台灣代謝健康過重/肥胖者與頸動脈粥狀動脈疾病之相關性研究

Association between the Metabolically Healthy Overweight/Obesity Phenotype and Carotid Atherosclerotic Disease in a Taiwanese Population

目的：代謝症候群與心血管疾病的關聯性已經相當確立，然而代謝健康的過重/肥胖(metabolically healthy overweight/obesity, MHOO)族群與心血管疾病的關係卻沒有明確的定論，這篇研究希望找出MHOO和頸動脈斑塊的關係。

方法：本篇研究蒐集了5,418位前往台北馬偕紀念醫院健康檢查的民眾。過重/肥胖定義為身體質量指數(BMI)大於等於24 kg/m2，代謝健康的定義為不符合代謝症候群的族群。我們將參與者們分成四組：代謝健康的體重正常(metabolically healthy normal weight, MHNW)；代謝健康的過重/肥胖(MHOO)；代謝不健康的體重正常(metabolically unhealthy normal weight, MUNW)；代謝不健康的體重過重/肥胖(metabolically unhealthy overweight/obesity MUOO)。頸動脈斑塊則透過頸動脈超音波檢查，斑塊的定義為頸動脈周邊厚度大於50%或0.5 mm，或是頸動脈內壁中層厚度大於1.5 mm。

結果：在本篇的5,418位民眾中女性約佔46.4%，平均年齡為52.5±11.4歲。頸動脈斑塊的盛行率在MHNW組為15.5%，而MHOO組為21.4%。多元羅吉斯迴歸的分析顯示相較於MHNW組，MHOO組有增加頸動脈斑塊的風險[odds ratio (OR) 1.23, 95% confidence interval (CI) 1.01-1.51]，同樣的結果也發生在MUNW組(OR 1.57, 95% CI 1.27-1.95)以及MUOO組(OR 1.90, 95% CI 1.60-2.27)。用性別以及年齡層（<65或≥65歲）的次群組分析也分別有同樣的趨勢。

結論：本篇研究顯示代謝健康的過重/肥胖族群仍然有較高的心血管疾病風險，且無論性別或年齡層都顯示類似的趨勢。

 

Purpose: The relationship between metabolic syndrome and cardiovascular disease is well established. However, the relationship between metabolically healthy overweight/obesity (MHOO) and atherosclerotic disease remains unclear. This study evaluated the association between the MHOO phenotype and the risk of carotid artery plaque development.

Methods: We examined 5,418 patients who underwent health check-ups at the Mackay Memorial Hospital, Taipei City, Taiwan. Overweight/obese was defined as a body mass index ≥24 kg/m2. Metabolically healthy was defined as individuals who did not meet the criteria for metabolic syndrome. Participants were classified into four groups: metabolically healthy normal weight (MHNW); MHOO; metabolically unhealthy normal weight (MUNW); and metabolically unhealthy overweight/obesity (MUOO). The carotid artery was examined using carotid duplex ultrasound by experienced clinicians and defined as focal wall thickening >50% (or 0.5 mm) of the surrounding intima–media thickness (IMT) or carotid IMT (cIMT) >1.5 mm.

Results: A total of 5,418 participants (46.4% female) were enrolled, with a mean age of 52.5±11.4 years. The prevalence of carotid artery plaque was 15.5% in the MHNW group and 21.4% in the MHOO group. Multivariate logistic regression analysis showed that the MHOO group had a higher risk of carotid artery plaque formation [odds ratio (OR) 1.23, 95% confidence interval (CI) 1.01-1.51] than the MHNW group. Similar results were found in the MUNW (OR 1.57, 95% CI 1.27-1.95) and MUOO (OR 1.90, 95% CI 1.60-2.27) groups. Subgroup analysis stratified by sex and age (<65 or ≥65 years) also showed a similar pattern.

Conclusions: Individuals with a MHOO phenotype are at a higher risk of carotid atherosclerotic disease, irrespective of sex or age.