Uncoupling Systemic Inflammation from Body Mass Index: The Unseen Role of Visceral Adiposity and Metabolic Phenotypes—A Subgroup Analysis of the Nationwide OBREDI-TR Cohort

Objectives: Although obesity is known to cause low-grade chronic inflammation, the extent to which body mass index (BMI) reflects this remains questionable. To investigate this, we classified a national obesity cohort by BMI and evaluated its association with complete blood count (CBC)-derived systemic inflammatory indices. Methods: This retrospective, multi-center study included 6499 adults from the OBREDI-TR cohort with available laboratory data. Patients were categorized by BMI into Class I (30.0–34.9 kg/m2, n = 2751), Class II (35.0–39.9 kg/m2, n = 1804), and Class III (≥40.0 kg/m2, n = 1944) obesity. We compared demographic, clinical, and laboratory parameters, especially in terms of CBC-derived inflammation parameters: neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI). Results: The Class III group was younger (42.73 ± 13.21 vs. 45.14 ± 14.12 in Class I) and predominantly female (p < 0.001 for both). None of the evaluated inflammatory indices showed significant differences across the groups (NLR, p = 0.435; PLR, p = 0.141; LMR, p = 0.520; SII, p = 0.326; SIRI, p = 0.459). Interestingly, hypertension was less common in the Class III obesity group (49.0% vs. 53.5% in Class I, p = 0.009). Conclusions: The failure of increasing inflammatory indices to parallel BMI, creating a “ceiling effect,” reflects the inadequacy of BMI in determining inflammatory burden. Evaluating the inflammatory burden of obesity through visceral adiposity and metabolic phenotyping (metabolically healthy (MHO) vs. metabolically unhealthy obesity (MUO) rather than BMI will provide a more accurate basis for objective clinical evaluation and personalized treatment.

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Journal
Journal of Clinical Medicine
Published
2026-05-14
DOI
https://doi.org/10.3390/jcm15103794
Primary Topic
Inflammatory Biomarkers in Disease Prognosis
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article
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article

Uncoupling Systemic Inflammation from Body Mass Index: The Unseen Role of Visceral Adiposity and Metabolic Phenotypes—A Subgroup Analysis of the Nationwide OBREDI-TR Cohort

Nalan Okuroğlu, Hasan Sözel, Ulaş Serkan Topaloğlu, Celalettin Küçük et al.
Journal of Clinical Medicine
Inflammatory Biomarkers in Disease Prognosis
article

Uncoupling Systemic Inflammation from Body Mass Index: The Unseen Role of Visceral Adiposity and Metabolic Phenotypes—A Subgroup Analysis of the Nationwide OBREDI-TR Cohort

Nalan Okuroğlu, Hasan Sözel, Ulaş Serkan Topaloğlu, Celalettin Küçük, Mehmet Kök, İhsan Solmaz, Osman Özüdoğru, Teslime Ayaz, Eşref Araç, Nur Düzen Oflas, Hacer Şen, Atilla Onmez, Aycan Acet, Sıbel Ocak Serın, Seyit Uyar, Ahmed Cihad Genç, Serdar Öztürk, A Z Güven, Uğur Korkmaz, Ali Burak Govez, Yusuf Usame Durmus, Aysun Isiklar, Zeynep Irmak Kaya, Aysegul Ertinmaz, Hamit Yildiz, Hilmi Erdem Sumbul, Nazif Yalcin, Gokhan Tazegul, Ozge Kama Basci, Ali Kirik, Kamil Konur, Yasin Sahinturk, Ahmet Dundar, Ahmet Aydin, Kubilay İşsever, Emine Binnetoglu, Ismail Demir, Alihan Oral, Nizameddin Koca, Selcuk Yaylacı
article en

Abstract

Objectives: Although obesity is known to cause low-grade chronic inflammation, the extent to which body mass index (BMI) reflects this remains questionable. To investigate this, we classified a national obesity cohort by BMI and evaluated its association with complete blood count (CBC)-derived systemic inflammatory indices. Methods: This retrospective, multi-center study included 6499 adults from the OBREDI-TR cohort with available laboratory data. Patients were categorized by BMI into Class I (30.0–34.9 kg/m2, n = 2751), Class II (35.0–39.9 kg/m2, n = 1804), and Class III (≥40.0 kg/m2, n = 1944) obesity. We compared demographic, clinical, and laboratory parameters, especially in terms of CBC-derived inflammation parameters: neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI). Results: The Class III group was younger (42.73 ± 13.21 vs. 45.14 ± 14.12 in Class I) and predominantly female (p < 0.001 for both). None of the evaluated inflammatory indices showed significant differences across the groups (NLR, p = 0.435; PLR, p = 0.141; LMR, p = 0.520; SII, p = 0.326; SIRI, p = 0.459). Interestingly, hypertension was less common in the Class III obesity group (49.0% vs. 53.5% in Class I, p = 0.009). Conclusions: The failure of increasing inflammatory indices to parallel BMI, creating a “ceiling effect,” reflects the inadequacy of BMI in determining inflammatory burden. Evaluating the inflammatory burden of obesity through visceral adiposity and metabolic phenotyping (metabolically healthy (MHO) vs. metabolically unhealthy obesity (MUO) rather than BMI will provide a more accurate basis for objective clinical evaluation and personalized treatment.

Journal of Clinical MedicineVol. 15(10)
Sakarya University (TR), Balıkesir University (TR), Van Yüzüncü Yıl Üniversitesi (TR), Dicle University (TR), Giresun University (TR), Recep Tayyip Erdoğan University (TR), Erzincan Binali Yıldırım University (TR), Bursa Technical University (TR), Akdeniz University (TR), Izmir Kâtip Çelebi University (TR), State Hospital (GB), Istanbul Medipol University (TR), Acıbadem University (TR), Turkish Society of Hematology (TR), Eskişehir City Hospital (TR), Biruni University (TR), Antalya Eğitim ve Araştırma Hastanesi (TR), Ümraniye Eğitim ve Araştırma Hastanesi (TR), Kayseri Eğitim ve Araştırma Hastanesi (TR), Sağlık Bilimleri Üniversitesi (TR), Universidad CES (CO), Diyarbakır Gazi Yaşargil Eğitim ve Araştırma Hastanesi (TR), Izmir Bozyaka Eğitim ve Araştırma Hastanesi (TR), Fatih Sultan Mehmet Eğitim Ve Araştırma Hastanesi (TR), Kutahya Saglik Bilimleri Universitesi, Düzce Üniversitesi (TR), Gaziantep University (TR), Marmara University (TR)
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Inflammatory Biomarkers in Disease Prognosis
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