Obesity

The intriguing metabolically healthy but obese phenotype meaning – Obesity, metabolic health, and mortality in adults: a nationwide population-based study in Korea

Published online Sep 4. Smart citations by scite.

When assessing intermediate risk populations such as the obese, the usefulness of traditional risk factor assessment such as Framingham diminishes. In addition, overall health of MHO individuals may be significantly impaired by several psycho-social factors, psychosomatic comorbidities, low fitness level, osteoarthritis, chronic pain, diseases of the respiratory system, the skin, and others. Arch Intern Med. View raw image Potential adipose tissue-related mechanisms underlying metabolically healthy obesity. Further adjustment of smoking status, alcohol drinking, exercise, and income status did not attenuate these associations.

  • Successful work towards a universally accepted definition of MHO would improve and simplify future studies and aid inter-study comparisons.

  • Diabetes Care.

  • Diabetes Care. The only one study that reported MHO and its impact on hypertension, diabetes, and metabolic syndrome in Taiwanese population [ 13 ] lacked CVD outcomes.

  • Hazard ratios of all-cause mortality in metabolically healthy but obese individuals compared with metabolically abnormal obese and metabolically healthy normal-weight individuals, using both body mass index and per cent body fat to define obesity. Identifying metabolically healthy but obese individuals in sedentary postmenopausal women.

  • In participants reporting multiple events, the first event was used for analysis. Prevalence and clinical profile of metabolic obesity and phenotypic obesity in Asian Indians.

Background

Kim, N. The obesity phenotype changes upon weight loss after Roux-en-Y gastric bypass surgery. In participants reporting multiple events, the first event was used for analysis.

  • The model one-way analysis of covariance was adjusted for age, sex, examination year, smoking, and alcohol consumption. What large-scale epidemiologic studies show about trends in a population doesn't necessarily apply to the patient sitting across from you.

  • Hazard ratios of cardiovascular disease mortality and incidence in metabolically healthy but obese individuals compared with metabolically abnormal obese and metabolically healthy normal-weight individuals, using both body mass index and body fat percentage to define obesity. Ann Epidemiol.

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  • This finding is consistent with previous epidemiological studies that reported increasing responding rates as BMI decreases.

There is strong evidence indicating that higher fitness levels are associated with fewer metabolic complications and lower prevalence of metabolic syndrome at any age and across different weight status groups. Second, metabolically unhealthy status was associated with a higher risk of all-cause and cardiovascular mortality regardless of BMI levels, and there was a dose-response relationship between the number of incident metabolic diseases and the risk of mortality. Advanced Search Help. Results S2 Fig illustrates the flow diagram of the participant enrollment process. These findings are consistent for all the outcomes studied, i. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. Categorical and continuous variables were analyzed using the chi-square test and analysis of variance, respectively.

  • BMC Endocr Disord.

  • The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Eur Heart J.

  • Pediatr Obes. Sahakyan, K.

  • Med Sci Sports Exerc.

  • Sex hormones, which act centrally as well as locally in adipocytes, exemplify significant differences in body weight, fat distribution, and energy balance between women and men. MR and TT assisted with discussion section.

Nature Medicine 18 — Are The intriguing metabolically healthy but obese phenotype meaning Helpful? Obesity Silver Spring ; 18 — The first comparison addressed in the present study provides for the first time evidence that metabolically healthy but obese individuals have a significantly better prognosis, in terms of mortality and morbidity, than the rest of obese individuals, after adjustment for fitness. Both non-obese and obese participants with at least two metabolic abnormalities, but not MHO individuals, were at an increased risk of all-cause and cardiovascular mortality over 7 years, compared with MHNO participants Results The baseline characteristics of the study sample are shown in Table 1. Metabolically healthy obesity across the life course: epidemiology, determinants, and implications [published online October 10, ].

Seven studies healtyh all-cause mortality [ 9 — 1113161923 ]. However, some people transition to a metabolically unhealthy state while others remain healthy. We combined the participants with obesity and overweight due to the small number of participants. Obesity, metabolic abnormalities, and mortality in older men. A proposed clinical staging system for obesity.

Invited Author's profile

Article Google Scholar 38 Kuo, J. Table 2 Results; cohort studies Full size table. Lastly, mortality risk was assessed, according to the presence of various combinations of metabolic disease components. The non-significant difference in our MHOO group may be explained by the small number of the elderly individuals.

S6 Table. Moreover, it is questionable whether MHO individuals stay healthy 48 The metabolically healthy but obese individual presents a favorable inflammation profile. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Declaration of interest The author declares that there is no conflict of interest that could be perceived as prejudicing the impartiality of the review. Potential adipose tissue-related mechanisms underlying metabolically healthy obesity.

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BMI and mortality: the limits of epidemiological evidence. January Issue. CI, confidence interval. Clinical relevance of MHO In the future, the diagnosis of MHO may be facilitated by recently standardized definitions of this phenotype Nine studies examined incident CVD events [ 91214 — 192123 ].

Kaplan—Meier survival curves were constructed to demonstrate the fatal and nonfatal CVD outcomes in the four groups over time. J Clin Epidemiol. Research shows that weight loss is associated with metabolic improvements in individuals who are both metabolically unhealthy and obese,8,11 but few sufficiently sized randomized trials have been done to assess whether weight loss interventions protect health. High cardiorespiratory fitness is an independent predictor of the reduction in liver fat during a lifestyle intervention in non-alcoholic fatty liver disease.

  • Obesity paradox in patients with hypertension and coronary artery disease.

  • Read article at publisher's site DOI : OrtegaFrancisco B.

  • Woolf SH, Braveman P. Church5 and Steven N.

  • Differences in baseline fitness among the three study groups were examined by one-way analysis of covariance, after adjustment for age, sex, examination year, smoking, and alcohol consumption. Romero-Corral, A.

None of these studies reported the association of vascular inflammation with CVD outcomes. Additional Information How to cite this article : Yang, H. The intriguing metabolically healthy but obese phenotype: Cardiovascular prognosis and role of fitness. Coronary artery disease risk among obese metabolically healthy young men.

Conclusions i Higher fitness should be considered a characteristic of metabolically healthy but obese hhe. Church5 and Steven N. Having only one metabolic disease was associated with a significantly higher risk, and developing all three diseases augmented this effect. It's possible that regular physical activity is a marker for a healthier lifestyle overall, rather than the major mechanism defining metabolic health,36 but we do know that exercise helps to improve body composition by reducing visceral fat and preserving muscle while promoting insulin sensitivity, lower blood pressure, and better lipid levels.

Introduction

Download citation. We observed similar response rates between metabolically healthy but obese participants and metabolically abnormal obese participants data not shown. NAFLD can be assessed non-invasively using ultrasound, and provides an early diagnostic marker for cardiovascular disease risk. Table 2 Results; cohort studies Full size table.

Indeed, our non-adjusted for fitness models concur with the results observed in the two mentioned studies, but once fitness is accounted for, the metabolically healthy but obese group had no longer a higher the intriguing metabolically healthy but obese phenotype meaning compared with their normal-fat peers. Either your web browser doesn't support Javascript or it is currently turned off. In this context, the Edmonton Obesity Staging System proposed by Sharma and Kushner 51 provide information on the presence or the extent of comorbidities or functional limitations that would guide clinicians' decision-making. Non-response bias is a concern in epidemiological surveillance, and this issue has been investigated in the ACLS. Primeau et al. Francisco B. Front Cardiovasc Med, 08 Jun

Either your web browser doesn't support Javascript or it is currently turned off. Table 2 Anthropometric and metabolic parameters according to study groups. Arch Intern Med. Our study focused on two comparisons: i metabolically healthy but obese vs. Data are means standard deviationsunless otherwise indicated.

Introduction

Article PubMed Google Scholar. Cause of death was classified according to the diagnostic codes of the ICD The median 25—75th percentiles follow-up period for mortality was Download PDF.

  • Table 5 Hazard ratios of cancer mortality in metabolically healthy but obese individuals compared with metabolically abnormal obese and metabolically healthy normal-weight individuals, using both body mass index and body fat percentage to define obesity. Both treatment of obesity and prevention of obesity-related diseases are frequently not successful.

  • Open questions about metabolically normal obesity.

  • Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. All three utilized self reported methods.

  • Duration of overweight and metabolic health risk in American men and women.

  • Journal of Geriatric Cardiology.

Jonatan R. A novel criterion for identifying metabolically obese but normal weight individuals using the product of triglycerides and glucose. These data suggest that metabolically unhealthy individuals are exposed to a higher risk of all-cause and cardiovascular mortality irrespective of their BMI status. Cardiorespiratory fitness and adiposity as mortality predictors in older adults. Obesity Silver Spring ; 18 — Stelmach-Mardas M, Walkowiak J.

  • Eur Heart J. It's possible that regular physical activity is a marker for a healthier lifestyle overall, rather than the major mechanism defining metabolic health,36 but we do know that exercise helps to improve body composition by reducing visceral fat and preserving muscle while promoting insulin sensitivity, lower blood pressure, and better lipid levels.

  • The characteristics of the study sample are presented as means and standard deviations or as frequencies and percentages, as appropriate.

  • Abstract Aims Current knowledge on the prognosis of metabolically healthy but obese phenotype is limited due to the exclusive use of the body mass index to define obesity and the lack of information on cardiorespiratory fitness.

  • No restrictions were used for publication status or date, but studies had to be peer-reviewed to be selected.

  • Seven of the eight studies measuring physical activity found increased activity in the metabolically healthy obese, when compared to the metabolically unhealthy obese.

  • The waist circumference was obtained at the level of the umbilicus with a plastic anthropometric tape.

Therefore, the usefulness of CRP as part of the definition of MHO, or as a predictor of Heslthy events in the metabolically healthy obese remains uncertain in the studies reviewed here. Influence of fatness, intelligence, education and sociodemographic factors on response rate in a health survey. This is in agreement with the belief that the natural tendency of the MHO is to progress to MUHO when physical activity is stopped or reduced [ 45 ]. Journal of Clinical Endocrinology and Metabolism 98 — The parallel lines of logarithm negative logarithm plot against logarithm of follow-up time indicate that the proportional hazards assumption was satisfied S1 Fig [ 21 ]. Journal of Gastroenterology Mechanisms explaining the relationship between metabolically healthy obesity and cardiovascular risk.

Metabolically meaniing obesity and risk of all-cause and cardiovascular disease mortality. Studies were also excluded if they failed to define metabolically healthy using either insulin sensitivity or components of metabolic syndrome or failed to define obesity using BMI, body fat percentage, or waist circumference. Am J Clin Nutr. Search Search articles by subject, keyword or author. Next, we sought to examine the effect of various combinations of metabolic disease components on the HRs for mortality Fig. BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of cohort studies with 3. In addition, overall health of MHO individuals may be significantly impaired by several psycho-social factors, psychosomatic comorbidities, low fitness level, osteoarthritis, chronic pain, diseases of the respiratory system, the skin, and others.

Publication types

However, a subset of obese people who seem to be protected against obesity-related metabolic complications has been identified. Identifying metabolically healthy but obese individuals in sedentary postmenopausal women. Steven N. Int J Obes Lond ; 33 —

The prevalence of healthy obesity and the metabolic john baker have obesity surgery recently investigated in the BioShare-EU real estate Factors associated with metabolically healthy status team prudential obesity, overweight, and normal weight at baseline of ELSA-Brasil. The Lancet Diabetes and Endocrinology. Further adjustment of smoking status, alcohol drinking, exercise, and income status did not attenuate these associations. We thank the Cooper Clinic physicians and technicians for collecting the baseline data, and staff at the Cooper Institute for data entry and data management. Brochu et al.

For this study, we used a customised NHIS database that included about 2. Perceived weight discrimination and obesity. In children and adolescents, prevalence of MHO has been recently defined in Article PubMed Google Scholar 8. Ortega et al.

Patterns of non-response to a mail survey. Int J Obes Lond40 114 Aug Reasons for this include sample size effects, differences in MONW definition, social and demographic factors, as well as assumptions made in establishing normal weight.

The model one-way analysis of covariance was adjusted for age, sex, examination year, smoking, and alcohol the intriguing metabolically healthy but obese phenotype meaning. All rights reserved. Table 3 Hazard ratios of all-cause mortality in metabolically healthy but obese individuals compared with metabolically abnormal obese and metabolically healthy normal-weight individuals, using both body mass index and per cent body fat to define obesity. Free full text. Table 3 Hazard ratios of all-cause mortality in metabolically healthy but obese individuals compared with metabolically abnormal obese and metabolically healthy normal-weight individuals, using both body mass index and per cent body fat to define obesity. Smart citations by scite. Diabetes Care.

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The incidence of one or more cardio-metabolic risk factors was About this article Phenltype this article Roberson, L. Article Google Scholar 36 Tobias, D. Indeed, in a recent study, MHO participants have been shown to have a better fitness than metabolically abnormal obese participants More long-term studies are needed to confirm its usefulness in the MHO population. Impact of body mass index and the metabolic syndrome on the risk of cardiovascular disease and death in middle-aged men.

An explanation could be that obesity plus metabolic the intriguing metabolically is so adverse condition that cannot be fully counteracted by fitness. We observed that fitness healthy but bht risk for mortality obese phenotype meaning morbidity all outcomes associated with obesity, i. Am J Clin Nutr. Parental history of CVD was additionally included in all the models, except when the outcome was cancer. Sci Rep11 127 Apr The metabolically healthy but obese individual presents a favorable inflammation profile. Identifying metabolically healthy but obese individuals in sedentary postmenopausal women.

First, we combined the overweight and obesity groups, and thus, healhy dangerous group may not have been evaluated specifically. Metabolically healthy but adverse effects of hepatic steatosis may be mediated by increased production of obese phenotype meaning including fetuin-A 64 or retinol-binding protein RBP -4 65 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 — Arch Intern Med. Subgroup analyses for fatal and nonfatal cardiovascular disease risk by metabolic statuses and body mass index categories by different reference groups.

  • The metabolically healthy but obese phenotype in African Americans. J Clin Med.

  • Interestingly, no difference in the prognosis is observed between metabolically healthy but obese individuals and metabolically healthy normal-fat individuals once fitness is accounted for, suggesting a key role of fitness in these associations. Church5 and Steven N.

  • A proposed clinical staging system for obesity. Phillips CM.

Ann N Y Acad Sci. Based on such findings and under the pressure of lbese healthcare resources, future guidelines for obesity treatment should distinguish between MHO and metabolically high-risk obese individuals 10 Non-fatal CVD events were ascertained from responses to mail-back health surveys in, and Skip to main content. Myocardial infarction and ischemic heart disease in overweight and obesity with and without metabolic Syndrome. In this review, the prevalence, potential biological mechanisms, and the clinical relevance of MHO are discussed.

Prevalence of insulin resistance in metabolic disorders: the Bruneck Study. Results The baseline characteristics of the study sample are shown in Table 1. Volume Obesity paradoxes.

Additional Information How to cite this article : Yang, H. Our results suggest that: i better fitness should be considered a characteristic of metabolically healthy but obese phenotype. J Hypertens.

The extent to which metabolically healthy but obese people are at a lower risk for diseases or have a beast bulking risk for mortality, compared with the agents of obese people, is currently obese debate. V O 2max was calculated from the final treadmill speed and grade. All participants provided written informed consent, and the study protocol was approved annually by the Institutional Review Board of the Cooper Institute. Hazard ratios of cancer mortality in metabolically healthy but obese individuals compared with metabolically abnormal obese and metabolically healthy normal-weight individuals, using both body mass index and body fat percentage to define obesity. A Cross Sectional Study. Prevalence of insulin resistance in metabolic disorders: the Bruneck Study. Cite Cite Francisco B.

Primeau et al. In spite of the strong evidence indicating that higher fitness levels are related to lower metabolic complications metaboliaclly lower prevalence of metabolic syndrome, 5—9 a recent review 4 characterizing the metabolically healthy but obese phenotype did not mention the possibility that the better metabolic profile observed in this subset of obese people could be, at least in part, explained by fitness. Ortega FB 1. Muscular strength is inversely related to prevalence and incidence of obesity in adult men.

Metabolic and body composition factors in subgroups of obesity: what do we know? Volume Mortality surveillance was based on the national death index NDI. We thank the Cooper Clinic physicians and technicians for collecting the baseline data, and staff at the Cooper Institute for data entry and data management.

Free full text. Impact of body mass index and the metabolic metabooically on the risk of cardiovascular disease and death in middle-aged men. This finding supports a major role of fitness in these associations and suggests that fitness should be included in future research on this topic as a relevant confounder. Hazard ratios of cardiovascular disease mortality and incidence in metabolically healthy but obese individuals compared with metabolically abnormal obese and metabolically healthy normal-weight individuals, using both body mass index and body fat percentage to define obesity.

Treatment of obesity by moderate and severe caloric restriction. We modified metabolic health definition according to MHO definition published in [ 11 ]. Skip to main content. Choi, K.

Meaning there persons who are obese, but metabolically healthy? In healthy but, there's ongoing debate obese phenotype whether being obese directly causes the intriguing metabolically contributes to chronic disease, or if it's simply that obesity and chronic disease often coexist. CRP was measured in two studies [ 2728 ] neither of which reported the association of CRP and CVD outcomes in the context of metabolic health and obesity. Medicine Baltimore 94e Association between body-mass index and risk of death in more than 1 million Asians.

Am Heart J. Purpose of review: Obesity is commonly associated with metabolic dysfunction but there are obese persons who are metabolically healthy. Abstract Purpose of review: Obesity is commonly associated with metabolic dysfunction but there are obese persons who are metabolically healthy. All rights reserved.

Eur J Nutr. First, individuals with the MUNO phenotype had a significantly higher obesity surgery dr john w baker team prudential real estate of all-cause, cardiovascular, cancer, and other-cause mortality whereas individuals with the Obsse phenotype had a significantly lower risk of death, compared with the MHNO group. What Is Metabolically Healthy Obesity? Body fat per cent was assessed by hydrostatic weighing or the sum of seven skinfold measures, following standardized protocols. Article Google Scholar 21 Batsis, J. In the subgroup analyses, in order to compare the fatal and nonfatal CVD risk between different sex and age groups, we changed the reference group to women with MHNW and, whom were less than 65 years old S6 Table.

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Body fat per cent was assessed by hydrostatic weighing or the obesse of seven skinfold measures, following standardized protocols. Supporting information. The Lancet Diabetes and Endocrinology. This finding supports a major role of fitness in these associations and suggests that fitness should be included in future research on this topic as a relevant confounder. Home About Contact.

Diabetologia 51 — Acknowledgments We would like to thank Dr. However, a trend towards a slight increase in risk in all but one study was observed, which was supported by increased subclinical disease burden observed in the cross-sectional studies. Results of clinical research trials. Hinnouho, G. Risk-reducing behaviors.

  • CRP is thought to be the best biomarker of vascular inflammation and has been shown to be predictive of CVD events [ 3435 ].

  • OrtegaFrancisco B. Publication types Research Support, Non-U.

  • The results were mostly reproduced in males Supplementary Table 2but the protective effect seen in the MHO group was not observed in females Supplementary Table 3. Check your body weight everyday.

  • Another limitation is the lack of information on the duration of obesity. Open in a separate window.

For the intriguing metabolically healthy but obese phenotype meaning study, we used a customised NHIS database that included about 2. Declaration of interest The author declares that there is no conflict of interest that could be perceived as prejudicing the impartiality of the review. The MUNO group had a significantly higher risk of all-cause hazard ratio, 1. In addition to adipose tissue distribution, preserved adipose tissue function determined by parameters such as lower adipocyte size, less macrophage infiltration into adipose tissue, and normal adipokine secretion patterns have been identified as contributing factors underlying insulin sensitivity in MHO Fig. View raw image Potential adipose tissue-related mechanisms underlying metabolically healthy obesity. What Is Metabolically Healthy Obesity? Figure 1: Mortality according to BMI and metabolic health status.

OrtegaFrancisco B. Am J Epidemiol. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The intriguing metabolically healthy but obese phenotype: cardiovascular prognosis and role of fitness Francisco B.

Metabolic and body composition factors in subgroups of obesity: what do we know? Alpha-protein kinase 3 ALPK3 -truncating variants are a cause of autosomal dominant hypertrophic cardiomyopathy. Cardiorespiratory fitness attenuates metabolic risk independent of abdominal subcutaneous and visceral fat in men. Published on behalf of the European Society of Cardiology.

Individuals with MHO are characterized by a distinct fat distribution with lower visceral fat mass, lower liver fat and skeletal muscle fat content compared with the intriguing metabolically healthy but obese phenotype meaning individuals with higher metabolic puenotype 121415 Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. According to the updated definition of metabolic health that was proposed inmetabolically healthy means absence of cardiometabolic diseases and a healthy cardiometabolic blood profile [ 11 ]. Patterns of non-response to a mail survey. Considering effect modifiers, previous studies have revealed that the prevalence of metabolic syndrome and CVD risk were higher in postmenopausal women than in men [ 22 ], which is consistent with our findings. However, this study has some limitations. Factors associated with metabolically healthy status in obesity, overweight, and normal weight at baseline of ELSA-Brasil.

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Search Menu. Pairwise comparisons were adjusted for the Bonferroni correction. We observed similar the intriguing metabolically healthy but obese phenotype meaning rates phenotypr metabolically healthy but obese participants and metabolically abnormal obese participants data not shown. In addition, we did not observe differences in the prognosis between metabolically healthy but obese individuals and metabolically healthy normal-fat individuals. The results did not materially change when excluding class 3 obesity, i.

The fact that measurement error for skinfolds is larger in obese population should be acknowledged. Cardiorespiratory fitness is inversely associated with the incidence of metabolic syndrome: a prospective study of men and women. Bobbioni-Harsch et al. Metabolically healthy obesity may be the result of genetic predisposition, diet and the intriguing metabolically healthy but obese phenotype meaning factors, or both. As mentioned previously, the definitions of MHO are quite heterogeneous and make quantitative synthesis of the reviewed studies difficult. High fitness level in MHO may therefore only be an indicator for a specific healthier lifestyle of this obesity subphenotype and does not necessarily represent the major mechanism defining MHO While some studies observed a low risk for cardiovascular disease CVD incidence and mortality in this group of people similar to that observed in metabolically healthy normal-weight people10 — 14 others suggested that obesity per se rather than the metabolic profile increased the risk of morbidity and mortality.

The incidence of co-morbidities related to obesity and byt a systematic review and meta-analysis. Jonatan R. Among 5 subjects mean [standard deviation] age, The prevalence of metabolic syndrome and metabolically healthy obesity in Europe: a collaborative analysis of ten large cohort studies. In the past, different definitions have been used to identify MHO individuals. Received : 07 March

However, a trend towards a slight increase in risk in all but one study was observed, which was supported by increased subclinical disease burden observed in the cross-sectional studies. Although it is difficult to directly compare these numbers with data from studies in Asian and African American populations due to different definitions of MHO, it is important to note that MHO can be identified independent of ethnicity and geographic regions of the world. Eur Cytokine Netw.

High mehabolically level in MHO may therefore only be an indicator for a specific healthier lifestyle of this obesity subphenotype and does not necessarily represent the major mechanism defining MHO Studies were excluded if they failed to include a comparison group to the MHO, the abstract and full text was unavailable, or were reviews, letters, and case-reports. Among 5 subjects mean [standard deviation] age, Obesity and overweight are well-known risk factors for CVD due to metabolic dysregulation. Karelis, A.

It has been shown that MHO individuals do not significantly improve the risk for cardiovascular and metabolic diseases upon the intriguing metabolically healthy but obese phenotype meaning loss interventions 1718 Other studies using various definitions for metabolic health have also reached similar conclusions 26 The lowest risk of death was seen in overweight subjects without metabolic syndrome Metabolically healthy obesity may be the result of genetic predisposition, diet and lifestyle factors, or both. Roberson, L. Subjects having only dyslipidaemia had lower risks of all-cause, cancer, and other-cause mortality, whereas this effect was abrogated by the combination of dyslipidaemia and other components. MRI scans of the abdominal region at L4 pictures are taken with permission from Matthias Raschpichler.

Your current browser may not support copying via this button. Insulin resistance as estimated by homeostasis model assessment predicts incident symptomatic cardiovascular disease in caucasian subjects from the general keaning the Bruneck study. Cardiovascular effects of intensive lifestyle intervention in type the intriguing metabolically healthy but obese phenotype meaning diabetes. It functions as an endocrine organ, secreting a variety of hormones and inflammation-promoting cytokines that promote the development of insulin resistance, type 2 diabetes, and other metabolic complications. This suggests that obesity itself may be more important than metabolic alterations for the development of heart failure In addition, we advocate adults to maintain metabolically healthy status in their early lifetime. Recent research on sedentary behavior, independent of physical activity, has shown that increased sedentary time is associated with increased risk of diabetes, cardiovascular events, and cardiovascular as well as all-cause mortality [ 44 ].

Sharma AM. BMC Public Health. Identification and characterization of metabolically benign obesity in humans.

Meainng PPT. Try out PMC Labs and tell us what you think. Some obese individuals exhibit lower degrees of insulin resistance and visceral adiposity and more favorable cardiovascular risk profiles despite their high BMI, and therefore are classified as having metabolically healthy obese MHO phenotype 11 Diabetes Care 36 —

  • When assessing intermediate risk populations such as the obese, the usefulness of traditional risk factor assessment such as Framingham diminishes. Author information Article notes Copyright and License information Disclaimer.

  • Table 5 Hazard ratios of cancer mortality in metabolically healthy but obese individuals compared with metabolically abnormal obese and metabolically healthy normal-weight individuals, using both body mass index and body fat percentage to define obesity. Clinical implications The results from the current study have important clinical implications.

  • Muennig P. Seoul 26—

  • A comparative analysis of four protocols for maximal treadmill stress testing.

Generalized equations for predicting body density of women. Google Preview. Publication types Research Support, Non-U. The metabolically healthy but obese individual presents a favorable inflammation profile. It is well known that obesity is related to a large number of chronic diseases and metabolic abnormalities.

Int J Obes Lond ; 34 — Cardiorespiratory fitness, different measures of adiposity, and cancer mortality in men. References 1. Based on the findings of the present and other studies, staging systems should consider the inclusion of fitness as an informative measure of the severity of obesity and functional limitations. Relative associations of fitness and fatness to fibrinogen, white blood cell count, uric acid and metabolic syndrome. Our study focused on two comparisons: i metabolically healthy but obese vs. Katzmarzyk5 Jonatan R.

In a random sample of these endpoints, we applied a standard definition for defining and adjudicating myocardial infarction, revascularization, and stroke. Search Menu. The metabolically healthy but obese group was used as referent in the analyses. Muscular strength is inversely related to prevalence and incidence of obesity in adult men.

  • The concept of MHO has recently gained much clinical relevance with novel prospective study data that individuals with MHO are not at increased risk of acute myocardial infarction compared with metabolically healthy normal-weight individuals

  • Br J Sports Med.

  • Survival curves were constructed with Kaplan-Meier estimates and compared using the log-rank test. Lancet —

  • Body fat per cent was assessed by hydrostatic weighing or the sum of seven skinfold measures, following standardized protocols.

The differences in defining metabolic health might be an important factor leading to discrepant results Moreover, it is questionable whether MHO individuals stay healthy 48 Introduction Cardiovascular disease CVD is thr leading cause of mortality worldwide. From a clinical perspective, the question remains how to best identify those who are at the lowest risk of developing these obesity-related complications, and monitor them in a cost effective way, while allocating the most resources to those in the highest risk group. Hamer, M. Am J Clin Nutr. Discussion From a large-scaled, nationwide, long-term follow-up study, we analysed the risk of mortality according to BMI and metabolic health status in the Korean population.

  • High fitness level in MHO may therefore only be an indicator for a specific healthier lifestyle of this obesity subphenotype and does not necessarily represent the major mechanism defining MHO

  • All participants provided written informed consent, and the study protocol was approved annually by the Institutional Review Board of the Cooper Institute. Frequency and percentage of deaths and incidence of non-fatal CVD events are shown in Table 2.

  • Subjects were selected using stratified random sampling to ensure that the sample was representative of the entire population.

Variable associations between MHO and reduced risk for the intriguing metabolically diseases and mortality 13212223 highlight the need for harmonized classification healthy but obese Phenotype meaning Our results suggest that: i better fitness should be considered a characteristic of metabolically healthy but obese phenotype. Our data provide and expand the findings from other population-based studies, and suggest a meaningful influence of metabolic health status and their interaction with BMI on mortality. The metabolically obese, normal-weight individual revisited. Eur Heart J. Kuo, J.

The metabolically obese, normal-weight individual revisited. Insulin resistance syndrome, body mass index and the risk of ischemic heart disease. All rights reserved. Open questions about metabolically normal obesity. Peter T.

Our results suggest that: i better fitness should be considered a characteristic of metabolically healthy but obese phenotype. Timothy S. In a random sample of these endpoints, we applied a standard definition for defining and adjudicating myocardial infarction, revascularization, and stroke.

Some intriguuing indicate that MHO individuals are not at a significantly increased risk of mortality compared to their normal-weight counterparts 262728while others showed a 2- to 3-fold increased risk 24 Endocrinology and Metabolism E — E All three utilized self reported methods. Batsis, J. Libraries were searched until December

Timothy S. Our study focused on two comparisons: i metabolically healthy but obese vs. When the same analyses were repeated using these new groups, almost identical findings were observed for all-cause mortality. Figure 1. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Twitter YouTube LinkedIn. Association of cardiorespiratory fitness with insulin sensitivity in overweight and obese postmenopausal women: a Montreal Ottawa New Emerging Team study.

BMI-based groups. Comparability of studies is difficult due to the different definitions used for MHO; consequently, the present review makes a proposal for harmonizing this definition in adults and in youth. Mortality surveillance was based on the national death index NDI. Insulin resistance syndrome, body mass index and the risk of ischemic heart disease. Metabolic syndrome, obesity, and mortality: impact of cardiorespiratory fitness.

Similar findings were observed from a retrospective study of Korean subjects who participated in a health screening program. Body-mass index and mortality among adults with incident type 2 diabetes. The intriguing metabolically healthy but obese phenotype meaning Clin Endocrinol Metab. Acknowledgments We would like to thank Dr. The phenomenon that some individuals are metabolically healthy despite long-standing obesity—even morbid obesity—was first described in the early s, challenging the paradigm that obesity leads to metabolic and cardiovascular risks. One of the first to identify and review this phenotype inwas Sims [ 30 ], who highlighted visceral adiposity and insulin resistance as key determinants of MHO. Clinicians should be hesitant to reassure patients that the metabolically benign phenotype is safe, as increased risk cardiovascular disease and death have been shown.

Prevalence of insulin resistance in metabolic disorders: the Bruneck Study. In secondary analyses, we also studied non-fatal coronary heart disease, myocardial infarction, and stroke separately. Prog Cardiovasc Dis58 107 May 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 — Arch Intern Med. The metabolically healthy but obese individual presents a favorable inflammation profile.

All statistical tests were 2-tailed with a type I error of 0. Until now, guidelines for obesity treatment should consider distinct obesity subphenotypes such as the distinction between MHO and metabolically high-risk obesity for a mettabolically of therapeutic strategies. Flegal, K. Fan, J. Mechanisms of MHO Behavioral and lifestyle factors may play a large role in why a subset of the obese do not present with metabolic abnormalities or present them at a slower pace. Recent research on sedentary behavior, independent of physical activity, has shown that increased sedentary time is associated with increased risk of diabetes, cardiovascular events, and cardiovascular as well as all-cause mortality [ 44 ].

Free full text. Katzmarzyk, Jonatan R. Cardiorespiratory fitness is inversely associated with the incidence of metabolic syndrome: a prospective study of men and women. Francisco B.

View in gallery Potential adipose tissue-related mechanisms underlying metabolically healthy obesity. Sign in to annotate. Metabolically healthy obesity across the life course: epidemiology, determinants, and implications [published online October 10, ]. However, significance was lost when subjects with prior diabetes, hypertension and cardiovascular disease were excluded, suggesting that these comorbid conditions explain much of the increased risk of mortality 7. Studies were examined in reference to their definition of MHO Table 1. However, this is a topic which has not been studied at length and presents mixed findings. Metabolically healthy obesity and the risk of cardiovascular disease and type 2 diabetes: the Whitehall II cohort study.

Relative associations of fitness and fatness to fibrinogen, white blood cell count, uric acid and metabolic syndrome. Abstract Aims. The phebotype the intriguing metabolically healthy but obese phenotype meaning analysis of covariance was adjusted for age, sex, examination year, smoking, and alcohol consumption. In secondary analyses, we also studied non-fatal coronary heart disease, myocardial infarction, and stroke separately. Secondary outcomes were coronary heart disease events myocardial infarction, coronary revascularization and myocardial infarction and stroke as separate endpoints. Characterizing the profile of obese patients who are metabolically healthy. Primeau et al.

  • In addition, normal-weight individuals have a higher mortality rate irrespective of their metabolic health status, compared with MHO individuals.

  • Characterizing the profile of obese patients who are metabolically healthy. Church5 and Steven N.

  • Secondary outcomes were coronary heart disease events myocardial infarction, coronary revascularization and myocardial infarction and stroke as separate endpoints. Prevalence of metabolically healthy obesity and its impacts on incidences of hypertension, diabetes and the metabolic syndrome in Taiwan.

Introduction Obesity is a intriguiny public health concern in most developed and developing countries. Jonatan R. Francisco B. Nevertheless, we believe it is unlikely that the results could be largely influenced by using a different definition for metabolically healthy, since previous prospective studies observed consistent results using both insulin resistance and metabolic syndrome definitions. View all jobs.

In this review, we aim to evaluate the MHO phenotype in context of cardiovascular disease risk and all-cause mortality. All authors read and approved the final manuscript. Third, we used BMI to define obesity, while measurement of waist circumference might have provided a better correlation to visceral adiposity Obesity severity and duration are associated with incident metabolic syndrome: evidence against metabolically healthy obesity from the Multi-Ethnic Study of Atherosclerosis. At any given BMI Fig.

Baseline characteristics of metabolically healthy obesity and metabolically healthy overweight participants. In this review, the prevalence, potential biological mechanisms, and the clinical relevance of MHO are discussed. Phillips CM.

However, whether MHO is a fact or phebotype, a friend or a foe [ 45 ], is being debated. Published : 22 July Article Google Scholar 44 Giovannucci, E. Introduction Obesity is a major public health concern in most developed and developing countries. Cardiovascular disease CVD is the leading cause of mortality worldwide. BMC Public Health.

This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector. Using the Edmonton obesity staging system to predict mortality in a population-representative cohort of people with overweight and obesity. European Journal of Clinical Nutrition 64 — First, we combined the overweight and obesity groups, and thus, the dangerous group may not have been evaluated specifically.

The characteristics of the 4 groups according to their BMI and metabolic health status were compared using one-way analysis of variance or Chi-squared tests. Research suggests that metabolic health is associated with being younger and female and with higher physical activity and smaller waist circumference. Nat Rev Endocrinol. Although consensus on the defining criteria is lacking, these subgroups are usually classified by BMI and the degree of insulin resistance or the number of metabolic abnormalities. The single study which was non-significant and did not point towards an increase in risk had a follow up of 6 years, small sample size ofand measured only incident heart failure [ 18 ].

J Sports Sci. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. Funding Funders who supported this work.

Five studies used metabolically healthy, normal weight MHNW as the comparison group [ 913161923 ] of which the two significant studies were included. Sims EA. S6 Table. The concept of MHO became more clinically relevant with recent data showing that individuals with MHO are not at increased risk for cardiovascular diseases compared with healthy normal-weight controls

Am J Clin Nutr. Published online Sep 4. PubMed Google Scholar. The log rank test was performed to compare the four groups.

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