Normal-weight obesity syndrome: diagnosis, prevalence, and clinical implications

Franco, Lila Louise Moreira Martins; Morais, Carla Cristina de; Cominetti, Cristiane

doi:10.1093/nutrit/nuw019

Cited by 123 publications

(131 citation statements)

References 40 publications

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“…Exercise interventions such as high-intensity interval training and resistance training have been shown to be especially effective at reducing abdominal fat and increasing leg LM, while also being feasible and enjoyable in obese populations [48,49]. Although current results are limited to overweight and obese individuals, segmental evaluation of body composition could also prove to be insightful in identifying at-risk normal and underweight individuals who often go undetected due to their normal weight status [50]. In conclusion, LM and FM, specifically trunk LM, leg LM, trunk FM, and VAT, were significantly associated with metabolic rate and substrate utilization.…”

Section: Discussionmentioning

confidence: 99%

Influence of segmental body composition and adiposity hormones on resting metabolic rate and substrate utilization in overweight and obese adults

Hirsch

Smith‐Ryan

Blue

et al. 2017

J Endocrinol Invest

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Purpose Low resting metabolic rate (RMR) and high carbohydrate reliance at rest are associated with weight gain, but are highly variable in obese individuals. This study determined the relationship of total and segmental body composition and adiposity hormones with RMR and respiratory exchange ratio (RER) in overweight and obese adults. Methods In 49 men (n=23) and premenopausal women (n=26) (Mean ± SD; Age = 35.0 ± 8.9 yrs; body mass index [BMI] = 33.6 ± 5.2 kg·m−2; percent body fat [%fat] = 40.0 ± 8.0%), RMR and RER were evaluated using indirect calorimetry. Total and segmental body composition (fat mass [FM], percent fat [%fat], lean mass [LM], visceral adipose tissue [VAT]), were estimated using dual-energy x-ray absorptiometry. Fasted blood and saliva samples were analyzed for insulin, leptin, estradiol, and cortisol. Results In men (M) and women (W), RMR significantly correlated (p<0.05) with FM (M: R=0.535; W: R=0.784) and LM (M: R=0.645; W: R=0.867). Of the segmental measures, trunk LM (M: R=0.593; W: R=0.879; p<0.05) and leg LM (M: R=0.664; W: R=0.821; p<0.05) had the strongest correlations with RMR. In men, but not women, RER significantly correlated with FM (R=0.449; p=0.032), trunk FM (R=0.501; p=0.015), and VAT (R=0.456; p=0.029). In men, RMR positively correlated with cortisol (R=0.430, p=0.040) and estradiol (R=0.649, p=0.001) and RER positively correlated with insulin (R=0.525, p=0.010). In women, RMR positively correlated with insulin (R=0.570, p=0.006), but RER was not significantly correlated with hormones (p>0.05). Conclusions Segmental evaluation of body composition, specifically in the lower extremities and abdomen, may be an effective and efficient way to evaluate metabolic status. Sex-specific evaluations are also imperative.

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Section: Discussionmentioning

confidence: 99%

Influence of segmental body composition and adiposity hormones on resting metabolic rate and substrate utilization in overweight and obese adults

Hirsch

Smith‐Ryan

Blue

et al. 2017

J Endocrinol Invest

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“…This group is defined by a normal body weight and BMI, but an elevated body fat percentage, comparable to that of obese individuals. There are already studies showing similar associations of normal weight obesity with metabolic syndrome and insulin resistance and obesity related co-morbidities (167)(168)(169). Less is known about the impact of normal weight obesity on immune cells and the resulting risk for cancer burden.…”

Section: Effects Of Systemic Obesity On Human Nk Cellsmentioning

confidence: 99%

Obesity-Associated Alterations of Natural Killer Cells and Immunosurveillance of Cancer

et al. 2020

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Obesity is accompanied by a systemic chronic low-grade inflammation as well as dysfunctions of several innate and adaptive immune cells. Recent findings emphasize an impaired functionality and phenotype of natural killer (NK) cells under obese conditions. This review provides a detailed overview on research related to overweight and obesity with a particular focus on NK cells. We discuss obesity-associated alterations in subsets, distribution, phenotype, cytotoxicity, cytokine secretion, and signaling cascades of NK cells investigated in vitro as well as in animal and human studies. In addition, we provide recent insights into the effects of physical activity and obesity-associated nutritional factors as well as the reduction of body weight and fat mass on NK cell functions of obese individuals. Finally, we highlight the impact of impaired NK cell physiology on obesity-associated diseases, focusing on the elevated susceptibility for viral infections and increased risk for cancer development and impaired treatment response.NK cells are large granular lymphocytes that mediate rapid innate immunity against viruses, bacteria, parasites, and tumor cells without prior sensitization. NK cells primarily develop and mature in the bone marrow, migrate through the bloodstream, and seed into secondary lymphoid organs, like thymus, spleen, and lymph nodes as well as in other peripheral tissues, like lung, liver, kidney, uterus, and the gastrointestinal tract (23). In blood, NK cells represent 1-6% of all leukocytes and comprise up to 15% of human peripheral blood mononuclear cells (PBMCs). Human NK cells have been defined by the expression of adhesion molecule CD56 and by the absence of the T cell marker CD3. Based on their expression level of CD56 and the Fcγ receptor CD16, NK cells are subdivided into different subpopulations. The two major and classically defined subsets are the CD56 dim CD16 bright NK cells and the CD56 bright CD16 dim/neg NK cells. CD56 dim CD16 bright NK cells represent about 90% of all NK cells and are predominantly found in peripheral blood (24). They are mostly responsible for cytotoxic activity and target cell killing but are also a source of pro-inflammatory Abbreviations: ACM, adipocyte-conditioned media; Adamts3, a disintegrin-like and metallopeptidase with thrombospondin type 1 motif, 3; AdipoR, adiponectin receptor; Anxa8, annexin A8; AT, adipose tissue; Bax, Bcl-2-associated X protein; Bcl, B-cell lymphoma; BMI, body mass index; CCR, CC chemokine receptor; Csf1r, colony stimulating factor 1 receptor; CX3CR1, C-X3-C-motif chemokine receptor 1; DNAM-1, DNAX accessory molecule-1; ESR, estrogen receptor; FasL, Fas ligand; IFN-γ, interferon; GM-CSF; granulocyte macrophage colony-stimulating factor; H6pd, hexose-6-phosphate dehydrogenase; Hk2, hexokinase 2; IL, interleukinIL-6R; interleukin-6 receptor; Il18rap, interleukin 18 receptor accessory protein; IP-10, interferon gamma-induced protein 10; JAK, Janus kinase; KIR, killer immunoglobulin-like receptor; Klra1, killer lectin-like receptor subfamil...

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“…Several recent studies have uncovered metabolic dysregulation in people classified with NWO [6], even among adolescents [9]. Confirming these results, our study suggests that NWO boys and girls show significantly higher levels for WC, triglycerides, systolic blood pressure, and cardiometabolic risk score than their NWL peers, and a lower level of HDL-C. On the basis of published studies, we can speculate that youth with NWO show altered levels of proinflammatory cytokines, which may contribute to an increased risk of developing cardiometabolic disorders [6]. Similarly, Olafsdottir et al [9] reported that metabolic risk was considerably higher among NWO adolescents than their NWL peers, with high WC being more prevalent in the former.…”

Section: Discussionmentioning

confidence: 99%

“…Two research groups are involved in the project: (a) Center of Studies in Physical Activity Measurements, School of Medicine and Health Sciences, University of Rosario, and (b) District Education Secretary, Bogotá, DC. All participants were of low-middle socioeconomic status (SES; 1-3 in a scale of 1-6 defined by the Colombian government) and were enrolled in 20 public elementary and high schools (i.e., grades [5][6][7][8][9][10][11]. The participants answered a questionnaire (paper-and-pencil format) containing information on socioeconomic, demographic, and behavioral variables (i.e., alcohol intake, diet, tobacco) during the 2014-2015 school year.…”

Section: Design and Study Populationmentioning

confidence: 99%

“…Accordingly, youth with normal BMI may have a higher-than-normal percentage of body fat and be at a greater risk of developing non-communicable chronic diseases [4]. Excess body fat despite normal BMI has been termed "normal-weight obesity (NWO) syndrome" [5], and research in adults shows that normal-weight obese individuals are insulin-resistant, hyperinsulinemic, and predisposed to type 2 diabetes mellitus and premature coronary heart disease [6].…”

Section: Introductionmentioning

confidence: 99%

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Normal-Weight Obesity Is Associated with Poorer Cardiometabolic Profile and Lower Physical Fitness Levels in Children and Adolescents

et al. 2020

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Normal-weight obesity (NWO) syndrome has been shown to be associated with cardiometabolic dysfunction. However, little is known regarding this potential relationship in Latin American children and adolescents. The aim of this study was two-fold: (i) to investigate whether Colombian youth with NWO syndrome have a poorer cardiometabolic profile and physical fitness performance than normal-weight lean (NWL) peers; and (ii) to determine if physical fitness levels are related to prevalence of normal-weight obesity in youth. This was an analytical cross-sectional study of 1919 youths (9–179 years old, 53.0% girls) in the capital area of Colombia. NWO was defined as a body mass index < 25 kg/m2 and a validated body fat percentage above the sex-age-specific 90th percentile for Colombian children and adolescents. Body fat was estimated using bioelectrical impedance analysis, cardiorespiratory fitness (CRF) was estimated using the 20-meter shuttle run test, and muscular fitness with the handgrip test. Biochemical profile blood samples were collected for cardiometabolic risk factors. After adjusting for chronological age, pubertal stage, and Mediterranean diet adherence, the NWO group (boys and girls) had significantly higher values for cardiometabolic risk factors, and waist circumference (WC) than the NWL group. The prevalence of NWO was lower in youth classified with healthy CRF (boys, odds ratio (OR) = 0.54, 95% confidence interval (CI) 0.37 to 0.78; girls, OR = 0.35, 95% CI 0.24 to 0.50), p < 0.001. Our findings indicate that using only body mass index for the assessment of cardiometabolic risk likely misrepresents true adiposity and suggest the need to include the assessment of body fat in the routine clinical evaluation of individuals during childhood and adolescence.

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Normal-weight obesity syndrome: diagnosis, prevalence, and clinical implications

Cited by 123 publications

References 40 publications

Influence of segmental body composition and adiposity hormones on resting metabolic rate and substrate utilization in overweight and obese adults

Influence of segmental body composition and adiposity hormones on resting metabolic rate and substrate utilization in overweight and obese adults

Obesity-Associated Alterations of Natural Killer Cells and Immunosurveillance of Cancer

Normal-Weight Obesity Is Associated with Poorer Cardiometabolic Profile and Lower Physical Fitness Levels in Children and Adolescents

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