The Obese Without Cardiometabolic Risk Factor Clustering and the Normal Weight With Cardiometabolic Risk Factor Clustering Prevalence and Correlates of 2 Phenotypes Among the US Population (NHANES 1999–2004)

Wildman, Rachel P.; Muntner, Paul; Reynolds, Kristi; McGinn, Aileen P.; Rajpathak, Swapnil; Wylie‐Rosett, Judith; Sowers, MaryFran

doi:10.1097/01.ogx.0000338100.83483.58

Cited by 461 publications

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“…This phenotype is referred in the literature as "metabolically healthy obesity" (MHO) and may account for around 30% of the obese population [60]. Interestingly, the MHO phenotype is characterized by a more favourable body fat distribution with lower visceral fat and greater subcutaneous fat [42], by a lower ectopic fat depot in the liver [61], and by a less inflammatory profile with lower levels of circulating inflammatory markers [14,42] compared to unhealthy obese phenotype.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Inflammation as a link between obesity, metabolic syndrome and type 2 diabetes

Esser

Legrand-Poels

Piette

et al. 2014

Diabetes Research and Clinical Practice

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:It is recognized that a chronic low-grade inflammation and an activation of the immune system are involved in the pathogenesis of obesity-related insulin resistance and type 2 diabetes. Systemic inflammatory markers are risk factors for the development of type 2 diabetes and its macrovascular complications. Adipose tissue, liver, muscle and pancreas are themselves sites of inflammation in presence of obesity. An infiltration of macrophages and other immune cells is observed in these tissues associated with a cell population shift from an anti-inflammatory to a pro-inflammatory profile. These cells are crucial for the production of pro-inflammatory cytokines, which act in an autocrine and paracrine manner to interfere with insulin signaling in peripheral tissues or induce β-cell dysfunction and subsequent insulin deficiency. Particularly, the pro-inflammatory interleukin-1β is implicated in the pathogenesis of type 2 diabetes through the activation of the NLRP3 inflammasome. The objectives of this review are to expose recent data supporting the role of the immune system in the pathogenesis of insulin resistance and type 2 diabetes and to examine various mechanisms underlying this relationship. If type 2 diabetes is an inflammatory disease, anti-inflammarory therapies could have a place in prevention and treatment of type 2 diabetes.

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Section: Accepted Manuscriptmentioning

confidence: 99%

Inflammation as a link between obesity, metabolic syndrome and type 2 diabetes

Esser

Legrand-Poels

Piette

et al. 2014

Diabetes Research and Clinical Practice

1,625

1,064

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“…Subsequent reports have shown that up to 40% of adults with obesity may be classified as MHO. Using nationally representative data collected in the U.S. National Health and Nutrition Examination Survey (1998-2004) (22), approximately one-half of overweight and one-third of obese adults were classified as metabolically healthy, prevalence levels that represent ;36 million and 19.5 million U.S. adults, respectively. In pediatrics, the documented prevalence of MHO has also varied considerably with proportions ranging from 6-36% (23-26), a range that encompasses the proportions found in the current study.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Metabolically Healthy Obesity in Children

et al. 2014

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OBJECTIVETo determine the prevalence of metabolically healthy obesity (MHO) in children and examine the demographic, adiposity, and lifestyle predictors of MHO status. RESEARCH DESIGN AND METHODSThis cross-sectional study included 8-17 year olds with a BMI ‡85th percentile who were enrolled in a multidisciplinary pediatric weight management clinic from 2005-2010. Demographic, anthropometric, lifestyle, and cardiometabolic data were retrieved by retrospective medical record review. Participants were dichotomized as either MHO or metabolically unhealthy obese (MUO) according to two separate classification systems based on: 1) insulin resistance (IR) and 2) cardiometabolic risk (CR) factors (blood pressure, serum lipids, and glucose). Multivariable logistic regression was used to determine predictors of MHO using odds ratios (ORs) with 95% CIs. RESULTSThe prevalence of MHO-IR was 31.5% (n = 57 of 181) and MHO-CR was 21.5% (n = 39 of 181). Waist circumference (OR 0.33 [95% CI 0.18-0.59]; P = 0.0002) and dietary fat intake (OR 0.56 [95% CI 0.31-0.95]; P = 0.04) were independent predictors of MHO-IR; moderate-to-vigorous physical activity (OR 1.80 [95% CI 1.24-2.62]; P = 0.002) was the strongest independent predictor of MHO-CR. CONCLUSIONSUp to one in three children with obesity can be classified as MHO. Depending on the definition, adiposity and lifestyle behaviors both play important roles in predicting MHO status. These findings can inform for whom health services for managing pediatric obesity should be prioritized, especially in circumstances when boys and girls present with CR factors.In Canada, numerous multidisciplinary clinics offer weight management care for children with obesity (1), most of which are affiliated with children's hospitals. The supply of these services is exceeded by the potential demand since there are .2 million young Canadians (2,3) who are either overweight or obese and eligible to receive health services in these clinics. Because of the demand for weight management care, in circumstances when services are limited or difficult to access, there is a need to prioritize service delivery in these specialized centers for those individuals who are at greatest cardiometabolic health risk. By distinguishing individuals with obesity based on their relative health risks, those at lower health risk can be guided to less intensive services (e.g., self-management resources or outpatient dietitian counseling), whereas their peers at higher health risk can be directed to more intensive services (e.g., multidisciplinary obesity management or bariatric surgery). The heterogeneous

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“…Although obesity is associated with adverse cardiovascular and kidney disease outcomes, there is increasing evidence that the magnitude and direction of these associations depend, in part, on the clustering of metabolic and cardiovascular risk factors (1). For example, certain individuals meet standard clinical criteria for obesity (i.e., body mass index [BMI] $30 kg/m 2 ) yet appear to have healthy metabolic profiles, characterized by normal insulin sensitivity, BP, and lipid parameters.…”

Section: Introductionmentioning

confidence: 99%

Metabolic Subtypes and Risk of Mortality in Normal Weight, Overweight, and Obese Individuals with CKD

Hanks

Tanner²,

Muntner³

et al. 2013

Clinical Journal of the American Society of Nephrology

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on behalf of the REGARDS Investigators Summary Background and objectives Higher body mass index (BMI) is paradoxically associated with lower mortality in persons with CKD, but whether cardiometabolic abnormalities modulate this association is unclear.Design, setting, participants, & measurements Participants with CKD from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study (n=4374) were analyzed. The harmonized criteria for metabolic syndrome were used to define metabolic health, and participants were categorized into one of six mutually exclusive categories defined by combined measures of metabolic health (metabolically healthy, ,3 criteria for metabolic syndrome; metabolically unhealthy, $3 criteria) and weight status (normal weight, BMI 18.5-24.9 kg/m 2 ; overweight, BMI 25-29.9 kg/m 2 ; obese, BMI $30 kg/m 2 ). Cox models were used to estimate the hazard ratio (HR) of death as a function of each category.Results A total of 683 deaths were observed over a mean 4.5 years of follow-up. In analyses adjusted for age, race, sex, and geographic region of residence, compared with metabolically healthy normal weight persons, the HRs of mortality in metabolically healthy overweight and obese persons were 0.68 (95% confidence interval [95% CI], 0.53 to 0.87) and 0.71 (95% CI, 0.51 to 0.98), respectively, whereas there were no statistically significant differences in survival among metabolically unhealthy overweight or obese individuals. After further adjustment for lifestyle, clinical and laboratory factors including markers of kidney function, the HR of mortality remained lower in metabolically healthy overweight individuals compared with metabolically healthy normal weight individuals (HR, 0.74; 95% CI, 0.57 to 0.96).Conclusions Metabolic abnormalities may attenuate the magnitude and strength of survival benefits associated with higher BMI in individuals with CKD.

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The Obese Without Cardiometabolic Risk Factor Clustering and the Normal Weight With Cardiometabolic Risk Factor Clustering Prevalence and Correlates of 2 Phenotypes Among the US Population (NHANES 1999–2004)

Abstract: Background:The prevalence and correlates of obese individuals who are resistant to the development of the adiposity-associated cardiometabolic abnormalities and normal-weight individuals who display cardiometabolic risk factor clustering are not well known.

Cited by 461 publications

References 0 publications

Inflammation as a link between obesity, metabolic syndrome and type 2 diabetes

Inflammation as a link between obesity, metabolic syndrome and type 2 diabetes

Predictors of Metabolically Healthy Obesity in Children

Metabolic Subtypes and Risk of Mortality in Normal Weight, Overweight, and Obese Individuals with CKD

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