What is the difference between obesity and malnutrition

Some studies indicate that deficient levels of specific micronutrients are associated with increased fat stores in the body, by way of altering serum leptin concentrations. Leptin is a hormone that helps control fat storage in the body through regulation of the appetite and energy expenditure. More studies are needed to explore this disruption, as well as whether there is increased physiologic requirements in obesity or more rapid depletion.

Both psychological and physiological stress, which is pervasive, leads to a more rapid depletion of micronutrients that correlate with the body mass index BMI. So which comes first malnutrition or obesity?

External driving forces that act as contributing factors also warrant examination. Rising rates of food insecurity might add to an increased risk of weight gain and malnutrition through various pathways. Not surprising, one response to household food insecurity involves increased purchases of inexpensive, low quality foods to stretch the food dollar further, limiting the amount of fresh foods like fruits and vegetables. Food insecurity can be traumatic and might not just singularly change our purchasing behaviors, it also threatens to change our relationship with food and eating.

A recent study showed adolescents from food insecure homes had increased likelihoods of developing a binge-eating disorder and obesity, suggesting food restrictions imposed by the external environmental conditions correlate with behavioral consequences such as disordered eating and unhealthy relationships with food. Food insecurity and the imposed constraints on food quality and quantity are associated with various behavioral and clinical consequences.

Food insecurity among children is also linked to developmental and other behavioral problems, increased anxiety and depression, lowered academic performance, toxic stress, reduced immunity and increased risk of developing infectious and chronic diseases. Most chronic diseases do not develop in silos.

Therefore, all of these scenarios, and many other influences such as genetics and perinatal nutrition, likely contribute and confound the risk, rate and coexistence of these health conditions. Clearly, we do not have all the answers, but one thing is abundantly obvious we are unlikely to successfully develop ways to mitigate these conditions if we approach them as mutually exclusive.

In more ways than not, they are inseparable. References Bird, J. Background: Pressure injuries PI are a significant clinical problem across all healthcare facilities, associated with poor patient outcomes, increased length of stay and healthcare costs.

This study aimed to determine whether PI prevalence was associated with levels of obesity; the complex association between morbid obesity, malnutrition and PI prevalence in hospital inpatients was also explored.

Bivariate tests were used to explore relationships between age, gender, BMI, malnutrition and PI prevalence. Of note, NT-proBNP levels were nearly double in both malnourished versus well-nourished groups, and were increased to a similar extent in both lean Both obese—malnourished and lean—malnourished individuals showed significantly higher NT-proBNP levels, even after adjustment for confounders Fig 1A.

Models adjusted for age, sex, systolic blood pressure, heart rate, fasting glucose, high-density lipoprotein cholesterol, total cholesterol, hypertension, diabetes, cardiovascular disease, and estimated glomerular filtration rate.

Likewise, the lean—malnourished low BMI, low SA participants showed similar echocardiographic characteristics greater LVMi, more diastolic dysfunction when compared to their lean—well-nourished counterparts Table 2.

These differences were consistent even after adjusting for clinical confounders age, sex, systolic blood pressure, heart rate, fasting glucose, HDL-C, total cholesterol, hypertension, diabetes, cardiovascular disease, and eGFR Table 2. Increased concentrations of SA were associated with better diastolic function. In all, 5, In the median 3.

Higher SA quartiles were associated with a significantly lower risk for HF hospitalization or all-cause mortality Table 3 ; Fig 2. Results were similar when analyzed by other anthropometric indices waist circumference and body fat Tables 3 and 4. The obese—malnourished group high BMI, GLIM-defined malnourishment on average was older; had the largest waist circumference, the highest percentage body fat, and the highest burden of comorbidities diabetes, The present study aimed to elucidate the complex relationship between obesity, nutritional status, and cardiac outcomes in an Asian population.

Among asymptomatic Asian individuals, we found that obese individuals defined by BMI, waist circumference, or body fat with poor nutritional status defined by SA or PNI had the highest burden of comorbidities, maladaptive cardiac remodeling, diastolic dysfunction, and the adverse composite outcome HF hospitalization and mortality , much higher than in the lean—malnourished and obese—well-nourished groups Table 4.

The lean—well-nourished low BMI, high SA individuals had the most favorable metabolic health and outcomes. Previous literature largely focused on examining the relationship between obesity or nutrition and cardiac outcomes in isolation [ 1 , 15 , 16 , 30 ], or used suboptimal measures of obesity and nutrition [ 14 ]. One study looking at the combined effect of obesity and nutrition showed that obese critically ill patients with malnutrition versus well-nourished had the poorest outcomes [ 14 ].

However, the study population consisted of critically ill patients admitted in medical and surgical intensive care units only, and heavily relied on BMI to define obesity [ 14 ], limiting the generalizability of the findings. Other studies on nutrition and cardiac outcomes have primarily focused on older or diseased populations e. Of note, malnourished status low SA in our study was associated with increased HF events in both lean and obese individuals, suggesting a prognostic role of protein-energy nutrition, even in the general population [ 31 ].

Two prior community cohorts have evaluated the relationship between nutritional status SA and HF outcomes in older adults [ 15 , 16 ]. Notably, our study adds that nutritional status was an independent predictor of HF outcomes, even in younger individuals mean age Of note, sub-analysis of CHS revealed that the higher risk with low SA was only evident among those aged 73 years and below [ 15 ].

The most important finding in our present study centers around characterizing the new obese—malnourished phenotype. We showed that obese—malnourished individuals from Asia were mostly women, with visceral obesity and a high comorbidity burden. Indeed, Asian individuals are predisposed towards visceral obesity, compared to white individuals, even at the same BMI [ 30 ]. A recent report identified that stunting, wasting, and thinness in women have decreased in parallel with an increase in the prevalence of overweight and obesity in low- and middle-income countries across Asia and sub-Saharan Africa [ 33 ].

Urbanization and industrialization in Asia have made food of low nutritional value easily accessible and affordable, whilst promoting a sedentary lifestyle, all contributing to the double burden of obesity and malnutrition [ 6 ]. Despite being a convenient measure, BMI falls short in distinguishing between the various elements of body composition, body fat distribution, and fluid accumulation and absolute weight gain [ 34 ].

It is therefore noteworthy that our results using waist circumference showed an even stronger association with outcomes larger HRs than BMI, suggesting that visceral adiposity could potentially be an instrumental driver of risk. Results were further supported by our results based on percentage body fat. Visceral adiposity, including cardiac steatosis or increased pericardial fat deposition, as well as underlying comorbidities such as hypertension, diabetes, and dyslipidemia , promote pro-inflammatory conditions, ultimately contributing to cardiovascular dysfunction [ 2 , 35 ].

Beyond visceral adiposity, we found that malnourished status versus being well-nourished was associated with less favorable cardiac structural and functional remodeling, to a greater extent in obese overall and visceral than lean asymptomatic individuals. Notably, these individuals also had the highest NT-proBNP levels at baseline, compared to other groups. This surfaces as a unique challenge in diagnosing chronic HF in obese patients, especially in an emergency department setting [ 23 ]. Interestingly, the obese—malnourished individuals in our study exhibited higher NT-proBNP levels in parallel with reduced diastolic function, compared to all other groups.

Among asymptomatic individuals in our study, the obese—malnourished individuals were at markedly higher risk of the composite outcome, compared to all other subgroups.

Physiologically, SA protects against oxidative stress and ischemic damage [ 8 , 9 , 11 ]. With the interplay between low SA levels and obesity pathology pro-inflammatory signaling, excessive visceral adiposity, and obesity-related comorbidities , cardiac maladaptation ensues, potentially leading to HFpEF [ 37 , 38 ]. Anthropometric and echocardiographic data were not available beyond the baseline visit.

Clinical data were not available during follow-up, restricting anthropometric and echocardiographic measurements as single-time-point measures at baseline.

Findings reported are from a single-center study in Taiwan. Nonetheless, our study is novel in comprehensively assessing the association of obesity using various anthropometric measures and nutrition using objective biological markers, SA, PNI, and GLIM criteria with cardiac characteristics and outcomes in a general population.

SA concentration is mainly determined by rates of synthesis, protein degradation, and body losses and may serve as a measure of protein-calorie malnutrition [ 7 — 9 ]. PNI, an alternative nutritional marker that incorporates total lymphocyte count as part of its scoring together with SA, represents combined nutritional—inflammatory status and has also been shown to provide prognostic information [ 11 , 31 , 40 , 41 ], including in HF [ 31 ].

Other strengths of our current work include the detailed echocardiographic analyses, which demonstrated key cardiac morphological left atrial and left ventricular and subclinical functional changes in various combined subgroups of obesity and nutritional status, as well as the robust associations with the composite outcome.

In this cohort study among asymptomatic Asian individuals, we observed that obese—malnourished individuals have the highest comorbidity burden, maladaptive cardiac remodeling, and the least favorable cardiac outcomes. Our findings suggest that the double burden of obesity and malnutrition in our Asian general community exists, and that healthy lifestyle programs and policies to promote nutritional health and reduce obesity are warranted in this region.

The contributions of the clinical coordinators are duly acknowledged. Abstract Background Obesity, a known risk factor for cardiovascular disease and heart failure HF , is associated with adverse cardiac remodeling in the general population. Methods and findings We examined 5, consecutive asymptomatic Asian participants who were prospectively recruited in a cardiovascular health screening program mean age Conclusions In our cohort study among asymptomatic community-based adults in Taiwan, we found that obese individuals with poor nutritional status have the highest comorbidity burden, the most adverse cardiac remodeling, and the least favorable composite outcome.

Author summary Why was this study done? Malnutrition is characterized by under- or overnutrition. Obesity, a condition with overnutrition, is an established risk factor for cardiovascular disease and cardiac failure. When undernutrition coexists alongside obesity being overweight , a double burden of malnutrition is present. Whilst it is possible that malnutrition will worsen the cardiac effects of obesity, no study has examined this relationship in depth, particularly in Asia.

We examined whether nutritional status assessed using serum albumin [SA], prognostic nutritional index, or Global Leadership Initiative on Malnutrition criteria affects the relationship between various obesity measures body mass index [BMI], waist circumference, and body fat percentage and cardiovascular outcomes in a general community population in Taiwan.

What did the researchers do and find? We characterized asymptomatic adult participants into 4 combined subgroups of nutrition and obesity, namely, lean—well-nourished, lean—malnourished, obese—well-nourished, and obese—malnourished. The obese—malnourished high BMI, low SA individuals were typically older and often women, and had a higher likelihood of visceral obesity, comorbidities, notable cardiac remodeling, and impaired cardiac relaxation function, compared to all other groups.

Obese—malnourished individuals also had the greatest risk of the composite outcome of heart failure hospitalization or all-cause mortality, compared to the lean—well-nourished low BMI, high SA group. Results were consistent across various measures of obesity and nutritional status.

What do these findings mean? The double burden of malnutrition exists among Asian adults, whereby undernutrition is present along with obesity. Among Asian asymptomatic adults, obese individuals with coexisting malnutrition obese—malnourished have the highest comorbidity burden, maladaptive cardiac remodeling, and least favorable cardiac outcomes. Introduction Rapid urbanization and industrialization in Asia in the past decades have led to an escalated prevalence of obesity in the region, especially among young adults in low- and middle-income countries [ 1 ].

Nutrition and blood measurements Blood samples were obtained after an overnight fast, in a sitting position. Standard echocardiography protocol Echocardiography at baseline was uniformly performed using the GE system Vivid i equipped with a 2- to 4-MHz transducer 3S-RS according to internationally accepted guidelines [ 20 ]. Outcomes Individuals were prospectively followed up for a median of 3. Download: PPT. Table 1. Baseline demographics of study participants according to obesity and serum albumin categories.

Table 2. Echocardiography information of study participants according to obesity and serum albumin categories. Table 3. Results Baseline characteristics Among 5, asymptomatic Taiwanese individuals mean age Fig 1. Forest plots depicting multivariable associations of key echocardiography measures and combined subgroups of BMI and nutrition.

Outcomes In all, 5, Fig 2.