Journal of Clinical and Diagnostic Research. 2019 Jun, Vol-13(6): OC01-OC06 1 1 DOI: 10.7860/JCDR/2019/41317.12890 Original Article Internal Medicine Section Subclinical Risk Markers for Cardiovascular Disease (CVD) in Metabolically Healthy Obese (MHO) Subjects INTRODUCTION MHO is an emerging concept which hypothesise an individual to be phenotypically obese but devoid of metabolic abnormalities. Studies have claimed that MHO individuals usually have a reduced inflammatory profile when compared to MS [1,2]. The estimated prevalence of MHO varies from 6 to 75%, [3,4] and some studies has shown that 10 to 25% of obese individuals are metabolically healthy. It is usually common in females and its prevalence decreases with age [5]. The term “MHO”, safeguards obesity as there is absence of any cardiometabolic risks in this phenotype. Studies are providing evidence that MHO individuals have increased risk of developing type 2 diabetes and cardiovascular events when compared with MHNO indivduals, but these risks are low as compared to MS [6,7]. Studies have established that some subclinical cardiovascular inflammatory risk markers like CIMT, hs-CRP and NAFLD, if present, can predict future cardiovascular events with fair predictability [8-11]. Very limited research work has been done till date focusing different parameters of cardiovascular risk profiles apart from dyslipidemia and diabetes in MHO populations. Still there is lack of substantial evidence about the existence of other cardiovascular risk factors like CIMT, NAFLD and inflammatory markers like CRP status in MHO. This study will add to the existing data; simultaneously assessing subclinical cardiovascular risk markers, like, abnormal CIMT, NAFLD and hs-CRP levels and their association with MHO population. This study was carried out with the aim to assess subclinical cardiovascular risk markers like CIMT, NAFLD and hs-CRP level in MHO population and to compare these variables with subjects of MS and MHNO group as control. MATERIALS AND METHODS This cross-sectional study with comparison group entitled “Subclinical risk markers for CVD in MHO subjects” was carried out over a period of three years (January 2016 to January 2019) in a tertiary care hospital. Institutional ethical committee (DMIMSU), clearance was taken before starting the study. All cases were randomly selected from the university students, staff, workers, and various health check-up camps organised by the hospital. Relevant demographic data (information comprised of sex, age, race, occupation and postal address) was collected after taking due consent. History of Diabetes mellitus, systemic hypertension was taken. Detailed drug history was obtained. Subjects with infections, sepsis, coronary artery disease, chronic liver and kidney disease, rheumatologic disorders, alcoholics, women on contraceptive pills, and subjects not giving consent were excluded. Metabolic unhealthy with normal weight phenotypes were also excluded. SOURYA ACHARYA 1 , SAMARTH SHUKLA 2 , ANIL WANJARI 3 Keywords: Carotid intima-media thickness, High sensitivity C-reactive protein, Metabolic syndrome, Metabolic healthy non obese, Non alcoholic fatty liver disease, Phenotype ABSTRACT Introduction: Metabolically Healthy Obesity/Metabolic Healthy Obesity (MHO) is an enigma in scientific medical literature. Debate is still on regarding the safety status of MHO phenotype. The general consensus states that it is a condition with obesity but lacking metabolic abnormalities such as dyslipidemia, impaired glucose tolerance, or Metabolic Syndrome (MS). MHO population has less visceral adipose tissue, and a decreased inflammatory profile as compared to MS. Aim: To assess subclinical cardiovascular risk markers like Carotid Intima-Media Thickness (CIMT), Non Alcoholic Fatty Liver Disease (NAFLD) and high sensitivity C-reactive Protein (hs-CRP) level in MHO subjects. Materials and Methods: This cross-sectional study was done in a tertiary care hospital conducted for a period of three years from January 2016 to January 2019. After obtaining institutional ethical clearance, this cross-sectional study was conducted on 222 MHO subjects, 65 MS and 81 Metabolic Healthy Non Obese (MHNO) subjects. Anthropometric data was obtained. Metabolic parameters like hs-CRP, CIMT and NAFLD status were estimated and compared with MS and MHNO group. The data was analysed using appropriate statistical significance tests. Results: In one way Analysis of Variance (ANOVA), anthropometric determinants and metabolic variables differed significantly across the groups (p<0.0001). The mean hs-CRP in MHO was; 4.01±1.68 versus control group; 2.16±0.56 (p<0.0001). Using Pearson’s correlation coefficient, significant positive correlation was found between the sub clinical CVD risk markers with other anthropometric and metabolic parameters. In multiple regression analysis body mass index Waist Circumference (WC), NAFLD and abnormal CIMT were significantly associated with elevated hs-CRP. The mean CIMT in MHO was; 0.74±0.17 versus control group; 0.65±0.14 (p<0.0001). In multiple regression analysis NAFLD and hs-CRP were significantly associated with CIMT values. Prevalence of NAFLD in MHO was 59.01%. In multiple regression analysis WC, CIMT and hsCRP were significantly associated with NAFLD. Adjusted Odd’s Ratio (AOR) for high hs-CRP, NAFLD, and abnormal CIMT in MHO as compared to MHNO was 1.98, 1.81, 1.61 respectively. Conclusion: MHO phenotype is associated with higher prevalence of fatty liver, increased hs-CRP levels and abnormal CIMT as compared to MHNO phenotype. This indicates that obesity even if associated with a healthy metabolic profile, still harbour subclinical inflammation. So subjects with MHO should be targeted for appropriate preventive strategies in form of health education, life style modifications to avoid future cardiovascular morbidities. MHO phenotype with evidence of subclinical vascular inflammation should not be considered a benign condition.