J Korean Diabetes.  2014 Mar;15(1):17-20. 10.4093/jkd.2014.15.1.17.

The Definition of Metabolically Healthy Obesity

• Yang HK
• Lee SH

• KMID: 1703377
• DOI: http://doi.org/10.4093/jkd.2014.15.1.17

Abstract

Metabolically healthy obesity (MHO) is a term indicating a subgroup of obese individuals who demonstrate normal to high levels of insulin sensitivity, a lower level of visceral adiposity and more favorable cardiovascular risk profiles. Although identifying MHO might have clinical significance in terms of management strategies, there is no consensus regardingthe criteria used for defining this subgroup. Several different definitions have been used for MHO, and this has resulted in a wide range of prevalence and low agreement between classifications. The analyses of clinical characteristics and the metabolic outcomes also showed controversial findings because of the different definitions used. Developing a standardized criteria that is easily applicable and that accurately accounts for risk factors for predicting the development of type 2 diabetes or cardiovascular outcomes is of clinical value and will broaden our understanding regarding the clinical importance of MHO.

Keyword

Body mass index; Diagnosis; Insulin resistance; Obesity

MeSH Terms

Adiposity
Body Mass Index
Classification
Consensus
Diagnosis
Insulin Resistance
Obesity*
Prevalence
Risk Factors

Reference

References

1. Karelis AD, Rabasa-Lhoret R. Inclusion of C-reactive protein in the identification of metabolically healthy but obese (MHO) individuals. Diabetes Metab. 2008; 34:183–4.

2. Stefan N, Kantartzis K, Machann J, Schick F, Thamer C, Rittig K, Balletshofer B, Machicao F, Fritsche A, Häring HU. Identification and characterization of metabolically benign obesity in humans. Arch Intern Med. 2008; 168:1609–16.

3. Wildman RP, Muntner P, Reynolds K, McGinn AP, Rajpathak S, Wylie-Rosett J, Sowers MR. The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering: prevalence and correlates of 2 phenotypes among the US population (NHANES 1999–2004). Arch Intern Med. 2008; 168:1617–24.

4. Karelis AD. Metabolically healthy but obese individuals. Lancet. 2008; 372:1281–3.

5. Karelis AD, St-Pierre DH, Conus F, Rabasa-Lhoret R, Poehlman ET. Metabolic and body composition factors in subgroups of obesity: what do we know? J Clin Endocrinol Metab. 2004; 89:2569–75.

6. Meigs JB, Wilson PW, Fox CS, Vasan RS, Nathan DM, Sullivan LM, D'Agostino RB. Body mass index, metabolic syndrome, and risk of type 2 diabetes or cardiovascular disease. J Clin Endocrinol Metab. 2006; 91:2906–12.

7. Bonora E, Kiechl S, Willeit J, Oberhollenzer F, Egger G, Targher G, Alberiche M, Bonadonna RC, Muggeo M. Prevalence of insulin resistance in metabolic disorders: the Bruneck Study. Diabetes. 1998; 47:1643–9.

8. Pajunen P, Kotronen A, Korpi-Hyövälti E, Keinänen-Kiukaanniemi S, Oksa H, Niskanen L, Saaristo T, Saltevo JT, Sundvall J, Vanhala M, Uusitupa M, Peltonen M. Metabolically healthy and unhealthy obesity phenotypes in the general population: the FIN-D2D Survey. BMC Public Health. 2011; 11:754.

9. Klöting N, Fasshauer M, Dietrich A, Kovacs P, Schön MR, Kern M, Stumvoll M, Blüher M. Insulin-sensitive obesity. Am J Physiol Endocrinol Metab. 2010; 299:E506–15.

10. Hwang LC, Bai CH, Sun CA, Chen CJ. Prevalence of metabolically healthy obesity and its impacts on incidences of hypertension, diabetes and the metabolic syndrome in Taiwan. Asia Pac J Clin Nutr. 2012; 21:227–33.

11. Geetha L, Deepa M, Anjana RM, Mohan V. Prevalence and clinical profile of metabolic obesity and phenotypic obesity in Asian Indians. J Diabetes Sci Technol. 2011; 5:439–46.

12. Lee SH, Ha HS, Park YJ, Lee JH, Yim HW, Yoon KH, Kang MI, Lee WC, Son HY, Park YM, Kwon HS. Prevalence and characteristics of metabolically obese but normal weight and metabolically healthy but obese in middle-aged Koreans: the Chungju Metabolic Disease Cohort (CMC) Study. Endocrinol Metab. 2011; 26:133–41.

13. Cherqaoui R, Kassim TA, Kwagyan J, Freeman C, Nunlee-Bland G, Ketete M, Xu S, Randall OS. The metabolically healthy but obese phenotype in African Americans. J Clin Hypertens (Greenwich). 2012; 14:92–6.

14. Karelis AD, Brochu M, Rabasa-Lhoret R. Can we identify metabolically healthy but obese individuals (MHO)? Diabetes Metab. 2004; 30:569–72.

15. Lynch LA, O'Connell JM, Kwasnik AK, Cawood TJ, O'Farrelly C, O'Shea DB. Are natural killer cells protecting the metabolically healthy obese patient? Obesity (Silver Spring). 2009; 17:601–5.

16. Aguilar-Salinas CA, García EG, Robles L, Riaño D, Ruiz-Gomez DG, García-Ulloa AC, Melgarejo MA, Zamora M, Guillen-Pineda LE, Mehta R, Canizales-Quinteros S, Tusie Luna MT, Gómez-Pérez FJ. High adiponectin concentrations are associated with the metabolically healthy obese phenotype. J Clin Endocrinol Metab. 2008; 93:4075–9.

17. Velho S, Paccaud F, Waeber G, Vollenweider P, Marques-Vidal P. Metabolically healthy obesity: different prevalences using different criteria. Eur J Clin Nutr. 2010; 64:1043–51.

18. Phillips CM, Dillon C, Harrington JM, McCarthy VJ, Kearney PM, Fitzgerald AP, Perry IJ. Defining metabolically healthy obesity: role of dietary and lifestyle factors. PLoS One. 2013; 8:e76188.

19. Lee K. Metabolically obese but normal weight (MONW) and metabolically healthy but obese (MHO) phenotypes in Koreans: characteristics and health behaviors. Asia Pac J Clin Nutr. 2009; 18:280–4.

20. Yoo HK, Choi EY, Park EW, Cheong YS, Bae RA. Comparison of Metabolic Characteristics of Metabolically Healthy but Obese (MHO) Middle-Aged Men According to Different Criteria. Korean J Fam Med. 2013; 34:19–26.

21. St-Pierree AC, Cantin B, Mauriège P, Bergeron J, Dagenais GR, Després JP, Lamarche B. Insulin resistance syndrome, body mass index and the risk of ischemic heart disease. CMAJ. 2005; 172:1301–5.

22. Arnlöv J, Ingelsson E, Sundström J, Lind L. Impact of body mass index and the metabolic syndrome on the risk of cardiovascular disease and death in middle-aged men. Circulation. 2010; 121:230–6.

23. Kuk JL, Ardern CI. Are metabolically normal but obese individuals at lower risk for all-cause mortality? Diabetes Care. 2009; 32:2297–9.

24. Janssen I, Katzmarzyk PT, Ross R. Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr. 2004; 79:379–84.

25. Marques-Vidal P, Pécoud A, Hayoz D, Paccaud F, Mooser V, Waeber G, Vollenweider P. Prevalence of normal weight obesity in Switzerland: effect of various definitions. Eur J Nutr. 2008; 47:251–7.

26. Karelis AD, Messier V, Brochu M, Rabasa-Lhoret R. Metabolically healthy but obese women: effect of an energy-restricted diet. Diabetologia. 2008; 51:1752–4.