DIFFERENCES IN HDL AND TRIGLYCERIDE LEVELS IN OBESE AND NORMAL WEIGHT PATIENTS WITH METABOLIC SYNDROME: A LITERATURE REVIEW
Abstract
Metabolic Syndrome (MS) is a cluster of complex metabolic disorders characterized by central obesity, insulin resistance, dyslipidemia, and hypertension, which collectively increase the risk of cardiovascular disease. One important indicator of dyslipidemia is the triglyceride-to-high-density lipoprotein (HDL) ratio, where elevated triglycerides and reduced HDL levels reflect an imbalance in lipid metabolism. The risk of MS is not only found in obese individuals but also in those with normal body weight (metabolically obese normal-weight individuals), indicating that visceral fat distribution, genetic factors, and lifestyle also play a role. This literature review aims to examine differences in HDL and triglyceride levels in MS patients with obesity and normal body weight. Articles were searched through PubMed, DOAJ, Google Scholar, and GARUDA databases within the last 10 years using relevant keywords. Of the 18 articles that met the inclusion criteria, the review showed a consistent pattern indicating that individuals with MS, whether in the obese or normal-weight groups, exhibited elevated triglyceride levels accompanied by significantly reduced HDL levels. These findings highlight that lipid abnormalities represent a central mechanism in MS that contributes to the risk of atherosclerosis and cardiovascular disease, regardless of body weight status. In conclusion, this review demonstrates that there are differences in triglyceride and HDL levels among MS patients with obesity and those with normal body weight, suggesting that lipid profile evaluation should be a primary focus in cardiometabolic disease prevention strategies.
Keywords: dyslipidemia, high-density lipoprotein (HDL), obesity, metabolic syndrome, triglycerides
References
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2. Rini S. Sindrom Metabolik. Vol. 4, J Majority. 2015.
3. Luscher, Thomas F. Epidemiology of Cardiovascular Disease: The New ESC Atlas and Beyond. European Heart Journal. 2018. 39.489-492. doi : 10.1093/eurheart/ehy070.
4. Setiati, Siti; Alwi, Idrus; Sudoyono, Aru. W; K. Simadibrata, Marcellus; Setiyohadi, Bambang; Syam Ari F. Ilmu Penyakit Dalam. 6th ed. Ilmu Penyakit Dalam. Jakarta Pusat: Inter-naPublishing; 2014. 4125–4129 p.
5. Siwalima K, Desa Waai M, Salahutu Theosobia Grace Orno K, Madiuw D, Allanled Siauta V. Edukasi dan Deteksi Dini Sindrom Metabolik .maret 2021 Available from: https://ojs.ukim.ac.id/index.php/KKS
6. Kawalec A. Analysis of the body composition of young adults and the frequency of occurrence of so-called normal weight obesity: A pilot study. Nursing and Public Health. 2019 Sep 30;9(3):167–71.
7. Sutanto K, Karjadidjaja I. Hubungan antara obesitas sentral dengan kejadi-an dislipidemia pada karyawan Uni-versitas Tarumanagara pengunjung poliklinik Fakultas Kedokteran Uni-versitas Tarumanagara. Vol. 1, Ta-rumanagara Medical Journal. 2019.
8. Suliga E, Kozieł D, Głuszek S. Prevalence of metabolic syndrome in normal weight individuals. Annals of Agricultural and Environmental Medicine. 2016;23(4):631–5.
9. Kusumaningnastiti B, Probosari E, Dieny FF, Fitranti DY. Tipe tubuh (somatotype) dengan sindrom metabolik pada wanita dewasa non-obesitas usia 25 – 40 tahun. Jurnal Gizi Klinik Indonesia. 2019 Oct 25;16(2):72
10. Indrayanti L, Tahiruddin, Nurfantri. Obesitas Berhubungan dengan Status Lipid pada Penderita PJK di Poli Jantung RSU Bahteramas Provinsi Sulawesi Tenggara. Jurnal Keperawa-tan [Internet]. Juni 2019;3(1):36–43. Tersedia pada: http://stikeskaryakesehatankendari.ac.id/
11. Yuliadewi NS LG, Arimbawa IM. Gambaran profil lipid dan dislipidemia pada remaja dengan obesitas di kota Denpasar, Bali, In-donesia. Intisari Sains Medis. 2020;11(2):629.
12. Shi TH, Wang B, Natarajan S. The influence of metabolic syndrome in predicting mortality risk among US adults: Importance of metabolic syn-drome even in adults with normal weight. Prev Chronic Dis. 2020;17.
13. Rustika R, Driyah S, Oemiati R, Hartati NS. Prediktor Sindrom Metabolik : Studi Kohor Prospektif Selama Enam Tahun di Bogor, Indo-nesia. Media Penelitian dan Pengem-bangan Kesehatan. 2019;29(3):215–24.
14. Xu H, Li X, Adams H, Kubena K, Guo S. Etiology of metabolic syn-drome and dietary intervention. Vol. 20, International Journal of Molecu-lar Sciences. MDPI AG; 2019
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16. Hamooya BM, Siame L, Muchaili L, Masenga SK, Kirabo A. Metabolic Syndrome: Epidemiology, Mecha-nisms, and Current Therapeutic Ap-proaches. Front Nutr. 2025;12. doi:10.3389/fnut.2025.1661603.
17. Puspaseruni K. Tatalaksana Dislipidemia terkait Penyakit Kardi-ovaskular Aterosklerosis (ASCVD): Fokus pada Penurunan LDL-c. Cer-min Dunia Kedokt [Internet]. 2021 Oct 25;48(10):395. Available from: http://www.cdkjournal.com/index.php/CDK/article/view/1512
18. Bokhari AS, Alshaya MM, Badghaish MMO. Metabolic Syn-drome : Pathophysiology and Treat-ment. Egypt J Hosp Med. 2018;70(8):1388–92.
19. Wang Z, Zhang R, Li X. Caveolin as a novel potential therapeutic target in cardiac and vascular diseases: a mini review. Aging Dis. 2020;11(2):378-89
20. McMaster WG, Kirabo A, Madhur MS, and Harrison DG. Inflammation Immunity, and Hypertensive End-Organ Damage. Circulation Re-search.2015;116: 1022-1033
21. Rochlani Y, Pothineni NV, Ko-velamudi S, Mehta JL. Metabolic syndrome: Pathophysiology, man-agement, and modulation by natural compounds. Vol. 11, Therapeutic Advances in Cardiovascular Disease. SAGE Publications Ltd; 2017. p. 215–25.
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23. Warganegara E, Nur NN. Faktor Risiko Perilaku Penyakit Tidak Men-ular. Vol. 5, Nida Nabilah Nur | Faktor Risiko Perilaku Penyakit Tid-ak Menular Majority |. 2016.
24. Shi TH, Wang B, Natarajan S. The influence of metabolic syndrome in predicting mortality risk among US adults: Importance of metabolic syn-drome even in adults with normal weight. Prev Chronic Dis. 2020;17.
25. Tinggi Ilmu Kesehatan Muhammadi-yah Klaten S, Rachmawati D, Sin-towati R, Lestari N, Agustina T, Kedokteran Universitas Muham-madiyah Surakarta F. Pengaruh Diet Dash (Dietary Approach To Stop Hypertension) Terhadap Penurunan Tekanan Darah Pada Penderita Hipertensi: Studi Literatur.
26. Eewinanto, anwar santoso J nugroho EP. Panduan Tatalaksana Dislipidemi 2017 PERKI. Perhimpunan Dokter Spesialis Kardiovaskular Indonesia; 2017.
27. Hasbullah Darmawan, Abdullah Tamrin N. Asupan Natrium Dan Sta-tus Gizi Terhadap Tingkat. 2018;25:11–7.
28. Atun L, Siswati T, Kurdanti W. Asupan Sumber Natrium, Rasio Ka-lium Natrium, Aktivitas Fisik, Dan Tekanan Darah Pasien Hipertensi. Mgmi. 2016;6(1):63–71.
29. Pencegahan E Al, Metabolik S, Upaya S, Derajat P, Masyarakat K. Munawaroh et. Vol.3, Smart Society Empowerment Journal . 2023.
30. Gómez-Zorita S, Queralt M, Vicente MA, González M, Portillo MP. Met-abolically healthy obesity and meta-bolically obese normal weight: a re-view. J Physiol Biochem. 2021;77(1):175–89
31. Conus, F; Lhoret, RB; Peronet, F. Characteristic of Metabolically Obese Normal Weight (MONW) Subject. Physiol. Nutr Metab. 32: 4-12. 2007
32. Ruderman, N; Chisholm, D; Sunyer, XP; Schnider, S. The Metabolically obese, Normal-Weight Individual. Perspective in Diabetes. Diabetes. Vol 47. May. 1998
33. Mata, Annabel; Jasul Jr, Gabriel. 2017. Prevalence of Metabolic Syn-drome and its Individual Fea-turesAcross Different (Normal, Overweight, Pre-Obese and Obese) Body Mass Index (IMT) Categories in a Tertiary Hospital in the Philippines. Journal of the ASEAN Federation Endocrin Societies Vol. 32 No. 2 November 2017. https://doi.org/10.15605/jafes.032.02.04
34. Bennett JP, Kawachi I, Xiao M, et al. Evaluation of visceral adipose tissue thresholds for elevated metabolic syndrome risk across diverse popula-tions: a systematic review. Obes Rev. 2024;25(9):e13767.
35. Pluta W, Dudzińska W, Lubkowska A. Metabolic Obesity in People with Normal Body Weight (MONW)-Review of Diagnostic Criteria. Int J Environ Res Public Health. 2022 Jan 6;19(2):624. doi: 10.3390/ijerph19020624. PMID: 35055447; PMCID: PMC8776153
36. Katsuki, A., Sumida, Y., Urakawa, H., Gabazza, E.C., Murashima, S., Maruyama, N., et al. 2003a. Increased visceral fat and serum levels of tri-glyceride are associated with insulin resis- tance in Japanese metabolically obese, normal weight subjects with normal glucose tolerance. Diabetes Care, 26: 2341–2344. PMID:12882859.
37. Deng M, Yan H, Guo X, Lyu L, Cui X, Zhou Z. Visceral adipose tissue area as a better predictor of metabolic risk than BMI in adult males with normal weight. Diabetes Metab Syndr Obes. 2023;16:2417-25.
38. Aswania GM, Yasmin AAADA. Dislipidemia sebagai prediktor ke-jadian kardiovaskular mayor pada pasien infark miokard akut. J Med Udayana [Internet]. 2020;9(11):91–100. Available from: https://ocs.unud.ac.id/index.php/eum/article/view/71028.
39. Jennifer L Dearborn, Catherine M Viscoli, Silvio E Inzucchi2, Law-rence H Young2 and Walter N Kernan. 2019. International Journal of Stroke 2019, Vol. 14(6) 639– 645, 2018 World Stroke Organization Ar-ticle reuse guidelines: sagepub.com/journals-permissions DOI:10.1177/174749301881642. journals.sagepub.com/home/wso.
Published
2025-12-31
How to Cite
RAMADHAN, Muhammad Zidan; RAKHMAT, Iis Inayati; YUSLIANTI, Euis Reni.
DIFFERENCES IN HDL AND TRIGLYCERIDE LEVELS IN OBESE AND NORMAL WEIGHT PATIENTS WITH METABOLIC SYNDROME: A LITERATURE REVIEW.
Medika Kartika : Jurnal Kedokteran dan Kesehatan, [S.l.], v. 8, n. 4, p. 423-433, dec. 2025.
ISSN 2655-6537.
Available at: <http://medikakartika.unjani.ac.id/medikakartika/index.php/mk/article/view/1435>. Date accessed: 07 jan. 2026.
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