Apolipoprotein A-I and Apolipoprotein B: Better Indicators of Dyslipidemia in Diabetic Retinopathy Patients?

ABSTRACT Diabetic retinopathy (DR) remains the leading cause of mortality and disability in adults with diabetes. Recently apolipoprotein A-I (Apo A-I) and apolipoprotein B (Apo B) have been found to be associated with biophysiological changes of DR than traditional lipids. The objective of the present study was to evaluate the lipid profile including Apo A-I, Apo B, and Apo B/Apo A-I levels in diabetes patients with or without retinopathy. The present study was conducted at Adichunchanagiri Institute of Medical Sciences and Hospital, India. The total numbers of subjects were 90, divided into three groups. Group I included 30 healthy controls, group II included 30 cases of diabetes mellitus (DM) without retinopathy, and group III had 30 cases of DR. Blood samples were drawn under aseptic precautions from study subjects. The investigations carried out were fasting plasma glucose (FPG), postprandial plasma glucose (PPPG), and lipid profile including Apo A-I and Apo B in all subjects. The FPG, PPPG, lipid profile, and apolipoproteins (Apo A-I and Apo B) were estimated using autoanalyzer EM 200.There was significant increase in FPG, PPPG, total cholesterol, triglycerides (TGs), low-density lipoproteins (LDLs) and no significant decrease in high-density lipoprotein (HDL) levels in group II and III subjects. There was significant decrease in Apo A-I and increase in Apo B levels and Apo B/Apo A-I ratio in group II and III subjects. There is a suggestive association of TGs, LDL, and Apo B/Apo A-I ratio in diabetic subjects with and without retinopathy. The Apo A-I, Apo B, and ratio of Apo B/Apo A-I are strong indicators of dyslipidemia in diabetic and DR patients. The ratio of Apo B/Apo A-I is better associated with DR and may contribute to development and progression of DR. How to cite this article Namitha D, Nusrath A, Rajeswari A, Rani NA, Shilpashree YD. Apolipoprotein A-I and Apolipoprotein B: Better Indicators of Dyslipidemia in Diabetic Retinopathy Patients? Indian J Med Biochem 2017;21(2):142-146.

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The relation between ApoB/ApoA-1 ratio and the severity of coronary artery disease in patients with acute coronary syndrome

The Egyptian Heart Journal ◽

10.1186/s43044-021-00150-z ◽

2021 ◽

Vol 73 (1) ◽

Author(s):

Rehab Ibrahim Yaseen ◽

Mohamed Hesham El-Leboudy ◽

Hend Mohammed El-Deeb

Keyword(s):

Acute Coronary Syndrome ◽

Apolipoprotein B ◽

Density Lipoprotein ◽

Serum Levels ◽

Cholesterol Homeostasis ◽

Gensini Score ◽

Structural Protein ◽

Apo B ◽

Coronary Syndrome ◽

Apolipoprotein A

Abstract Background Apolipoprotein B is considered the primary protein constituent of low-density lipoprotein. LDL contains variable quantities of cholesterol, but each lipoprotein contains a single ApoB protein. Thus, ApoB is a better index for the LDL circulation if compared to LDL cholesterol. On the contrary, apolipoprotein A-1 is a main structural protein of high-density lipoprotein. It has a major role in reversing cholesterol flow and cellular cholesterol homeostasis once detected. The aim of the study is to measure apo B/apo A-1 ratio in patients with acute coronary syndrome and assess its relationship with the severity of CAD. A total of 90 patients were enrolled in the study and subdivided into 3 groups: 30 patients of STEMI, 30 patients of NSTEMI, and 30 patients presented with unstable angina. Serum levels of apolipoprotein A-1 and apolipoprotein B were properly measured upon admission, and apo B/apo A-1 ratio was calculated. Results Both of Apo B and Apo B/Apo A1 ratio correlated significantly with Gensini scores (P value <0.001). High Gensini score patients had significantly high Apo B/Apo A1 ratio with the best cutoff value of 0.8 with sensitivity of 90% and specificity of 70%. Conclusion Apo B is an independent risk predictor for the severity of CAD in patients with acute coronary syndromes. Moreover, the Apo B/Apo A1 ratio remains highly significant in patients with high Gensini score.

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Role of Apo B and Apo A1 Levels in Relation to Conventional Lipid Profile in Patients of Ischaemic Heart Disease with or without Type II Diabetes Mellitus

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/50956.15611 ◽

2021 ◽

Author(s):

Hardik N Javia ◽

Milav H Bhavsar ◽

Bhavesh R Sadariya ◽

Amitkumar V Maheshwari ◽

Hariom Sharma

Keyword(s):

Diabetes Mellitus ◽

Lipid Profile ◽

Type Ii Diabetes ◽

Type Ii Diabetes Mellitus ◽

P Value ◽

Type Ii ◽

Apo B ◽

Group Iii ◽

Group I ◽

Group Ii

Introduction: Ischaemic Heart Disease (IHD) or Coronary Artery Disease (CAD) is the most prevalent chronic disease and the main leading cause of death in the world, with more than half a million newly diagnosed IHD patients each year. Central to this are disorders of lipoprotein metabolism. Apolipoprotein B (Apo B) and Apolipoprotein A1 (Apo A1) are structural and functional components of lipoprotein particles that serve as transporters of cholesterol. Apo B and Apo A1 are among the emerging markers for Cardiovascular Diseases (CVD). Routine conventional lipid profile does not incorporate these markers. Aim: To determine the level of Apo A1 and Apo B in patients of IHD with or without Type II Diabetes Mellitus (T2DM) and analyse the significance of these parameters over the conventional lipid profile. Materials and Methods: The case-control study was conducted at Government Medical College, Bhavnagar, Gujarat, India from July 2013 to December 2013. The study consists of 100 participants including 50 having IHD only (Group I), 50 having IHD with T2DM (Group II) as study groups and 50 healthy individuals (Group III) as control. Various biochemical parameters including Apo B and Apo A1 were analysed and statistically evaluated to come to conclusion. Results: The demographic details of the participants which shows no significant different in age and gender among groups I, II and III. Apo B and A1 were elevated in group I and II and were found highly significant (p-value <0.0001) as compared to the group III. There was positive correlation of serum Apo B levels with total cholesterol (r=0.495, p-value <0.0001), Low-Density Lipoproteins (LDL-C) (r=0.526, p-value <0.0001) and Apo A1 (r=0.685, p-value <0.0001) in group I and LDL-C (r=0.468, p-value=0.001) and Apo A1 (r=0.754, p-value <0.0001) in group II. Similarly, Apo A1 levels were positively correlated with Apo B (r=0.685, p<0.0001) in group I and LDL-C (r=0.305, p-value=0.031) and Apo B (r=0.754, p-value <0.0001) in group II. Conclusion: As the Apo B and Apo A1 cover both atherogenic and antiatherogenic lipid parameters respectively, it can be used as a better predictor of development of IHD with and without T2DM in comparison to conventional parameters of lipid profile.

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A study of lipid profile in subclinical hypothyroidism in tertiary care hospital, Kolkata, India

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20201507 ◽

2020 ◽

Vol 7 (5) ◽

pp. 760

Author(s):

Kaushik Saha ◽

Dipa Saha

Keyword(s):

Lipid Profile ◽

Total Cholesterol ◽

Subclinical Hypothyroidism ◽

Ldl Cholesterol ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Low Density ◽

Care Hospital ◽

Group I ◽

Group Ii

Background: Objective was to study lipid profile in patients of subclinical hypothyroidism in tertiary centre in Kolkata, West Bengal and compare the same with matched controls.Methods: This observational study (single exposure) was conducted May 2019 to Nov 2019 at Department of Medicine, KPC Medical College, Jadavpur, Kolkata in subjects diagnosed with Sub Clinical Hypothyroidism [defined as normal T3 or FT3, normal T4 or FT4, and with increased TSH. Sixty patients with subclinical hypothyroidism were selected after careful exclusion; lipid profile was compared with matched controls.Results: Between the two groups (group I - controls vs. group II - cases), the values were as follows: Mean serum total T3 value was 114.03±29.22 ng/dl vs. 106.15±36.24 ng/dl (p = 0.3476); mean total T4 was 7.07±1.69 μg/dl vs. 6.86±1.31 μg/dl (p = 0.535); mean TSH was 3.17±1.28 μIU/ml vs. 9.77±4.19 μIU/ml (p <0.0001). Lipid profile pattern (group I vs. group II) was as follows: Mean total cholesterol (TC) 125.50±9.18 mg/dl vs. 162.07±42.32 mg/dl (p <0.0001), mean triglycerides (TG) is 136.65±14.82 mg/dl vs. 148.90±65.27 mg/dl (p = 0.3236), low-density lipoprotein (LDL)-cholesterol is 62.17±7.40 mg/dl vs. 98.81±33.26 mg/dl (p <0.0001), high-density lipoprotein (HDL)-cholesterol 39.17±6.62 mg/dl vs. 34.27±9.63 mg/dl (p = 0.0702), very low-density lipoprotein (VLDL) levels are 34.54±15.38 mg/dl vs. 32.08±13.21 mg/dl (p = 0.5245)..Conclusions: Subclinical hypothyroidism is associated with increased serum total cholesterol and LDL-Cholesterol levels. Therefore, there is a potential association between Subclinical hypothyroidism and atherosclerosis.

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An adverse lipid profile is associated with disability and progression in disability, in people with MS

Multiple Sclerosis Journal ◽

10.1177/1352458514533162 ◽

2014 ◽

Vol 20 (13) ◽

pp. 1737-1744 ◽

Cited By ~ 74

Author(s):

Prudence Tettey ◽

Steve Simpson ◽

Bruce Taylor ◽

Leigh Blizzard ◽

Anne-Louise Ponsonby ◽

...

Keyword(s):

Linear Regression ◽

Lipid Profile ◽

Total Cholesterol ◽

Apolipoprotein B ◽

Serum Lipids ◽

Density Lipoprotein ◽

Population Based ◽

Serum Samples ◽

Apolipoprotein A ◽

Disability Status

Background: There is accumulating data suggesting an association between serum lipids, apolipoproteins and disability in multiple sclerosis (MS). Objectives: To investigate the associations between serum lipids, apolipoproteins and disability in MS. Methods: A cohort of 178 participants with clinically-definite MS in southern Tasmania, Australia were prospectively followed from 2002 – 2005, and serum samples were obtained at study entry and at each biannual review, to measure lipid profile and apolipoprotein levels. Associations with disability and annual change in disability were evaluated using linear regression and multilevel mixed-effects linear regression. Results: In the unadjusted analyses, nearly all lipid-related variables were positively associated with Expanded Disability Status Scale (EDSS). After adjustment for confounders, total cholesterol (TC) ( p = 0.037), apolipoprotein B (ApoB) ( p = 0.003), and the apolipoprotein B to apolipoprotein A-I ratio (ApoB/ApoA-I ratio) ( p = 0.018) were independently associated with a higher EDSS. Higher body mass index (BMI) was also independently associated with higher EDSS ( p = 0.013). With the progression analysis, the total cholesterol to high density lipoprotein (HDL) ratio (TC/HDL ratio) ( p = 0.029) was prospectively associated with subsequent change in EDSS. Conclusion: In this prospective population-based cohort study, an adverse lipid profile was associated with high levels of MS disability and disease progression. Improving serum lipids may be beneficial for MS patients, to potentially improve clinical outcomes and vascular comorbidities.

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Conventional Lipid Profile and Lipoprotein(a) Concentrations in Treated Patients with Rheumatoid Arthritis

The Journal of Rheumatology ◽

10.3899/jrheum.080928 ◽

2009 ◽

Vol 36 (7) ◽

pp. 1365-1370 ◽

Cited By ~ 19

Author(s):

CARMEN GARCÍA-GÓMEZ ◽

JOAN M. NOLLA ◽

JOSEP VALVERDE ◽

JUAN A. GÓMEZ-GERIQUE ◽

MARÍA J. CASTRO ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Cardiovascular Risk ◽

Lipid Profile ◽

Postmenopausal Women ◽

Apolipoprotein B ◽

Density Lipoprotein ◽

Lipoprotein Cholesterol ◽

Lipoprotein A ◽

Apolipoprotein A

Objective.Patients with rheumatoid arthritis (RA) have an increased cardiovascular risk not completely explained by traditional cardiovascular risk factors. If the proatherogenic lipid profile observed in active and untreated RA improves by effectively treating RA without the use of a lipid-lowering agent, other nonconventional cardiovascular lipid risk factors may be implicated. We evaluated conventional lipid risk factors and lipoprotein(a) in treated patients with RA.Methods.This cross-sectional study was conducted in 122 patients with RA. Lipid profiles of patients were compared with a control group, consisting of a population-based study cohort (DRECE study), matched for sex, age, menopausal status, and body mass index. Excess lipoprotein(a) was defined by a serum concentration > 0.3 g/l.Results.High-density lipoprotein cholesterol (HDL-c) concentrations were higher in pre- and postmenopausal women with RA than in controls (p = 0.023 and p ≤ 0.001, respectively). All RA patients had significantly lower levels of apolipoprotein B and apolipoprotein B/apolipoprotein A-I ratio, and postmenopausal women with RA also had significantly lower low-density lipoprotein cholesterol and total cholesterol levels than their respective controls. No differences were observed in serum levels of apolipoprotein A-I and triglyceride. All RA patients had higher lipoprotein(a) values than controls. Fourteen men (56%) and 10 (53%) and 42 (54%) pre- and postmenopausal women with RA, respectively, had hyperlipoproteinemia(a).Conclusion.RA patients undergoing antirheumatic therapy display a nonatherogenic conventional lipid profile, i.e., high HDL-c, low apolipoprotein B concentrations, and low apolipoprotein B/apolipoprotein A-I ratio. This may be counteracted by the high prevalence of hyperlipoproteinemia(a) observed in these patients.

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The level of endogenous testosterone and its correlation with lipid profile in men older than 40 years with acute myocardial infarction

Vojnosanitetski pregled ◽

10.2298/vsp180519135b ◽

2020 ◽

Vol 77 (8) ◽

pp. 804-810

Author(s):

Branko Barac ◽

Sanja Stankovic ◽

Milika Asanin ◽

Zorana Vasiljevic-Pokrajcic ◽

Svetlana Vujovic

Keyword(s):

Lipid Profile ◽

Significant Positive Correlation ◽

Density Lipoprotein ◽

Hdl Cholesterol ◽

Apolipoprotein A1 ◽

Acute Myocardial Infarct ◽

Healthy Men ◽

Positive Correlation ◽

Group I ◽

Group Ii

Background/Aim. The influence of lipid profile on acute myocardial infarct (AMI) is well known. On the other hand, the role of testosterone (T), as one of the possible predictive factors of AMI in men and its influence on lipid profile in men is still controversial. The aim of the study was to determine levels of T in AMI and six months after AMI in the same group of patients, and to compare with T levels in healthy men. Also we correlated T levels with lipid profile in patients with AMI and 6 months after AMI. Methods. The study was designed as prospective study. Patients were divided into III groups: Group I included 35 men, aged 55 ? 3 years, with AMI. Group II included the same 35 patients, analyzed 6 months after AMI. The group III consisted of 20 healthy men aged 57 ? 2.12 years (control group). Blood samples of the group I (AMI) were taken in the first 12 hours from the AMI beginning and also 6 months after AMI (group II). Following analyses were performed: levels of total cholesterol, triglycerides, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, lipoprotein(a) [Lp(a)], apolipoprotein A1 (Apo A1), apolipoprotein B (Apo B) and T. Results. Levels of T in patients with AMI (16.86 ? 7.18 nmol/L) as well as 6 months after AMI (18.12 ? 7.96 nmol/L) were statistically significantly lower than those in healthy persons of the same age (27.11 ? 10.48 nmol/L) (p < 0.001). In the group I, statistically significant, positive correlation was found between levels of T and HDL cholesterol (r = 0.403, p < 0.05), and levels of T and Apo A1 (r = 0.747, p < 0.01). In the group II, statistically significant, positive correlation was also found between levels of T and HDL cholesterol (r = 0.388, p < 0.05) and T and Apo A1(r = 0.354, p < 0.05). Conclusion. This study showed that men, over 40 years of age, with AMI had statistically significantly lower concentrations of endogenous T compared to healthy male population of the same age. Levels of T in the same patients after 6 months from AMI maintained statistically significantly lower values in comparison to those in healthy men.

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Systemic inflammation, oxidative stress and apolipoprotein B/A1 ratio in active psoriasis: bridging an apparent paradox

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20160350 ◽

2015 ◽

Vol 1 (1) ◽

pp. 10

Author(s):

Rahul Saxena ◽

Shilpa Suneja ◽

Raj Saxena ◽

Dilutpal Sharma ◽

Alok Milton Lal

Keyword(s):

Oxidative Stress ◽

Lipid Profile ◽

Patient Group ◽

Systemic Inflammation ◽

Apolipoprotein B ◽

Healthy Controls ◽

Cvd Risk ◽

Apparent Paradox ◽

Apo B ◽

Group I

Background: Psoriasis is characterized by systemic increase of inflammation and oxidative stress. In addition, increased incidence of dyslipidemia in dermatological disorders is also in alarming phase. It is conceivable that association of inflammation, oxidative stress and dyslipidemia enhances the future the risk of cardiovascular disease (CVD) in psoriasis patients. The main of the study is to estimate the marker of systemic inflammation, oxidative stress, plasma lipid profile and apolipoprotein levels in psoriasis patients and to determine their role in predicting CVD risk in psoriasis.Methods: The study population consist of subjects categorized into two groups; Group I: Healthy controls and Group II: Psoriasis patients (n= 25 in each group). Erythrocyte malondialdehyde (MDA), plasma C-reactive protein (CRP) and lipid profile along with apolipoprotein B and A1 were measured and statistically analyzed using standard methods.Results: Plasma CRP, total cholesterol, triglycerides, LDL-cholesterol and MDA levels were significantly high (p<0.05) in patient group as compared to healthy controls. HDL-cholesterol levels were altered insignificantly (p<0.1) in patient group. Plasma Apo B/Apo A1 ratio were increased significantly (p<0.01) in patient groups as compared to controls.Conclusions: Thus, enhanced inflammation, oxidative stress along with increase in Apo B, A1 and its ratio authenticates the fact that these markers are more efficient in prediction of CVD risk in psoriasis patients than conventional lipid profile parameters.

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Potential role of apolipoprotein B/A1 ration in obese and non-obese female patients of coronary artery disease

Asian Journal of Medical Sciences ◽

10.3126/ajms.v7i3.13504 ◽

2016 ◽

Vol 7 (3) ◽

pp. 18-22

Author(s):

Sunita Mahto ◽

Suman Bala Sharma ◽

Shridhar Dwivedi ◽

Mani Sethi ◽

Rahul Saxena

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Lipid Profile ◽

Apolipoprotein B ◽

Obese Patients ◽

Apo B ◽

Group I ◽

Group 3 ◽

Group 2 ◽

Artery Disease

Background: Obesity and hyperlipidemia are considered to be risk factor for cardiovascular diseases. Many patients who develop coronary artery disease (CAD) are non obese and have normal lipoprotein cholesterol. Assessment of apolipoproteins can improve future risk of cardiovascular complications.Aims and Objectives: We have investigated effect of weight in relation with lipoprotein and apolipoprotein levels as efficient marker of CAD in North Indian females.Materials and Methods: The study population consist of 90 subjects categorized into three groups: Group I: Healthy controls; Group 2: Non obese patients of CAD and Group 3: Obese patients of CAD (n= 30 each group). Serum lipid profile along with apolipoprotein B and A1 were measured and apolipoprotein B/A1 ratio were calculated.Result: Total cholesterol and triglycerides levels were significantly high in obese patients as compared to non-obese and controls. LDL-C and HDL-C were altered insignificantly (p<0.1) in Group 2 and Group 3 as compared to Group 1. Apo B and apo A1 were significantly high in obese and non-obese CAD patients as compared to controls whereas insignificant difference was observed (p<0.1) when Group 3 patients were compared with Group 2. ApoB/Apo A1 ratio was increased significantly (p<0.01)) in patient groups as compared to controls. Conclusion: Although LDL-C and HDL-C were normal in subjects of CAD, increase in Apo B, A1 and its ratio authenticates the fact that these markers are more efficient in detection of CAD risk in obese and non obese patients than conventional lipid profile parameters.Asian Journal of Medical Sciences Vol. 7(3) 2016 18-22

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Spondias mombin promotes gastric mucosa and lipid profile status in gastric ulceration

Journal of Morphological Sciences ◽

10.4322/jms.058313 ◽

2014 ◽

Vol 31 (02) ◽

pp. 082-088

Author(s):

A. Akinlolu ◽

K. Ghazali ◽

O. Ameen ◽

A. Odewabi

Keyword(s):

Lipid Profile ◽

Gastric Acidity ◽

Density Lipoprotein ◽

Physiological Saline ◽

Gastric Ulceration ◽

Lipoprotein Cholesterol ◽

Bark Extract ◽

Spondias Mombin ◽

Group I ◽

Group Ii

Abstract Introduction: Spondias mombin has been reported to possess medicinal properties. Material and Methods: This study evaluated the anti-ulcer properties of Spondias mombin. Rats of Group I received physiological saline only while 40mg/kg/bodyweight of Indomethacin (an ulcerogen) was administered to rats of Groups II - VI. Four hours after administrations of the ulcerogen; rats of Groups III - VI were treated daily with oral administrations of 250, 500 and 1000mg/kg/bodyweight of Spondias mombin bark extract and 40mg/kg/bodyweight of Omeprazole respectively for four days. Rats were euthanized on Days 1 (Group II) and 5 (Groups I and III - VI); stomach and liver samples were removed for evaluations of gastric acidity, histo-pathological and lipid profile status. Results: AAnalyses of gastric acidity and lipid profile status in the stomach and liver samples of rats of Group II showed statistically significant higher levels (P≤0.05) of gastric acidity, total cholesterol, low density lipoprotein-cholesterol and triglycerides but lower high density lipoprotein-cholesterol levels (P≤0.05) when compared to rats of Groups I, and III - VI. Histo-pathological evaluations showed dose-dependent restorations of stomach and liver histology to pre-ulceration states in rats of Groups III - VI. Conclusions: This study concluded that Spondias mombin administrations promoted histo-pathological restorations of the stomach and liver; and lipid profile status of male wistar rats in Indomethacin - induced gastric ulceration.

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HIGH SENSITIVE C-REACTIVE PROTEIN AND ITS RELATIONSHIP WITH OTHER CARDIOVASCULAR RISK VARIABLES IN OBESE, OVERWEIGHT AND HEALTHY INDIVIDUALS

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2018.v11i8.26056 ◽

2018 ◽

Vol 11 (8) ◽

pp. 194

Author(s):

Gayathri B ◽

Vinodhini Vm

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Plasma Glucose ◽

Density Lipoprotein ◽

Lipoprotein Cholesterol ◽

C Reactive Protein ◽

Reactive Protein ◽

Group I ◽

Group Ii ◽

Hs Crp

Objective: More than 50% of the world’s population is considered overweight and being overweight is associated with several comorbidities such as Type 2 diabetes mellitus, hypertension, cardiovascular diseases, dyslipidemia, respiratory diseases, osteoarthritis, and depression. Therefore, in this study, we have estimated the high sensitive C-reactive protein (hs-CRP) levels in obese, overweight, and normal body mass index (BMI) individuals and whether there was any relationship between hs-CRP and other risk factors of the cardiovascular system such as serum total cholesterol (TC) and other lipids.Methods: A total of 150 participants, divided into three groups. Group I - 50 participants with normal BMI (18–22.99 kg/m2), Group II - 50 participants who were overweight (BMI = 23–24.99 kg/m2), and Group III - 50 who were obese (BMI ≥25 kg). We measured fasting plasma glucose, postprandial plasma glucose, serum TC, triacylglycerol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and hs-CRP.Results: Obese individuals had increased hs-CRP compared with control (Group I) and overweight (Group II) groups. hs-CRP positively correlated with BMI and lipid profile.Conclusion: Elevated hs-CRP was associated with cardiovascular risk factors in overweight and obese individuals. This high-risk group should be targeted for therapeutic lifestyle modifications to prevent further complications.

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