Increased Heart Failure Risk in Normal-Weight People With Metabolic Syndrome Compared With Metabolically Healthy Obese Individuals

There is conflicting evidence regarding the association between metabolically healthy obese (MHO) and metabolically unhealthy normal weight (MUNW) with incident hypertension and type 2 diabetes. The role of cardiorespiratory fitness on these associations has not been fully explored. We tested the hypothesis that obesity phenotypes predict incident hypertension and type 2 diabetes, but cardiorespiratory fitness modifies these associations in a prospective study of apparently healthy men. 3800 men (mean age 48±6 yrs, range 20-76 yrs) participated in two health examinations during 1998-2009. All subjects were free of hypertension and type 2 diabetes at baseline examination. MHO was defined as obesity (body mass index ≥ 25 kg/m2) with no more than one metabolic abnormality, and MUNW was defined as body mass index < 23 kg/m2) with two or more abnormalities. Cardiorespiratory fitness was directly measured by peak oxygen uptake during a treadmill test. Incident hypertension and type 2 diabetes were defined as blood pressure ≥140/90mmHg and as ≥6.5% of HbA1c or ≥126mg/dl of fasting glucose at second examination, respectively. During an average follow-up of 5 years (1-12 yrs), there were 371 (9.8%) men incident hypertension and 170 (4.5%) men incident type 2 diabetes. MHO and MUNW were present in 844 (22%) and 249 (6.6%) men. Compared with metabolically healthy normal weight men, MHO and MUNW men were at increased risk for hypertension (relative risk (RR) =1.82, 95% Confidence Interval (CI): 1.29-2.56 and 1.75, 1.11-2.74) and type 2 diabetes (RR=3.68, 1.92-7.07 and 5.35, 2.61-10.94), respectively. These risks in MHO and MUNW men were still persisted with adjustment for confounder variables and cardiorespiratory fitness (hypertension=1.57, 1.05-2.34 and 1.59, 1.01-2.51; type 2 diabetes=3.35, 1.63-6.89 and 4.76, 2.32-9.77). Metabolically healthy obese or metabolically unhealthy normal weight men were at increased risk of hypertension and type 2 diabetes compared with metabolically healthy normal weight men. However, these associations were not attenuated by cardiorespiratory fitness or other confounder factors.

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The prevalence of metabolically healthy obesity according to the sample of the Moscow region

Obesity and metabolism ◽

10.14341/omet2017451-56 ◽

2017 ◽

Vol 14 (4) ◽

pp. 51-56 ◽

Cited By ~ 2

Author(s):

Elena V. Ostrovskaya ◽

Tatiana I. Romantsova ◽

Andrei N. Gerasimov ◽

Tamara E. Novoselova

Keyword(s):

Metabolic Syndrome ◽

Carbohydrate Metabolism ◽

Medical Records ◽

Density Lipoprotein ◽

Homa Index ◽

Obese Patients ◽

Hip Circumference ◽

Metabolically Healthy Obese ◽

Healthy Obese ◽

Metabolically Healthy

Introduction. Obesity is a major factor for cardiometabolic risk. However, there is a category of obese patients without disorders of lipid, carbohydrate metabolism and cardiovascular disease metabolically healthy obese (MHO). Aim. Our goal was to investigate the prevalence and characteristics of this phenotype compared to patients with metabolic syndrome (MS). Materials and methods. To evaluate the prevalence of the MHO phenotype we analyzed 389 medical records of females aged 1860 years with obesity. Three types of MHO criteria were used: 1) HOMA index (2.7); 2) IDF-criteria of metabolic syndrome, 2005; 3) the BioSHaRE-EU 2013 criteria (obese patients without any symptoms of MS). We conducted a comparative analysis of anthropometry, status of lipid and carbohydrate metabolism, the functional state of the liver. Results. The MHO prevalence was: 34.5% according to HOMA index, according to the definitions of MS 2005 38.6%, in BioSHaRE-EU 9.6%. In groups of MHO and MS dyslipidemia was observed in 27.3 and 49.5% (p0.05), hypertension in 25% and 71.6% (p0.05), steatogepatosis in 47.7% vs 51.3% (p0.05) of observations, respectively. Among comorbidities the gynecological pathology was most prevalent - 50.8 and 61.4% (p0.05), disorders of carbohydrate metabolism differed significantly in frequency- 6.82 and 39.1% of patients (p0.05). Patients with MHO had a shorter duration of the existence of obesity than MS (18.7 vs. 24 years) (p=0.0004) and less likely to have attempted to reduce weight 85.8% and 91.6%. Average BMI, waist circumference, hip circumference, fasting glucose, total cholesterol, insulin basal, basal C-peptide, HOMA index in groups of MHO and MS differed significantly (p0.05). Median ALT was 20 and 23.2 U/l, AST 20 and 23 U/l, triglycerides 1.1 and 1.8 mmol/l, high-density lipoprotein 1.4 and 1.1 mmol/l, respectively. Conclusions. The MHO prevalence was maximal according to the MS definitions from 2005, and minimal with BioSHaRE-EU criteria. The main analyzed indicators differed significantly in groups MHO and MS. Longer obesity existence in the MS group may suggest an instability of MHO phenotype over time.

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Integrating Publicly Available Genome-Wide Association Data to Study the Genetic Basis of Metabolically Healthy Obese and Metabolically Obese but Normal-Weight Individuals

Diabetes ◽

10.2337/db14-1358 ◽

2014 ◽

Vol 63 (12) ◽

pp. 4004-4007 ◽

Cited By ~ 9

Author(s):

R. J. F. Loos

Keyword(s):

Genetic Basis ◽

Normal Weight ◽

Genome Wide Association ◽

Metabolically Healthy Obese ◽

Genome Wide ◽

Healthy Obese ◽

Metabolically Healthy ◽

Association Data

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Molecular insights into the role of white adipose tissue in metabolically unhealthy normal weight and metabolically healthy obese individuals

The FASEB Journal ◽

10.1096/fj.14-263913 ◽

2014 ◽

Vol 29 (3) ◽

pp. 748-758 ◽

Cited By ~ 66

Author(s):

Flavia Badoud ◽

Maude Perreault ◽

Michael A. Zulyniak ◽

David M. Mutch

Keyword(s):

Adipose Tissue ◽

White Adipose Tissue ◽

Normal Weight ◽

Metabolically Healthy Obese ◽

Healthy Obese ◽

Metabolically Healthy

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Metabolically healthy obese and metabolic syndrome of the lean: the importance of diet quality. Analysis of MAGNETIC cohort

Nutrition Journal ◽

10.1186/s12937-020-00532-0 ◽

2020 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Kamila Osadnik ◽

Tadeusz Osadnik ◽

Marta Lonnie ◽

Mateusz Lejawa ◽

Rafał Reguła ◽

...

Keyword(s):

Metabolic Syndrome ◽

Diet Quality ◽

Quality Analysis ◽

Metabolically Healthy Obese ◽

Healthy Obese ◽

Metabolically Healthy

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2061-P: Inflammation Status Is Independent Risk Factor for the Development of Metabolic Syndrome in Both Metabolically Healthy Obese and Nonobese Adults

Diabetes ◽

10.2337/db19-2061-p ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 2061-P

Author(s):

KYU YEON HUR ◽

MIN SUN CHOI ◽

SUNG WOON PARK ◽

SEUNG-EUN LEE ◽

JIYEON AHN ◽

...

Keyword(s):

Metabolic Syndrome ◽

Risk Factor ◽

Independent Risk Factor ◽

Metabolically Healthy Obese ◽

Healthy Obese ◽

Metabolically Healthy

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Abstract 163: The Prevalence of the Metabolically Healthy Obese Phenotype in an Aging Population and its Association with Subclinical Cardiovascular Disease: The Brazilian Study on Healthy Aging

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.33.suppl_1.a163 ◽

2013 ◽

Vol 33 (suppl_1) ◽

Author(s):

Lara L Roberson ◽

Shozab A Siddiqui ◽

Michael J Blaha ◽

Arthur A Agatston ◽

Roger S Blumenthal ◽

...

Keyword(s):

Cardiovascular Disease ◽

Waist Circumference ◽

Healthy Aging ◽

Subclinical Atherosclerosis ◽

Aging Population ◽

Normal Weight ◽

Metabolically Healthy Obese ◽

Subclinical Cardiovascular Disease ◽

Healthy Obese ◽

Metabolically Healthy

BACKGROUND Obese and overweight individuals have been shown to be at higher risk of CVD events than normal weight individuals. Current literature has elucidated a new phenotype, Metabolically Healthy Obese (MHO), with risks of CVD similar to that of normal weight individuals. Few studies have examined the MHO phenotype in an aging population, especially in association with subclinical cardiovascular disease. METHODS The cross sectional study population consisted of 208 individuals (79% Female), age 80 and older (mean age 84±4, range 80-102). Anthropometrics & biochemical parameters were measured. The Adult Treatment Panel definition of metabolic syndrome (MetS), excluding waist circumference, criteria was used to define metabolically healthy (<3 MetS components) versus unhealthy. A combination of BMI and waist circumference were used to define normal weight and overweight/obese. Multidetector-row cardiac CT for coronary artery calcium score (CACS) was used to detect subclinical atherosclerosis. High reactive C reactive protein (hs-CRP) was measured to assess degree of underlying inflammation. RESULTS The prevalence of MHO defined by BMI≥25 kg/m2 &/or waist circumference >88cm in women, >102cm in men & having 3mg/dl, Uric Acid >6 mg/dl (p=NS). Gender, total cholesterol, HDL, LDL, triglycerides, and SBP was significantly associated with MHO (p<0.05). CONCLUSIONS Our results suggest that the MHO phenotype is still seen in octogenarians, but at lower rates than in the general population suggesting MHO may not simply be an intermediary stage, driven by length of spent in the obese state. Those with this phenotype tended to have lower triglycerides, higher HDL, and lower body fat % than their metabolically at risk obese counterparts (p<0.05), however, degree of subclinical CVD was not different. Further studies are needed to explore the related risk of CVD among MHO octogenarians.

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The role of the gut microbiota on the metabolic status of obese children

Microbial Cell Factories ◽

10.1186/s12934-021-01548-9 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Xin Yuan ◽

Ruimin Chen ◽

Kenneth L. McCormick ◽

Ying Zhang ◽

Xiangquan Lin ◽

...

Keyword(s):

Gut Microbiota ◽

Fecal Microbiota ◽

Normal Weight ◽

Chinese Children ◽

Metabolic Status ◽

Alpha And Beta Diversity ◽

Metabolically Healthy Obese ◽

Tnf Α ◽

Healthy Obese ◽

Metabolically Healthy

Abstract Background The term “metabolically healthy obese (MHO)” denotes a hale and salutary status, yet this connotation has not been validated in children, and may, in fact, be a misnomer. As pertains to obesity, the gut microbiota has garnered attention as conceivably a nosogenic or, on the other hand, protective participator. Objective This study explored the characteristics of the fecal microbiota of obese Chinese children and adolescents of disparate metabolic statuses, and the associations between their gut microbiota and circulating proinflammatory factors, such as IL-6, TNF-α, lipopolysaccharide-binding protein (LBP), and a cytokine up-regulator and mediator, leptin. Results Based on weight and metabolic status, the 86 Chinese children (ages 5–15 years) were divided into three groups: metabolically healthy obese (MHO, n = 42), metabolic unhealthy obese (MUO, n = 23), and healthy normal weight controls (Con, n = 21). In the MUO subjects, the phylum Tenericutes, as well as the alpha and beta diversity, were significantly reduced compared with the controls. Furthermore, Phylum Synergistetes and genus Bacteroides were more prevalent in the MHO population compared with controls. For the MHO group, Spearman’s correlation analysis revealed that serum IL-6 positively correlated with genus Paraprevotella, LBP was positively correlated with genus Roseburia and Faecalibacterium, and negatively correlated with genus Lactobacillus, and leptin correlated positively with genus Phascolarctobacterium and negatively with genus Dialister (all p < 0.05). Conclusion Although there are distinct differences in the characteristic gut microbiota of the MUO population versus MHO, dysbiosis of gut microsystem is already extant in the MHO cohort. The abundance of some metabolism-related bacteria associates with the degree of circulating inflammatory compounds, suggesting that dysbiosis of gut microbiota, present in the MHO children, conceivably serves as a compensatory or remedial response to a surfeit of nutrients.

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