title: Metabolically healthy obese subjects are at risk of fatty liver but not of pre-clinical atherosclerosis.
abstract: OBJECTIVE
  Whether obesity increases risk of cardiovascular disease (CVD) and fatty liver because of the co-existence of other risk factors is uncertain. We investigated odds ratios (ORs) for: a) a measure of pre-clinical atherosclerosis and b) fatty liver, in metabolically healthy obese (MHO) subjects, metabolically abnormal obese (MAO) subjects and metabolically abnormal non obese subjects (MANO), using a metabolically healthy non obese (MHNO) group as the reference.
  
  
  RESULTS
  14,384 South Koreans from an occupational cohort underwent cardiac computed tomography (CT) estimation of CAC score, liver ultrasound determination of fatty liver, and measurement of cardiovascular risk factors. Pre-clinical atherosclerosis was defined by a CAC score >0. We used logistic regression to determine ORs for CAC >0, and fatty liver in MHO, MAO and MANO subjects (reference group MHNO). There was no increase in OR for CAC score >0 (OR = 0.93, [95% CIs 0.67,1.31], p = 0.68), in the MHO group, whereas there was an increase in the ORs for CAC score >0 in the MAO, and MANO groups (OR = 1.64 [95% CI 1.36,1.98], p < 0.001) and (OR = 1.38 [95% CI 1.17,1.64], p < 0.001), respectively. In contrast, for fatty liver, there was an increase in OR in each group (OR = 3.63 [95% CI 3.06, 4.31] p < 0.001); (OR = 5.89 [5.18,6.70] p < 0.001); and (OR = 1.83 [95% CI 1.69,2.08]) in the MHO, MAO group and MANO groups respectively.
  
  
  CONCLUSIONS
  MHO subjects are at risk of fatty liver but attenuated risk of pre-clinical atherosclerosis. Both MAO and MANO subjects are at risk of fatty liver and pre-clinical atherosclerosis.
authors.affiliation: Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108, Pyung Dong, Jongro-Ku, Seoul 110-746, Republic of Korea. Electronic address: kcmd.sung@samsung.com.
authors.forename: Ki-Chul
authors.initials: KC
authors.lastname: Sung
authors.affiliation: Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108, Pyung Dong, Jongro-Ku, Seoul 110-746, Republic of Korea.
authors.forename: Sung-Chul
authors.initials: SC
authors.lastname: Cha
authors.affiliation: Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108, Pyung Dong, Jongro-Ku, Seoul 110-746, Republic of Korea.
authors.forename: Joo-Wook
authors.initials: JW
authors.lastname: Sung
authors.affiliation: Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108, Pyung Dong, Jongro-Ku, Seoul 110-746, Republic of Korea.
authors.forename: Min-Suk
authors.initials: MS
authors.lastname: So
authors.affiliation: Nutrition and Metabolism Unit, IDS Building, Southampton General Hospital, University of Southampton, and Southampton National Institute for Health Research Biomedical Research Centre, MP 887 Southampton, UK.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Byrne
mesh_terms: D000328:Adult; D050197:Atherosclerosis / Q000453:epidemiology*; D015992:Body Mass Index; D015331:Cohort Studies; D005234:Fatty Liver / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology*; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D056910:Republic of Korea; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
keywords: Atherosclerosis; Cardio-metabolic risk factors; Coronary artery calcium (CAC) score; Fatty liver; Metabolic syndrome (MetS); Metabolically healthy obese; Non alcoholic fatty liver disease (NAFLD)