The prevalence of metabolically healthy obesity: a systematic review and critical evaluation of the definitions used

Abstract

We performed a systematic review of the prevalence of metabolically healthy obesity (MHO). Medline, Web of Science and EMBASE were searched for original articles from inception to November 2013. Only prospective and cross-sectional studies were included. After screening 478 titles, we selected 55 publications, of which 27 were population-based studies and were used in the narrative synthesis. From the 27 studies, we identified 30 definitions of metabolic health, mainly based on four criteria: blood pressure, high-density lipoprotein cholesterol, triglycerides and plasma glucose. Body mass index ≥30 kg m(-2) was the main indicator used to define obesity (74% of the studies). Overall, MHO prevalence ranged between 6% and 75%. In the studies that stratified the analysis by sex, prevalence was higher in women (seven out of nine studies) and in younger ages (all four studies). One-third of the studies (n = 9) reported the response rate. Of these, four reported a response rate of ≥70% and they showed MHO prevalence estimates between 10% and 51%. The heterogeneity of MHO prevalence estimates described in this paper strengthens calls for the urgent need for a commonly established metabolic health definition.

Mediterranean diet, Dietary Approaches to Stop Hypertension (DASH) style diet, and metabolic health in U.S. adults

“…The prevalence of MHO was relatively higher in the younger age group whereas the prevalence of MONW was relatively higher in the older age group, which also has been reported from other studies [34,49]. In addition, both MHO and MONW phenotypes were associated with DM parental history in the younger age group; and with physical activity in the older ager group, suggesting that genetic factors in younger age group and lifestyle related factors in older age group might be predominantly related to metabolic health independent of obesity status.…”

Cardiometabolic Health in Obese Adolescents Is Related to Length of Obesity Exposure: A Pilot Study

“…Research on the paradoxical finding of "metabolically healthy obesity" (MHO) has drawn much attention particularly in adult studies. A definition of the MHO phenotype is mostly based either on the absence of cardiometabolic risk factors or presence of only one risk factor (a manifestation of obesity per se) or on preservation of high insulin sensitivity (3). Several studies aimed at identifying determinants and predictors of MHO, focusing on hereditary and lifestyle factors (4 -7).…”

Serum Uric Acid Levels as an Indicator for Metabolically Unhealthy Obesity in Children and Adolescents

“…Although MHO has been well studied in adult populations, research focused on children and adolescents is far more scarce [7]. The reported prevalence of MHO in children varies considerably, ranging from 6 to 75%, depending on the classification system used to define this condition [8, 9]. Due to a lack of consensus, the definition of MHO remains controversial [10].…”