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Soumitra Ghosh, MBBS, MD, DTCD, FACE, FACP, FRCP (Edin) – Prof and Head, Department of Medicine. Head, Obesity and Lifestyle Diseases Division, Institute of Post-Graduate Medical Education and Research, Kolkata, India


Objective :

To overcome limitations of BMI to predict health outcomes, the AACE introduced Adiposity Based Chronic Disease (ABCD). ABCD is complication centric rather than BMI centric. Overweight & obese are staged as Stage 0,1 & 2 based on absence or presence of minor & major complications. Heart failure (HF) is increasingly recognised as a major diabetes comorbidity. Favorable effect on unrecognised HF may be one of the causes for good outcomes with novel agents in diabetes cardiovascular (CV) outcome trials. HF maybe unrecognised in obesity too. In obesity, there is need to identify left ventricular systolic dysfunction (LVSD) & diastolic dysfunction (LVDD), harbingers of HF

Methods :

Obesity was diagnosed as per Indian criteria (overweight: BMI ≥23, obese: BMI ≥25) & staged as per AACE. Patients with normal ECG to rule out ischemic heart disease (IHD)  were assessed for epicardial adipose tissue (EAT), LVSD & LVDD by transthoracic echocardiography. 149 obese & overweight of our Obesity Clinic qualified for final analysis. SPSSv22 was used for statistical analysis.

Results :

Mean age was 38.9±9.8 years. Mean BMI was 32.4±3.4. AACE Stage 0, 1 & 2 were 20.8%, 57.7% & 21.4% respectively. 76.39% had NAFLD. 75% had microalbuminuria & 16% had microalbuminuria. In Stage 0 obesity, 26 patients had microalbuminuria & 2 had macroalbuminuria.
12.8% had LVSD of which 15.78%, 36.8% &47.3% were in AACE Stage 0, 1 & 2 respectively. Increasing obesity stage was associated with worsening LVSD (p=0.013). 63% had LVDD of which 14%, 62.7% & 23.3% were in Stage 0, 1 & 2 respectively. Increasing obesity stage was associated with worsening LVDD (p=0.023). Mean EAT was 6.1±1.8mm. EAT increased with higher obesity stage (p=0.006). As LVDD grade increased EAT increased (p=0.02). As NAFLD grade increased EAT increased (p=0.001).

Discussion :

More than1/3rd had different NAFLD grades suggesting high prevalence of ectopic fat. EAT another marker of ectopic fat correlated with NAFLD. Many patients had LVSD & LVDD, even those with Stage 0 obesity. Stage 0 is therefore not entirely benign. LVDD & LVSD worsened with increasing obesity stage. LVDD worsened with increasing EAT. Albuminuria, a marker of renal and endothelial injury was highly prevalent affecting even Stage 0. 

Conclusion :

LVSD & LVDD were highly prevalent in all AACE stages of obesity even in absence of IHD. Stage 0 is not benign as adverse CV markers like LVSD, LVDD & albuminuria were present. It is important to identify overt and covert LV dysfunction in obesity which can adversely affect disease outcome. AACE obesity staging should include cardiac dysfunction also.

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