Metabolically healthy obesity

Metabolically healthy obesity or metabolically-healthy obesity (MHO) is a disputed<ref name=Puri-2014/> medical condition characterized by obesity which does not produce metabolic complications.<ref name=lancet>,

 Metabolically healthy obesity: epidemiology, mechanisms, and clinical implications, 
 The Lancet Diabetes & Endocrinology, 
 
 Vol. 1(Issue: 2),
 pp. 152–162,
 DOI: 10.1016/S2213-8587(13)70062-7,
 PMID: 24622321,</ref>

Characteristics

No universally accepted criteria exist to define putative MHO,<ref name=lancet/> but definitions generally require the patient to be obese and to lack metabolic abnormalities such as dyslipidemia, impaired glucose tolerance,<ref name=Puri-2014>,

 Is it Finally Time to Dispel the Concept of Metabolically-Healthy Obesity?, 
 Journal of the American College of Cardiology, 
 
 Vol. 63(Issue: 24),
 pp. 2687–2688,
 DOI: 10.1016/j.jacc.2014.03.043,
 PMID: 24794116,</ref> or metabolic syndrome.<ref name=mam>, 
 'Metabolically healthy obesity': Origins and implications, 
 Molecular Aspects of Medicine, 
 
 Vol. 34(Issue: 1),
 pp. 59–70,
 DOI: 10.1016/j.mam.2012.10.004,
 PMID: 23068072,
 PMC: 3583231,</ref>

MHO individuals display less visceral adipose tissue, smaller adipocytes, and a reduced inflammatory profile relative to metabolically unhealthy obese individuals.<ref name=mam/><ref>,

 Can Metabolically Healthy Obesity be explained by diet, genetics and inflammation?, 
 Molecular Nutrition & Food Research, 
 
 Vol. 59(Issue: 1),
 pp. 75–93,
 DOI: 10.1002/mnfr.201400521,
 PMID: 25418549,</ref><ref>, 
 Does Metabolically Healthy Obesity Exist?, 
 Nutrients, 
 
 Vol. 8(Issue: 6),
 
 DOI: 10.3390/nu8060320,
 PMID: 27258304,
 PMC: 4924161,</ref> As a result, it has been argued that cardiometabolic risk might not improve significantly as a result of weight loss interventions.<ref>, 
 MECHANISMS IN ENDOCRINOLOGY: Are metabolically healthy obese individuals really healthy?, 
 European Journal of Endocrinology, 
 
 Vol. 171(Issue: 6),
 pp. R209–R219,
 DOI: 10.1530/EJE-14-0540,
 PMID: 25012199,</ref>

Epidemiology

Prevalence estimates of MHO have varied from 6 to 75 percent,<ref>,

 The prevalence of metabolically healthy obesity: a systematic review and critical evaluation of the definitions used., 
 Obesity Reviews, 
 
 Vol. 15(Issue: 10),
 pp. 781–90,
 DOI: 10.1111/obr.12198,
 PMID: 25040597,</ref> and it has been argued that between 10 and 25 percent of obese individuals are metabolically healthy.<ref>, 
 The distinction of metabolically 'healthy' from 'unhealthy' obese individuals, 
 Current Opinion in Lipidology, 
 
 Vol. 21(Issue: 1),
 pp. 38–43,
 DOI: 10.1097/MOL.0b013e3283346ccc,
 PMID: 19915462,</ref> One study found that 47.9% of obese people had MHO, while another found that 11% did.<ref name=mam/> It seems to be more prevalent in women than men, and its prevalence decreases with age.<ref>, 
 Metabolically healthy obesity from childhood to adulthood — Does weight status alone matter?, 
 Metabolism, 
 
 Vol. 63(Issue: 9),
 pp. 1084–1092,
 DOI: 10.1016/j.metabol.2014.06.009,
 PMID: 25038727,</ref><ref>, 
 The prevalence of metabolic syndrome and metabolically healthy obesity in Europe: a collaborative analysis of ten large cohort studies, 
 BMC Endocrine Disorders, 
 
 Vol. 14(Issue: 1),
 pp. 9,
 DOI: 10.1186/1472-6823-14-9,
 PMID: 24484869,</ref>

Outcomes

Some research suggests that metabolically healthy obese individuals are at an increased risk of several adverse outcomes, including type 2 diabetes,<ref>,

 Metabolically healthy obesity and risk of incident type 2 diabetes: a meta-analysis of prospective cohort studies., 
 Obesity Reviews, 
 
 Vol. 15(Issue: 6),
 pp. 504–15,
 DOI: 10.1111/obr.12157,
 PMID: 24661566,
 PMC: 4309497,
 
 Full text,</ref> depressive symptoms,<ref>, 
 Association of metabolically healthy obesity with depressive symptoms: pooled analysis of eight studies, 
 Molecular Psychiatry, 
 
 Vol. 19(Issue: 8),
 pp. 910–914,
 DOI: 10.1038/mp.2013.162,
 PMID: 24296976,
 PMC: 4921125,</ref> and cardiovascular events.<ref>, 
 Are Metabolically Healthy Overweight and Obesity Benign Conditions?, 
 Annals of Internal Medicine, 
 
 Vol. 159(Issue: 11),
 pp. 758–69,
 DOI: 10.7326/0003-4819-159-11-201312030-00008,
 PMID: 24297192,</ref><ref>Eckel, Nathalie, 
 Metabolically healthy obesity and cardiovascular events: A systematic review and meta-analysis, 
 European Journal of Preventive Cardiology, 
 2016,
 Vol. 23(Issue: 9),
 pp. 956–966,
 DOI: 10.1177/2047487315623884,
 PMID: 26701871,</ref> Other research also suggests that although MHO individuals display a favorable metabolic profile, this does not necessarily translate into a decrease in mortality.<ref>, 
 Characterizing the profile of obese patients who are metabolically healthy, 
 International Journal of Obesity, 
 
 Vol. 35(Issue: 7),
 pp. 971–981,
 DOI: 10.1038/ijo.2010.216,</ref> Research to date has produced conflicting results with respect to cardiovascular disease and mortality.<ref>, 
 Metabolically healthy obesity: Definitions, determinants and clinical implications, 
 Reviews in Endocrine and Metabolic Disorders, 
 
 Vol. 14(Issue: 3),
 pp. 219–227,
 DOI: 10.1007/s11154-013-9252-x,
 PMID: 23928851,</ref> MHO individuals are at a higher risk of cardiovascular disease compared to metabolically healthy non-obese individuals, but they are also at a lower risk thereof than individuals who are both unhealthy and obese.<ref>, 
 Beyond BMI: The "Metabolically healthy obese" phenotype & its association with clinical/subclinical cardiovascular disease and all-cause mortality -- a systematic review, 
 BMC Public Health, 
 
 Vol. 14(Issue: 1),
 pp. 14,
 DOI: 10.1186/1471-2458-14-14,
 PMID: 24400816,
 PMC: 3890499,</ref><ref>, 
 Combined effect of obesity and cardio-metabolic abnormality on the risk of cardiovascular disease: A meta-analysis of prospective cohort studies, 
 International Journal of Cardiology, 
 
 Vol. 168(Issue: 5),
 pp. 4761–4768,
 DOI: 10.1016/j.ijcard.2013.07.230,
 PMID: 23972953,</ref> A 2016 meta-analysis found that MHO individuals were not at an increased risk of all-cause mortality (but were at an increased risk of cardiovascular events).<ref>, 
 The long-term prognosis of cardiovascular disease and all-cause mortality for metabolically healthy obesity: a systematic review and meta-analysis., 
 Journal of Epidemiology and Community Health, 
 
 Vol. 70(Issue: 10),
 pp. 1024–1031,
 DOI: 10.1136/jech-2015-206948,
 PMID: 27126492,</ref> The relatively low risk of cardiovascular disease among people with MHO relative to metabolically unhealthy obese people has been attributed to differences in white adipose tissue function between the two groups.<ref>, 
 Molecular insights into the role of white adipose tissue in metabolically unhealthy normal weight and metabolically healthy obese individuals., 
 FASEB Journal, 
 
 Vol. 29(Issue: 3),
 pp. 748–758,
 DOI: 10.1096/fj.14-263913,
 PMID: 25411437,</ref>

References

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