Main Article Content

Fadhilah Adawiyyah Alimbran
Filda Vionita Irene de Lima
Vina Zakiah Latuconsina
Rachmawati Dwi Agustin
Rahmi R. Latief
Irwan

Introduction. Cardiovascular disease remains the leading cause of mortality in Indonesia, with obesity recognized as a major risk factor. Excess body weight not only contributes to obesity but also alters lipid metabolism, thereby accelerating atherosclerosis. Interestingly, not all individuals with metabolic risk exhibit excess weight. This condition, termed normal weight obesity (NWO), describes individuals with a normal BMI (18.5-24.9 kg/m2) but an elevated body fat percentage (men >25%, women >30%). One of the important predictors of cardiovascular risk is the Castelli-II Index, defined as the LDL/HDL ratio, which reflects the balance between atherogenic and protective lipoproteins. This study aimed to evaluate the Castelli-II Index as a predictor of cardiovascular disease in individuals with NWO and obesity among medical students at the Faculty of Medicine, Universitas Pattimura. Methods. An analytic observational design with a cross-sectional approach was employed. A total of 52 respondents were recruited, comprising 26 individuals with NWO and 26 with obesity. BMI and body fat composition were assessed using a bioelectrical impedance analyzer (BIA), while LDL and HDL levels were determined through direct enzymatic testing. Results. Bivariate analysis using the chi-square test demonstrated no statistically significant difference in the Castelli-II Index between the NWO and obesity groups (p = 0.235). Conclusion. In conclusion, despite differences in body composition, the Castelli-II Index did not significantly differ between students with NWO and those with obesity. Further studies with larger and more diverse samples are recommended to validate the role of the Castelli-II Index in predicting cardiovascular risk among young adults.

Keywords: Obesity Cardiovascular Young adults Castelli-II index Normal weight obesity
1. de Andrades C dos S, Poletti VV, Closs VE, da Silva Gustavo A, da Silva Oliveira M, Fagundes Donadio MV, et al. Prevalence of dyslipidemia, atherogenic and cardiovascular risk in overweight and obese adolescents. Rev Paul Pediatr. 2023;41.
2. WHO. Obesity and overweight. 2024. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
3. Powell-Wiley TM, Poirier P, Burke LE, Després JP, Gordon-Larsen P, Lavie CJ, et al. Obesity and cardiovascular disease a scientific statement from the American Heart Association. Circulation. 2021;143:e984–1010.
4. Feingold KR. Obesity and dyslipidemia. In: Feingold K, Anawalt B, Blackman M, editors. Endotext. South Dartmouth (MA): MDText.com, inc.; 2023.
5. Ma M, Lv D, Wu X, Chen Y, Dai S, Luo Y, et al. Association between normal weight obesity and comorbidities and events of cardiovascular diseases among adults in South China. PLoS One. 2025;20(1):1–20.
6. De Lorenzo A, Gobbo V Del, Premrov MG, Bigioni M, Galvano F, Renzo L Di. Normal-weight obese syndrome : early inflammation?. Am J Clin Nutr. 2007;85(1):40–5.
7. Gebremedhin S, Mekonene M, Hagos S, Baye K, Shikur B, Berhane A, et al. Association between normal-weight obesity and cardiometabolic risk factors among adults in Addis Ababa, Ethiopia. Sci Rep. 2023;13(1):1–10.
8. Khonsari NM, Khashayar P, Shahrestanaki E, Kelishadi R, Mohammadpoor Nami S, Heidari-Beni M, et al. Normal weight obesity and cardiometabolic risk factors: a systematic review and meta-analysis. Front Endocrinol. 2022;13:1–16.
9. Maitiniyazi G, Chen Y, Qiu Y yu, Xie Z xing, He J yun, Xia S fang. Characteristics of body composition and lifestyle in Chinese University students with normal-weight obesity : a cross-sectional study. Diabetes, Metab Syndr Obes Targets Ther. 2021;14:3427–36.
10. Janampa-Apaza A, Pérez-Mori T, Benites-Yshpilco L, Meza K, Santos-Paucar J, Perez-Mendez R, et al. Physical activity and sedentary behavior in medical students at a Peruvian public university. Medwave. 2021;21(5):1–8.
11. Ma`ruf, Juhairina, Istiana, Triawanti, Setyohadi. Hubungan durasi tidur dan aktivitas fisik dengan kejadian obesitas pada mahasiswa PKPS FK ULM. Homeostasis. 2023;6:665–74.
12. Zhao S, Kusminski CM, Scherer PE. Adiponectin, Leptin and Cardiovascular Disorders. Circ Res. 2021;128(1):136–49.
13. Belalcazar S, Acosta EJ, Medina-Murillo JJ, Salcedo-Cifuentes M. Conventional biomarkers for cardiovascular risks and their correlation with the castelli risk index-indices and tg/hdl-c. Arch Med. 2019;20(1):11–22.
14. Raaj I, Thalamati M, N VGM, Rao A. The role of the atherogenic index of plasma and the Castelli risk index I and II in cardiovascular disease. Cureus. 2024;16(11):1–12.
15. Nogueira MD de A, Braga RAM, Pinto FJM, Silva FR, Coutinho VF, Damasceno NRT, et al. Castelli risk index I and II as robust predictors in estimating cardiovascular risk in excess weight adolescents. Res Soc Dev. 2021;10(4):1–11.
16. Yilmaz R, Toprak K, Karagoz A, Yontar OC, Ucar M. Prognostic value of non-traditional lipid indices for in-hospital mortality in patients with acute coronary syndromes. Medicina. 2025;1–19.
17. Wahyudin, Wardana T, Tiara Yusan R, Arjadi F, Saad N. Prediktor penyakit jantung koroner (PJK)melalui pemeriksaan profil lipid (HDL, LDL, trigliserid) menggunakan rumus castelli dan indeks aterogenik plasma (AIP) di Desa Srowot Kecamatan Kalibagor Kabupaten Banyumas. Linggamas J Pengabdi Masy. 2023;1(2):2024.
18. NCEP ATP III. ATP III Guidelines At-A-Glance Quick Desk Reference. National Institute of Health. 2001.
19. Steiner BM, Berry DC. The Regulation of Adipose Tissue Health by Estrogens. Front Endocrinol (Lausanne). 2022;13(May):1–20.
20. Xega V, Liu JL. Beyond reproduction: unraveling the impact of sex hormones on cardiometabolic health. Med Rev. 2024;4(4):284–300.
21. Venkatesh VS, Grossmann M, Zajac JD, Davey RA. The role of the androgen receptor in the pathogenesis of obesity and its utility as a target for obesity treatments. Obes Rev. 2022;23(6):1–21.
22. Han S, Jeon YJ, Lee TY, Park GM, Park S, Kim SC. Testosterone is associated with abdominal body composition derived from computed tomography: a large cross sectional study. Sci Rep. 2022;12(1):1–8.
23. Kwon S, Menezes AMB, Ekelund U, Wehrmeister FC, Gonçalves H, da Silva BGC, et al. Longitudinal change in physical activity and adiposity in the transition from adolescence to early adulthood: the 1993 Pelotas cohort study. Int J Behav Nutr Phys Act. 2022;19(1):1–9.
24. Han JY, Morris K, Wellard-Cole L, Davies A, Rangan A, Allman-Farinelli M. Snacking behaviours of Australian young adults: secondary analysis of the MYMeals cross-sectional study. Nutrients. 2023;15(20).
25. El Khoudary SR, Chen X, Wang Z, Brooks MM, Orchard T, Crawford S, et al. Low-density lipoprotein subclasses over the menopausal transition and risk of coronary calcification and carotid atherosclerosis: The SWAN Heart and HDL ancillary studies. Menopause. 2023;30(10):1006–13.
26. Telle-Hansen VH, Christensen JJ, Formo GA, Holven KB, Ulven SM. A comprehensive metabolic profiling of the metabolically healthy obesity phenotype. Lipids Health Dis. 2020;19(1):1–12.
27. Małodobra-Mazur M, Cierzniak A, Pawełka D, Kaliszewski K, Rudnicki J, Dobosz T. Metabolic differences between subcutaneous and visceral adipocytes differentiated with an excess of saturated and monounsaturated fatty acids. Genes (Basel). 2020;11(9):1–16.
28. Jayaraman S, Pérez A, Miñambres I, Sánchez-Quesada JL, Gursky O. LDL binding to cell receptors and extracellular matrix is proatherogenic in obesity but improves after bariatric surgery. J Lipid Res. 2023;64:1–13.
29. El Khoudary SR, Chen X, Nasr A, Billheimer J, Brooks MM, McConnell D, et al. HDL subclasses, lipid content, and function trajectories across the menopause transition: SWAN-HDL study samar. HHS Public Access. 2021;41(2):1–22.
30. Chung N, Jisu M young P, Park KH young, Hwang H, Han C ho LJ soo, So J. Non-exercise activity thermogenesis (NEAT): a component of total daily energy expenditure. J Exerc Nutr Biochem. 2018;22(2):23–30.
31. Sun T, Chen M, Shen H, PingYin, Fan L, Chen X, et al. Predictive value of LDL/HDL ratio in coronary atherosclerotic heart disease. BMC Cardiovasc Disord. 2022;22(1):1–11.
32. Hu S, Fan H, Zhang S, Chen C, You Y, Wang C, et al. Association of LDL-C/HDL-C ratio with coronary heart disease: a meta-analysis. Indian Heart J. 2024;76(2):79–85.
33. Wang Z long, Li J, Sun C hao, Yin X, Zhi X yu, Liu Y tian, et al. Strong association between atherogenic index of plasma and obesity in college students. BMC Endocr Disord. 2025;25(1):1–8.