosclerotic burden in metabolically healthy obese (MHO) or metabolically unhealthy (MU) populations, were compared to those of metabolically healthy non-obesity subjects (MHNO). Coronary artery calcification score (CACS) and visceral fat, including pericardial fat (PCF)/thoracic peri-aortic fat (TAT), were quantified in 2846 asymptomatic subjects using a CT dataset. A cross-sectional analysis comparing CACS, inflammatory marker hs-CRP, and visceral fat burden among four obesity phenotypes (MHNO, metabolically unhealthy non-obesity (MUNO), MHO, and metabolically unhealthy obese (MUO)) was performed. Both MUNO and MUO demonstrated significantly higher hs-CRP and greater CACS than MHNO/MHO (adjusted coefficient: 25.46, 95% confidence interval (CI): 5.29-45.63; 43.55, 95% CI: 23.38-63.73 for MUNO and MUO (MHNO as reference); both p < 0.05). Visceral fat (PCF/TAT) was an independent determinant of MU and was similarly higher in the MUNO/MHO groups than in the MHNO group, with the MUO group having the largest amount. PCF/TAT, obesity, and MU remained significantly associated with higher CACS even after adjustment, with larger PCF/TAT modified effects for MU and diabetes in CACS (both p_interaction < 0.05). MU tightly linked to excessive visceral adiposity was a strong and independent risk factor for coronary atherosclerosis even in lean individuals, which could be partially explained by its coalignment with pathological pro-inflammatory signaling.

Keywords: coronary artery calcification score (CACS); hs-CRP; metabolically unhealthy; obese phenotype; visceral adiposity.