High-Risk Obesity Phenotypes: Target for Multimorbidity Prevention at the ROFEMI Study

Juana Carretero-Gómez; Pablo Pérez-Martínez; José Miguel Seguí-Ripoll; Francisco Javier Carrasco-Sánchez; Nagore Lois Martínez; Esther Fernández Pérez; Onán Pérez Hernández; Miguel Ángel García Ordoñez; Candelaria Martín González; Juan Francisco Vigueras-Pérez; Francesc Puchades; María Cristina Blasco Avaria; María Isabel Pérez Soto; Javier Ena; José Carlos Arévalo-Lorido; On Behalf Of Diabetes Obesity And Nutrition Working Group Of Spanish Society Of Internal Medicine

doi:10.3390/jcm11164644

High-Risk Obesity Phenotypes: Target for Multimorbidity Prevention at the ROFEMI Study

J Clin Med. 2022 Aug 9;11(16):4644. doi: 10.3390/jcm11164644.

Authors

Juana Carretero-Gómez¹, Pablo Pérez-Martínez^{2

3}, José Miguel Seguí-Ripoll⁴, Francisco Javier Carrasco-Sánchez⁵, Nagore Lois Martínez⁶, Esther Fernández Pérez⁷, Onán Pérez Hernández⁸, Miguel Ángel García Ordoñez⁹, Candelaria Martín González¹⁰, Juan Francisco Vigueras-Pérez¹¹, Francesc Puchades¹², María Cristina Blasco Avaria¹³, María Isabel Pérez Soto¹⁴, Javier Ena¹⁵, José Carlos Arévalo-Lorido¹, On Behalf Of Diabetes Obesity And Nutrition Working Group Of Spanish Society Of Internal Medicine

Affiliations

¹ Internal Medicine Department, University Hospital of Badajoz, 06085 Badajoz, Spain.
² Internal Medicine Department, IMIBIC/Reina Sofia University Hospital, University of Cordoba, 14004 Cordoba, Spain.
³ CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain.
⁴ Internal Medicine Department, San Juan de Alicante University Hospital, 03550 San Juan de Alicante, Spain.
⁵ Internal Medicine Department, Juan Ramón Jiménez University Hospital, 21005 Huelva, Spain.
⁶ Internal Medicine Department, Severo Ochoa University Hospital, 28911 Leganés, Spain.
⁷ Internal Medicine Department, León University Hospital, 24071 León, Spain.
⁸ Internal Medicine Department, Nuestra Señora de la Candelaria University Hospital, 38010 Santa Cruz de Tenerife, Spain.
⁹ Internal Medicine Department, Antequera University Hospital, 29200 Antequera, Spain.
¹⁰ Internal Medicine Department, Canarias University Hospital, 38320 Santa Cruz de Tenerife, Spain.
¹¹ Internal Medicine Department, Vithas Hospital, 35005 Las Palmas de Gran Canarias, Spain.
¹² Internal Medicine Department, General Hospital of Valencia, 46014 Valencia, Spain.
¹³ Internal Medicine Department, University Hospital of Manises, 46940 Manises, Spain.
¹⁴ Internal Medicine Department, Vinalopó University Hospital, 03293 Elche, Spain.
¹⁵ Internal Medicine Department, La Vila Joyosa University Hospital, 03570 Villajoyosa, Spain.

Abstract

Background: Describe the profile of patients with obesity in internal medicine to determine the role of adiposity and related inflammation on the metabolic risk profile and, identify various “high-risk obesity” phenotypes by means of a cluster analysis. This study aimed to identify different profiles of patients with high-risk obesity based on a cluster analysis. Methods: Cross-sectional, multicenter project that included outpatients attended to in internal medicine. A total of 536 patients were studied. The mean age was 62 years, 51% were women. Patients were recruited from internal medicine departments over two weeks in November and December 2021 and classified into four risk groups according to body mass index (BMI) and waist circumference (WC). High-risk obesity was defined as BMI > 35 Kg/m2 or BMI 30−34.9 Kg/m2 and a high WC (>102 cm for men and >88 cm for women). Hierarchical and partitioning clustering approaches were performed to identify profiles. Results: A total of 462 (86%) subjects were classified into the high-risk obesity group. After excluding 19 patients missing critical data, two profiles emerged: cluster 1 (n = 396) and cluster 2 (n = 47). Compared to cluster 1, cluster 2 had a worse profile, characterized by older age (77 ± 16 vs. 61 ± 21 years, p < 0.01), a Charlson Comorbidity Index > 3 (53% vs. 5%, p < 0.001), depression (36% vs. 19%, p = 0.008), severe disability (64% vs. 3%, p < 0.001), and a sarcopenia score ≥ 4 (79% vs. 16%, p < 0.01). In addition, cluster 2 had greater inflammation than cluster 1 (hsCRP: 5.8 ± 4.1 vs. 2.1 ± 4.5 mg/dL, p = 0.008). Conclusions: Two profiles of subjects with high-risk obesity were identified. Based on that, older subjects with obesity require measures that target sarcopenia, disability, psychological health, and significant comorbidities to prevent further health deterioration. Longitudinal studies should be performed to identify potential risk factors of subjects who progress from cluster 1 to cluster 2.

Keywords: adiposity; inflammation; obesity; phenotypes; waist circumference.

Grants and funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.