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

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.

Association of Chronic Heart Failure with Frailty, Malnutrition, and Sarcopenia Parameters in Older Patients—A Cross-Sectional Study in a Geriatric Ward

“…The group of patients with HF showed a significantly more frequent occurrence of obesity diagnosed by BMI. This may indicate that sarcopenic obesity may be a more frequent clinical problem than sarcopenia among geriatric patients with HF [ 28 ]. Malnutrition significantly worsens the quality of life and the prognosis of HF patients [ 29 ].…”

Índice Triglicérides-Glicose E Hiperuricemia Como Marcadores De Desfechos Cardiovasculares Adversos: Revisão Narrativa

“…Estudos anteriores indicaram a associação entre oíndice TyG e DM2, hipertensão arterial, esteatose hepática não alcoólica, aterosclerose e hiperuricemia(ZHOU et al, 2022). A presença de ácidos graxos e triglicérides nos músculos, fígado e tecido adiposo e também a toxicidade pela hiperglicemia podem favorecer o desenvolvimento de RI, o que poderia justificar estra correlação(CARRETERO-GÓMEZ et al, 2022).…”

“…Como limitador, esse índice contém apenas indicadores do metabolismo da glicose e lipídios, ignorando outras variáveis, consequentemente, pode não refletir totalmente os efeitos cardiovasculares da RI(WANG et al, Muitos estudos têm relacionado o índice TyG a processos fisiopatológicos diversos, como obstrução(CHENG et al, 2023), espessamento (LIU et al, 2023 e calcificação arterial coronariana(LIU et al, 2023;LIU et al, 2022b;CHENG et al, 2023). Em um estudo com pacientes obesos adultos (536 pacientes com idade média de 62 anos, 51% mulheres) o índice TyG auxiliou na identificação dos pacientes de alto risco(CARRETERO-GÓMEZ et al, 2022). Estudo populacional sugeriu que o índice TyG pode identificar precocemente a síndrome metabólica, sendo necessário o controle dos múltiplos fatores associados nestes indivíduos(JIANG et al, 2022).Em pacientes pós angioplastia com stent farmacológico, o índice foi associado com desfechos compostos por infarto agudo do miocárdio, revascularização, AVC e mortalidade por todas as causas em pacientes idosos e femininos, mesmo após análise de fatores confundidores(CHENG et al, 2023).…”