Transition from metabolically benign to metabolically unhealthy obesity and 10-year cardiovascular disease incidence: The ATTICA cohort study

A Metabolically Healthy Profile Is a Transient Stage When Exercise and Diet Are Not Supervised: Long-Term Effects in the EXERDIET-HTA Study

“…This suggests that supervision or alternative strategies of exercise provision are required given the need for MHO profile not to be a transient condition toward metabolic deterioration and consequently, a higher risk of developing cardiovascular disease [51,52]. Thus, in the present study, although the adherence with the 16-week intervention was very high in the SupExT, 6 M later, only 51% of all participants were engaged in physical activity ( >2 times per week) and implementing the recommendations (unpublished data from the EXERDIET-HTA study).…”

Adipose Tissue Distribution, Inflammation and Its Metabolic Consequences, Including Diabetes and Cardiovascular Disease

“…Thus, some individuals classified as having MHO rather fall somewhere between metabolically healthy and unhealthy. Moreover, individuals with so-called MHO can progress to develop features of the metabolic syndrome with time (181)(182)(183)(184). Because CVD outcomes in general relate to the number of metabolic abnormalities present in individuals with MUHO (185)(186)(187)(188), there is less CVD in individuals with MHO than those with the metabolic syndrome.…”

Metabolically healthy obesity: facts and fantasies

“…The prevalence of MHO, defined as "normal" insulin sensitivity (based on the HOMA-IR score) and absence of any metabolic syndrome components (excluding waist circumference), is approximately 7%, whereas half of all people with obesity can be classified as MHO when defined as ≤2 metabolic syndrome components (including waist circumference). However, it is likely that these results overestimate the prevalence of MHO in the general population, because many studies excluded people with existing cardiometabolic diseases, such as T2D and CVD (9,11,13,28,(42)(43)(44).…”

“…The normal decline in metabolic health associated with increasing age, the metabolic insult of prolonged excess adiposity, and the tendency to gain weight throughout middle age likely influence the stability of MHO. The data from longitudinal studies suggest that approximately 30% to 50% of people with MHO convert to MUO after 4 to 20 years of follow-up (25,28,42,(45)(46)(47)(48). The major factors associated with the conversion of MHO to MUO are a decline in insulin sensitivity and an increase in fasting blood glucose (49).…”

“…In conjunction with the alterations in adipose tissue immune cells, adipose tissue expression of inflammation-related genes is also greater in people with MUO than in those with MHO (21,129,145,146,150,151), but there is inconsistency in the specific genes that are upregulated among studies, and the differences in gene expression markers between MUO and MHO groups are often small (21,129,145,146,150,151). Plasma concentrations of markers of inflammation, primarily C-reactive protein, plasminogen activator inhibitor-1 (PAI-1), IL-6, and TNF-α, are either higher in those with MUO than MHO (21,23,42,96,(152)(153)(154) or not different between the two groups (155)(156)(157). The variability in results is likely related to the definitions used to identify MUO and MHO, the specific inflammatory markers evaluated in different studies, and the sample size needed for adequate statistical power because of small mean differences in plasma concentrations between groups.…”