Insulin Resistance Is the Main Characteristic of Metabolically Unhealthy Obesity (MUO) Associated with NASH in Patients Undergoing Bariatric Surgery
(1) Background: Metabolically healthy obesity (MHO) is a concept that applies to obese patients without any elements of metabolic syndrome (metS). In turn, metabolically unhealthy obesity (MUO) defines the presence of elements of metS in obese patients. The components of MUO can be divided into subg...
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MDPI AG
2023-05-01
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| Online Access: | https://www.mdpi.com/2227-9059/11/6/1595 |
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| author | Sophia M. Schmitz Sebastian Storms Alexander Koch Christine Stier Andreas Kroh Karl P. Rheinwalt Sandra Schipper Karim Hamesch Tom F. Ulmer Ulf P. Neumann Patrick H. Alizai |
| author_facet | Sophia M. Schmitz Sebastian Storms Alexander Koch Christine Stier Andreas Kroh Karl P. Rheinwalt Sandra Schipper Karim Hamesch Tom F. Ulmer Ulf P. Neumann Patrick H. Alizai |
| author_sort | Sophia M. Schmitz |
| collection | DOAJ |
| description | (1) Background: Metabolically healthy obesity (MHO) is a concept that applies to obese patients without any elements of metabolic syndrome (metS). In turn, metabolically unhealthy obesity (MUO) defines the presence of elements of metS in obese patients. The components of MUO can be divided into subgroups regarding the elements of inflammation, lipid and glucose metabolism and cardiovascular disease. MUO patients appear to be at greater risk of developing non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) compared to MHO patients. The aim of this study was to evaluate the influence of different MUO components on NAFLD and NASH in patients with morbid obesity undergoing bariatric surgery. (2) Methods: 141 patients undergoing bariatric surgery from September 2015 and October 2021 at RWTH Aachen university hospital (Germany) were included. Patients were evaluated pre-operatively for characteristics of metS and MUO (HbA1c, HOMA, CRP, BMI, fasting glucose, LDL, TG, HDL and the presence of arterial hypertension). Intraoperatively, a liver biopsy was taken from the left liver lobe and evaluated for the presence of NAFLD or NASH. In ordinal regression analyses, different factors were evaluated for their influence on NAFLD and NASH. (3) Results: Mean BMI of the patients was 52.3 kg/m<sup>2 </sup> (36–74.8, SD 8.4). Together, the parameters HbA1c, HOMA, CRP, BMI, fasting glucose, LDL, TG, HDL and the presence of arterial hypertension accounted for a significant amount of variance in the outcome, with a likelihood ratio of χ<sup>2</sup> (9) = 41.547, <i>p</i> < 0.001, for predicting the presence of NASH. Only HOMA was an independent predictor of NASH (B = 0.102, SE = 0.0373, <i>p</i> = 0.007). Evaluation of steatosis showed a similar trend (likelihood ratio χ<sup>2</sup> (9) = 40.272, <i>p</i> < 0.001). Independent predictors of steatosis were HbA1c (B = 0.833, SE = 0.343, <i>p</i> = 0.015) and HOMA (B = 0.136, SE = 0.039, <i>p</i> < 0.001). (4) Conclusions: The above-mentioned model, including components of MUO, was significant for diagnosing NASH in patients with morbid obesity undergoing bariatric surgery. Out of the different subitems, HOMA independently predicted the presence of NASH and steatosis, while HbA1c independently predicted steatosis and fibrosis. Taken together, the parameter of glucose metabolism appears to be more accurate for the prediction of NASH than the parameters of lipid metabolism, inflammation or the presence of cardiovascular disease. |
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| spelling | doaj.art-88e95fbdcf224a3d94a62deb870a5c8e2023-11-18T09:25:31ZengMDPI AGBiomedicines2227-90592023-05-01116159510.3390/biomedicines11061595Insulin Resistance Is the Main Characteristic of Metabolically Unhealthy Obesity (MUO) Associated with NASH in Patients Undergoing Bariatric SurgerySophia M. Schmitz0Sebastian Storms1Alexander Koch2Christine Stier3Andreas Kroh4Karl P. Rheinwalt5Sandra Schipper6Karim Hamesch7Tom F. Ulmer8Ulf P. Neumann9Patrick H. Alizai10Department of General-, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, GermanyDepartment of General-, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, GermanyDepartment of Gastroenterology, Digestive Diseases and Intensive Care Medicine, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, GermanyDepartment of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital Wuerzburg, 97080 Wuerzburg, GermanyDepartment of General-, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, GermanyDepartment of Bariatric, Metabolic and Plastic Surgery, St. Franziskus-Hospital, Schönsteinstr. 63, 50825 Cologne, GermanyDepartment of General-, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, GermanyDepartment of Gastroenterology, Digestive Diseases and Intensive Care Medicine, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, GermanyDepartment of General-, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, GermanyDepartment of General-, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, GermanyDepartment of General-, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany(1) Background: Metabolically healthy obesity (MHO) is a concept that applies to obese patients without any elements of metabolic syndrome (metS). In turn, metabolically unhealthy obesity (MUO) defines the presence of elements of metS in obese patients. The components of MUO can be divided into subgroups regarding the elements of inflammation, lipid and glucose metabolism and cardiovascular disease. MUO patients appear to be at greater risk of developing non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) compared to MHO patients. The aim of this study was to evaluate the influence of different MUO components on NAFLD and NASH in patients with morbid obesity undergoing bariatric surgery. (2) Methods: 141 patients undergoing bariatric surgery from September 2015 and October 2021 at RWTH Aachen university hospital (Germany) were included. Patients were evaluated pre-operatively for characteristics of metS and MUO (HbA1c, HOMA, CRP, BMI, fasting glucose, LDL, TG, HDL and the presence of arterial hypertension). Intraoperatively, a liver biopsy was taken from the left liver lobe and evaluated for the presence of NAFLD or NASH. In ordinal regression analyses, different factors were evaluated for their influence on NAFLD and NASH. (3) Results: Mean BMI of the patients was 52.3 kg/m<sup>2 </sup> (36–74.8, SD 8.4). Together, the parameters HbA1c, HOMA, CRP, BMI, fasting glucose, LDL, TG, HDL and the presence of arterial hypertension accounted for a significant amount of variance in the outcome, with a likelihood ratio of χ<sup>2</sup> (9) = 41.547, <i>p</i> < 0.001, for predicting the presence of NASH. Only HOMA was an independent predictor of NASH (B = 0.102, SE = 0.0373, <i>p</i> = 0.007). Evaluation of steatosis showed a similar trend (likelihood ratio χ<sup>2</sup> (9) = 40.272, <i>p</i> < 0.001). Independent predictors of steatosis were HbA1c (B = 0.833, SE = 0.343, <i>p</i> = 0.015) and HOMA (B = 0.136, SE = 0.039, <i>p</i> < 0.001). (4) Conclusions: The above-mentioned model, including components of MUO, was significant for diagnosing NASH in patients with morbid obesity undergoing bariatric surgery. Out of the different subitems, HOMA independently predicted the presence of NASH and steatosis, while HbA1c independently predicted steatosis and fibrosis. Taken together, the parameter of glucose metabolism appears to be more accurate for the prediction of NASH than the parameters of lipid metabolism, inflammation or the presence of cardiovascular disease.https://www.mdpi.com/2227-9059/11/6/1595NAFLDmetabolically unhealthy obesityobesity surgeryinsulin resistance |
| spellingShingle | Sophia M. Schmitz Sebastian Storms Alexander Koch Christine Stier Andreas Kroh Karl P. Rheinwalt Sandra Schipper Karim Hamesch Tom F. Ulmer Ulf P. Neumann Patrick H. Alizai Insulin Resistance Is the Main Characteristic of Metabolically Unhealthy Obesity (MUO) Associated with NASH in Patients Undergoing Bariatric Surgery Biomedicines NAFLD metabolically unhealthy obesity obesity surgery insulin resistance |
| title | Insulin Resistance Is the Main Characteristic of Metabolically Unhealthy Obesity (MUO) Associated with NASH in Patients Undergoing Bariatric Surgery |
| title_full | Insulin Resistance Is the Main Characteristic of Metabolically Unhealthy Obesity (MUO) Associated with NASH in Patients Undergoing Bariatric Surgery |
| title_fullStr | Insulin Resistance Is the Main Characteristic of Metabolically Unhealthy Obesity (MUO) Associated with NASH in Patients Undergoing Bariatric Surgery |
| title_full_unstemmed | Insulin Resistance Is the Main Characteristic of Metabolically Unhealthy Obesity (MUO) Associated with NASH in Patients Undergoing Bariatric Surgery |
| title_short | Insulin Resistance Is the Main Characteristic of Metabolically Unhealthy Obesity (MUO) Associated with NASH in Patients Undergoing Bariatric Surgery |
| title_sort | insulin resistance is the main characteristic of metabolically unhealthy obesity muo associated with nash in patients undergoing bariatric surgery |
| topic | NAFLD metabolically unhealthy obesity obesity surgery insulin resistance |
| url | https://www.mdpi.com/2227-9059/11/6/1595 |
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