Which One Is More Important, Obesity or Cardio Metabolic Risk Factors?

Implication for health policy/practice/research/medical education: This editorial covers a hot topic in fields of obesity and cardiovascular disease and can help reaserchers to design relevant studies and also healch care provider to pay more attention to metabolic risk factors. which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Obesity defined as a BMI of 30 or above is a major health hazard, which is obviously linked to dyslipidemia, hyper-tension and type2 diabetes. However, clustering of CVD risk factors is different across the continuum of body mass index (BMI) leading to recognition of phenotype subgroups of obesity. Accordingly since the 1980s two well-known phenotypes of obesity have been described in medical literature i.e. " Metabolically obese but normal weight " (MONW) and " metabolically healthy but obese " (MHO) (1).5% of normal-weight adults were metabolically abnormal, whereas 51.3% of overweight adults and 31.7% of obese adults were metabolically healthy (2). Moreover few studies reported an increasing trend of MNOW. For instance a dramatic 4-fold increase in prevalence of metabolic syndrome has been reported among normal weight Tehranian adults during 6.6 years of follow up (3). There are controversial findings regarding the independent role of obesity in the development of CVD and all-cause mortality. Some studies have shown that obesity, regardless of the presence or absence of Metabolic syndrome and IR, was associated with a higher risk for Cardio metabolic comorbidities (4). While, others have demonstrated that BMI, and other anthropomet-ric indices, whether assessed singly or in combination, do not importantly improve cardiovascular disease risk prediction when additional information is available for systolic blood pressure, history of diabetes, and lipids (5). Accordingly, considering the different outcomes for the phenotypes, importance of metabolic abnormalities for predicting CVD events in comparison with weight status per se emerges as an important question. In fact it seems that some kinds of interaction exist between obesity and metabolic risk factors in the development of CVD outcomes. Obesity-related phenotypic characteristics and CVD outcomes have been investigated in several epidemiological studies yielding some conflicting results (6-12). The majority of studies have reported an increased risk of CVD in MNOW compared to MHO. Within the framework of Tehran Glucose and Lipid Study (TLGS), during a mean of 8.1 years of follow up, among 6,215 subjects aged >30 years free of CVD at baseline, we showed that, compared to normal weight subjects without …