Dysmetabolic signals in ¡°metabolically healthy?obesity

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• 作者：Peter Manu^a ; ^b ; ^{pmanu@nshs.edu} ; Constantin Ionescu-Tirgoviste^d ; James Tsang^c ; Barbara A. Napolitano^c ; Martin L. Lesser^c ; Christoph U. Correll^a ; ^b ; ^c
• 关键词：Obesity ; Metabolic Health ; HDL-cholesterol ; Non-HDL-choleserol ; Coronary risk
• 刊名：Obesity Research Clinical Practice
• 出版年：2012
• 出版时间：January-March 2012
• 年：2012
• 卷：6
• 期：1
• 页码：e9-e20
• 全文大小：212 K

文摘

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Summary

Background

Obesity is associated with decreased insulin sensitivity, atherogenic dyslipidemia and hypertension, but clinical studies have also identified a ¡°metabolically healthy?obese phenotype.

Objective

To compare the characteristics of so-called ¡°metabolically healthy?obese (MHO), normal weight subjects (MHNW) and obese with insulin resistance in the United States National Health and Nutrition Examination Survey, 1999-2004 (NHANES).

Design, setting and participants

Insulin resistance was defined by a homeostatic model assessment (HOMA) value in the upper tertile for the entire NHANES cohort. ¡°Metabolic health?was defined as the absence of diabetes, insulin resistance, metabolic syndrome, and lipid-lowering therapy. The study evaluated the 314 MHO, 1173 MHNW and 843 insulin-resistant obese from among the 6485 non-diabetic, non-pregnant adults aged 20-79 years.

Main outcome measures

Demographic, metabolic, nutrition and physical activity features.

Results

MHO and MHNW groups were similar regarding age, and fasting glucose and triglyceride levels. MHO had higher insulin (P < 0.0001), insulin resistance as measured with the homeostatic model (P < 0.0001), non-HDL cholesterol (P = 0.002 in females and P = 0.049 in males) and C-reactive protein levels (P < 0.0001 in females and P = 0.038 in males), and lower high-density lipoprotein cholesterol (HDL) levels (P < 0.002). In addition, MHO females had higher low-density lipoprotein (LDL) cholesterol levels (P = 0.012) and systolic blood pressure (P = 0.02), and lower intake of dietary fiber (P = 0.0009) and levels of physical activity (P = 0.002). Triglycerides levels were normal in the MHO group.

Conclusions

¡°Metabolically healthy?obese people have multiple dysmetabolic changes that may signal increased risk for coronary artery disease.