Metabolically Healthy but Obese, a Matter of Time? Findings From the Prospective Pizarra Study

Soriguer, Federico; Gutiérrez-Repiso, Carolina; Rubio‐Martín, Elehazara; Garcı́a-Fuentes, Eduardo; Almaraz, María Cruz; Colomo, Natalia; Antonio, Isabel Esteva de; Adana, María Soledad Ruiz de; Chaves, Felipe Javier; Morcillo, Sonsoles; Valdés, Sergio; Rojo-Martínez, Gemma

doi:10.1210/jc.2012-4253

Cited by 217 publications

(205 citation statements)

References 34 publications

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“…Some authors consider the appearance of metabolic abnormalities and other comorbidities associated with obesity to be only a matter of time; i.e., it is merely a question of evolution of the disease as evidenced by studies showing that MHO subjects exhibit increased risk of developing diabetes, hypertension, or metabolic syndrome in the long term (41,42). In this sense, a growing number of studies have questioned the apparently healthy metabolic condition of MHO, showing that these obese patients have increased morbidity and mortality as compared whiskers showing from minimum to maximum.…”

Section: Discussionmentioning

confidence: 99%

Increased Cardiometabolic Risk Factors and Inflammation in Adipose Tissue in Obese Subjects Classified as Metabolically Healthy

et al. 2014

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OBJECTIVEIt has been suggested that individuals with the condition known as metabolically healthy obesity (MHO) may not have the same increased risk for the development of metabolic abnormalities as their non-metabolically healthy counterparts. However, the validity of this concept has recently been challenged, since it may not translate into lower morbidity and mortality. The aim of the current study was to compare the cardiometabolic/inflammatory profile and the prevalence of impaired glucose tolerance (IGT) and type 2 diabetes (T2D) in patients categorized as having MHO or metabolically abnormal obesity (MAO). RESEARCH DESIGN AND METHODSWe performed a cross-sectional analysis to compare the cardiometabolic/inflammatory profile of 222 MHO and 222 MAO patients (62% women) matched by age, including 255 lean subjects as reference (cohort 1). In a second cohort, we analyzed the adipokine profile and the expression of genes involved in inflammation and extracellular matrix remodeling in visceral adipose tissue (VAT; n = 82) and liver (n = 55). RESULTSThe cardiometabolic and inflammatory profiles (CRP, fibrinogen, uric acid, leukocyte count, and hepatic enzymes) were similarly increased in MHO and MAO in both cohorts. Moreover, above 30% of patients classified as MHO according to fasting plasma glucose exhibited IGT or T2D. The profile of classic (leptin, adiponectin, resistin) as well as novel (serum amyloid A and matrix metallopeptidase 9) adipokines was almost identical in MHO and MAO groups in cohort 2. Expression of genes involved in inflammation and tissue remodeling in VAT and liver showed a similar alteration pattern in MHO and MAO individuals. CONCLUSIONSThe current study provides evidence for the existence of a comparable adverse cardiometabolic profile in MHO and MAO patients; thus the MHO concept should be applied with caution. A better identification of the obesity phenotypes and a more precise diagnosis are needed for improving the management of obese individuals.

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Section: Discussionmentioning

confidence: 99%

Increased Cardiometabolic Risk Factors and Inflammation in Adipose Tissue in Obese Subjects Classified as Metabolically Healthy

et al. 2014

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“…However, our finding that MH OWOB individuals were at no greater risk of CVD mortality than MH NW individuals suggests that such further discrimination may add little to CVD risk evaluation, consistent with CVD risk associated with increasing adiposity being fully explained by established risk factors (28). However, although increased sub-clinical inflammation in MHO may be relatively benign with regard to CVD risk, the increased insulin resistance may indicate increased risk of type 2 diabetes (26,29,30).…”

Section: Discussionmentioning

confidence: 73%

“…Also, in accord with our findings, the proportion of individuals MHO at baseline becoming MUH at follow-up was substantial at 30%. Likewise, Soriguer et al, in a study of 1051 individuals, found that 48% of those MH OB at baseline were MUH at a 6-year follow-up (30). However, in neither of these studies was the time profile of attrition of MH distinguished, there being only a single follow-up estimate of change in MH status.…”

Section: Discussionmentioning

confidence: 99%

Does metabolic health in overweight and obesity persist? – Individual variation and cardiovascular mortality over two decades

Kaur

Johnston

Godsland

2016

European Journal of Endocrinology

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Objective: Overweight and obese individuals may be metabolically healthy, but attention needs to be given to long-term persistence of this trait and any associated variation in cardiovascular risk. Design: Cross-sectional and longitudinal variation in metabolic health and associated cardiovascular mortality were analysed in 1099 white European-origin normal-weight and overweight or obese males followed for 20 years. Methods: Definitions of metabolic health were based on LDL and HDL cholesterol, triglycerides, blood pressure, fasting glucose and cardiovascular risk. Insulin resistance (e.g. HOMA-IR) and sub-clinical inflammation (ESR and white blood cell count) were explored. Cardiovascular mortality risks and persistence of metabolic health status were evaluated. Results: There were 87 cardiovascular deaths. Insulin resistance was increased in metabolically healthy overweight or obese participants (median HOMA-IR 2.63, 95% CI: 1.79-3.65, P < 0.001) relative to normal-weight participants (median HOMA-IR 1.67, 95% CI: 1.08-2.67, P < 0.001) as was sub-clinical inflammation but metabolically healthy overweight or obese individuals were not at increased risk of cardiovascular mortality compared with the metabolically healthy normal-weight individuals (hazard ratio 1.13, 95% CI: 0.34-3.72, P = 0.8). The proportions of initially metabolically healthy overweight or obese who remained metabolically healthy for visits 2, 3 and 4 were 54, 48 and 39% respectively, and for initially normal-weight individuals, 68, 51 and 41%. A lower proportion of metabolically healthy overweight or obese individuals remained metabolically healthy at visit 2 compared with normal-weight individuals (P = 0.007), but proportions converged thereafter. Conclusions: Despite being insulin resistant and having greater sub-clinical inflammation, and despite instability in metabolic health status, metabolically healthy overweight or obese individuals were at no greater risk of cardiovascular mortality than their normal-weight equivalents.

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“…The healthy obese phenotype is characterized by preserved insulin sensitivity, relatively low visceral fat mass and normal adipose tissue function. However, initially MHO individuals undergo adverse metabolic changes associated with obesity over time, therefore metabolically healthy obesity may not be a stable condition [11,17,18]. While there were significant lower levels of low-density lipoprotein and triglycerides in MHO among patients younger than 40 years, the significance was lost among older patients.…”

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confidence: 99%

Healthy obese child: when and in whom do comorbidities develop?

Małecka-Tendera¹

2014

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Metabolically Healthy but Obese, a Matter of Time? Findings From the Prospective Pizarra Study

Abstract: The results suggest that MHO is a dynamic concept that should be taken into account over time. As a clinical entity, it may be questionable.

Cited by 217 publications

References 34 publications

Increased Cardiometabolic Risk Factors and Inflammation in Adipose Tissue in Obese Subjects Classified as Metabolically Healthy

Increased Cardiometabolic Risk Factors and Inflammation in Adipose Tissue in Obese Subjects Classified as Metabolically Healthy

Does metabolic health in overweight and obesity persist? – Individual variation and cardiovascular mortality over two decades

Healthy obese child: when and in whom do comorbidities develop?

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