Characterizing the profile of obese patients who are metabolically healthy

Abstract

The presence of obesity-related metabolic disturbances varies widely among obese individuals. Accordingly, a unique subset of obese individuals has been described in the medical literature, which seems to be protected or more resistant to the development of metabolic abnormalities associated with obesity. These individuals, now known as 'metabolically healthy but obese' (MHO), despite having excessive body fatness, display a favorable metabolic profile characterized by high levels of insulin sensitivity, no hypertension as well as a favorable lipid, inflammation, hormonal, liver enzyme and immune profile. However, recent studies have indicated that this healthier metabolic profile may not translate into a lower risk for mortality. Mechanisms that could explain the favorable metabolic profile of MHO individuals are poorly understood. However, preliminary evidence suggests that differences in visceral fat accumulation, birth weight, adipose cell size and gene expression-encoding markers of adipose cell differentiation may favor the development of the MHO phenotype. Despite the uncertainty regarding the exact degree of protection related to the MHO status, identification of underlying factors and mechanisms associated with this phenotype will eventually be invaluable in helping us understand factors that predispose, delay or protect obese individuals from metabolic disturbances. Collectively, a greater understanding of the MHO individual has important implications for therapeutic decision making, the characterization of subjects in research protocols and medical education. Keywords: metabolically healthy but obese; insulin sensitivity; body composition; metabolic risk factors; cardiovascular diseases Introduction Obesity has been increasing at a rapid rate over the past decades and has now reached epidemic proportions. Recent data suggest that 65% of US adult are overweight (body mass index425 kg m À2) and 30% are obese (body mass index430 kg m À2).1 Obesity is associated with numerous metabolic complications such as Type 2 diabetes, dyslipidemia, hypertension, cardiovascular diseases and several forms of cancer. 2 The risk of developing obesity-related complications is proportional to the degree of obesity, and more specifically to android fat accumulation. 3 However, the presence of these obesity-related metabolic disturbances varies widely among obese individuals. 4,5 Accordingly, a unique subset of obese individuals has been described in the medical literature that seems to be protected or more resistant to the development of metabolic abnormalities associated with obesity. 6-12 These individuals, now known as 'metabolically healthy but obese' (MHO), despite having excessive body fatness, display favorable metabolic profiles characterized by high levels of insulin sensitivity, no hypertension, as well as favorable lipid, inflammation, hormonal, liver enzyme and immune profiles 7,9,[13][14][15] ( Figure 1). This phenomenon has also been observed in adolescents. 16 Despite a clinical awareness of the MHO individu...

Impact of BMI on the incidence of metabolic abnormalities in metabolically healthy men

“…3,4 A unique subset of obese individuals that appears to be protected from obesity-related metabolic abnormalities has been identified. 3,5 These individuals, referred to as metabolically healthy but obese (MHO), are relatively insulin sensitive and have a favorable cardiovascular risk profile despite excessive body fat. 6 Previous studies indicate that MHO individuals, regardless of body mass index, are not at increased risk for cardiovascular diseases compared with normal-weight subjects without insulin resistance.…”

“…1,2 However, the incidence of obesity-related metabolic disturbances varies widely among obese individuals. 3,4 A unique subset of obese individuals that appears to be protected from obesity-related metabolic abnormalities has been identified. 3,5 These individuals, referred to as metabolically healthy but obese (MHO), are relatively insulin sensitive and have a favorable cardiovascular risk profile despite excessive body fat.…”

Uric acid levels in metabolically healthy and unhealthy obese patients

“…Ancak, obezite bulunan ve metabolik olarak sağlıklı obez, komplike olmayan obez ya da metabolik olarak benign obez olarak adlandırılan hastaların bir grubunun, obezite ile ilişkili morbiditelerin bir kısmından korundukları, bu morbiditelere karşı daha dirençli oldukları gösterilmiştir [1]. Antropometrik olarak, MHO grubunun, daha düşük viseral yağ oranına sahip oldukları bazı çalışmalar-la gösterilmiştir [10][11][12]. Ayrıca, literatürde artmış ürik asit seviyelerinin visseral yağ oranı ile ilişkisini gösteren raporlar da mevcuttur [13,14].…”

Oxidized LDL as A Biomarker in Metabolic Syndrome

“…Metabolic syndrome is a combination of unfavorable health factors including abdominal obesity, dyslipidemia, hypertension and glucose intolerance and is strongly associated with increased risk of cardiovascular disease (CVD) and type-2 diabetes [3][4]. One of the key drivers in the development of metabolic syndrome is obesity [5]. Oxidized LDL, a marker of lipoproteinassociated Oxidative stress, is an emerging cardiovascular risk factor.…”