![]() To assess this, there is increased interest in discovering biomarkers that differentiate those who are obese and metabolically well from those who are obese and metabolically unwell ( Zhong et al., 2017). This controversy suggests that current definitions of MS do not completely describe physiologic risk factors or consequences of this process. However, the use of these criteria has also led to the recognition of a population of obese individuals who have been designated as “metabolically well,” and studies differ over whether this group has a higher morbidity and earlier mortality than their lean counterparts ( Fan et al., 2013 Kramer, Zinman & Retnakaran, 2013 Mørkedal et al., 2014 Lavie, De Schutter & Milani, 2015). ![]() These criteria provide useful clinical and pathophysiological insights. ![]() These criteria differ, but most include increased body mass index, hyperglycemia, hypertension, and dyslipidemia to describe an individual’s degree of progression toward cardiovascular disease and/or T2D. To group these factors into standardized criteria, four main definitions of metabolic syndrome (MS) have been formulated: the original World Health Organization (WHO) definition of 1998 criteria of the European Group for the study of Insulin Resistance (EGIR) criteria of the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III and criteria of the International Diabetes Foundation (IDF) ( Alberti & Zimmet, 1998 Balkau & Charles, 1999 Zimmet et al., 2005 Grundy et al., 2005). Besides obesity, a constellation of factors is associated with the development of cardiovascular disease, T2D, and all-cause mortality. Obesity, a major risk factor for cardiovascular disease, type 2 diabetes (T2D), and all-cause mortality, has dramatically increased in population prevalence over the past several decades ( Ogden, Carroll & Flegal, 2003 The GBD 2015 Obesity Collaborators, 2017). Abbreviations are as follows: ABU, aminobutyrate ALA, alanine ASP, asparagine CIT, citrulline GLU, glutamate GLN, glutamine HIS, histidine ILE, isoleucine LEU, leucine LYS, lysine MET, methionine ORN, ornithine PHE, phenylalanine TAU, taurine THR, threonine TRP, tryptophan TYR, tyrosine VAL, valine C2, acetylcarnitine C3, propionylcarnitine C4, iso/butyrylcarnitine C5, isovalerylcarnitine, C6, hexanoylcarnitine C8, octanoylcarnitine C10, decanoylcarnitine C10:1, decenoylcarnitine C16, hexadecanoylcarnitine (palmitoylcarnitine), C16-OH=3-OH-hexadecenoylcarnitine. Glucogenic amino acids are alanine, arginine, asparagine, aspartic acid, cystine, glutamate, glutamine, glycine, histidine, methionine, proline, serine, and valine. Both glucogenic and ketogenic amino acids are isoleucine, phenylalanine, threonine, tryptophan, and tyrosine. Values are rounded to 0.1 and are given as median (Q1, Q3) Bolded values were significantly different upon Kruskal-Wallis testing ( p < 0.005). Table S5C: Median sums or ratios Acylcarnitine levels are reported as nanomoles/liter, except for C0 and C2 that are reported as micromoles/liter.
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