Relationship with body composition

Abstract

Obesity is a chronic, complex, multifactorial and multisystemic disease. The name of obesity as an adiposity-based chronic disease (ABCD) is of particular relevance, and is in line with the proposal of the European Association for the Study of Obesity (EASO) to improve diagnostic criteria based on three dimensions: etiology, degree of adiposity and health risks.

The correct approach to the person with obesity requires a greater understanding of the pathophysiology and characterization of the adipose organ, and in this way get closer to precision medicine. The body mass index (BMI) is the anthropometric measure used by the World Health Organization (WHO) to determine the nutritional status of a person because it is considered simple, reproducible and has a good correlation with cardiovascular disease. However, BMI as a single measure does not reflect all the complexity of the disease, since the information it provides does not offer data on body mass. Knowing the percentage of fat mass is relevant when understanding obesity as a disease of the adipose organ, whose defunctionalization generates a state of chronic low-grade inflammation with cardiometabolic consequences. Given the relationship of visceral adipose tissue with cardiometabolic comorbidities, another Anthropometric measurement such as waist circumference becomes important. Despite its limitations, it is a simple, economical method and is a good indicator of abdominal adiposity and morbidity and mortality.

The definition of obesity refers to excess adiposity, the amount of which correlates with the presence of comorbidities. Body composition measurement techniques facilitate the phenotyping of people with obesity from an anthropometric point of view in relation to the presence and distribution of adipose tissue. It provides us with data that allows us to understand the increased cardiovascular risk observed in relation to the dysfunctional fat mass that it secretes, proinflammatory adipocytokines and lead to increased cardiometabolic risk. The percentage of fat mass has a good correlation with cardiovascular disease and type 2 diabetes mellitus (T2DM), among other metabolic comorbidities. The cut-off points to define obesity are: in women ≥35% and in men ≥25%. Body composition has also made it possible to identify sarcopenic obesity, establish more refined obesity phenotypes and better define the cardiometabolic risk associated with obesity in order to act accordingly.

Currently there are different classifications to characterize people with obesity. It is essential that these Stratification systems take into account body composition to more accurately predict risk profiles for disease and mortality, and thus probably achieve greater success in their treatment.