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IntroductionObesity represents a public health problem due to its increasing prevalence despite public awareness programs [1]. Based on cardiovascular (CV) risk factors, clinical studies have identified 2 types of obesity -metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUHO). MHO are characterized by the presence of obesity as defined by a body mass index (BMI) equal or over 30 kg/m 2 without metabolic CV risk factors. MUHO associates obesity with the presence of metabolic CV risk factors and an increased risk of diabetes and CV diseases [2][3][4]. Studies assessing the health risks associated with MHO have shown conflicting results, some showing similar or lower risk of CV disease and diabetes when compared to MUHO. Despite numerous clinical cross-sectional and prospective epidemiological studies evaluating the CV risk associated with this obesity phenotype and its clinical implications, controversies surrounding the health risks associated with MHO remain [5][6][7]. Therefore, it still under debate whether MHO represents a distinct phenotype compared with MUHO (lower health associated risks during lifetime or just a MUHO precursor) [8].In parallel with the increasing prevalence of obesity an increased prevalence of nonalcoholic fatty liver disease (NAFLD) has been reported [9]. Obesity and ab- AbstractAims: The objective of this prospective study was to assess the correlation between carotid intima-media thickness at the common carotid (CIMTc) and carotid bifurcation (CIMTb) level, hepatic fat accumulation, and obesity phenotypes. Material and methods: Two hundred obese adults, in which CIMTc and CIMTb thickness was determined, were included. According to body mass index (BMI) and presence of metabolic syndrome (MetS), patients were classified as metabolically healthy obese (MHO, obesity without MetS) and metabolically unhealthy obese (MUHO, obesity with MetS). MHO patients were further classified as MHO1 (obese with increased waist circumference) and MHO2 (obese with increased waist circumference plus one of the 4 criteria for MetS). Non-alcoholic fatty liver disease (NAFLD) presence was assessed by fatty liver index (FLI). Results: CIMTc and CIMTb increased with obesity phenotypes from 0.74 mm and 1.04 mm in MHO1 to 0.84 mm and 1.23 mm in MHO2 and 0.88 mm and 1.74 mm in MUHO. Obesity phenotypes were significantly correlated with CIMTb. NAFLD frequency increased from 66.0% in the MHO1 to 73.0% in the MHO2 and 84.2% in the MUHO (p<0.05). Independent of age, BMI, total cholesterol, HbA1c, and HOMA-IR, the CIMTc was significantly associated with FLI in all obesity phenotypes and CIMTb only in MHO2 and MUHO. Conclusions: Our results suggest that subclinical atherosclerosis varies according to obesity phenotypes and is correlated with the hepatic fat accumulation.Keywords: carotid intima-media thickness; non-alcoholic fatty liver disease; obesity phenotypes Carotid intima-media thickness (CIMT) is a simple and non-invasive method of the assessment of subclinical atherosclerosis and has be...

Heart failure is a significant healthcare problem, because of its impact at the individual and populational level, through multiple rehospitalizations and increased morbi-mortality. At the individual level, the multidimensional impact of this clinical condition and its treatment on patients' daily lives is reflected in the quality of life (QoL). QoL needs to be accurately measured, because it's related to high hospitalization and mortality rates and provides valuable information that cannot be directly obtained using clinical, biological or imaging measurements. For these reasons, QoL evaluation (global score, subscale scores, answers to various items, etc.) is a significant parameter for assessing the impact of and for structuring the cardiac rehabilitation programs (exercise training, nutritional counseling, psychosocial support and interventions, etc). In order to increase the long-term efficiency, these programs need also to include strategies to optimize and increase adherence to lifestyle changes and to medical therapy.

Background and objectives: Polycystic ovary syndrome (PCOS) displays a phenotype-dependent cardio-metabolic risk. By performing a systematic search of the literature, we aimed to summarize metabolomic signatures associated with obesity in PCOS women.Data sources and study eligibility criteria: We conducted a comprehensive search including: Embase, PubMed, and Web of Science until 31st of May 2019. We used the terms: metabolomics and polycystic ovary syndrome. We excluded the following papers: animal studies, studies that included only lean PCOS women, reviews, meta-analyses, results of interventional studies, those that did not apply metabolomic techniques.Results: The lipid signature in obese women with PCOS showed increased levels of free fatty acids (carnitine, adipic acid, linoleic acid, oleic acid) and lower levels of lysophosphatidylcholines and glycerolphosphocholine compared with non-obese PCOS women. Regarding carbohydrate metabolism, a decrease in citric and lactic acid levels characterized obese PCOS women. Decreased lactic acid in obese PCOS women suggests augmented insulin stimulated glucose muscle use in lean, but not in obese women. Considering amino acid metabolomic markers, valine, glycine, serine, threonine, isoleucine and lysine were higher in obese PCOS women. Patients with visceral obesity presented a diminished uptake of essential amino acids, BCAA, leucine and serine in the skeletal muscle. α-ketoglutarate was significantly higher in obese women with PCOS in comparison with lean women with PCOS, distinguishing these 2 subgroups of PCOS with high ‘predictive accuracy’.Limitations: Overall, a small number of studies have focused on the impact of obesity on the metabolic fingerprints of PCOS women. There is need for properly controlled, high-quality studies.Conclusions: There is compelling evidence of significant alterations in carbohydrate, lipid, and amino acid metabolism in women with PCOS and obesity. Metabolomics may identify new metabolic pathways involved in PCOS and improve our understanding of the complex relation between PCOS and obesity in order to personalize PCOS therapy.

Aim To evaluate the changes in quality of life (QOL), diabetic neuropathy (DN) and amputations over 4 years in patients with diabetes. Methods In 2012, 25,000 Romanian‐translated Norfolk QOL‐DN self‐administered questionnaires were distributed during a cross‐sectional study. Between March‐December 2016, all patients identified from the 2012 cohort and enrolled in this follow‐up study completed the Norfolk QOL‐DN questionnaire; amputations suffered since 2012 were recorded. The influence of age and duration of diabetes (DD) on delta QOL scores (defined as the differences between 2012 and 2016 scores) and of sex, age, diabetes type, DD and declared DN on amputations was explored using multivariate linear and logistic regression, respectively. Results The mean (standard deviation) age of the 1865 participants was 60.6 (10.3) years. Mean total QOL‐DN score increased from 2012 to 2016 by 4.39% (P = .079). Both DD (b = 0.39, 95% confidence interval [CI] 0.21‐0.57, P < .001) and age (b = 0.25, 95% CI 0.13‐0.36, P < .001) were significantly correlated with total QOL‐DN score. Delta total QOL was higher in patients whose statement about having DN changed since 2012. Over 4 years, 36 patients suffered amputations. Male sex (OR = 3.11, 95% CI 1.46‒6.62, P = .003), physical functioning/large‐fibre neuropathy subscale score (OR = 1.04, 95% CI 1.001‒1.09, P = .047), autonomic neuropathy subscale score (OR = 0.78, 95% CI 0.64‒0.94, P = .011) and small‐fibre neuropathy subscale score (OR = 1.21, 95% CI 1.05‒1.40, P = .007) were significant predictors of amputations. Delta total QOL‐DN score was 10 times higher in patients who suffered amputation(s) compared with their amputation‐free counterparts. Conclusion QOL deteriorates with age and DD. Norfolk QOL‐DN subscale scores can predict amputations.

Background. sST2 represents a useful biomarker for the diagnosis and prognosis of patients with heart failure, but limited data is available on its role in patients with hypertension. The aim of this study is to evaluate the short-term prognosis value of sST2 for an unfavorable outcome in hypertensive patients. Methods. This was a prospective observational study which enrolled 80 patients with hypertension, who were followed for one year. All patients underwent clinical, laboratory (including sST2), and echocardiographic assessment at baseline. The patients were grouped according to the cardiovascular (CV) events reported during the follow-up: group A (with CV events) and group B (without CV events). Results. Overall, 59 CV events were reported during the follow-up period. Compared to group B, the patients in group A had significantly higher sST2 levels, a higher number of CV risk factors, and a higher left ventricle mass. Except for the diastolic dysfunction parameters, the echocardiographic findings were similar in the two groups. Patients in group A had a lower E/A ratio, larger deceleration time, and increased telediastolic pressure as quantified by the E/E′ ratio than those in group B. Multivariate logistic regression analysis showed that sST2 and fasting plasma glucose at baseline were independent predictors for the CV events reported during the follow-up period. sST2 levels > 28:5 ng/mL were associated with poor clinical outcomes (p = 0:006, Kaplan-Meier analysis). Conclusions. sST2 levels were correlated with the risk of adverse CV outcomes in hypertensive patients and may represent a useful prognostic marker in these patients.