PAGE 107

2023 March; 29(2): 107-112

p-ISSN 0854-4263 e-ISSN 2477-4685
Available at www.indonesianjournalofclinicalpathology.org

Obesity Indices Could Predict High Apolipoprotein B/Apolipoprotein

A1 Ratio in Non-menopausal Indonesian Adult Females

1
Department of Clinical Pathology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. E-mail:
[email protected]
2
Faculty of Medicine and Health Sciences, Krida Wacana University, Jakarta, Indonesia
3
Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
4
Department of Biochemistry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

ABSTRACT

Previous research has demonstrated associations between high obesity indices with increased risk of metabolic and
cardiovascular disorders. It has also been established that abnormalities of lipoprotein metabolism have an important role
in atherogenesis and that non-menopausal females are protected from atherosclerotic cardiovascular events relative to
males and menopausal females. This study aimed to investigate the relationship between obesity indices such as Body Mass
Index (BMI), Waist Circumference (WC), Body Fat Percentage (BF), and Visceral Fat (VF) with apolipoprotein
B/apolipoprotein A1 ratio in non-menopausal Indonesian mongoloid adult females. A total of 75 non-menopausal
Indonesian adult females were included as subjects in this cross-sectional study. The measured indices in this study were
BMI, WC, BF, and VF. Measurement of apolipoprotein B and A1 was performed by immunoturbidimetry, followed by
calculation of the ratio. A cut-off value of 0.8 was used to define the high apolipoprotein B/apolipoprotein A1 ratio.
Apolipoprotein B/Apolipoprotein A1 ratio was significantly correlated with BMI (r=0.384, p=0.001), WC (r=0.363, p=0.001),
BF (r=0.385, p=0.001), VF (r=0.380, p=0.001). The area under the curve of BF (0.754) was slightly larger than BMI (0.722), VF
(0.721), and WC (0.686) in predicting high apolipoprotein B/apolipoprotein A1 ratio. A positive weak correlation was
observed between obesity indices and the apolipoprotein B/apolipoprotein A1 ratio. Obesity indices could be used to
predict high apolipoprotein B/apolipoprotein A1 ratio.

Keywords: Apolipoprotein B/apolipoprotein A1 ratio, obesity, non-menopausal female

INTRODUCTION interorgan fuel, maintenance of endogenous and

exogenous cholesterol metabolism, and reverse
The global obesity prevalence has nearly doubled cholesterol transport. Abnormalities of lipoprotein
in the last thirty years.1 Around 2 billion people are metabolism have been related to the atherogenesis
categorized as overweight, and one-third of them is process, which may lead to coronary heart disease.4
considered obese.1 This rapid increase is observed Apolipoprotein B is contained in Low-Density
not only in high-income cough income but also in Lipoprotein (LDL), Intermediate-Density Lipoprotein
countries with low- and middle-income countries (IDL), and Very-Low-Density Lipoprotein (VLDL) and
including Indonesia.1 According to a previous report, has proatherogenic and inflammatory features.5
central obesity and obesity prevalence among the Apolipoprotein A1 constitutes 70% of High-Density
adult Indonesian population was 28% and 23.1 Lipoprotein (HDL) apolipoproteins and has
respectively, with higher occurrence in females antioxidant and anti-inflammatory features.4
(28.6%) relative to males (16.9%).2 Obesity, which can The use of apolipoprotein B/apolipoprotein A1
be measured by several anthropometric indices, is ratio as a reflection of pro-and anti-inflammatory
linked to the progression of metabolic syndrome mechanisms is often used in predicting
and cardiometabolic risks.3 cardiovascular risk and is a better marker than other
Obesity affects many facets of human lipid markers such as total, HDL, and LDL cholesterol.4
metabolism, including the regulation of lipoproteins. The apolipoprotein B/apolipoprotein A1 ratio is not
Lipoproteins are involved in many crucial roles, only associated with metabolic and cardiovascular
including the distribution of triglycerides as an disorders but also has been shown as a superior

Obesity Indices Could Predict High Apolipoprotein B - Kurniawan, et al.

Indonesian Journal of Clinical Pathology and Medical Laboratory, 2023 March, 29 (2) : 107 - 112 PAGE 108

predictor of type 2 diabetes risk relative to other and height data were collected, and BMI was then
routine lipid markers.6 In addition to age, smoking, calculated by the formula of body mass (kg) divided
alcohol intake, and obesity have been frequently by height squared (m2). A measuring tape was used
reported as important determinants of this ratio.7 to measure WC at the midway level of the iliac crest
A report conducted on the Indian population and the lower border of the 12th rib. Other obesity
revealed that the apolipoprotein B/apolipoprotein indices including BF and VC were determined by the
A1 ratio a had significant association with metabolic bioelectrical impedance analysis (BIA) method using
syndrome and its components.8 The optimal cut-off the Tanita-BC541 (Tokyo, Japan) device. Subjects
points for the prediction of coronary heart disease were categorized as normal weight, overweight, and
risk were between 0.80 and 0.90.9 obese based on the World Health Organization
An interesting feature regarding cardiovascular (WHO) criteria for the Asian population.11
risk is that non-menopausal females are protected After an 8-12 hours overnight fasting period, a
from atherosclerotic cardiovascular events relative sample of 3 mL venous blood was obtained from
to menopausal females and males. One commonly each subject by using a vacutainer, followed by
proposed theory highlights the endogenous serum separation for direct fasting plasma glucose
protective features of estrogen against (FPG) testing (Abx Pentra 400, Horiba, USA) to
cardiovascular diseases, as lipid abnormalities surge exclude type 2 diabetes based on the American
along with the decline of endogenous estrogens in Diabetes Association (ADA) 2018 criteria.12 The
menopausal females.10 Hence, this study aimed to serum was stored at -20oC until the testing of insulin
evaluate the relationship between several common (Elecsys 2010, Roche, USA), and apolipoproteins B
obesity indices such as Body Mass Index (BMI), Waist and A1 (Cobas C501, Roche, USA). Insulin resistance
Circumference (WC), Body Fat Percentage (BF), and was then calculated using the assessment model of
Visceral Fat (VF) with apolipoprotein insulin resistance (HOMA-IR) index = (fasting plasma
B/apolipoprotein A1 ratio in non-menopausal glucose [mg/dL] x insulin [µIU/mL] / 405).13 The
Indonesian adult females as a representative of apolipoprotein B/apolipoprotein A1 ratio value
South East Asia regional population, and to above 0.80 was considered as high (atherogenic and
determine which obesity index had better harmful), based on a previous report.9
correlation with this ratio. This study focused only on The normality of data distribution was tested by
non-menopausal female adults because menopause the Kolmogorov-Smirnov test. The normally
and male gender might alter lipoprotein metabolism distributed numerical variables were analyzed with
and could have bias potential. the one way ANOVA test followed by post-hoc
testing using Fisher's for Least Significant Difference
METHODS (LSD). Parameters with abnormal distribution were
analyzed with the Kruskal Wallis test followed by a
This research was a cross-sectional study post-hoc Mann-Whitney test. The Pearson and
conducted from September 2018 to February 2019. Spearman tests were used to assess correlation in
Ethical approval was obtained from Health Research normally and abnormally distributed parameters,
Ethical Committee, at the Faculty of Medicine, respectively. Further simple linear regression
Hasanuddin University, Makassar (approval analyses were also performed and R2 was reported.
recommendation number 730/H4.8.4.5.31/ Receiver Operating Characteristic (ROC) curves were
PP36-KOMETIK/2018). created to evaluate the performance of obesity
Research subjects were non-menopausal indices as predictors of high apolipoprotein
Indonesian mongoloid adult females aged 18-40 B/apolipoprotein A1 ratio.
years old who voluntarily joined the study with The area under the ROC curve (AUC) was analyzed
signed informed consent. Exclusion criteria were and the optimal cut-off points for predicting the high
subjects who suffered from diabetes mellitus or had apolipoprotein B/apolipoprotein A1 ratio of obesity
recently consumed certain medications including indices were determined by the largest sum of
corticosteroid drugs or cholesterol-lowering agents specificity and sensitivity. Logistic regression analysis
within one month before sampling. Subjects with a was then conducted to evaluate the odds ratio
history of regular smoking and alcohol intake were of obesity indices in determining the high
also excluded. apolipoprotein B/apolipoprotein A1 ratio. Subjects
Obesity indices measurements were performed were categorized as obese, overweight, and normal
by a single examiner on the same day as blood weight based on BMI, and the odds ratio of
sampling. Body mass was measured by a scale (Seca) having high apolipoprotein B/apolipoprotein A1

Obesity Indices Could Predict High Apolipoprotein B - Kurniawan, et al.

Indonesian Journal of Clinical Pathology and Medical Laboratory, 2023 March, 29 (2) : 107 - 112 PAGE 109

ratio between obese and overweight compared to groups. FPG, insulin, and HOMA-IR were significantly
normal subjects was analyzed. All statistical tests higher in the obese group compared to normal and
were performed using the Statistical Package for the overweight groups. Meanwhile, there was no
Social Sciences, Version 21.0 (SPSS Inc, Chicago, IL, significant difference in apolipoprotein A1 levels
USA). among those three groups; apolipoprotein B and
apolipoprotein B/apolipoprotein A1 ratio remained
RESULTS AND DISCUSSIONS higher in the obese compared to normal weight
group (post-hoc p=0.005 and 0.010, respectively).
A total of 75 subjects were recruited for the The Apolipoprotein B/apolipoprotein A1 ratio was
study and were categorized as normal weight higher in the obese compared to the overweight
(n=25), overweight (n=18), and obese (n=32). The group (p=0.047), while there was no significant
study subjects age range was 18-40 years. difference in apolipoprotein B between the obese
Kolmogorov-Smirnov test showed that age, BF, and overweight group.
apolipoprotein B, apolipoprotein A1, and its ratio All obesity indices had a significant correlation
were normally distributed, while other parameters with apolipoprotein B but showed no significant
were not normally distributed. The general correlation with apolipoprotein A1. The correlations
characteristics of the subjects within the three were even stronger with the apolipoprotein
groups are presented in Table 1. There was no B/apolipoprotein A1 ratio compared to
significant difference in age and height among those apolipoprotein B alone (Table 2). Further analysis
Table 1. Characteristics of all, normal, overweight, and obese subjects
Variable Total (n=75) Normal (n=25) Overweight (n=18) Obese (n=32) p
*
Age, year 31.81+4.50 30.92+4.40 31.56+4.78 32.66+4.40 0.342
#
BM, kg 61.15+10.26 52.36+3.90 57.08+2.88 70.30+8.76 <0.001
#
Height, m 155.75+5.05 156.30+5.89 155.03+3.81 155.72+5.06 0.855
2 #
BMI, kg/m 25.21+4.10 21.38+1.17 23.75+0.57 29.02+3.29 <0.001
#
WC, cm 83.63+9.35 75.52+5.31 81.06+3.51 91.41+7.81 <0.001
*
BF, % 33.30+4.68 29.04+2.33 31.98+3.13 37.36+3.16 <0.001
#
VF, unit 7.67+4.97 3.72+1.06 5.67+0.59 11.88+4.96 <0.001
#
FPG, mg/dL 89.96+12.25 84.68+9.94 86.34+9.30 96.11+12.85 0.003
#
Insulin, µIU/mL 10.96+6.92 8.77+5.58 8.57+1.97 14.01+8.44 <0.001
#
HOMA-IR, unit 2.38+1.74 1.82+1.08 1.82+0.44 3.13+2.28 <0.001
*
Apo A1, mg/dL 145.60+23.04 144.68+19.83 151.94+21.12 142.75+26.18 0.393
*
Apo B, mg/dL 102.21+24.34 92.48+24.07 101.06+17.09 110.47+25.64 0.019
*
Apo B/Apo A1 0.72+0.21 0.65+0.22 0.68+0.14 0.79+0.21 0.021
* One way ANOVA test; # Kruskal-Wallis test

Table 2. Correlation of apolipoprotein B/apolipoprotein A1 ratio with obesity indices, and other laboratory variables
Apo B Apo A1 Apo B/Apo A1
Variables
r p r p r p
Univariate
# # #
BMI 0.310 0.007 -0.130 0.266 0.384 0.001
# # #
WC 0.314 0.006 -0.082 0.485 0.363 0.001
* * *
BF 0.346 0.002 -0.129 0.200 0.385 0.001
# # #
VF 0.299 0.009 -0.143 0.222 0.380 0.001
# # #
FPG 0.154 0.187 -0.188 0.107 0.246 0.034
# # #
Insulin 0.302 0.008 -0.101 0.388 0.335 0.003
# # #
HOMA-IR 0.287 0.013 -0.111 0.344 0.314 0.006
Controlling for insulin
BMI 0.241 0.038 -0.139 0.236 0.289 0.013
WC 0.318 0.006 -0.062 0.599 0.317 0.006
BF 0.320 0.005 -0.161 0.169 0.370 0.001
VF 0.192 0.102 -0.146 0.216 0.245 0.035
Controlling for HOMA-IR
BMI 0.251 0.031 -0.138 0.241 0.293 0.011
WC 0.323 0.005 -0.069 0.560 0.321 0.005
BF 0.326 0.005 -0.163 0.164 0.372 0.001
VF 0.208 0.075 -0.140 0.234 0.254 0.029
* Pearson correlation test; # Spearman correlation test

Obesity Indices Could Predict High Apolipoprotein B - Kurniawan, et al.

Indonesian Journal of Clinical Pathology and Medical Laboratory, 2023 March, 29 (2) : 107 - 112 PAGE 110

revealed that the apolipoprotein B/apolipoprotein BF had a better predictive value than BMI, VF, and
A1 ratio also had a significant correlation with insulin WC. BF and WC had the highest sensitivity with a
and HOMA-IR. Therefore, insulin and HOMA-IR were cut-off of 33.15 and 80, respectively, while VF had the
adjusted to determine their independent effect on highest sensitivity with a cut-off of f 7.5 (Table 4).
the association between obesity indices and Further logistic regression analysis showed that
apolipoprotein B/apolipoprotein A1 ratio. After each 1-point increase of BMI, WC, BF, and VF
controlling insulin and HOMA-IR, the correlation increased 1.249, 1.090, 1.256, and 1.208 occurrences
between obesity indices with apolipoprotein of high apolipoprotein B/apolipoprotein A1 ratio
B/apolipoprotein A1 ratio remained significant, (Table 5).
despite slight decreases in the coefficient correlation
values. Table 5. Logistic regression analysis in determining high
Further analysis by simple linear regression in apolipoprotein B/apolipoprotein A1 ratio
Table 3 showed that each obesity indices could 95% CI
describe apolipoprotein B/apolipoprotein A1 ratio Variables OR
Lower Upper
(p<0.005) with BF having the greatest effect (R2
BMI 1.249 1.080 1.444
=0.136) compared to other indices. WC 1.090 1.025 1.159
A ROC analysis showed that the AUC of all obesity BF 1.256 1.096 1.440
indices had a strong value in predicting the high VF 1.208 1.059 1.379
apolipoprotein B/apolipoprotein A1 ratio (Figure 1).

Figure 1. A ROC curve for BMI, WC, VF, and BF as predictors of high apolipoprotein B/apolipoprotein A1 ratio

Table 3. Obesity indices, FPG, insulin, and HOMA-IR simple linear regression with apolipoprotein
B/apolipoprotein A1 ratio
Apo B Apo A1 ApoB/ApoA1
Variables
2 p 2 p 2 p
R R R
BMI 0.063 0.017 0.002 0.289 0.083 0.007
WC 0.106 0.003 -0.010 0.623 0.101 0.003
BF 0.107 0.002 0.009 0.200 0.136 0.001
VF 0.041 0.045 0.003 0.269 0.061 0.018
FPG 0.025 0.091 0.009 0.201 0.056 0.023
Insulin 0.005 0.241 -0.014 0.979 0.001 0.305
HOMA-IR 0.002 0.290 -0.013 0.852 -0.003 0.370

Table 4. The AUC, cut-off point, sensitivity, and specificity of obesity indices in predicting high apolipoprotein
B/apolipoprotein A1 ratio
Variables AUC (95% CI) Sensitivity Specificity Cut-off Point
BMI 0.722 (0.596-0.848) 0.667 0.706 25.4
WC 0.686 (0.559-0.814) 0.792 0.549 80
BF 0.754 (0.633-0.875) 0.792 0.627 33.15
VF 0.721 (0.595-0.847) 0.667 0.725 7.5

Obesity Indices Could Predict High Apolipoprotein B - Kurniawan, et al.

Indonesian Journal of Clinical Pathology and Medical Laboratory, 2023 March, 29 (2) : 107 - 112 PAGE 111

Table 6. The odds ratio of high apolipoprotein B/apolipoprotein A1 ratio among normal, overweight, and obese subjects
Apo B/ Apo A1 Ratio
High Normal p OR (CI 95%)
n % n %
Obese 16 50 16 50 0.020 4.0 (1.20-13.28)
BMI Overweight 3 16.7 15 83.3 0.782 0.8 (0.17-3.89)
Normal 5 20 20 80 Reference
Total 24 32 51 68

Obese subjects had 4.0 times higher risk to suffer Several explanations may describe these study
from high apolipoprotein B/apolipoprotein A1 ratio findings. Chronic hyperinsulinemia and insulin
compared to the normal-weight subjects (Table 6). resistance in obesity induce the liver to resist from
Among the subjects of non-menopausal inhibitory effects of insulin on the secretion of VLDL.
Indonesian mongoloid adult females in this study, Fatty liver, a condition frequently found in obese
we found a significant correlation between all subjects, results in the increased synthesis of
obesity indices with apolipoprotein B, but none was triglyceride-rich lipoproteins through the
found with apolipoprotein A1. BF had a slightly overproduction of VLDL cholesterol.17 Increased lipid
stronger correlation compared to other obesity availability in obesity and insulin resistance may also
indices. This finding was consistent with another protect apolipoprotein B from local degradation by
report on the South-East Asian population.14 hepatocytes, induce defect in hepatic VLDL
Vanavanan et al. in Thailand, reported that the clearance, and will therefore increase the
percentage of body fat was a good indicator of apolipoprotein B and its ratio because each VLDL
atherogenic lipoprotein molecules in adults.14 In one contains one molecule of apolipoprotein B100.17,18
study, which did not include BF and VF in the analysis, Although all obesity indices correlate
BMI was reported as a stronger index for the significantly with the apolipoprotein
prediction of atherogenic parameters than other B/apolipoprotein A1 ratio, BF has a slightly better
body indices including waist circumferences, value in predicting a high ratio compared to others.
waist-to-hip ratio, and waist-to-height ratio.15 This may be explained by the fact that BF tends to
A stronger correlation was observed between the reflect all body fat including hepatic fat, which can
obesity indices with the apolipoprotein cause lipoprotein metabolism abnormalities, while
B/apolipoprotein A1 ratio in comparison with BMI may be biased by the possibility of
apolipoprotein B alone, indicating the interaction of miscalculation of muscle as fat. Additionally, VF and
pro- and anti-inflammatory features.4 WC only specifically reflect fat in the abdominal
Apolipoprotein B/apolipoprotein A1 ratio was also region.
significantly correlated with insulin resistance In this study, obese subjects (BMI >25 kg/m2) were
(HOMA-IR) showing that metabolic disorders found to be 4 times more likely to have a high
occurring in obese states may contribute to apolipoprotein B/apolipoprotein A1 ratio compared to
lipoprotein abnormality.8 In fact, a strong correlation those of normal weight. On the other hand,
existed even after controlling the effect of insulin overweight subjects (BMI 23-24.9 kg/m2) did not
resistance (insulin/HOMA-IR), indicating that excess demonstrate a higher risk of having high
fat may solely become an independent factor of apolipoprotein B/apolipoprotein A1 ratio compared to
lipoprotein metabolic disorders. One study reported normal-weight subjects. It seemed that the lipoprotein
that the apolipoprotein B/apolipoprotein A1 ratio metabolism of overweight non-menopausal
was higher in Metabolically Abnormal Obese (MAO) mongoloid adult female subjects in our population
compared to Metabolically Healthy Obese (MHO) was not or only minimally disturbed and might share
individuals. Metabolically healthy obese subjects similar features with normal-weight subjects.
were obese subjects, which did not have any of the Other interesting findings in our study were the
four components of metabolic syndrome criteria BMI and WC cut-off in defining the high
(after excluding the WC criteria) based on the apolipoprotein B/apolipoprotein A1 ratio. This study
National Cholesterol Education Program (NCEP) found that the most optimal BMI cut-off to define
Adult Treatment Panel III (ATP III), in contrast to MAO the high ratio was 25.4, which was close to 25 as the
subjects whose at least one of the four criteria.16 BMI cut-off used to define the obese state in the

Obesity Indices Could Predict High Apolipoprotein B - Kurniawan, et al.

Indonesian Journal of Clinical Pathology and Medical Laboratory, 2023 March, 29 (2) : 107 - 112 PAGE 112

Asian population. Meanwhile, the most optimal WC 6. Chou YC, You SL, Bai CH, Liao YC, Wei CY, Sun CA.
cut-off to define a high ratio was 80, the same value Utility of apolipoprotein measurements in predicting
used to define central obesity in female adults stated incident type 2 diabetes: A Chinese cohort study. J
Formos Med Assoc, 2020; 119: 51-58.
by IDF. Therefore, our findings confirmed the BMI
7. Frondelius K, Borg M, Ericson U, Borne Y, Melander O,
and WC cut-off values, which had been proposed
Sonestedt E. Lifestyle and dietary determinants of
previously for defining obesity in the Asian serum apolipoprotein A1 and apolipoprotein B
population and gave an impact on predicting concentration: Cross-sectional analyses within a
lipoprotein abnormalities, especially the Swedish cohort of 24,984 individuals. Nutrients, 2017;
apolipoprotein B/apolipoprotein A1 ratio. 9: 211.
The inability of this cross-sectional design to 8. War GA, Raina S, Jain R, Kant S. Correlation of
explain the causality of the association between apolipoprotein B and apolipoprotein A1 with
obesity indices and apolipoprotein B/apolipoprotein metabolic syndrome–single center experience from
Delhi. JIACM, 2018; 19(3): 191-194.
A1 ratio and the inability of this single-center study
9. Kaneva A, Potolitsyna NN, Bojko ER, Odland JO. The
to represent multi-ethnic Indonesian populations
apolipoprotein B/apolipoprotein A-I ratio as a
remained the limitations of this study. potential marker of plasma atherogenity. Disease
Markers, 2015; Article ID 591454.
CONCLUSIONS AND SUGGESTIONS 10. Palmisano BT, Zhu L, Eckel RH, Stafford JM. Sex
difference in lipid and lipoprotein metabolism. Mol
The obesity indices comprising of BF, BMI, VF, Metab, 2018; 15: 45-55.
and WC were significantly correlated with the 11. Nam GE, Park HS. Perspective on diagnostic criteria for
apolipoprotein B/apolipoprotein A1 ratio in obesity and abdominal obesity in Korean adults. J
Obes Metab Syndr, 2018; 27: 134-142.
non-menopausal Indonesian mongoloid adult
12. American Diabetes Association. Classification and
females and might be used to predict the high ratio.
diagnosis of diabetes: Standards of medical care in
Future multicenter and larger studies should be diabetes-2018. Diabetes Care, 2018; 41(suppl. 1):
performed on multiple Indonesian ethnic groups to S13-S27.
generalize the cut-off values. 13. Gutch M, Kumar S, Razi SM, Gupta KK, Gupta A.
Assessment of insulin sensitivity/resistance. Indian J
REFERENCES Endocrinol Metab, 2015; 19(1): 160-164.
14. Vanavanan S, Srisawasdi P, Rochanawutanon M,
1. Seidell JC, Halberstadt J. The global burden of obesity Kumproa N, Kruthkul K, Kroll MH. Performance of
and the challenges of prevention. Ann Nutr Metab, body mass index and percentage of body fat in
2015; 66(suppl 2): 7-12. predicting cardiometabolic risk factors in Thai adults.
2. Harbuwono DS, Pramono LA, Yunir E, Subekti I. Diabetes Metab Syndr Obes, 2018; 11: 241-253.
Obesity and central obesity in Indonesia: evidence 15. Eslami O, Shahraki M, Shahraki T. Obesity indices in
from a national health survey. Med J Indones, 2018; 27: relation to lipid abnormalities among medical
114-120. university students in Zahedan, south-east of Iran. Int J
3. Drozdz D, Alvarez-Pitti J, Wojcik M, Borghi C, Prev Med, 2019; 10: 15.
Gabbianelli R, et al. Obesity and cardiometabolic risk 16. Wang W, Blackett P, Khan S, Lee E. Apolipoproteins A-I,
factors: From childhood to adulthood. Nutrients, 2021; B, and C-III and obesity in young adult Cherokee. J
13: 4176. Lipids, 2017; Article ID 8236325.
4. Wang HH, Garruti G, Liu M, Portincasa P, Wang DQH. 17. Ormazabal V, Nair S, Elfeky O, Aguayo C, Salomon C,
Cholesterol and lipoprotein metabolism and Zuniga FA. Association between insulin resistance and
atherosclerosis: Recent advances in reverse the development of cardiovascular disease.
cholesterol transport. Ann Hepatol, 2017; 16(suppl 1): Cardiovasc Diabetol, 2018; 17: 122.
s27-s42. 18. Morita S. Metabolism and modification of
5. Sniderman AD, Thanassoulis G, Glavinovic T, Navar apolipoprotein B-containing lipoproteins involved in
AM, Pencina M, Catapano A, et al. Apolipoprotein B dyslipidemia and atherosclerosis. Biol Pharm Bull,
particles and cardiovascular disease: A narrative 2016; 39: 1-24.
review. JAMA Cardiol, 2019; 4(12): 1287-1295.

Obesity Indices Could Predict High Apolipoprotein B - Kurniawan, et al.