Not all obese subjects of multiethnic origin are at similar risk for developing hypertension and type 2 diabetes

Genelhu, Virgínia; Celoria, Bruno Miguel Jorge; Duarte, Stênio Fernando Pimentel; Cabello, Pedro Hernán; Francischetti, E. A.

doi:10.1016/j.ejim.2008.09.009

Cited by 26 publications

(15 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several studies have reported higher levels of adiponectin in MHO than in MAO individuals. 13,16,26,37,38 In addition, a recent study extended these results by showing that MHO individuals had significantly higher levels of high-molecular weight adiponectin compared with MAO individuals. 39 However, the ability of acute hyperinsulinemia to reduce plasma adiponectin levels is not different between MHO and MAO.…”

Section: Hormonal and Inflammation Profiles Of Mho Individualssupporting

confidence: 50%

“…Results on blood pressure in MHO individuals are less consistent than those observed for blood lipids. Accordingly, several studies observed lower blood pressure in MHO individuals, 20,26,36 whereas others have not. 7,9 Finally, recent data indicates that the favorable metabolic profile of MHO subjects extends to the immune system with higher circulating levels of natural killer cells and cytotoxic T lymphocytes.…”

Section: Clinical and Biochemical Characteristics Of Mho Individualsmentioning

confidence: 99%

“…24,25 Finally, it should be noted that several studies have defined MHO individuals based on the extremes of insulin sensitivity (that is, upper quartiles or lower tertiles). 11,15,20,26,27 Therefore, caution should be taken with the prevalence of MHO subjects (that is, 25 or 33%) in these studies because the number is simply a reflection of the predefined selection criteria. In addition, several studies have reported that lean body mass (LBM) was significantly lower in MHO individuals compared with MAO subjects.…”

Section: Evidence Of a Subgroup Of Metabolically Healthy But Obese Inmentioning

confidence: 99%

See 2 more Smart Citations

Characterizing the profile of obese patients who are metabolically healthy

et al. 2010

View full text Add to dashboard Cite

The presence of obesity-related metabolic disturbances varies widely among obese individuals. Accordingly, a unique subset of obese individuals has been described in the medical literature, which seems to be protected or more resistant to the development of metabolic abnormalities associated with obesity. These individuals, now known as 'metabolically healthy but obese' (MHO), despite having excessive body fatness, display a favorable metabolic profile characterized by high levels of insulin sensitivity, no hypertension as well as a favorable lipid, inflammation, hormonal, liver enzyme and immune profile. However, recent studies have indicated that this healthier metabolic profile may not translate into a lower risk for mortality. Mechanisms that could explain the favorable metabolic profile of MHO individuals are poorly understood. However, preliminary evidence suggests that differences in visceral fat accumulation, birth weight, adipose cell size and gene expression-encoding markers of adipose cell differentiation may favor the development of the MHO phenotype. Despite the uncertainty regarding the exact degree of protection related to the MHO status, identification of underlying factors and mechanisms associated with this phenotype will eventually be invaluable in helping us understand factors that predispose, delay or protect obese individuals from metabolic disturbances. Collectively, a greater understanding of the MHO individual has important implications for therapeutic decision making, the characterization of subjects in research protocols and medical education. Keywords: metabolically healthy but obese; insulin sensitivity; body composition; metabolic risk factors; cardiovascular diseases Introduction Obesity has been increasing at a rapid rate over the past decades and has now reached epidemic proportions. Recent data suggest that 65% of US adult are overweight (body mass index425 kg m À2) and 30% are obese (body mass index430 kg m À2).1 Obesity is associated with numerous metabolic complications such as Type 2 diabetes, dyslipidemia, hypertension, cardiovascular diseases and several forms of cancer. 2 The risk of developing obesity-related complications is proportional to the degree of obesity, and more specifically to android fat accumulation. 3 However, the presence of these obesity-related metabolic disturbances varies widely among obese individuals. 4,5 Accordingly, a unique subset of obese individuals has been described in the medical literature that seems to be protected or more resistant to the development of metabolic abnormalities associated with obesity. 6-12 These individuals, now known as 'metabolically healthy but obese' (MHO), despite having excessive body fatness, display favorable metabolic profiles characterized by high levels of insulin sensitivity, no hypertension, as well as favorable lipid, inflammation, hormonal, liver enzyme and immune profiles 7,9,[13][14][15] ( Figure 1). This phenomenon has also been observed in adolescents. 16 Despite a clinical awareness of the MHO individu...

show abstract

Section: Hormonal and Inflammation Profiles Of Mho Individualssupporting

confidence: 50%

Section: Clinical and Biochemical Characteristics Of Mho Individualsmentioning

confidence: 99%

Section: Evidence Of a Subgroup Of Metabolically Healthy But Obese Inmentioning

confidence: 99%

See 1 more Smart Citation

Characterizing the profile of obese patients who are metabolically healthy

et al. 2010

View full text Add to dashboard Cite

show abstract

“…As one example, MHO adults in the current study, as defined by both the HOMA-IR and ATP-III definitions, show average LDL-C levels above the recommended 2.6 mmol/L, while only the Combined definition, which includes LCL-C as a criterion, results in LDL-C within the normal range. Other studies have shown that even when average levels of health markers are normal, anywhere from 7 to 51% of participants classified as MHO have elevated levels of the same health markers [8, 14, 48, 53]. In summary, results presented here indicate that a very small percentage of obese participants (~4%) are healthy by every metabolic health criteria that might be considered, returning to the question of which definition of metabolic health should be used.…”

Section: Discussionmentioning

confidence: 46%

All-Cause Mortality Risk of Metabolically Healthy Obese Individuals in NHANES III

2012

View full text Add to dashboard Cite

Mortality risk across metabolic health-by-BMI categories in NHANES-III was examined. Metabolic health was defined as: (1) homeostasis model assessment-insulin resistance (HOMA-IR) <2.5; (2) ≤2 Adult Treatment Panel (ATP) III metabolic syndrome criteria; (3) combined definition using ≤1 of the following: HOMA-IR ≥1.95 (or diabetes medications), triglycerides ≥1.7 mmol/L, HDL-C <1.04 mmol/L (males) or <1.30 mmol/L (females), LDL-C ≥2.6 mmol/L, and total cholesterol ≥5.2 mmol/L (or cholesterol-lowering medications). Hazard ratios (HR) for all-cause mortality were estimated with Cox regression models. Nonpregnant women and men were included (n = 4373, mean ± SD, age 37.1 ± 10.9 years, BMI 27.3 ± 5.8 kg/m2, 49.4% female). Only 40 of 1160 obese individuals were identified as MHO by all definitions. MHO groups had superior levels of clinical risk factors compared to unhealthy individuals but inferior levels compared to healthy lean groups. There was increased risk of all-cause mortality in metabolically unhealthy obese participants regardless of definition (HOMA-IR HR 2.07 (CI 1.3–3.4), P < 0.01; ATP-III HR 1.98 (CI 1.4–2.9), P < 0.001; combined definition HR 2.19 (CI 1.3–3.8), P < 0.01). MHO participants were not significantly different from healthy lean individuals by any definition. While MHO individuals are not at significantly increased risk of all-cause mortality, their clinical risk profile is worse than that of metabolically healthy lean individuals.

show abstract

“…Some authors use sub-clinical thresholds based on the National Cholesterol Education Program's Adult Treatment Panel III metabolic syndrome criteria (1,2,4), while others use insulin sensitivity cutoffs (3,21) to define MNOB. As a result, the prevalence of MNOB can vary greatly from as many as 30-40% of the obese population (2,3,(22)(23)(24)(25) to as few as 6% depending on the definition used (1). In this study, we used clinical accepted cutoffs to define metabolic health status.…”

Section: Discussionmentioning

confidence: 99%

Influence of a clinical lifestyle‐based weight loss program on the metabolic risk profile of metabolically normal and abnormal obese adults

Liu

Wharton

Sharma

et al. 2013

Obesity

View full text Add to dashboard Cite

Objective: It is unclear whether all obese individuals should be prescribed weight loss (WL) treatment. The effect of a clinically significant WL of 5% on metabolic factors among metabolically normal and abnormal overweight and obese (MNO and MAO) individuals was examined. Design and Methods: The sample included 392 overweight and obese adults from the Wharton Medical Clinic. MAO was defined as having one or more clinically relevant aberrations in glucose, triglycerides, blood pressure (BP), high-density lipoprotein-C, low-density lipoprotein-C, preexisting, or current medication use for metabolic conditions. Results: Of the 392 patients, 21.2% of the sample was MNO at baseline and 41.3% of the sample attained a 5% WL. Regardless of initial metabolic health status, improvements in most risk factors were observed with a 5% WL in comparison with those who did not lose weight. Even MAO patients who did not achieve a 5% WL still significantly improved BP and cholesterol over the treatment period. Conclusions: A clinically significant WL is beneficial for the cardiometabolic risk profile of both MNO and MAO. However, a 5% WL is not necessarily required to improve the cardiometabolic risk profile of MAO. Thus, lifestyle-based WL provides beneficial metabolic effects for all overweight and obese individuals, particularly those with significant metabolic aberrations.

show abstract

Not all obese subjects of multiethnic origin are at similar risk for developing hypertension and type 2 diabetes

Cited by 26 publications

References 34 publications

Characterizing the profile of obese patients who are metabolically healthy

Characterizing the profile of obese patients who are metabolically healthy

All-Cause Mortality Risk of Metabolically Healthy Obese Individuals in NHANES III

Influence of a clinical lifestyle‐based weight loss program on the metabolic risk profile of metabolically normal and abnormal obese adults

Contact Info

Product

Resources

About