Metabolically healthy obesity and metabolically obese normal weight: a review

Gómez‐Zorita, Saioa; Queralt, Maite; Vicente, M. A.; González, Marcela; Portillo, Marı́a P.

doi:10.1007/s13105-020-00781-x

Cited by 34 publications

(31 citation statements)

References 129 publications

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“…Type of adipose tissue growth (hypertrophy or hyperplasia), adipose tissue anatomical location, adipose tissue inflammation, ectopic fat accumulation, genetics, and lifestyles factors (i.e., diet and physical activity) collectively contribute to the development of either metabolically healthy or unhealthy adipose tissue. 9 Angiogenesis and mitochondrial biogenesis are key factors influencing healthy and unhealthy adipose tissue expansion. 10,11 As pre-adipocytes differentiate into mature adipocytes, mitochondrial biogenesis and oxygen consumption increase 20-to 30-fold.…”

Section: Factors Affecting Healthy Vs Unhealthy Adipose Tissue Expansionmentioning

confidence: 99%

Section: Factors Affecting Healthy Vs Unhealthy Adipose Tissue Expansionmentioning

confidence: 99%

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Healthy versus Unhealthy Adipose Tissue Expansion: the Role of Exercise

Meister

Hong

Shin

et al. 2022

Journal of Obesity & Metabolic Syndrome

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Although the hallmark of obesity is the expansion of adipose tissue, not all adipose tissue expansion is the same. Expansion of healthy adipose tissue is accompanied by adequate capillary angiogenesis and mitochondria-centered metabolic integrity, whereas expansion of unhealthy adipose tissue is associated with capillary and mitochondrial derangement, resulting in deposition of immune cells (M1-stage macrophages) and excess production of pro-inflammatory cytokines. Accumulation of these dysfunctional adipose tissues has been linked to the development of obesity comorbidities, such as type 2 diabetes, hypertension, dyslipidemia, and cardiovascular disease, which are leading causes of human mortality and morbidity in modern society. Mechanistically, vascular rarefaction and mitochondrial incompetency (for example, low mitochondrial content, fragmented mitochondria, defective mitochondrial respiratory function, and excess production of mitochondrial reactive oxygen species) are frequently observed in adipose tissue of obese patients. Recent studies have demonstrated that exercise is a potent behavioral intervention for preventing and reducing obesity and other metabolic diseases. However, our understanding of potential cellular mechanisms of exercise, which promote healthy adipose tissue expansion, is at the beginning stage. In this review, we hypothesize that exercise can induce unique physiological stimuli that can alter angiogenesis and mitochondrial remodeling in adipose tissues and ultimately promote the development and progression of healthy adipogenesis. We summarize recent reports on how regular exercise can impose differential processes that lead to the formation of either healthy or unhealthy adipose tissue and discuss key knowledge gaps that warrant future research.

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Section: Factors Affecting Healthy Vs Unhealthy Adipose Tissue Expansionmentioning

confidence: 99%

Section: Factors Affecting Healthy Vs Unhealthy Adipose Tissue Expansionmentioning

confidence: 99%

Healthy versus Unhealthy Adipose Tissue Expansion: the Role of Exercise

Meister

Hong

Shin

et al. 2022

Journal of Obesity & Metabolic Syndrome

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“…Studies investigating the obesity paradox in HF often use BMI as a single measure of obesity, not taking into account body composition and other contributors to increased body weight. Powerful markers of cardiometabolic health such as increased visceral fat, dyslipidaemia, IR, hypertension, and NAFLD exist in both obese and normal weight individuals, therefore risk stratification should not be based on weight alone ( 95 , 96 ).…”

Section: Improving Body Compositionmentioning

confidence: 99%

Low Carbohydrate Diets for Diabetic Cardiomyopathy: A Hypothesis

et al. 2022

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Elevated blood glucose levels, insulin resistance (IR), hyperinsulinemia and dyslipidemia the key aspects of type 2 diabetes mellitus (T2DM), contribute to the development of a certain form of cardiomyopathy. This cardiomyopathy, also known as diabetic cardiomyopathy (DMCM), typically occurs in the absence of overt coronary artery disease (CAD), hypertension or valvular disease. DMCM encompasses a variety of pathophysiological processes impacting the myocardium, hence increasing the risk for heart failure (HF) and significantly worsening outcomes in this population. Low fat (LF), calorie-restricted diets have been suggested as the preferred eating pattern for patients with HF. However, LF diets are naturally higher in carbohydrates (CHO). We argue that in an insulin resistant state, such as in DMCM, LF diets may worsen glycaemic control and promote further insulin resistance (IR), contributing to a physiological and functional decline in DMCM. We postulate that CHO restriction targeting hyperinsulinemia may be able to improve tissue and systemic IR. In recent years low carbohydrate diets (LC) including ketogenic diets (KD), have emerged as a safe and effective tool for the management of various clinical conditions such as T2DM and other metabolic disorders. CHO restriction achieves sustained glycaemic control, lower insulin levels and successfully reverses IR. In addition to this, its pleiotropic effects may present a metabolic stress defense and facilitate improvement to cardiac function in patients with HF. We therefore hypothesize that patients who adopt a LC diet may require less medications and experience improvements in HF-related symptom burden.

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“…Another confusing component of disrupted fuel homeostasis in metabolic syndrome is that there are two groups of outliers in the general population: "metabolically healthy" obese individuals and "metabolically obese" normal weight individuals. Metabolically obese normal weight individuals (24% of normal weight individuals) are primarily a result of genetics and lifestyle factors, whereas metabolically healthy obese individuals (32% of obese individuals) are impacted by a multitude of factors, such as inflammation of adipose tissue (11,12). In both groups, poor metabolic "fitness" is strongly correlated with increased hepatic fat stores, which are likely a result of de novo lipid synthesis, increased uptake, and decreased disposal (13).…”

Section: Disrupted Fuel Homeostasis the Metabolic Syndrome And Covid-19mentioning

confidence: 99%

Homeostasis Disrupted and Restored—A Fresh Look at the Mechanism and Treatment of Obesity During COVID-19

Dickey

Davtyan

et al. 2021

Front. Cardiovasc. Med.

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The prevalence of obesity in the United States approaches half of the adult population. The COVID-19 pandemic endangers the health of obese individuals. In addition, the metabolic syndrome poses a challenge to the health of obese adults. Bariatric surgery and diet restore metabolic homeostasis in obese individuals; however, it is still unclear which strategy is most effective. For example, intermittent fasting improves insulin sensitivity and diet alone decreases visceral adipose tissue at a disproportionately high rate compared to weight loss. Bariatric surgery causes rapid remission of type 2 diabetes and increases incretins for long-term remission of insulin resistance before meaningful weight loss has occurred. Malabsorptive surgeries have provided insight into the mechanism of altering metabolic parameters, but strong evidence to determine the duration of their effects is yet to be established. When determining the best method of weight loss, metabolic parameters, target weight loss, and risk-benefit analysis must be considered carefully. In this review, we address the pros and cons for the optimal way to restore metabolic homeostasis.

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Metabolically healthy obesity and metabolically obese normal weight: a review

Cited by 34 publications

References 129 publications

Healthy versus Unhealthy Adipose Tissue Expansion: the Role of Exercise

Healthy versus Unhealthy Adipose Tissue Expansion: the Role of Exercise

Low Carbohydrate Diets for Diabetic Cardiomyopathy: A Hypothesis

Homeostasis Disrupted and Restored—A Fresh Look at the Mechanism and Treatment of Obesity During COVID-19

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