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Metabolically obese normal weight mortality rate – Obesity, metabolic health, and mortality in adults: a nationwide population-based study in Korea

Conclusion Visceral obesity is increasing faster in the North American population than generalized obesity is and it has a more profound effect on morbidity and mortality. This phenotype is closely linked to atherogenic dyslipidemia, which predisposes one to the deposition of cholesterol in the vascular endothelium and resultant atherosclerosis.

Similar to our findings, Mmetabolically et al metabolically obese normal weight mortality rate higher mortality in the normal-weight-with-central-obesity group than in their normal-weight-no-central-obesity group Previous studies on normal-weight obesity attribute the cause of MetS in normal-weight adults to excess body fat percentage despite a normal overall weight. Obes Res Clin Pract. Lavie, C. Epidemic obesity and type 2 diabetes in Asia. Actual Study Start Date :.

  • Actual Study Start Date :.

  • Hip circumference was unrelated to mortality Sharma et al, 56 Prospective observational study average 7. Lowest mortality associated with these categories.

  • Risk of developing diabetes and cardiovascular disease in metabolically unhealthy normal-weight and metabolically healthy obese individuals.

Quality of evidence

It is easily used in austere settings with minimal equipment. MA of prospective observational studies 3—30 y. Ann Nutr Metab. Sci Rep.

Thereby, vegetarian diet propose a novel criterion for defining MONW, which could be lose weight utilized due to its simplicity, and show plan effectiveness in predicting the incidence of diabetes. Based on our analyses, we propose a simple diagnostic criterion for MONW. In Singapore, the prevalence of type 2 diabetes is expected to double from 7. First, individuals with the MUNO phenotype had a significantly higher risk of all-cause, cardiovascular, cancer, and other-cause mortality whereas individuals with the MHO phenotype had a significantly lower risk of death, compared with the MHNO group.

Article Google Scholar 21 Batsis, J. Wang, J. Associations from this research should be further examined by future prospective study. Obesity paradox does exist. These individuals are often referred to as "metabolically-obese normal-weight" MONWand have increased risk for cardiometabolic disease despite their normal BMI and total body fat values. Having established cardiovascular diseases or its equivalent diabetes might have led to higher HRs than those in our study, which accounted for the risk factors of cardiovascular diseases.

Introduction

Body mass index nodmal risk of diabetes mellitus in the Asia-Pacific region. Conclusions: We propose a simple diagnostic criterion of MONW, which might be used to discriminate subjects with a higher risk of metabolic diseases. Our study re-emphasizes that weight loss should continue to be encouraged among people who are obese. J Diabetes Sci Technol. Manifestation of cardiovascular risk factors at low levels of body mass index and waist-to-hip ratio in Singaporean Chinese.

  • Are metabolically normal but obese individuals at lower risk for all-cause mortality.

  • Subcutaneous fat, particularly in the femorogluteal area, might provide a depot helping to prevent lipid deposition at intra-abdominal and visceral sites, where it might be more damaging. The weight and metabolic condition of participants over multiple points as time-varying covariates would be needed to achieve a more comprehensive analysis than the one provided here.

  • Additional Information How to cite this article : Yang, H. However, we found different distributions between men and women.

  • Sahakyan, K.

  • Diabetes Care.

WC used as measure of central obesity in mortality prediction. We focused on people with normal weight and MetS. We categorized the study sample into 3 weight groups based on BMI according to standard definitions: normal weight Lustig RH. Prog Cardiovasc Dis. Cancel Continue.

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Statistical analysis All statistical analyses were performed using the SAS 9. The lack of significant differences in HRs between the normal-weight—MetS group and the normal-weight—no-MetS group in both studies was probably due to their small metabolically obese normal weight mortality rate sizes. Relationships of body fat distribution, insulin sensitivity and cardiovascular risk factors in lean, healthy non-diabetic Thai men and women. However, our understanding of the complex interactions between ethnicity, body composition, and metabolic dysfunction and its reversal remains rudimentary. Individuals designated as MONW, who have a normal weight and TyG levels higher than cutoff, displayed a metabolically unhealthy phenotype and an approximately twofold higher risk of developing diabetes compared with metabolically healthy normal weight subjects.

Three metabolically obese normal weight mortality rate disease components diabetes, hypertension and dyslipidaemia were used to define metabolic health status. Full size image. The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U. Methods A total of 17, normal-weight individuals were recruited from 37, individuals in Zhejiang province in southeastern China. Clinical and Experimental Nephrology

Triglyceride, being an energy substrate, is hydrolyzed in various tissues, metabolicxlly these particles gradually become smaller and more dense, forming intermediate-density lipoprotein IDL and low-density lipoprotein LDL cholesterol particles. The analysis included 12, adults. Characteristics of subcutaneous and visceral fat. The future of obesity reduction: beyond weight loss. Our study found that the normal-weight—MetS group had the highest risk of mortality among MetS and obesity categories — a risk that has not been previously identified in US adults. The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.

Publication types

References 1. Other studies that examined groups of people of primarily European descent stratified by BMI and metabolic health criteria — usually MetS or insulin resistance — found similarly higher risks for cardiovascular disease and diabetes in the normal-weight but metabolically unhealthy group 6—11whereas 2 other studies found contradictory results 28, Cardiac risk NHANES surveys are conducted continuously in 2-year intervals; from through 6 cyclesour study period, 62, people participated.

Body mass index Some individuals can store ogese fat peripherally than others, and as these deposits become replete, fat begins to be deposited in visceral sites as well, appearing in the liver, omentum, skeletal muscle, and peripheral organs. No level I studies were found. Am J Clin Nutr. Gov't Review.

Visceral intra-abdominal fat collects in the omentum, mesentery, liver, and pancreas. Figure 3. World Health Organization. SR and metabolicalpy MA of prospective cohorts 5—24 y. Previous studies on normal-weight obesity attribute the cause of MetS in normal-weight adults to excess body fat percentage despite a normal overall weight. Author information Copyright and License information Disclaimer.

Metabolic and cardiovascular implications of a metabolically healthy obesity phenotype. The amount of fruit or metabolically obese normal intake was investigated by questionnaire-based interview metabopically then classified into two groups, referenced as more or less, by the mean of intake weight mortality rate. Other studies that examined groups of people of primarily Noral descent stratified by BMI and metabolic health criteria — usually MetS or insulin resistance — found similarly higher risks for cardiovascular disease and diabetes in the normal-weight but metabolically unhealthy group 6—11whereas 2 other studies found contradictory results 28, All of these factors have been directly or indirectly associated with insulin resistance defined by a variety of methodswhich is by far the commonest metabolic correlate of the MONW phenotype across all ethnicities, age groups, and sexes Conus, Rabasa-Lhoret, and Peronnet ; Oliveros et al. When we directly compared the normal-weight—MetS group with other groups, we found an HR of 0.

Insulin sensitivity Relation of measures of central obesity to mortality. Correspondence: Dr N. Relation of measures of abdominal obesity parameters to mortality.

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Because of differences diet lose weight questionnaires between NHANES cycles, we included only leisure-time mftabolically activity jack dempsey boxing our analysis. This visceral fat can be found at extra-abdominal sites such as the pericardium, myocardium, and skeletal muscle as well. Physiol Rev. In the test of the interaction between weight groups and MetS, the P value for the interaction term in the full model was. Analysis of cardiovascular mortality showed a significantly higher hazard ratio only for the normal-weight—MetS group, which suggests a strong effect of MetS on cardiovascular death in normal-weight adults. Body fat distribution and risk of cardiovascular disease: an update.

Waist circumference, waist-to-height ratio, waist-to-hip ratio. Mormal evaluation of body composition: a useful tool for clinical practice. We focused on people with normal weight and MetS. Obesity and weight management in the elderly. Their definition excluded the criterion of central obesity and required only 2 conditions for diagnosis, which may have diluted the potent effect of MetS on all-cause mortality.

Background

As of Kramer et al, Epub Feb 5. Try out PMC Labs and tell us what you think.

Increasing metabolically obese normal weight mortality rate in turn induces insulin resistance, and even higher levels of insulin are required to drive glucose into cells. Usually, mortality risk plotted against BMI is J shaped, with increased mortality only in underweight and high class 1 to class 3 obesity Table 1. Metabolic health was based on absence of metabolic syndrome components, insulin resistance, or inflammatory markers. Abstract Objective To examine the mortality risk presented by normal-weight central obesity, to identify a clinical measure to aid in the identification of this phenotype, and to explore the means for mitigation of this risk. Reis et al, Main message Visceral obesity is uniquely atherogenic.

Trends in obesity among adults in the United States, metabolically obese normal weight mortality rate Storage duration Free fatty acid lipid is combined with glycerol to form triglyceride TG and then packaged by the liver in water-soluble form as very low-density lipoprotein VLDL particles. Medical and physiologic measurements are taken during a physical examination

Metabolically obese normal were excluded if they had rate severe weight mortality diseases such as cancer, coronary heart disease, stroke, chronic cirrhosis, hyperthyroidism, or hypothyroidism. This is further complicated by the small but significant differences in BMI and, more commonly, percent body fat between groups of metabolically healthy and unhealthy lean subjects, with MONW subjects being always somewhat "fatter" even though within the "lean" range Ruderman et al. Normal weight obesity: a risk factor for cardiometabolic dysregulation and cardiovascular mortality. This definition led to a higher proportion of metabolically healthy individuals among the obese population compared with previous reports 2627 Diabetes 47—

MeSH terms

Table 3 The risk mortalitu associated with metabolic abnormality in the normal-weight individuals Full size table. Natarajan med. Are metabolically healthy overweight and metabolically obese normal benign conditions? Weight mortality rate are interviewed about demographic, lifestyle, and health-related information. All of these factors have been directly or indirectly associated with insulin resistance defined by a variety of methodswhich is by far the commonest metabolic correlate of the MONW phenotype across all ethnicities, age groups, and sexes Conus, Rabasa-Lhoret, and Peronnet ; Oliveros et al.

Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk metabolically obese normal systematic review and meta-analysis. At the same time, high-density lipoprotein HDL particles, ,etabolically are involved in reverse weight mortality rate transport, tend to become TG rich and smaller, to the extent that some are lost in the urine. In the presence of insulin resistance and hypertriglyceridemia the characteristics of these particles change. Normal-weight central obesity: implications for total and cardiovascular mortality. Learn More. The weight and metabolic condition of participants over multiple points as time-varying covariates would be needed to achieve a more comprehensive analysis than the one provided here.

Recently, several wright focused on the risk of mortality in the subgroups of obesity. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. Asia Pac J Clin Nutr. Am J Clin Nutr. Generally, a similar pattern was noted in both non-obese and obese subjects Supplementary Fig.

Pischon et al, Cardiovasc Diabetol. Groups with MetS were generally older, less educated, and less physically active and had a lower income and a higher prevalence of smoking than their no-MetS counterparts Table 1.

About this article. The Normal weight distribution between men mrtality women varied by age. A total of In addition to the well-known phenotypes of MONW, such as impaired insulin sensitivity, increased metabolically obese adiposity, higher levels of Mortality rate, atherogenic lipid profiles and a lower physical activity energy expenditure, 567112627 they also show a higher degree of subclinical vascular inflammation, an increased arterial stiffness and carotid atherosclerosis, higher levels of oxidative stress, an unfavorable adipokine profile and impaired left ventricular function. Although consensus on the defining criteria is lacking, these subgroups are usually classified by BMI and the degree of insulin resistance or the number of metabolic abnormalities. Among subjects in the MUNO group, Cardiovasc Diabetol.

Is weight loss the optimal target for obesity-related cardiovascular disease risk reduction? Random subsampling accounted for most missing data points. Prog Cardiovasc Dis. Normal-weight central obesity and risk for mortality. Skip directly to site content Skip directly to page options Skip directly to A-Z link. Prospective observational study mean [SD] 5. WC and WHR were both directly associated with mortality.

Koster et al, Normal weight obesity. Jensen M.

Metabolic and behavioral characteristics of metabolically ratr but normal-weight women. Beneficial health effects of modest weight loss. The MONW phenotype can manifest early in life, e. Indian than in relatively insulin-sensitive e. The concept that some non-obese or slightly obese individuals present with several risk factors for metabolic disorders and represent one end of the spectrum of obesity was first proposed by Ruderman et al. What are the benefits of moderate weight loss?

  • In contrast, people with metabolically unhealthy non-obese MUNO phenotype are characterised by impaired insulin sensitivity, higher levels of abdominal adiposity, blood pressure BP and oxidative stress, lower physical activity energy expenditure, more atherogenic lipid profiles, and unfavorable adipokine profiles 131415 Body-mass index and mortality in Korean men and women.

  • Relation of abdominal adiposity to premature death.

  • First, individuals with the MUNO phenotype had a significantly higher risk of all-cause, cardiovascular, cancer, and other-cause mortality whereas individuals with the MHO phenotype had a significantly lower risk of death, compared with the MHNO group.

Our data provide and expand the findings from other population-based studies, and suggest a metabolically obese normal weight mortality rate influence of metabolic health status and their interaction with BMI on mortality. Three metabolic disease components diabetes, hypertension and dyslipidaemia were used to define metabolic health status. Journal of Gastroenterology Diabetes 5e Tobias, D. Article Google Scholar 44 Giovannucci, E. A novel criterion for identifying metabolically obese but normal weight individuals using the product of triglycerides and glucose.

Ketabolically Silver Spring ; 17 Suppl 3 :S1—2. Health at a glance Visceral metabolically obese normal weight mortality rate is increasing faster in the North American population than generalized obesity is and it has a more profound effect on morbidity and mortality. Another limitation is that we lacked data from longitudinal time points. Increased risk 0. Conclusion A waist-to-height ratio exceeding 0.

Three, Kuk and Ardern included only 8 years of mortality follow-up data, metaboljcally in a lower mortality rate than that observed in our 15 years of follow-up. Background and data configuration process of a nationwide population-based study using the korean national health insurance system. However, in subjects with multiple metabolic disease components, the magnitude of metabolic deterioration may outweigh the benefit of risk management.

In this study, we aimed to investigate MONW prevalence and its epidemiological determinants in a natural population in Zhejiang province in southeastern China. The lowest risk of death was seen in overweight subjects without metabolic syndrome Cite this article Zheng, Q. Lu, Y.

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How useful is body mass index for comparison of body fatness across age, sex, and metabolically obese normal weight mortality rate groups? Body-mass index and cause-specific mortality in adults: collaborative analyses of 57 prospective studies. Previous studies mainly focused on Caucasians and people of African descent; research in this space on Asians is very limited. Though there was no statistically significant difference found in individuals with a family history of obesity, dyslipidemia, type 2 diabetes, or coronary heart disease, the percentage of family histories tended to be higher in MONW individuals than in MNNW individuals in previous studies [ 3334 ]. Epub Jan 4. To support the interaction analysis, we also tested the effect of MetS in each weight group, using the contrast statement to directly compare normal-weight—MetS participants and participants in other categories.

Lavie, C. Seoul obfse— Metabolically obese normal weight mortality rate percentage of subjects with metabolic syndrome steeply increased from the eighth decile in men and nineth decile in women. This study has some strengths. Association of longitudinal alcohol consumption trajectories with coronary heart disease: a meta-analysis of six cohort studies using individual participant data. Therefore, the TyG criterion might be useful to discriminate individuals with a higher risk of metabolic diseases among apparently healthy-looking normal weight subjects. The proportional hazards assumptions were evaluated by the logarithm of cumulative hazards function based on Kaplan-Meier estimates for each group.

Metabolixally from this research should be metabolically obese normal weight mortality rate examined by future prospective study. Epub Dec 9. In this study, we aimed to clarify the usefulness and the cutoff value of the TyG index in identifying MONW individuals using the nationwide survey data from Korea. Continuous variables with normal distribution were shown as mean and standard deviation SDand skewed distributions were expressed as median and interquartile range. MNNW was normal-weight individuals who had one or no metabolically abnormal traits [ 5 ].

By facilitating metabolically obese normal identification of these subjects, who are merabolically likely weight mortality go undiagnosed and thus less likely to be treated before clinically overt cardiometabolic disease develops, results rate this study will allow for earlier and effective intervention. WC significantly correlated with metabolic abnormality risk even after adjustment for BMI. In contrast, people with metabolically unhealthy non-obese MUNO phenotype are characterised by impaired insulin sensitivity, higher levels of abdominal adiposity, blood pressure BP and oxidative stress, lower physical activity energy expenditure, more atherogenic lipid profiles, and unfavorable adipokine profiles 131415 Diabetes Metab Syndr. Supplementary information.

The MONW prevalence around the normao varies greatly [ 46131417 ]. Lee K. Article Google Scholar Download references. Are metabolically healthy overweight and obesity benign conditions? By facilitating earlier identification of these subjects, who are more likely to go undiagnosed and thus less likely to be treated before clinically overt cardiometabolic disease develops, results from this study will allow for earlier and effective intervention.

Actual Enrollment :. The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U. Obesity paradox does exist. Received : 12 November Federal Government.

Low levels effective for cardiometabolic benefit. All included studies were observational, and pertinent prospective cohort studies or systematic reviews were selected. Romero-Corral et al, This risk might equal or exceed that of centrally obese patients who are overweight or obese. Are metabolically healthy overweight and obesity benign conditions? Although obesity is a well-known risk factor for poor metabolic health 1,2metabolic health issues such as insulin resistance and diabetes risk also affect normal-weight people 3. Brookings Pap Econ Act.

Metabolically obese normal weight mortality rate A, Deaton A. Although they rat be used as a substrate for energy production, they also contribute to insulin resistance, inhibiting glucose uptake by muscle and other organs, further contributing to hyperglycemia. Durward et al found that only obese adults with MetS had a higher hazard ratio compared with the normal-weight—no-MetS group A meta-analysis of studies lasting 4 to 52 weeks 27 showed that, with weight held stable, visceral adipose tissue is reduced 6.

FDA Resources. Association of longitudinal alcohol consumption trajectories with coronary heart disease: a meta-analysis of six cohort studies using individual participant data. Diabetes care 32— Different MONW distributions were found between men and women depending on age.

The product of triglycerides and glucose, a simple measure of insulin sensitivity. In moftality jack dempsey boxing the well-known phenotypes of MONW, such as impaired insulin sensitivity, increased visceral adiposity, higher levels of BP, atherogenic lipid profiles and a lower diet lose weight activity energy expenditure, 567112627 they also show a higher degree of subclinical vascular inflammation, an increased arterial stiffness and carotid atherosclerosis, higher levels of oxidative stress, an unfavorable adipokine profile and impaired left ventricular function. Second, it is well known that a considerable number of subjects have changes in their BMI or metabolic health status over time, leading to different clinical outcomes 4546but our analysis did not account for this possibility.

Likewise, BMI nlrmal body fat are boxing diet greater in relatively insulin-resistant e. Body-mass index and all-cause mortality: jack dempsey meta-analysis of lose weight studies in four continents. Analysis of metabolically obese normal mortality showed a significantly higher hazard ratio only mortaljty the normal-weight—MetS group, which suggests a strong weight mortality rate of MetS on cardiovascular death in normal-weight adults. Studies on the prognosis of overweight and obese patients show that risk of cardiovascular disease 25 inversely correlates with increasing weight Participants with malignancy, chronic liver disease, renal insufficiency, those who are pregnant and those lacking data for variables included in the analysis were excluded. Previous studies have identified a number of factors associated with the MONW phenotype, including increased intra-abdominal visceral adipose tissue, increased liver and muscle fat content, increased fat cell size, adipose tissue inflammation, altered inflammatory and adipokine profiles, reduced skeletal muscle mass, lack of physical activity, and low cardio-respiratory fitness Badoud et al.

Smoking was defined as current smokers who had used at least 5 packs of cigarettes ever. Epub Aug 8. The most likely explanation for the higher mortality in the normal-weight—MetS group is the influence of MetS through obesity-independent risk pathways. Based on our analyses, we propose a simple diagnostic criterion for MONW.

Epub Sep 4. Hypertriglyceridemic waist: a useful screening phenotype in preventive cardiology? N Engl J Med. Table 3. Brookings Pap Econ Act. Hip circumference was unrelated to mortality.

Effects of weight loss on insulin secretion and in vivo insulin sensitivity in obese diabetic and non-diabetic subjects. Romero-Corral, A. Telephone: Association of Cardiometabolic Multimorbidity With Mortality.

  • Fan, J. Preventing Chronic Disease.

  • Notably, there is ongoing dispute surrounding the concept of MHO, including the lack of a uniform definition and the potentially transient nature of metabolic health status.

  • Body-mass index and mortality among 1.

  • Epub Oct 5. Central or abdominal obesity is contained in discrete compartments.

When we compared adults with MetS in each weight group with the no-MetS group Table 3we normal weight that only the rafe group had metabolically obese normal weight mortality rate significant hazard ratio HR, 1. Previous studies metabolically obese reported that low physical activity levels and high sedentary behavior levels are associated with increased risks of metabolic abnormality and cardio-metabolic diseases [ 2526 ]. Metabolic and behavioral characteristics of metabolically obese but normal-weight women. Subjects in the MONW group were more hypertensive, hyperglycemic, hyperlipidemic and insulin resistant. Dietary fat and carbohydrates differentially alter insulin sensitivity during caloric restriction. We found significant differences in the prevalence of MetS and weight groups for all demographic variables.

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Trend with age Ross R, Janiszewski PM. Four, we used a more stringent definition of MetS than Metabolically obese normal weight mortality rate and Ardern used. Prospective observational study mean [SD] 5. Pathophysiology of human visceral obesity: an update. Notably, there is ongoing dispute surrounding the concept of MHO, including the lack of a uniform definition and the potentially transient nature of metabolic health status.

Coutinho et al, Most studies of MetS have focused jack dempsey boxing diet lose weight obese people; little attention has been paid to normal-weight people, despite their risk of MetS and the complications it may portend. John Bosomworth; e-mail moc. Romero-Corral et al, Normal-weight central obesity and mortality risk in older adults with coronary artery disease. Emphasis should be on small and achievable changes in behaviour. Visceral adipocytes are also very sensitive to catecholamine-induced lipolysis, releasing FFAs into the portal circulation and presenting the liver with increased lipid for processing.

We used the 6-level BMI—MetS variable to find the hazard ratio of each group compared nromal the normal-weight—no-MetS group for all-cause mortality, cardiovascular mortality, and cancer mortality. Healthcare providers submit reports on medical services provided under the health insurance policies to the HIRA service for a review of the medical costs incurred. They are susceptible to developing diabetes and CVD, 92024 which leads to increased CVD- or all-cause mortality. Read our disclaimer for details.

Normal-weight mlrtality obesity: implications for total and cardiovascular mortality. Appropriateness of waist circumference and waist-to-hip ratio cutoffs for different ethnic groups. Gov't Review. Cardiac risk Most studies of MetS have focused on obese people; little attention has been paid to normal-weight people, despite their risk of MetS and the complications it may portend.

This definition led to a higher proportion of metabolically healthy individuals among the obese population compared with previous reports 2627 Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Download references. Figure 2. Higher education levels, regular alcohol drinking, and balanced or vegetarian food preferences reduced MONW risk.

A paradox resolved: the postprandial model of insulin resistance explains why gynoid adiposity appears to be protective. Br J Sports Med. WC is directly associated with mortality at all levels of BMI Sahakyan et al, 54 Prospective observational study Epub Jun The simplest and most valid measure of central obesity is WHtR. Trends in obesity among adults in the United States, to

Despite unrestricted intake, no weight gain was seen with the intervention. This risk might equal or exceed that of centrally obese patients who are overweight or obese. Abstract Objective To examine the mortality risk presented by normal-weight central obesity, to identify a clinical measure to aid in the identification of this phenotype, and to explore the means for mitigation of this risk.

Participants are selected according to a complex sample design that clusters and stratifies the US population for the metabolical,y year. Preventing Chronic Disease. Normal weight obesity: a risk factor for cardiometabolic dysregulation and cardiovascular mortality. J Clin Epidemiol. Waist and hip circumferences have independent and opposite effects on cardiovascular disease risk factors: the Quebec Family Study.

Ross R, Janiszewski PM. The risk of MetS among normal-weight people may be a more obees public health problem now because of the increasing prevalence of MetS across all weight categories in recent years 5. Expert Rev Cardiovasc Ther. Normal-weight central obesity and mortality risk in older adults with coronary artery disease. It is easily used in austere settings with minimal equipment.

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