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Heart Rate Recovery in Metabolically Healthy Obesity and Metabolically Unhealthy Obesity Korean Adults
Biomed Sci Letters 2018;24:245-252
Published online September 30, 2018;  https://doi.org/10.15616/BSL.2018.24.3.245
© 2018 The Korean Society For Biomedical Laboratory Sciences.

Kyung-A Shin†,*

Department of Clinical Laboratory Science, Shinsung University, Dangjin 31801, Korea
Correspondence to: Kyung-A Shin. Department of Clinical Laboratory Science, Shinsung University, 1 Daehak-ro, Jeongmi-myeon, Dangjin 31801, Korea. Tel: +82-41-350-1408, Fax: +82-41-350-1355, e-mail: mobitz2@hanmail.net
Received June 7, 2018; Revised July 11, 2018; Accepted September 7, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract

Heart rate recovery (HRR) is simply an indicator of autonomic balance and is a useful physiological indicator to predict cardiovascular morbidity and mortality. The purpose of this study was to compare the differences in HRR between metabolically healthy obesity group and metabolically unhealthy obesity and to ascertain whether heart rate recovery is a predictor of metabolic syndrome. Metabolic syndrome was defined according to the standards of the National Cholesterol Education Program Adult Care Panel III. Obesity was assessed according to WHO Asian criteria. It was classified into three groups of metabolically healthy non-obesity group (MHNO, n=113), metabolically healthy obesity group (MHO, n=66), metabolically unhealthy obesity (MUO, n=18). Exercise test was performed with Bruce protocol using a treadmill instrument. There was no difference in HRR between MHO and MUO (32.71±12.25 vs 25.53±8.13), but there was late HRR in MUO than MHNO (25.53±8.13 vs 34.51±11.80). HRR in obese was significantly correlated with BMI (r=-0.342, P=0.004), waist circumference (r=-0.246, P=0.043), triglyceride (r=-0.350, P=0.003), HbA1c (r=-0.315, P=0.009), insulin (r=-0.290, P=0.017) and uric acid (r=-0.303, P=0.012). HRR showed a lower prevalence of abdominal obesity, hypertriglyceridemia, and low HDL-cholesterol in the third tertile than in the first tertile. In conclusion, MHO had no difference in vagal activity compared with MHNO, but MUO had low vagal activity. HRR is associated with metabolic parameters and is a useful predictor of abdominal obesity, hypertriglyceridemia, and low HDL-cholesterolemia

Keywords : Heart rate recovery, MHO, MUO
꽌濡

옄쑉떊寃쎄퀎 湲곕뒫옣븷뒗 鍮꾨쭔쓣 룷븿븳 궗利앺썑援 援ъ꽦슂냼 諛 떖룓泥대젰怨 愿젴씠 엳뒗 떖삁愿怨 쐞뿕씤옄씠떎 (Bjelakovic et al., 2017). 삉븳 援먭컧떊寃쎌쓽 솢꽦 利앷 遺援먭컧떊寃쎌쓽 솢꽦룄 媛먯냼뿉 뵲瑜 옄쑉떊寃쎄퀎 議곗젅뒫젰쓽 븯뒗 궗씠긽쓣 삁痢≫븳떎怨 蹂닿퀬맂떎(Berntson et al., 2008; Licht et al., 2013). 떖諛뺤닔 쉶蹂(heart rate recovery, HRR) 媛꾨떒븯寃 옄쑉떊寃쎄퀎 洹좏삎쓣 寃利앺븯뒗 吏몴씠硫, 떖삁愿吏덊솚쓽 씠솚쑉 諛 궗留앸쪧쓣 삁痢≫븯뒗뜲 쑀슜븳 깮由ъ쟻 吏몴씠떎(Peçanha et al., 2014; Yu et al., 2016). 떖諛뺤닔 쉶蹂듭 슫룞 吏곹썑쓽 옄쑉떊寃쎄퀎 蹂솕瑜 諛섏쁺븯硫, 理쒕 떖諛뺤닔 슫룞 썑 1遺꾨 떖諛뺤닔쓽 李⑥씠濡 젙쓽릺뒗 遺援먭컧떊寃 옱솢꽦룄瑜 굹궦떎(Shetler et al., 2001; Kim et al., 2011). 삉븳 궗利앺썑援곗 옄쑉떊寃쎄퀎 湲곕뒫옣븷 븿猿 떖삁愿吏덊솚 쐞뿕쓣 利앷떆궎뒗 슂씤쑝濡 젣떆릺硫, 援궡뿉꽌 꽦씤쓣 긽쑝濡 뙆븙븳 궗利앺썑援 쑀蹂묐쪧 1998뀈 24.9%뿉꽌 2007뀈뿉뒗 31.3%濡 利앷븯뒗 異붿꽭瑜 蹂댁씤떎(Curtis and O’Keefe, 2002; Libby et al., 2002; Lim et al., 2011). 궗利앺썑援곗쓽 떖諛뺤닔 쉶蹂듭뿉 븳 Shin (2011)쓽 뿰援ш껐怨쇱뿉 뵲瑜대㈃ 30꽭 씠긽 꽦씤쓣 긽쑝濡 궗利앺썑援 쐞뿕슂씤씠 뾾뒗援 蹂대떎 궗利앺썑援 吏꾨떒援곗뿉꽌 뒭 떖諛뺤닔 쉶蹂듭쓣 蹂댁씤떎怨 蹂닿퀬븯쑝硫, 쑀궗븯寃 Singh怨 Shen(2013) 泥냼뀈쓣 긽쑝濡 젙긽 泥댁쨷蹂대떎 怨쇱껜以 泥냼뀈뿉꽌 誘몄<떊寃 솢꽦룄쓽 媛먯냼濡 씤빐 떖諛뺤닔 쉶蹂듭씠 뒓由щ떎뒗 寃곌낵瑜 젣떆븯떎. 諛섎㈃ 留덈Ⅸ 泥댄삎怨 鍮꾨쭔 泥댄삎쓽 理쒕 슫룞 썑 떖諛뺤닔 쉶蹂듦낵 떖諛뺣룞닔 蹂씠(heart rate variability)뿉뒗 李⑥씠媛 뾾떎뒗 씪愿릺吏 븡 寃곌낵媛 蹂닿퀬맂떎(Guilkey et al., 2017).

븳렪, 泥댁쭏웾吏닔(body mass index, BMI)瑜 湲곗쑝濡 怨쇱껜以묒씠굹 鍮꾨쭔씤 씠긽吏吏덊삁利, 怨좏삁븬 諛 떦눊蹂묎낵 媛숈 궗빀蹂묒쬆쓽 쑀蹂묒쑉씠 넂쑝굹, 紐⑤뱺 怨쇱껜以묎낵 鍮꾨쭔씤뿉꽌 궗쟻쑝濡 씠긽쓣 굹궡뒗 寃껋 븘땲떎(Grundy, 2004; Dorresteijn et al., 2012). 怨쇱껜以 삉뒗 鍮꾨쭔씤쓽 18~44%뒗 씤뒓由 媛먯닔꽦씠 넂怨 떦눊蹂, 씠긽吏吏덊삁利, 怨좏삁븬, 궙 뿼利 諛 媛 슚냼移섎 蹂댁뿬 씠윭븳 궗엺쓣 궗쟻쑝濡 嫄닿컯븳 鍮꾨쭔씤(metabolically healthy obesity, MHO)씠씪怨 洹쒖젙븯怨 엳떎(Primeau et al., 2011). 븯吏留 鍮꾨쭔씤뿉꽌 뒓由 떖諛뺤닔 쉶蹂듭쓣 蹂댁씠뒗 寃껋뿉 븳 紐낇솗븳 利앷굅뒗 遺議깊븯硫, 援궡뿉꽌뒗 궗쟻쑝濡 嫄닿컯븳 鍮꾨쭔援곌낵 궗쟻쑝濡 씠긽씠 엳뒗 鍮꾨쭔援곗쓣 援щ텇븯뿬 떖諛뺤닔 쉶蹂듦낵쓽 愿怨꾨 솗씤븳 뿰援щ뒗 젣븳쟻씠떎. 삉븳 븘떆븘씤 諛깆씤怨 鍮꾧탳븯뿬 BMI媛 궙吏留 떖삁愿吏덊솚쓽 諛쒖깮 쐞뿕 뜑 넂 寃껋쑝濡 蹂닿퀬릺怨 엳뼱 꽌援ъ씤쓣 긽쑝濡 븳 뿰援ш껐怨쇰 援궡뿉 쟻슜븯湲곗뿉 뼱젮씠 엳떎(Deurenberg et al., 1998).

蹂 뿰援ъ쓽 紐⑹쟻 궗쟻쑝濡 嫄닿컯븳 鍮꾨쭔援곌낵 궗쟻쑝濡 씠긽씠 엳뒗 鍮꾨쭔援곌컙뿉 옄쑉떊寃쎄퀎 씠긽쓣 媛꾨떒븯寃 寃利앺븷 닔 엳뒗 吏몴씤 떖諛뺤닔 쉶蹂듭쓽 李⑥씠瑜 鍮꾧탳븯怨 떖諛뺤닔 쉶蹂듭씠 궗利앺썑援 諛쒕퀝쓣 삁痢≫븯뒗 吏몴씤吏瑜 솗씤븯怨좎옄 븯떎.

옱猷 諛 諛⑸쾿

뿰援 긽옄 諛 궗利앺썑援 吏꾨떒湲곗

蹂 뿰援ъ쓽 긽옄뒗 2016뀈 3썡遺꽣 2018뀈 3썡源뚯 寃쎄린냼옱 씪媛 醫낇빀蹂묒썝 醫낇빀寃吏꾩꽱꽣뿉꽌 슫룞遺븯寃궗瑜 諛쏆 20꽭 씠긽쓽 꽦씤쓣 뿰援 긽쑝濡 븯떎. 쟾泥 긽옄 210紐 以 떖諛뺤닔뿉 쁺뼢쓣 誘몄튂뒗 빟젣瑜 蹂듭슜 以묒씤 옄, 떊泥 怨꾩륫移 諛 삁븸寃궗 닔移섍 늻씫맂 옄, 쇅援씤 긽옄瑜 젣쇅븳 理쒖쥌 뿰援ъ뿉 룷븿맂 긽옄뒗 197紐낆씠뿀떎. 蹂듭슜 以묒씤 빟젣뿉 븳 젙蹂대뒗 옄湲곌린엯떇 꽕臾몄瑜 넻빐 뼸뿀쑝硫, 蹂 뿰援щ뒗 寃쎄린냼옱 醫낇빀蹂묒썝뿉꽌 湲곌깮紐낆쑄由ъ쐞썝쉶쓽 떖쓽瑜 諛쏆븘 떆뻾릺뿀떎. 궗利앺썑援곗 NCEP-ATP III (Executive Summary of The Third Report of The National Cholesterol Education Program Adult Treatment Panel III) 湲곗뿉 뵲씪 5媛吏 빆紐 以 3媛吏 씠긽 빐떦븯뒗 寃쎌슦 궗쟻쑝濡 씠긽씠 엳떎怨 뙋젙븯떎(National Cholesterol Education Program-Adult Treatment Panel III, 2001). 궗利앺썑援 吏꾨떒湲곗 以 蹂듬鍮꾨쭔 븘떆븘씤쓽 湲곗쓣 쟻슜븯떎(WHO, 2000). 삉븳 꽭怨꾨낫嫄닿린援ъ뿉꽌 젣떆븳 븘떆븘씤쓽 湲곗뿉 뵲씪 BMI ≥ 25 kg/m2씤 寃쎌슦 鍮꾨쭔쑝濡 뙋젙븯쑝硫, 젙긽 泥댁쨷 18.5~22.9 kg/m2濡 젙쓽븯떎(WHO, 2000). 씠긽쓽 궗利앺썑援곌낵 鍮꾨쭔쓽 젙쓽뿉 뵲씪 궗쟻쑝濡 嫄닿컯븳 젙긽 泥댁쨷援(metabolically healthy nonobesity, MHNO, n=113), 궗쟻쑝濡 嫄닿컯븳 鍮꾨쭔援(metabolically healthy obesity, MHO, n=66), 궗쟻쑝濡 씠긽씠 엳뒗 鍮꾨쭔援(metabolically unhealthy obesity, MUO, n=18)쑝濡 吏묐떒쓣 遺꾨쪟븯떎(Oh et al., 2006).

떊泥 怨꾩륫 諛 삁븸寃궗

DS-103M (Jenix, Seoul, Korea) 옄룞 떊泥 怨꾩륫湲곕 궗슜븯뿬 떊옣怨 泥댁쨷쓣 怨꾩륫븯쑝硫, BMI뒗 泥댁쨷(kg) / {떊옣(m2)}濡 怨꾩궛븯뿬 젣떆븯떎. 뿀由щ몮젅뒗 뼇諛쒖쓣 25~30 cm 젙룄 踰뚮━怨 닲쓣 궡돭 긽깭濡 媛덈퉬堉 媛옣 븘옒 遺遺꾧낵 怨⑤컲쓽 媛옣 넂 쐞移섏씤 옣怨⑤뒫쓽 以묎컙遺쐞瑜 以꾩옄濡 痢≪젙븯떎. 뿁뜦씠 몮젅뒗 뿁뜦씠쓽 媛옣 룎異쒕맂 吏젏쓣 吏굹 닔룊쑝濡 痢≪젙븯怨 뿀由щ몦遺鍮(waist to hip ratio, WHR)뒗 뿀由щ몮젅瑜 뿁뜦씠 몮젅濡 굹늿 媛믪쑝濡 븯떎. 삁븬 10遺 젙룄 븞젙쓣 痍⑦븳 썑 닔 삁븬怨(HICO, Tokyo, Japan)濡 10遺 媛꾧꺽쑝濡 2쉶 痢≪젙븯뿬 룊洹좉컪쓣 쟻슜븯떎. 삁븸遺꾩꽍 8떆媛 씠긽 怨듬났 썑 쟾二쇱젙留(antecubital vein)뿉꽌 梨꾪삁븯뿬 珥앹퐳젅뒪뀒濡, 以묒꽦吏諛, HDL-肄쒕젅뒪뀒濡, LDL (low density lipoprotein)-肄쒕젅뒪뀒濡, 怨듬났삁떦, 슂궛, 怨좉컧룄 C-諛섏쓳 떒諛(high sensitivity Creactive protein, hs-CRP), 샇紐⑥떆뒪뀒씤쓣 옄룞깮솕븰遺꾩꽍湲 TBA-200FR NEO (Toshiba, Tokyo, Japan)濡 痢≪젙븯떎. 떦솕삁깋냼(hemoglobin A1c, HbA1c)뒗 Variant II (Bio-Rad, CA, USA)濡 HPLC (high performance liquid chromatography, HPLC)踰뺤쑝濡 痢≪젙븯떎. 씤뒓由곗 Modular Analytics E170 (Roche, Mannheim, Germany) 옣鍮꾨줈 ECLIA (electrochemiluminescence immunoassay)쓽 썝由щ줈 寃궗븯쑝硫, 紐⑤뱺 삁븸寃궗뒗 寃쎄린냼옱 醫낇빀蹂묒썝 吏꾨떒寃궗쓽븰怨쇱뿉꽌 吏곸젒 遺꾩꽍븯떎.

슫룞遺븯寃궗

슫룞遺븯寃궗뒗 treadmill (Medtrack ST 55, Quinton Instrument Co., USA) 湲곌뎄濡 Bruce protocol뿉 뵲씪 利앹긽 젣븳꽦(symptom limited) 슫룞遺븯瑜 떆뻾븯떎. Bruce protocol 3遺 媛꾧꺽쑝濡 쉶쟾냽룄 寃쎌궗룄뿉 쓽빐 슫룞 떒怨꾨퀎(stage) 遺븯웾쓣 利앷떆궎뒗 諛⑸쾿씠떎. 슫룞吏곸쟾怨 슫룞 以 3遺 媛꾧꺽쑝濡 떖쟾룄, 삁븬, 떖諛뺤닔瑜 湲곕줉븯쑝硫, 슫룞 썑 쉶蹂듦린뒗 1遺, 3遺, 5遺꾨뿉 떖쟾룄, 삁븬, 떖諛뺤닔瑜 痢≪젙븯떎. 슫룞遺븯寃궗 以 떖諛뺤닔 떖쟾룄 痢≪젙 12梨꾨꼸 Quinton stress test system (Q4500, Quinton Instrument Co., USA)쑝濡 痢≪젙븯쑝硫, 220뿉꽌 寃궗옄쓽 굹씠瑜 類 理쒕 떖諛뺤닔쓽 85~90% 씠긽 룄떖븷 븣源뚯 슫룞遺븯 寃궗瑜 떆뻾븯떎. 삉븳 슫룞媛뺣룄뒗 궗떦웾(metabolic equivalents, MET)쑝濡 援ы븯쑝硫, treadmill 냽룄 寃쎌궗룄瑜 씠슜븯뿬 援ы븯떎. 슫룞 썑 쉶蹂듦린 諛섏쓳 treadmill 寃쎌궗룄 0%, 냽룄 1.3 mph濡 븯뿬 30~40珥덇컙 嫄룰쾶 븯怨, treadmill씠 셿쟾엳 젙吏븳 떎쓬 移⑤뿉 늻썙 5遺 룞븞 떖쟾룄, 삁븬, 떖諛뺤닔쓽 쉶蹂 諛섏쓳쓣 湲곕줉븯떎. 떖諛뺤닔 쉶蹂(heart rate recovery, HRR) 슫룞遺븯寃궗떆 룄떖븳 理쒕 떖諛뺤닔뿉꽌 1遺꾨 쉶蹂듦린 떖諛뺤닔瑜 類 媛믪쑝濡 怨꾩궛븯떎(Cole et al., 1999). 理쒕 떖諛뺤닔 諛 삁븬 슫룞떆, 쉶蹂듦린 룞븞뿉 媛옣 넂 떖諛뺤닔 諛 삁븬쑝濡 젙쓽븯떎.

옄猷뚯쿂由щ갑踰

넻怨꾨텇꽍 SPSS Windows 21.0 (IBM, Armonk, USA) 봽濡쒓렇옩쑝濡 遺꾩꽍븯떎. MHNO, MHO, MUO援곗쓽 꽭 吏묐떒媛 씤泥댁륫젙 蹂씤, 깮솕븰쟻 蹂씤 諛 떖諛뺤닔 쉶蹂듭쓣 룷븿븳 슫룞遺븯寃궗뿉 뵲瑜 삁뿭븰쟻 諛섏쓳쓽 李⑥씠瑜 솗씤븯湲 쐞빐 씪썝遺꾩궛遺꾩꽍(one-way ANOVA)쓣 떆뻾븯쑝硫, 궗썑寃젙 Scheffe 寃젙諛⑸쾿쓣 쟻슜븯떎. 삉븳 移댁씠젣怨 寃젙(chi-square test)쓣 넻빐 꽭 吏묐떒媛 꽦蹂꾩뿉 李⑥씠媛 엳뒗吏瑜 솗씤븯떎. 떖諛뺤닔 쉶蹂듦낵 궗利앺썑援 愿젴 吏몴뱾媛꾩쓽 愿젴꽦쓣 븣븘蹂닿린 쐞빐 꽦蹂꾧낵 뿰졊쓣 蹂댁젙븳 썑 긽愿愿怨(correlation coefficient) 遺꾩꽍쓣 떆뻾븯쑝硫, 떖諛뺤닔 쉶蹂듭쓣 궪遺꾩쐞닔濡 굹늻뼱 궗利앺썑援 諛 궗利앺썑援 援ъ꽦슂냼쓽 諛쒕퀝 쐞뿕쓣 븣븘蹂닿린 쐞빐 꽦蹂꾧낵 뿰졊쓣 蹂댁젙븳 썑 濡쒖뒪떛 쉶洹(logistic regression) 遺꾩꽍쓣 떎떆븯떎. 紐⑤뱺 넻怨꾩쟻 쑀쓽닔以 P<0.05濡 젙븯떎.

寃곌낵

吏묐떒媛 씤泥댁륫젙 諛 깮솕븰쟻 吏몴

씠 뿰援ъ뿉꽌뒗 긽옄瑜 MHNO, MHO, MUO援곗쑝濡 遺꾨쪟븯뿬 吏묐떒媛 씤泥댁륫젙 諛 깮솕븰쟻 吏몴쓽 李⑥씠瑜 鍮꾧탳븳 寃곌낵 Table 1怨 媛숇떎. 뿰졊 吏묐떒媛 李⑥씠媛 뾾뿀쑝굹, 꽦蹂꾩 MHNO, MHO, MUO 꽭 吏묐떒媛 李⑥씠媛 엳뿀떎(P=0.016). 泥댁쨷, BMI, 뿀由щ몮젅, 뿁뜦씠 몮젅뒗 MHNO援곕낫떎 MHO援곌낵 MUO援곗씠 넂븯쑝硫, MUO援곗 MHO援곕낫떎 넂븯떎(紐⑤몢 P<0.001). WHR, 닔異뺢린 씠셿湲 삁븬 MHNO援곕낫떎 MHO援곌낵 MUO援곗씠 넂븯떎(紐⑤몢 P<0.001). 珥앹퐳젅뒪뀒濡(P=0.004)怨 LDL-肄쒕젅뒪뀒濡(P<0.001) MHNO援곕낫떎 MHO援곗씠 넂븯떎. 以묒꽦吏諛, 怨듬났삁떦, HbA1c뒗 MHNO援곌낵 MHO援곕낫떎 MUO援곗씠 넂븯떎(紐⑤몢 P<0.001). 씤뒓由곗 MHNO援곕낫떎 MHO援곌낵 MUO援곗씠 넂븯쑝硫, MUO援곗 MHO援곕낫떎 넂븯떎(P<0.001). 슂궛 MHNO援곕낫떎 MHO援곌낵 MUO援곗뿉꽌 넂寃 굹궗떎(P=0.001). HDL-肄쒕젅뒪뀒濡ㅼ MHNO援곕낫떎 MUO援곗씠 궙븯쑝硫(P=0.001), hs-CRP 샇紐⑥떆뒪뀒씤 吏묐떒媛 李⑥씠媛 뾾뿀떎.

Anthropometric and biochemical characteristics of the study subjects according to obesity phenotype

 VariablesMHNO (n=113)MHO (n=66)MUO (n=18)P-value
Age (years)46.30±10.5149.19±9.3251.22±6.720.050
Sex (male, %)§72 (63.7)55 (83.3)14 (77.8)0.016
Height (cm)165.58±8.80167.45±8.72168.36±8.630.245
Weight (kg)60.58±8.2175.51±10.30*81.50±10.91*<0.001
BMI (kg/m2)21.99±1.6726.84±2.04*28.72±2.53*<0.001
WC (cm)76.95±6.7087.30±6.26*93.88±6.72*<0.001
HC (cm)91.52±4.7198.07±3.93*101.43±8.03*<0.001
WHR0.85±0.060.93±0.04*0.95±0.05*<0.001
SBP (mmHg)109.77±13.09117.80±14.19*123.05±13.51*<0.001
DBP (mmHg)71.32±9.9176.66±9.29*82.50±11.66*<0.001
TC (mg/dL)195.01±30.51212.33±37.99*197.05±30.580.004
TG (mg/dL)111.94±66.02131.43±68.76217.83±103.14*<0.001
HDL-C (mg/dL)55.36±13.6651.34±11.4143.61±11.35*0.001
LDL-C (mg/dL)121.76±27.54141.13±34.31*123.61±31.06<0.001
Glucose (mg/dL)92.01 ±17.5494.48±9.98112.50±24.04*<0.001
HbAlc (%)5.71±0.655.73±0.406.48±0.81*<0.001
Insulin (μυ/mL)4.74±2.747.51±4.07*10.69±6.10*<0.001
Uric acid (mg/dL)5.17±1.405.88±1.30*6.15±1.36*0.001
hs-CRP (mg/dL)0.16±0.400.30±0.860.22±0.170.363
Homocysteine12.09±3.6413.19±4.0712.83±3.210.171

Calculated by one way ANOVA and Scheffe test. Values are presented as mean±SD.

*Significantly different from MHNO at P<0.05,

Significantly different from MHO at P<0.05.

§Calculated by χ2-test. Data are presented as number (%).

Abbreviation: MHNO, metabolically healthy non obesity; MHO, metabolically healthy obesity; MUO, metabolically unhealthy obesity; BMI, body mass index; WC, waist circumference; HP, hip circumference; WHR, waist hip ratio; SBP, systolic blood pressure; DBP, diastolic blood pressure; TC, total cholesterol; TG, triglyceride; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; HbAlc, hemoglobin A1c; hs-CRP, high sensitivity C-reactive protein.


吏묐떒媛 슫룞遺븯寃궗뿉 뵲瑜 삁뿭븰쟻 諛섏쓳

吏묐떒媛 슫룞遺븯寃궗뿉 뵲瑜 삁븸븰쟻 諛섏쓳쓽 李⑥씠瑜 鍮꾧탳븳 寃곌낵 슫룞吏냽떆媛꾩 MHNO援곌낵 MHO援곕낫떎 MUO援곗씠 궙寃 굹궗쑝굹(P=0.047), MET뒗 吏묐떒媛 李⑥씠媛 뾾뿀떎. 븞젙떆 닔異뺢린 삁븬(P=0.009)怨 理쒕 떖諛뺤닔(P=0.001), 理쒕 닔異뺢린 삁븬(P=0.005) MHNO援곕낫떎 MHO援곌낵 MUO援곗씠 넂븯쑝硫, 븞젙떆 씠셿湲 삁븬 MHNO援곌낵 MHO援곕낫떎 MUO援곗씠 넂븯떎(P=0.001) (Table 2). 삉븳 떖諛뺤닔 쉶蹂듭 MUO援곕낫떎 MHO援곗씠 넂 寃쏀뼢쓣 蹂댁쑝굹 넻怨꾩쟻 쑀쓽꽦 뾾뿀쑝硫, MHNO援곕낫떎 MUO援곗씠 궙寃 굹궗떎(P=0.009) (Fig. 1).

Exercise capacity and haemodynamic parameters of the study subjects according to obesity phenotype

 VariablesMHNO (n=113)MHO (n=66)MUO (n=18)P-value
Exercise duration (min)9.89±1.669.57±2.008.81±1.39*0.047
Exercise capacity (MET)11.96±1.8011.50±2.2310.92±1.490.064
Rest HR (beats/min)63.52±11.4660.66±7.5763.55±11.180.187
Rest SBP (mmHg)116.46±14.35121.83±14.39*125.22±12.84*0.009
Rest DBP (mmHg)72.89±11.1876.40±10.8382.61±11.05*0.001
Max HR (beats/min)164.26±13.98157.48±17.62*151.88±13.70*0.001
Max SBP (mmHg)160.99±18.75170.04±24.11*173.88±25.19*0.005
Max DBP (mmHg)79.40±11.5881.78±11.2285.05±11.340.101

Calculated by one way ANOVA and Scheffe test. Values are presented as mean±SD.

*Significantly different from MHNO at P<0.05, Significantly different from MHO at P<0.05. Abbreviation: MHNO, metabolically healthy non obesity; MHO, metabolically healthy obesity; MUO, metabolically unhealthy obesity; obesity; MHO, metabolically healthy obesity; MUO, metabolically abnormal obesity; MET, metabolic equivalents; SBP, systolic blood pressure; DBP, diastolic blood pressure; HR, heart rate; HRR, heart rate recovery.


Fig. 1.

Difference of HRR of MHNO, MHO and MUO groups MHNO (34.51±11.80), MHO (32.71±12.25), MUO (25.53±8.13). *Significantly different from MHNO at P<0.05. Abbreviation: MHNO, metabolically healthy non obesity; MHO, metabolically healthy obesity; MUO, metabolically abnormal obesity; HRR, heart rate recovery.


鍮꾨쭔援곗뿉꽌 떖諛뺤닔 쉶蹂듦낵 궗利앺썑援 愿젴 吏몴뱾媛꾩쓽 긽愿꽦

뿰졊怨 꽦蹂꾩쓣 蹂댁젙븳 썑 鍮꾨쭔援곗뿉꽌 떖諛뺤닔 쉶蹂듦낵 궗利앺썑援 愿젴 吏몴뱾媛꾩쓽 긽愿愿怨꾨 遺꾩꽍븳 寃곌낵 BMI(r=-0.342, P=0.004), 뿀由щ몮젅(r=-0.246, P=0.043), HbA1c(r=-0.315, P=0.009), 씤뒓由(r=-0.290, P=0.017), 슂궛(r=-0.303, P=0.012), 以묒꽦吏諛(r=-0.350, P=0.003) 떖諛뺤닔 쉶蹂듦낵 쑀쓽븳 뿭긽愿 愿怨꾨 굹깉떎(Table 3) (Fig. 2).

Fig. 2.

Age and gender adjusted correlations between the heart rate recovery and triglyceride in obese. Abbreviation: TG, triglyceride; HRR, heart rate recovery.


Age and gender adjusted correlations the heart rate recovery and metabolic parameters in obese

Metabolic parametersHRR (beats)

Correlation coefficientP-value
BMI (kg/m2)-0.3420.004
WC (cm)-0.2460.043
SBP (mmHg)0.0150.904
DBP (mmHg)-0.1070.385
TC (mg/dL)0.0650.596
HDL-C (mg/dL)0.1470.230
LDL-C (mg/dL)0.0880.478
Glucose (mg/dL)-0.2150.078
HbA1c (%)-0.3150.009
Insulin (μU/mL)-0.2900.017
Uric acid (mg/dL)-0.3030.012

Abbreviation: HRR, heart rate recovery; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; TC, total cholesterol; TG, triglyceride; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; HbA1c, hemoglobin A1c.


떖諛뺤닔 쉶蹂 궪遺꾩쐞닔뿉 뵲瑜 궗利앺썑援 諛 궗利앺썑援 援ъ꽦슂냼쓽 諛쒕퀝 쐞뿕

뿰졊怨 꽦蹂꾩쓣 蹂댁젙븳 썑 떖諛뺤닔 쉶蹂 궪遺꾩쐞닔뿉 뵲瑜 궗利앺썑援 諛 궗利앺썑援 援ъ꽦슂냼뿉 븳 援먯감鍮(odds ratio) 95% 떊猶곌뎄媛(confidence interval, CI)쓣 Table 4뿉 젣떆븯떎. 利앷맂 뿀由щ몮젅뒗 떖諛뺤닔 쉶蹂듭쓽 젣1궪遺꾩쐞닔蹂대떎 젣3궪遺꾩쐞닔뿉꽌 0.27諛(95% CI: 0.103~0.690), 넂 以묒꽦吏諛⑹ 떖諛뺤닔 쉶蹂 젣1궪遺꾩쐞닔蹂대떎 젣3궪遺꾩쐞닔뿉꽌 0.34諛(95% CI: 0.145~0.773) 궙 쑀蹂묐쪧쓣 굹깉떎(P<0.005). 삉븳 궙 HDL-肄쒕젅뒪뀒濡ㅼ 떖諛뺤닔 쉶蹂듭쓽 젣1궪遺꾩쐞닔蹂대떎 젣3궪遺꾩쐞닔뿉꽌 0.33諛(95% CI: 0.126~0.852) 궙 쑀蹂묐쪧쓣 蹂댁떎(P<0.005).

Adjusted odds ratios (OR) and 95% confidence intervals (CI) of the HRR associated with metabolic syndrome components

 Metabolic parameterHRR (beats)

1st Tertile2nd Tertile3rd Tertile
Large waist circumference1.00 (Reference)0.513 (0.222~1.187)0.266 (0.103~0.690)*
High triglyceride level1.00 (Reference)0.656 (0.306~1.405)0.335 (0.145~0.773)*
Reduced HDL-C1.00 (Reference)0.656 (0.285~1.508)0.328 (0.126~0.852)*
Increased blood pressure1.00 (Reference)0.518 (0.214~1.255)0.678 (0.288~1.599)
Elevated fasting blood sugar1.00 (Reference)0.794 (0.284~2.222)0.604 (0.201~1.813)
Metabolic syndrome1.00 (Reference)0.333 (0.079~1.400)1.083 (0.351~3.344)

Adjusted odds ratios for metabolic components and metabolic syndrome. Adjusted for age and gender.

*P<0.05. Abbreviation: HRR, heart rate recovery; HDL-C, high density lipoprotein cholesterol.


怨좎같

븳援꽦씤쓣 긽쑝濡 븳 씠 뿰援ш껐怨 MHO援곗 MHNO援곌낵 鍮꾧탳븯뿬 誘몄<떊寃 솢꽦룄뿉 李⑥씠媛 뾾뿀쑝굹, MUO援곗 뒭 떖諛뺤닔 쉶蹂듭쓣 蹂댁뿬 誘몄<떊寃 솢꽦룄媛 궙븯떎. 떖諛뺤닔 쉶蹂듭 BMI, 뿀由щ몮젅, 以묒꽦吏諛, HbA1c, 씤뒓由, 슂궛怨 뿭긽愿 愿怨꾨 蹂댁떎. 삉븳 떖諛뺤닔 쉶蹂듭 궗利앺썑援 援ъ꽦슂냼 以 蹂듬鍮꾨쭔, 怨좎쨷꽦吏諛⑺삁利, 궙 HDL-肄쒕젅뒪뀒濡ㅽ삁利앹쓣 삁痢≫븯뒗 쑀슜븳 吏몴엫쓣 솗씤븯떎.

궗쟻쑝濡 嫄닿컯븳 鍮꾨쭔씤 궗쟻쑝濡 씠긽씠 엳뒗 鍮꾨쭔씤뿉 鍮꾪빐 넂 씤뒓由 媛먯닔꽦怨 怨좏삁븬, 씠긽吏吏덊삁利, 뿼利 諛섏쓳 벑 궗쟻 씠긽쓽 諛쒖깮鍮덈룄媛 궙 寃껋쑝濡 븣젮졇 엳떎(Primeau et al., 2011). 듅엳 援먭컧떊寃쎌쓽 솢꽦룄 利앷 遺援먭컧떊寃쎌쓽 솢꽦솕 媛먯냼뿉 쓽븳 옄쑉떊寃쎄퀎 湲곕뒫옣븷뒗 鍮꾨쭔씤뿉꽌 옄二 諛쒓껄릺硫 씤뒓由 빆꽦, 以묒떖꽦 鍮꾨쭔, 떆긽븯遺쓽 뿼利, 떖룓泥대젰 븯쓽 寃곌낵濡 異붿젙릺怨 엳떎(Rodríguez-Colón et al., 2011; Zhu et al., 2016; Jais and Brüning, 2017). 옄쑉떊寃쎄퀎 諛 떖삁愿怨 湲곕뒫쓽 룊媛뒗 떖諛뺣룞닔 蹂씠 諛 븬젰닔슜泥 誘쇨컧룄(baroreceptor sensitivity)濡 異붿젙븷 닔 엳쑝굹, 痢≪젙쓽 媛꾪렪꽦 븣臾몄뿉 떖諛뺤닔 쉶蹂듭쓣 쓷엳 궗슜븳떎(Cole et al., 1999). 슫룞꽑닔굹 嫄닿컯씤 슫룞 썑 떖諛뺤닔 쉶蹂 諛섏쓳씠 鍮좊Ⅴ寃 굹굹硫, 뒓由 떖諛뺤닔 쉶蹂듭 怨좏삁븬, 떦눊蹂 諛 떖삁愿吏덊솚쓽 쐞뿕쓣 삁痢≫븯뒗 吏몴濡 젣떆맂떎(Imai et al., 1994; Cole et al., 1999; Nishime et al., 2000).

蹂 뿰援ш껐怨 MHO援곌낵 MUO援곌컙뿉 떖諛뺤닔 쉶蹂듭 李⑥씠媛 뾾뿀쑝굹, MHNO援곕낫떎 MUO援곗뿉꽌 뒭 떖諛뺤닔 쉶蹂 諛섏쓳쓣 굹깉떎. 씠뒗 궗利앺썑援곗쓣 룞諛섑븳 鍮꾨쭔꽦씤뿉꽌 떖諛뺤닔 쉶蹂듭쑝濡 룊媛맂 옄쑉떊寃 湲곕뒫옣븷媛 議댁옱븿쓣 븫떆븯뒗 寃곌낵씠떎. 삉븳 鍮꾨쭔씤뿉꽌 떖諛뺤닔 쉶蹂듭 궗吏몴 以 BMI, 뿀由щ몮젅, 以묒꽦吏諛, HbA1c, 씤뒓由, 슂궛怨 쑀쓽븳 뿭긽愿 愿怨꾨 蹂댁떎. 理쒓렐 뿰援ъ뿉꽌 떖諛뺤닔 쉶蹂듭쓽 媛먯냼뒗 BMI媛 넂쓣닔濡 쁺뼢쓣 諛쏆쑝硫, 궗쟻쑝濡 嫄닿컯븳 鍮꾨쭔 븘룞蹂대떎 궗쟻쑝濡 씠긽씠 엳뒗 鍮꾨쭔 븘룞뿉꽌 떖諛뺤닔 쉶蹂듭쑝濡 룊媛븳 옄쑉떊寃쎄퀎 湲곕뒫옣븷媛 議댁옱븿쓣 솗씤븯떎(Bjelakovic et al., 2017). 삉븳 MHO援곗 MUO援곌낵 鍮꾧탳븯뿬 떖삁愿怨꾩쭏솚 諛 궗留 쐞뿕씠 궙쑝硫, MHNO援곌낵 鍮꾧탳븯뿬룄 쐞뿕씠 넂吏 븡 寃껋쑝濡 蹂닿퀬맂떎(Phillips, 2013; Stefan et al., 2013; Blüher, 2014; Samocha-Bonet et al., 2014). 삉 떎瑜 뿰援ъ뿉꽌뒗 MHO援곗뿉꽌 쁽븯吏뒗 븡쑝굹 옞옱쟻씤 떖삁愿吏덊솚 쐞뿕怨 궗옣븷瑜 궡룷븯怨 엳뼱 泥댁쨷留뚯쑝濡 嫄닿컯 긽깭瑜 뙆븙븯뒗 寃껋쓽 遺쟻빀꽦쓣 蹂닿퀬븯떎(Hong et al., 2012; Shin et al., 2017). 씠윭븳 寃곌낵뱾쓣 醫낇빀븯硫 鍮꾨쭔븯뜑씪룄 궗쟻 긽깭뿉 뵲씪 鍮꾨쭔쓽 以묒옱쟻 젒洹쇱쓣 떖由ы빐빞 븯硫, 옞옱쟻씤 떖삁愿怨꾨 룊媛븯뒗뜲 鍮꾨쭔 긽깭肉먮쭔 븘땲씪 궗쟻 씠긽 쑀臾대 룞떆뿉 怨좊젮븯뒗 寃껋씠 以묒슂븿쓣 쓽誘명븳떎. 洹몃윭굹 뵾뿕옄쓽 嫄닿컯 긽깭뒗 MHO援곗뿉꽌 MUO援곗쑝濡 쟾솚맆 닔 엳쑝硫, 洹 諛섎룄 쟾솚맆 닔룄 엳떎. 삁而⑤, Soriguer 벑(2013) 6뀈媛꾩쓽 異붿쟻愿李 寃곌낵 MHO쓽 30~40%媛 MUO濡 쟾솚맂 寃껋쓣 솗씤븯떎. Adelaide Health Study뿉꽌뒗 5.5~10.3뀈쓽 異붿쟻愿李 湲곌컙 룞븞 MHO 몴쁽삎쓣 蹂댁뜕 媛쒖씤쓽 빟 1/3씠 MUO 몴쁽삎쑝濡 쟾솚릺뼱 MHO 몴쁽삎 젙쟻씤 긽깭媛 븘땲씪뒗 寃껋쓣 利앸챸븯떎(Appleton et al., 2013). 蹂 뿰援ъ뿉꽌 떖諛뺤닔 쉶蹂듭 젣1궪遺꾩쐞닔蹂대떎 젣3궪遺꾩쐞닔뿉꽌 蹂듬鍮꾨쭔, 怨좎쨷꽦吏諛⑺삁利, 궙 HDL-肄쒕젅뒪뀒濡ㅽ삁利앹쓽 쑀蹂묐쪧씠 궙寃 굹굹 떖諛뺤닔 쉶蹂듭씠 궗利앺썑援 援ъ꽦슂냼 以 蹂듬鍮꾨쭔, 怨좎쨷꽦吏諛⑺삁利, 궙 HDL-肄쒕젅뒪뀒濡ㅽ삁利앹쓣 삁痢≫븯뒗 쑀슜븳 吏몴엫쓣 솗씤븯떎. 옄쑉떊寃쎄퀎 湲곕뒫옣븷뒗 떖삁愿怨 쐞뿕 利앷 諛 궗留앸쪧怨 愿젴씠 엳쑝誘濡 떖삁愿怨 쐞뿕쓣 룊媛븯湲 쐞빐꽌뒗 鍮꾨쭔씤쓽 떖諛뺤닔 쉶蹂듭쓣 痢≪젙븿쑝濡쒖뜥 옄쑉떊寃쎄퀎 湲곕뒫쓣 젙웾솕븷 븘슂꽦씠 엳寃좊떎(Bjelakovic et al., 2017). 洹몃윭굹 씠윭븳 紐⑹쟻쓣 쐞빐꽌뒗 떖諛뺤닔 쉶蹂듭쓣 룊媛븯뒗 봽濡쒗넗肄쒖쓽 몴以솕 몴쟻 옣湲곗넀긽쓽 쐞뿕쓣 삁痢≫븯뒗 떖諛뺤닔 쉶蹂듭쓽 쟻젙 젅떒媛믪뿉 븳 寃넗媛 슂援щ맂떎(Bjelakovic et al., 2017).

蹂 뿰援щ뒗 슒떒硫 뿰援щ줈 씤怨쇨怨꾨 洹쒕챸븯뒗뜲 뼱젮씠 엳쑝硫, 媛議깅젰, 쓬二, 씉뿰, 슫룞뒿愿 벑쓽 옄猷뚮議깆쑝濡 뿰援ъ뿉꽌 怨좊젮븯吏 紐삵븯떎. 洹몃윭굹 蹂 뿰援щ뒗 븳援씤쓣 긽쑝濡 鍮꾨쭔 몴쁽삎뿉 뵲瑜 떖諛뺤닔 쉶蹂 諛섏쓳쓽 李⑥씠 떖諛뺤닔 쉶蹂듦낵 궗吏몴媛꾩쓽 愿젴꽦 諛 떖諛뺤닔 쉶蹂듭쓽 궗利앺썑援 삁痢〓뒫젰쓣 솗씤븳 뿰援щ줈 쓽誘멸 엳寃좊떎.

ACKNOWLEDGEMENTS

None.

CONFLICTS OF INTEREST

The authors declare no conflicts of interest.

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