Background: Obesity is associated with numerous metabolic complications, such as type 2 diabetes mellitus (DM2), dyslipidemia, arterial hypertension (AH), cardiovascular diseases and some forms of cancer. Nevertheless, the literature describes a group of obese individuals who are more resistant to the development of metabolic disorders. At present, this phenomenon is known as "Metabolically healthy obesity", "metabolically healthy obesity" (MZO). Despite the presence of excess weight or obesity, a favorable metabolic profile can be observed in this cohort of patients, characterized by preserved insulin sensitivity, absence of arterial hypertension, normal lipid, hormonal profile, absence of inflammation and unchanged hepatic transaminases. Aims: To study the prevalence of metabolically healthy obesity (MHO) and its characteristics in men and women at the age of 4569 years in Novosibirsk. Materials and methods: To study covered 3197 persons from the base of the international project HAPPIE. They had a body mass index (BMI 30 kg/m). Metabolically healthy obesity was determined as obesity (BMI 30 kg/m, with 2 and fewer components of metabolic syndrome (MS) by criteria NCEP ATP III, 2001. Statistical analisys SPSS-13. Results: The prevalence of metabolic healthy obesity (MHO) was 42% (38% for men and 43% for women). The examined people with MHO have reliably more favorable average level of TG, HDL-cholesterol, indicators of blood glucose, systolic arterial pressure and diastolic arterial pressure and less waist circumference. In the groups withMHO and MS abdominal obesity is common in men at 95 and 71%, in women at 99 and 90%; hyperTG in men at 74 and 9%, in women at 72 and 5,5%; lower level HDL-cholesterol in 16 and 1% for men, and in 44,5% and 3% for women; AP in 96 and 77% and 94 and 71% in men and women respectively, the frequency fasting of hyperglycaemia 77 and 21% in men and 60 and 5% in women was markedly different. According to the data obtained by us, the frequency in the sample is high and amounted to 42%. In the subgroup the most commonly found is the MHO phenotype 53%, than in the men -38%, р 0,001 Conclusions: According to our data, the frequency of metabolic healthy obesity in the sample is high and amounted to 42%. In the female subgroup, a metabolically healthy phenotype is more common 43% than in the male 38%, p 0.001. Metabolically healthy obese individuals are characterized by a significantly lower incidence of fasting hyperglycaemia and dyslipidemia.

Aim of the study was to investigate the risk of developing type 2 diabetes mellitus (T2DM) in individuals with metabolically healthy and unhealthy obesity phenotypes (MHO and MUO) and evaluate the contribution of metabolic syndrome (MS) components to the 12-year risk of developing T2DM according to a prospective study.Material and methods. The study included 1958 people with a BMI ≥30 kg/m² and no T2DM, from among those examined at the baseline screening in 2003– 2005 of the HAPPIE project. New cases of T2DM were diagnosed between 2003 and 2018 according to the register of diabetes mellitus and repeated screenings. The median follow-up period was 12.1 years. Were used to define MHO: criteria of the NCEPATP III, 2001 and IDF, 2005.Results. The incidence of T2DM in the MHO group according to all studied criteria is on 1,5 times lower than in persons with MUO, p<0,001. According to the results of Cox regression multivariate analysis, the risk of developing T2DM in individuals with MHO is 2.3 times lower according to the IDF criteria, 2005 and 2,2 times lower according to the NCEP ATP III, 2001 criteria, compared with persons with MUO. The risk of developing T2DM increases in direct proportion to the number of MS components: 3 components—OR = 3,1 (95% CI: 1.0; 9.9), p = 0.048, 4 components—OR = 4.4 (95% CI: 1.4; 14.0), p = 0.011. However, the presence of obesity in a person with one risk factor does not lead to the development of T2DM within 12 years, p>0.05. When analyzing obese individuals who had abdominal obesity (AO), the risk of developing T2DM is 2 times higher compared to individuals with normal waist circumference (WC), and people without AO demonstrate no risk of developing T2DM, with an increase in the number of MS components, p> 0.05.Conclusions. The incidence of first-­onset T2DM during 12 years in the MHO group by any used criteria is on 1.5 times lower than in the MUO group. In individuals with obesity, regardless of its phenotype, the most significant independent predictors of the risk of incident T2DM are AO and fasting hyperglycaemia. In individuals without AO, the risk of developing T2DM does not increase, even with an increase in the number of MS components. In the presence of AO, the risk of developing T2DM increases 2 times already with the appearance of any other component.

Цель. Оценить динамику фенотипов ожирения и их связь с риском развития инфаркта миокарда (ИМ) за 13-летний период наблюдения. Материал и методы. Исследование выполнено на материале международного проекта HAPIEE (популяционная выборка мужчин и женщин 45-69 лет, n=9360, базовое обследование 2003-2005гг). В анализ включены лица с индексом массы тела (ИМТ) ≥30 кг/м 2 : 3197 человек; 857 мужчин (26,8%) и 2340 женщин (73,2%). Для анализа частоты новых случаев ИМ была сформирована выборка 3008 человек без исходного ИМ в анамнезе (752 мужчины и 2256 женщин). Новые случаи ИМ собраны по данным программы ВОЗ "Регистр острого инфарк та миокарда", проводящейся в НИИТПМ-филиал ИЦиГ СО РАН длительное время; результатам двух повторных обследований (2006-2008гг и 2015-2017гг) и почтовых опросов когорты в среднем за 13,6 лет наблюдения. Анализ проведен у лиц с метаболически здоровым фенотипом ожирения (МЗФО). МЗФО определен в соответствии с различными классификациями: 1. (IDF, 2005)-окружность талии (ОТ) ≥94 см у мужчин и ≥80 см у женщин и любой компонент метаболического синдрома (МС) по IDF или без него; 2. (NCEPATP III, 2001) при наличии 2 или менее компонентов МС и 3. (РКО, 2017) показатель индекса ОТ/окружность бедер (ОБ) ≤0,9 у мужчин и ОТ/ОБ ≤0,85 у женщин. Статистический анализ проведен с помощью пакета программ SPSS V. 13.0. Результат. Частота МЗФО в анализируемой выборке по критериям IDF составила 20%, NCEP ATP III-45%, РКО-31%. По данным проспективного наблюдения от 51 до 59% лиц с МЗФО в течение 13 лет перешли в метаболически нездоровый фенотип ожирения (МНФО). Женщины чаще сохраняли МЗФО по критериям NCEP ATP III и РКО, а также более часто, чем мужчины, переходили за 13 лет в группу МЗФО из МНФО по критериям IDF и РКО. Относительный риск ИМ у лиц c МНФО в среднем в 2,5 раза выше, чем у лиц с МЗФО: по критериям NCEP ATP III-отношение шансов (ОШ) =1,9 (95% доверительный интервал (ДИ) 1,2;2,9), у лиц с МНФО по критериям РКО ОШ=3,2 (95% ДИ 1,7;6,1). По критериям IDF не выявлено достоверных различий в частоте развития новых случаев ИМ. Заключение. МЗФО является нестабильным состоянием, так как более половины мужчин и женщин в течение 13 лет наблюдения переходит в МНФО. Относительный риск ИМ в группе с МНФО выше, чем в группе с МЗФО: по критериям NCEP ATP III-ОШ=1,9 (95% ДИ 1,2;2,9), по критериям РКО ОШ=3,2 (95% ДИ 1,7;6,1).

Aim. To study the contribution of behavioral and social risk factors to the development of metabolically unhealthy obesity (MUO) according to a prospective study in the Russian population.Material and methods. From the HAPPIE project, 3197 people aged 45-69 years with a body mass index ≥30 kg/m2 were selected, who had all the necessary parameters for obesity phenotype determination. The prospective analysis included the first (2003-2005) and third screenings (2015-2017). A subsample was formed (n=1275; 276 men — 22%, 999 women — 78%). The mean follow-up period was 12,4 years. IDF criteria (2005) were taken for analysis.Results. Men with a metabolically healthy obesity (MHO) phenotype most often have a secondary and higher education, while women with MHO — vocational and secondary education. In women, secondary education was most often noted. Among persons with obesity, both men and women are more often not single, while having MUO as follows: 56,8% and 34,2%, respectively. Men and women have a low-intensity activity, regardless of the obesity phenotype. The prevalence of smoking in the present time does not differ in the MHO and MUO groups. Metabolically healthy women consume more alcohol than those with MUO. In men with sedentary lifestyle and fasting hyperglycemia, the risk of MUO over a 12-year follow-up period was significantly higher. In women, the risk of conversion from MHO to MUO is increased when blood pressure (BP) is ≥130/85 mmHg.Conclusion. In the Russian population, the risk of MUO in men increases with a level of physical activity <3 h/week and a blood glucose level ≥6,1 mmol/l; in women, only BP ≥130/85 mm Hg contributes to the development of MUO.