Markers of gut barrier function and its associations with cardiometabolic indices among metabolically healthy obese Arab women

The prevalence of obesity in Saudi Arabia is high, but a high percentage of the obese population is considered metabolically healthy. It is known that metabolically unhealthy obese individuals exhibit a dysfunctional gut barrier, but such dysregulation has not been demonstrated for other obesity phenotypes. The present cross-sectional study evaluated the associations between gut barrier function with cardiometabolic indices among metabolically healthy obese (MHO) Saudi women. A total of 100 Saudi women (mean age 31.0 ± 7.1 years; body mass index, Body Mass Index 35.1 ± 4.7 kg/m²) were screened for MHO [presence of 2 or fewer components of metabolic syndrome (obesity, dyslipidemia, hypertension, and elevated glucose)]. Demographic and clinical characteristics were measured, including anthropometrics. Fasting blood samples were taken to ascertain lipid and glycemic profiles using routine analysis. Circulating levels of cluster of differentiation 14 (CD14), fatty acid binding protein 2 (FABP2), and endotoxin were measured using commercially available assays. Bivariate associations showed that CD14 was inversely associated with C-peptide (R=-0.37, p=0.02). FABP2 was inversely associated with age (R=-0.21, p=0.04) and positively correlated with glycated hemoglobin (R= 0.24, p=0.02). Stepwise linear regression analyses using gut barrier function markers as dependent variables revealed that CD14 explains 15% of the variance perceived in insulin sensitivity, as measured using homeostasis model assessment for β function (HOMA-β) (adjusted R² = 0.15; p=0.02). On the other hand, FABP2 predicted 17% of the variance perceived in triglyceride levels (adjusted R² = 0.17; p=0.02). No significant predictors were seen in endotoxins. In conclusion, the findings suggest that gut barrier function markers like CD14 and FABP2 may serve as early indicators of metabolic risk among women with MHO. Prospective studies are needed to explore the mechanisms behind these associations, especially in populations like Arab women, where genetic, dietary, and lifestyle factors may play a unique role.