Metabolic normality in overweight and obese subjects. Which parameters? Which risks?

Abstract

Objectives: The objective of this study was to define metabolic normality and to investigate the cardiometabolic profile of metabolically normal obese. Design: Cross-sectional study conducted at 21 research centers in Europe. Subjects: Normal body weight (nbw, n ¼ 382) and overweight or obese (ow/ob, n ¼ 185) subjects free from metabolic syndrome and with normal glucose tolerance, were selected among the Relationship between Insulin Sensitivity and Cardiovascular Disease study participants. Main outcome measures: Insulin sensitivity was assessed by the clamp technique. On the basis of quartiles in nbw subjects, the limits of normal insulin sensitivity and of normal fasting insulinemia were established. Subjects with normal insulin sensitivity and fasting insulin were defined as metabolically normal. Results: Among ow/ob subjects, 11% were metabolically normal vs 37% among nbw, Po0.0001. Ow/ob subjects showed increased fasting insulin (P ¼ 0.0009), low-density lipoprotein cholesterol (LDL-cholesterol) (P ¼ 0.004), systolic (P ¼ 0.0007) and diastolic (P ¼ 0.001) blood pressure, as compared with nbw. When evaluating the contribution of body mass index (BMI), hyperinsulinemia and insulin resistance, BMI showed an isolated effect on high-density lipoprotein (P ¼ 0.007), high-sensitivity C-reactive protein (Po0.0001), systolic (P ¼ 0.002) and diastolic (P ¼ 0.008) blood pressures. BMI shared its influence with insulinemia on total cholesterol (P ¼ 0.04 and 0.003, respectively), LDL-cholesterol (P ¼ 0.003 and 0.006, respectively) and triglycerides (P ¼ 0.02 and 0.001, respectively). Conclusion: In obese subjects, fasting insulin should be taken into account in the definition of metabolic normality. Even when metabolically normal, obese subjects could be at increased risk for cardiometabolic diseases. Increased BMI, alone or with fasting insulin, is the major responsible for the less favorable cardio-metabolic profile.

The color of fat and its central role in the development and progression of metabolic diseases

“…Considering that a "healthy" subcutaneous adipose tissue can expand becoming a buffer for excess circulating substrates, the presence of a phenotype defined as "metabolically healthy obese" (or MHO) has been hypothesized. These subjects, despite being obese, have close to normal insulin sensitivity and lipid homeostasis [38], [72], [73], [74]. MHO individuals do not have dyslipidemia or hyperglycemia and are protected from metabolic and cardiovascular comorbidities [38], [75].…”

Healthy excessive weight in Portuguese women 4years after delivery of a liveborn

“…In Portugal, 20% of women in their thirties are overweight and 8% obese (Carreira et al, 2012) and this increase in excessive body weight will have an important impact on the global incidence of several diseases, (Visscher and Seidell, 2001). However, a subset of obese subjects seems to be protected from obesity-related cardiovascular and cardiometabolic abnormalities (Pataky et al, 2011;Stefan et al, 2008;Karelis, 2008;Manu et al, 2012). The phenotype called healthy obesity is characterized by a favorable metabolic profile: high levels of insulin sensitivity, no hypertension, as well as a favorable inflammatory (Phillips and Perry, 2013), lipid, hormonal and immune profile (Primeau et al, 2011).…”

QOF should be more about disease and risk factors prevention

“…Furthermore, their findings suggest that high BMI, alone or with fasting insulin, negatively affects the cardiometabolic profile. 5 Interestingly, patients may be more upset by being told that they are obese, or scared of having their weight checked, than being told about high cholesterol or abnormal glucose tolerance. GPs tend to avoid using the term 'obese' and often prefer to use a euphemism.…”