Metabolically healthy obesity across the life course: epidemiology, determinants, and implications

Phillips, Catherine M.

doi:10.1111/nyas.13230

Cited by 149 publications

(131 citation statements)

References 135 publications

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“…Metabolic parameters such as metabolic traits, insulin resistance, and subclinical inflammation have been widely used to define metabolic abnormality [18]. However, in most circumstances, insulin resistance and subclinical inflammation are not determined, therefore, an individual may be practically considered metabolically healthy when fewer than two parameters of metabolic syndrome are abnormal [8,19,20]. In this study, with this common criterion for metabolic health employed, the MONW prevalence was 34.1% in normal-weight individuals.…”

Section: Discussionmentioning

confidence: 83%

Prevalence and epidemiological determinants of metabolically obese but normal-weight in Chinese population

Zheng¹,

Lin²,

Liu³

et al. 2020

BMC Public Health

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Background: There is metabolic heterogeneity in normal-weight individuals, however, there has been limited research in the Chinese population. This study aimed to investigate the prevalence, distribution and epidemiological determinants of metabolically obese but normal-weight (MONW) in a Chinese population. Methods: A total of 17,876 normal-weight individuals were recruited from 37,815 individuals in Zhejiang province in southeastern China. Normal-weight was defined as a body mass index (BMI) of 18.5-23.9 kg/m 2 . Metabolically abnormal traits were assessed by metabolic syndrome criteria from the International Diabetes Federation (IDF) in 2015. MONW was defined as individuals who had at least two metabolically abnormal trait but normal weight. Multiple logistic regression was used to investigate MONW risk factors, adjusting for potential confounders. Results: The prevalence of metabolic abnormality was 34.1% in normal-weight individuals, and the overall prevalence of MONW was 16.1% in the general population. Different MONW distributions were found between men and women depending on age. Compared with women, men had a significantly higher MONW prevalence among those aged < 45 years old, and there was a lower prevalence for those aged ≥50 years old. Higher BMI or waist circumference (WC), central obesity, menopause, and family histories of hypertension, diabetes, and cardiovascular diseases, increased MONW risk. Higher education levels, regular alcohol drinking, and balanced or vegetarian food preferences reduced MONW risk.Conclusions: Normal-weight individuals have metabolic heterogeneity in China. The MONW distribution between men and women depends on age. BMI, WC, dietary factors, and family history of chronic diseases, are associated with metabolic status.

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Section: Discussionmentioning

confidence: 83%

Prevalence and epidemiological determinants of metabolically obese but normal-weight in Chinese population

Zheng¹,

Lin²,

Liu³

et al. 2020

BMC Public Health

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“…Not all obese individuals, even if morbidly obese, are at risk for these obesity-related complications, a condition defined as “healthy obesity”. Such individuals have evidence of less adipose inflammation than those with complications (55,56). …”

Section: Discussionmentioning

confidence: 99%

Docosahexaenoic acid supplementation is not anti-inflammatory in adipose tissue of healthy obese postmenopausal women

Holt

Alemán

Walker

et al. 2017

IJN

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Adipose tissue inflammation is associated with obesity comorbidities. Reducing such inflammation may ameliorate these comorbidities. n-3 fatty acids have been reported to have anti-inflammatory properties in obesity, which may modulate this inflammatory state. In the current study a 1 gram per day oral supplement of the n-3 fatty acid docosahexaenoic acid (DHA) was administered for 12 weeks to 10 grade 1-2 obese postmenopausal women and markers of adipose tissue and systemic inflammation measured and compared before and after supplementation. DHA administration resulted in approximately a doubling of plasma and red cell phospholipid and adipose tissue DHA content but no change in systemic markers of inflammation, such as circulating C-reactive protein (CRP) or interleukins (IL) 6, 8 and 10 (IL-6, IL-8, IL-10). DHA supplementation did not alter the adipose tissue marker of inflammation crown-like structure density nor did it affect any gene expression pathways, including anti-inflammatory, hypoxic and lipid metabolism pathways. The obese postmenopausal women studied were otherwise healthy, which leads us to suggest that in such women DHA supplementation is not an effective means for reducing adipose tissue or systemic inflammation. Further testing is warranted to determine if n-3 fatty acids may ameliorate inflammation in other, perhaps less healthy, populations of obese individuals.

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“…Obesity is a strong risk factor for a lot of entities, including NAFLD. However, some obese people do not suffer from the common metabolic disturbances related to obesity, adopting the concept of metabolically healthy obesity (MHO) . Similarly, some non‐obese people are at risk of NAFLD‐related outcomes in opposite to other non‐obese subjects with a few metabolic factors .…”

Section: Introductionmentioning

confidence: 99%

“…However, some obese people do not suffer from the common metabolic disturbances related to obesity, adopting the concept of metabolically healthy obesity (MHO). 11 Similarly, some non-obese people are at risk of NAFLD-related outcomes in opposite to other non-obese subjects with a few metabolic factors. 12 There is no general agreement on the criteria to define the metabolically healthy status, although most of the studies focus on subjects with two or fewer metabolic components.…”

Section: Introductionmentioning

confidence: 99%

The effects of metabolic status on non‐alcoholic fatty liver disease‐related outcomes, beyond the presence of obesity

Ampuero¹,

Aller²,

Gallego‐Durán³

et al. 2018

Aliment Pharmacol Ther

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Summary Background Metabolically healthy obesity (MHO) shows a reduced risk compared with obese patients with adverse metabolic conditions. Lean people suffering some metabolic derangements also have non‐alcoholic fatty liver disease (NAFLD)‐related outcomes compared with non‐obese subjects with a few metabolic risks. Aim To define the impact of the metabolic status on the NAFLD‐related outcomes, beyond the presence of obesity. Methods We designed a multicentre cross‐sectional study, including 1058 biopsy‐proven NAFLD patients. Metabolically healthy status was strictly defined by the lack of metabolic risk factors (diabetes mellitus, low HDL, hypertriglyceridemia, arterial hypertension). Non‐alcoholic steatohepatitis (NASH) and significant fibrosis (F2‐F4) were identified by liver biopsy. Chronic kidney disease epidemiology collaboration equation was calculated for kidney function and the atherogenic index of plasma (AIP) for cardiovascular risk. Results Metabolically healthy (OR 1.88; P = 0.050) and unhealthy obesity (OR 3.47: P < 0.0001), and unhealthy non‐obesity (OR 3.70; P < 0.0001) were independently associated with NASH together with homeostatic model assessment (HOMA), ALT, and platelets. Significant fibrosis was more frequently observed in the presence of adverse metabolic conditions in obese (OR 3.89; P = 0.003) and non‐obese patients (OR 3.92; P = 0.002), and independently associated with platelets, albumin, ALT, HOMA, and age. The number of metabolic factors determined the risk of NASH and significant fibrosis. Glomerular filtration rate was lower in unhealthy (91.7 ± 18) than healthy metabolism (95.6 ± 17) (P = 0.007). AIP was higher in adverse metabolic conditions (P = 0.0001). Metabolically unhealthy non‐obesity showed higher liver damage (NASH 55.8% vs 42.4%; P < 0.05; significant fibrosis 31.7% vs 11.4%; P < 0.0001) and cardiovascular risk (P < 0.0001) than healthy obesity. Conclusions Metabolic unhealthy status showed a greater impact on NASH, significant fibrosis, kidney dysfunction, and atherogenic profile than obesity. However, metabolically healthy obesity was not a full healthy condition. We should focus our messages especially on patients with adverse metabolic conditions.

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Metabolically healthy obesity across the life course: epidemiology, determinants, and implications

Cited by 149 publications

References 135 publications

Prevalence and epidemiological determinants of metabolically obese but normal-weight in Chinese population

Prevalence and epidemiological determinants of metabolically obese but normal-weight in Chinese population

Docosahexaenoic acid supplementation is not anti-inflammatory in adipose tissue of healthy obese postmenopausal women

The effects of metabolic status on non‐alcoholic fatty liver disease‐related outcomes, beyond the presence of obesity

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