Table 3.
Association of NWO with CMRFs in included studies.
| Author Year | Outcome | Definition of outcome | OR (95% CI)** | Adjustment |
|---|---|---|---|---|
| W. K. Cho 2015 (17) (Male) | HOMA | Fasting glucose (in millimoles per liter) × fasting insulin (in milliunits per liter)/22.5 | 2.46 (1.21-4.99) | Age, weight, and ALT |
| W. K. Cho 2015 (17) (Female) | HOMA | 1.51 (0.83-2.75) | ||
| M. Correa 2020 (18) | hyperglycemia | FBS ≥5.6 mmol/L [100 mg/dL] | 1.31 (0.73-2.33) | Age and sex |
| HTN | ≥130 mm Hg SBP and/ or DBP 85 mm Hg | 1.42 (0.89-2.27) | ||
| Elevated TG | ≥1.7 mmol/L [151 mg/dL] | 1.31 (0.62-2.76) | ||
| Elevated LDL | ≥2.6 mmol/L [100 mg/dL] | 1.27 (0.85-1.90) | ||
| Reduced HDL | low HDL: < 1 mmol/L [38.7 mg/dL] in men and 1.3 mmol/L [50.3 mg/dL] in women | 2.34 (1.61-3.93)* | ||
| Cardiometabolic risk Z-score | + 1 SD above the mean | 3.10 (2.06-4.67)* | ||
| obesity | Waist to hip ratio > 0.49 in men and > 0.50 in women | 2.61 (0.69-9.87) | ||
| Abdominal Obesity | WC ≥ 90 cm in men, and ≥ 80 cm in women | 7.27 (1.09-48.60)* | ||
| Ramsaran 2017 (19) | Elevate DBP | high SBP and DBP systolic ≥ 120 mm Hg and the diastolic ≥ 80 mm Hg | 0.98 (0.39-2.48) | Not adjusted |
| Elevate SBP | 1.85 (0.52-5.52) | |||
| Elevated WC | men ≥ 94 cm and women ≥ 80 cm | 26.61 (4.75-149.14)* | ||
| H. He 2019 (21) | HTN | SBP ≥ 140 and,or DBP ≥ 90 | 1.82 (1.43-2.30)* | Age, sex, social economic profiles, lifestyle factors, family history of HTN and other disease status, etc. |
| A. Jia 2018 (22) | DM | FBS 7.0 ≥ mmol/L; blood glucose 2 h after an OGTT ≥ 11.1 mmol/L; a previous diagnosis of diabetes; or current use of hypoglycemic agents | 1.44 (1.10–1.88)* | Age , sex, ethnicity, smoking, alcohol use, exercise, education, yearly family income, family history of disease, and WC |
| HTN | SBP ≥ 130 and,or DBP ≥85 | 1.53 (1.27–1.84)* | ||
| MetS | IDF1 | 1.48 (1.22–1.79)* | ||
| Elevated Framingham risk | Score ≥ 10% | 2.36 (1.76–3.17)* | ||
| Kapoor 2020 (23) | DM | FBS ≥ 126 mg/dl and/or 2-h plasma glucose value of ≥ 200 mg/dl were diagnosed to have diabetes/ | 2.72 (1.46–5.08)* | Age, sex, tobacco use and alcohol intake |
| HTN | SBP ≥ 140 and, or DBP ≥ 90 | 1.89 (0.92–3.86) | ||
| Dyslipidemia | taking lipid-lowering medications and/or TC >200 mg/dl and/or LDL >100 mg/dl and/or HDL <40 mg/dl in men and <50 mg/dl in women and/ or TG >200 mg/dl. | 2.37 (1.55–3.64)* | ||
| Kim, 2014 (24) (Male) | DM | fasting blood glucose ≥ 126 mg/dl or treatment of the disease | 1.38 (1.04 -1.83)* | Age and lifestyle factors |
| HTN | SBP ≥ 140 and, or DBP ≥ 90 | 1.70 (1.42 - 2.02)* | ||
| dyslipidemia | total cholesterol ≥ 240 mg/dl and/or high-density lipoprotein (HDL) cholesterol <40 mg/dl and/or triglyceride ≥ 150 mg/dl or treatment of dyslipidemia** | 2.69 (2.29 - 3.17)* | ||
| MetS | 2.50 ( 2.10 - 2.97)* | |||
| Mets risk factor above 1 | plus 1 metabolic risk odds | 3.54 ( 2.89 - 4.34)* | ||
| Kim, 2014 (24) (Female) | DM | fasting blood glucose ≥ 126 mg/dl or treatment of the disease | 1.72 (1.30 - 2.29)* | |
| HTN | SBP ≥ 130 mmHg and, or DBP ≥85 mmHg | 1.52 (1.25 - 1.86)* | ||
| dyslipidemia | total cholesterol ≥ 240 mg/dl and/or high-density lipoprotein (HDL) cholesterol <40 mg/dl and/or triglyceride ≥ 150 mg/dl or treatment of dyslipidemia** | 1.70 (1.40 - 2.06)* | ||
| MetS | 1.80 (1.48 - 2.20)* | |||
| Mets risk factor above 1 | plus 1 metabolik risk odds | 2.47 (2.01 - 3.03)* | ||
| Kim 2018 (25) | MetS | IDF | 1.83 (1.21 - 2.76)* | Potential confounders |
| Plaque formation risk | (–) | 1.46 (1.027 - 2.07)* | ||
| H. Zhao 2012 (27) | HTN risk | (-) | 2.18* | Age and sex |
| Hyperglycemia | 2.12* | |||
| dyslipidemia | 2.08* | |||
| Hyperuricemia | 3.49* | |||
| Tayefi 2019 (28) | Risk of metabolically abnormal phenotype | (-) | 2.02 (1.68-2.42)* | Age and sex |
| Cardiac risk (Q) | QRISK calculated online by using the Framingham risk equation | 6 (4.45-8.08)* | ||
| T. Shirasawa 2019 (8) (Male) | DM | FBS ≥ 126 mg/dl, random plasma glucose ≥ 200 mg/dl, HbA1c (National Glycohemoglobin Standardization Program) ≥ 6.5%, or receiving medical treatment for DM | 1.35 (1.25-1.46)* | Age, weight, smoking status, alcohol intake, and physical activity |
| HTN | SBP ≥ 140 and, or DBP ≥ 90 or taking medication for HTN | 1.22 (1.17-1.27)* | ||
| Dyslipidemia | as LDL-C ≥ 140 mg/dl, HDL-C < 40 mg/dl, TG ≥ 150 mg/dl, or taking medication for dyslipidemia | 1.84 (1.74-1.89)* | ||
| T. Shirasawa 2019 (8) (Female) | DM | FBS ≥ 126 mg/dl, random plasma glucose ≥ 200 mg/dl, HbA1c ≥ 6.5%, or receiving medical treatment for DM | 1.60 (1.35-1.90)* | |
| HTN | SBP ≥ 140 and,or DBP ≥ 90 or taking medication for hypertension | 1.23 (1.16-1.31)* | ||
| dyslipidemia | as LDL-C ≥ 140 mg/dl, HDL-C < 40 mg/dl, triglycerides ≥ 150 mg/dl, or taking medication for dyslipidemia | 1.60 (1.52-1.69)* | ||
| A. S. Olafsdottir (29) | Mets | IDF | 2.2 (1.2-3.9) | not adjusted |
| F. M. Moy 2015 (30) | Elevated TG | TG ≥ 1.7 mmol/L | 2.51 (1.47–4.29)* | age and ethnicity |
| Reduced HDL | HDL-C ≤ 1.3 mmol/L in women | 1.09 (0.75–1.58) | ||
| Hypertension | systolic ≥130 mmHg and/or diastolic ≥85 mmHg or on antihypertensive treatment | 1.63 (1.15–2.31)* | ||
| Hyperglycemia | FBG ≥ 5.6 mmol/L | 1.67 (0.90–3.08 | ||
| Mets | IDF | 1.70 (0.87–3.32) | ||
| Hypercholesterolemia | (–) | 2.22 (0.21–23.20) | ||
| Diabetes | Hyperglycemia: FBG ≥ 5.6 mmol/L. | 1.28 (0.34–4.92) | ||
| P. Marques-Vidal 2010 (32) | Elevated TG | TG ≥ 1.7 mmol/L [151 mg/dL] and/or LDL ≥ 2.6 mmol/L [100 mg/dL] (in the presence of myocardial infarction, stroke, coronary artery disease or diabetes) and ≥ 4.2 mmol/L [163 mg/dL] in other cases and/or hypolipidaemic drug treatment | 2.21 (1.43-3.42)* | |
| Low HDL | 1 mmol/L in men and 1.3 mmol/L in women | 2.10 (1.23-3.57)* | ||
| HTN | (–) | 1.38 (0.97-1.98)* | ||
| Hyperglycemia | fasting hyperglycemia; HOMA > 4.88 (90th percentile in men) or >3.57 (90th percentile in women) | 1.63 (1.10-2.42)* | ||
| dyslipidemia | HDL < 1 mmol/L in men and 1.3 mmol/L in women and/or TG ≥ 1.7 mmol/L [151 mg/dL] and/or LDL ≥ 2.6 mmol/L [100 mg/dL] (in the presence of myocardial infarction, stroke, coronary artery disease or diabetes) and ≥ 4.2 mmol/L [163 mg/dL] in other cases and/or hypolipidaemic drug treatment | 1.90 (1.34-2.68)* | ||
| CMRF | the presence of at least two of the following: HTN ; TG ≥ 1.7 mmol/L; HDL cholesterol < 1 mmol/L [38.7 mg/dL] in men and 1.3 mmol/L [50.3 mg/dL] in women; fasting hyperglycemia; HOMA > 4.88 (90th percentile in men) or >3.57 (90th percentile in women) and CRP > 5.2 mg/L (90th percentile in men) or >6.1 mg/L (90th percentile in women) , definition 1. A second definition of metabolic risk was also applied, using the same criteria but with HOMA > 5.0 and CRP > 4.0 mg/L | 1.37 (0.97-1.95)* | ||
| Abdominal obesity | (–) | 2.64 (1.73–4.04)* | ||
| F. B. Madeira 2013 (4) | Elevated TG | TG ≥ 150 mg/dL, use of lipid medications or self-reported diagnosis of hypertriglyceridemia | 1.89 (0.97-3.70) | age, sex, skin colour, early and adult life variables (alcohol consumption, family income, schooling, marital status, smoking, percentage of fat in the diet and physical activity |
| Reduced HDL | HDL < 40 mg/dL for men and ,50 mg/dL for women | 1.53 (1.00-2.34) | ||
| HTN | SBP ≥ 130 mmHg and/ DBP ≥ 85 mmHg, current usage of antihypertensive drugs or previous diagnosis of hypertension | 1.17 (0.65-2.13) | ||
| Hyperglycemia | high fasting blood glucose (≥100 mg/dL), current use of anti-diabetic medication or previously diagnosed diabetes | 2.68 (1.01-7.12)* | ||
| HOMA | (–) | 4.91 (1.85-13.04)* | ||
| Mets | IDF | 8.89 (3.32-4.47)* | ||
| Elevated WC | central obesity (WC ≥ 90 cm for men and ≥ 80 cm for women | 9.27 (5.32-16.15)* | ||
| P. J. Liu 2017 (33) | Elevated TG | TGs ≥1.7 mmol/L | 2.13 (1.10-4.12)* | age, smoking status ,drinking status, total cholesterol, LDL-c, high sensitivity C-reactive protein, and the remaining non-adipose MetS components, body fat percentage |
| Reduced HDL | HDL <1.30 mmol | 1.04 (0.61-1.75) | ||
| HTN | blood pressure ≥130/85 mmHg or current antihypertensive medication use | 2.06 (1.09-3.90)* | ||
| Hyperglycemia | FBS ≥5.6 mmol/L, type 2 diabetes mellitus previously diagnosed by a physician, or current antidiabetic medication use | 1.44 (0.77-2.68) | ||
| Mets risk factor above 2 | IDF | 2.00 (1.19-3.33)* | ||
| C. C. N. Da Silva 2021 (34) | Elevated TG | TG levels above 150 mg/dL or use of lipid-lowering drugs | 1.77 (1.12-2.79)* | total calories, family income, added sugar intake, total lipids intake, and physical activity |
| Reduced HDL | <40 mg/dL for men and <50 mg/dL for women or use of lipid-lowering drugs | 1.27 (0.98-1.65) | ||
| HTN | SBP > 130 mmHg, DBP > 85 mmHg, or use of antihypertensive drugs | 1.44 (0.94-2.21) | ||
| Hyperglycemia | FBS > 100 mg/dL or use of glucose-lowering drugs | 1.48 (0.96-1.65) | ||
| Mets | IDF | 1.87 (1.36-2.57)* | ||
| Elevated WC | WC 90 cm for men and 80 cm for women | 9.27 (5.32-16.15)* |
NWO, Normal weight obesity, M, male, F, female, TC, total cholesterol, HOMA, Homeostatic Model Assessment for Insulin Resistance, LDL, low-density lipoproteins, HDL, high-density lipoproteins, TG, triglyceride, SBP, systolic blood pressure, DBP, diastolic blood pressure, BMI, body mass index, WC, waist circumference, Mets, metabolic syndrome, DM, diabetes mellitus, HTN, hypertension, CM, centimeters, IDF, International Diabetes Federation, OR, odds ratio, CI, Confidence Interval.
*Statistically significant (p-value < 0.05).
**OR calculated for NWO compare to NWNO.
1MetS is defined based on the criteria of IDF.