Evolution of Metabolic Phenotypes of Obesity in Coronary Patients after 5 Years of Dietary Intervention: From the CORDIOPREV Study

Abstract

Background: Obesity phenotypes with different metabolic status have been described previously. We analyzed metabolic phenotypes in obese coronary patients during a 5-year follow-up, and examined the factors influencing this evolution. Methods: The CORDIOPREV study is a randomized, long-term secondary prevention study with two healthy diets: Mediterranean and low-fat. All obese patients were classified as either metabolically healthy obese (MHO) or metabolically unhealthy obese (MUO). We evaluated the changes in the metabolic phenotypes and related variables after 5 years of dietary intervention. Results: Initially, 562 out of the 1002 CORDIOPREV patients were obese. After 5 years, 476 obese patients maintained their clinical and dietary visits; 71.8% of MHO patients changed to unhealthy phenotypes (MHO-Progressors), whereas the MHO patients who maintained healthy phenotypes (MHO-Non-Progressors) lost more in terms of their body mass index (BMI) and had a lower fatty liver index (FLI-score) (p < 0.05). Most of the MUO (92%) patients maintained unhealthy phenotypes (MUO-Non-Responders), but 8% became metabolically healthy (MUO-Responders) after a significant decrease in their BMI and FLI-score, with improvement in all metabolic criteria. No differences were found among dietary groups. Conclusions: A greater loss of weight and liver fat is associated with a lower progression of the MHO phenotype to unhealthy phenotypes. Likewise, a marked improvement in these parameters is associated with regression from MUO to healthy phenotypes.

Adherence to the Mediterranean diet as a possible additional tool to be used for screening the metabolically unhealthy obesity (MUO) phenotype

“…Adherence to MD but also to Mediterranean-DASH intervention for neurodegenerative delay has been reported to be associated with a lower risk of MUO phenotype in subjects with obesity, as retrospectively observed over a mean of 5.91 years of follow-up [ 36 ]. These interesting results were definitively confirmed by a randomized controlled trial called the CORDIOPREV study that randomized subjects with obesity and coronary artery disease to receive Mediterranean or low-fat diets, finding that MD was not inferior to a low-fat diet in reducing the risk of developing MUO phenotype over the years [ 37 ].…”

Metabolic phenotypes and risk of end-stage kidney disease in patients with type 2 diabetes

“…Compared with MHO, MUO was considered an alteration in the distribution of ectopic fat. The ectopic fat accumulation triggered an inflammatory cascade, and lipotoxicity was considered an inducer of metabolic dysfunction ( 35 ). The transitions between MHO and MUO are not unidirectional and may change over time.…”

Association of obesity and different metabolic status with prognosis in patients with bladder cancer: a retrospective cohort study

“…Inconsistent results could be explained that obesity adversely affected metabolism, but not all obese subjects presented the same metabolic risk. 12 Therefore, given these conflicting views, it seems more appropriate to investigate the association of obesity or metabolic status alone or in combination with readmission risk in patients with BC.…”