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Aim: To evaluate the associations between metabolically healthy obesity (MHO) and different types of incident cardiovascular events in a contemporary population. Materials and Methods: All patients discharged from French hospitals in 2013 with at least 5 years of follow‐up and without a history of major adverse cardiovascular event (MACE; myocardial infarction, heart failure [HF], ischaemic stroke or cardiovascular death [MACE‐HF]) or underweight/malnutrition were identified. They were categorized by phenotypes defined by obesity and three metabolic abnormalities (diabetes, hypertension and hyperlipidaemia). Hazard ratios (HRs) for cardiovascular events during follow‐up were adjusted on age, sex and smoking status at baseline. Results: In total, 2 873 039 individuals were included in the analysis, among whom 272 838 (9.5%) had obesity. During a mean follow‐up of 4.9 years, when pooling men and women, individuals with MHO had a higher risk of MACE‐HF (multivariate‐adjusted HR 1.22, 95% confidence interval [CI]: 1.19‐1.24), new‐onset HF (HR 1.34, 95% CI 1.31‐1.37) and atrial fibrillation (AF; HR 1.33, 95% CI 1.30‐1.37) compared with individuals with no obesity and zero metabolic abnormalities. By contrast, risks were not higher for myocardial infarction (HR 0.92, 95% CI 0.87‐0.98), ischaemic stroke (HR 0.93, 95% CI 0.88‐0.98) and cardiovascular death (HR 0.99, 95% CI 0.93‐1.04). MHO in men was associated with a higher risk of clinical events compared with metabolically healthy men of normal weight (HR 1.12‐1.80), while women with MHO had a lower risk for most events than metabolically healthy women of normal weight (HR 0.49‐0.99). Conclusions: In a large and contemporary analysis of patients seen in French hospitals, individuals with MHO did not have a higher risk of myocardial infarction, ischaemic stroke or cardiovascular death than metabolically healthy individuals with no obesity. By contrast, they had a higher risk of new‐onset HF and new‐onset AF. However, notable differences were observed in men and women in the sex‐stratified analysis. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine whether the association between obstructive sleep apnea severity and glucose control differs between patients with newly diagnosed and untreated type 2 diabetes, and patients with known and treated type 2 diabetes. This multicentre cross-sectional study included 762 patients investigated by sleep recording for suspected obstructive sleep apnea, 497 of whom were previously diagnosed and treated for type 2 diabetes (treated diabetic patients), while 265 had no medical history of diabetes but had fasting blood glucose ≥126 mg dL−1 and/or glycated haemoglobin (HbA1c) ≥6.5% consistent with newly diagnosed type 2 diabetes (untreated diabetic patients). Multivariate regression analyses were performed to evaluate the independent association between HbA1c and obstructive sleep apnea severity in treated and untreated patients with diabetes. In untreated diabetic patients, HbA1c was positively associated with apnea-hypopnea index ( P = 0.0007) and 3% oxygen desaturation index ( P = 0.0016) after adjustment for age, gender, body mass index, alcohol habits, metabolic dyslipidaemia, hypertension, statin use and study site. The adjusted mean value of HbA1c increased from 6.68% in the lowest quartile of the apnea-hypopnea index (<17) to 7.20% in the highest quartile of the apnea-hypopnea index (>61; P = 0.033 for linear trend). In treated patients with diabetes, HbA1c was associated with non-sleep variables, including age, metabolic dyslipidaemia and insulin use, but not with obstructive sleep apnea severity. Obstructive sleep apnea may adversely affect glucose control in patients with newly diagnosed and untreated type 2 diabetes, but may have a limited impact in patients with overt type 2 diabetes receiving anti-diabetic medications. [ABSTRACT FROM AUTHOR]

Background SHBG and liver enzymes levels are both associated with the risk of type 2 diabetes. However, the relationship between SHBG with liver enzymes and intrahepatic fat content remain poorly understood. Objective To investigate whether SHBG is correlated with glucose and lipids levels and whether this association depends on fatty liver content, liver enzymes or sex hormone concentrations. Design and Patients We studied 233 dysmetabolic men with measures of plasma SHBG, total testosterone, 17β-oestradiol, glucose, adiponectin, liver enzymes and hepatokines. Intrahepatic liver fat and visceral fat contents were measured by magnetic resonance imaging in 108 of these individuals. Results After adjustment for age, SHBG concentration was inversely correlated with fasting glucose (βstandardized = −0·21, P = 0·0007), HbA1c (βstandardized = −0·27, P < 0·0001), triglycerides (βstandardized = −0·19, P = 0·003) and positively correlated with HDL-Cholesterol (βstandardized = 0·14, P = 0·03). These correlations persisted after adjustment for either total testosterone or 17β-oestradiol levels. SHBG was not related to either fetuin A or FGF 21 concentrations. The inverse association of SHBG with HbA1c and glycaemia was not altered after adjusting for liver markers but was no longer significant after adjustment for hepatic fat content. Conclusion The significant association between SHBG and fasting glycaemia, HbA1c and lipid levels in dysmetabolic men was not related to either sex hormones or markers of liver function, but was dependent on intrahepatic fat. This suggests that intrahepatic fat, but not alterations in liver function markers, may be involved in the association between SHBG and glucose and lipid metabolism. [ABSTRACT FROM AUTHOR]

Context In men, obesity and the metabolic syndrome are accompanied by decreased testosterone levels, but little is known about the associations between visceral adipose tissue ( VAT), VAT-related inflammation and sex steroids. Objective To examine the relative impact of VAT, abdominal subcutaneous adipose tissue ( SAT) and interleukin 6 ( IL-6), a marker of VAT-induced inflammation, on testosterone ( T) and 17β-oestradiol ( E2) levels in dysmetabolic men. Methods We study the NUMEVOX cohort of 229 men, aged 27-77 years, who all had at least one metabolic syndrome criterion (on average three). IL-6, C-reactive protein, Homeostasis Model Assessment of ( HOMA) insulin resistance index ( HOMA- IR), liver enzymes, E2, LH, sex hormone-binding globulin ( SHBG), T, waist circumference and body mass index ( BMI) were measured; bioavailable testosterone ( BT) was calculated from T and SHBG; MRI-assessed VAT and SAT were analysed in 109 of these men. Results Visceral adipose tissue was strongly correlated with E2 (Spearman r = 0·38, P < 0·001) and with BT/ E2 ratio ( r = −0·42, P < 0·001), while SAT was not correlated with either. IL-6 was correlated with E2 ( r = 0·19, P = 0·007), BT ( r = −0·19, P = 0·006) and BT/ E2 ratio ( r = −0·30 P < 0·001). In multivariate linear analysis, the relation between VAT and E2 was independent of age, BMI ( P = 0·008), leptin ( P < 0·001), T and SHBG. Log( IL-6) was significantly inversely related with log( BT) ( P = 0·032) independently of age, VAT, leptin and HOMA- IR. Conclusions 17β-oestradiol levels were positively associated with VAT, but not with SAT, while T and BT were negatively and independently associated with IL-6. The significant inverse association between IL-6 and T suggests an important role of low-grade visceral fat inflammation in the central hypogonadism associated with the metabolic syndrome. [ABSTRACT FROM AUTHOR]