Journal List > J Korean Diabetes > v.15(1) > 1054917

J Korean Diabetes. 2014 Mar;15(1):12-16. Korean.
Published online March 31, 2014.  https://doi.org/10.4093/jkd.2014.15.1.12
Copyright © 2014 Korean Diabetes Association
Pathogenesis and Clinical Implications of Metabolically Healthy Obesity (MHO) and Metabolically Obese Normal Weight (MONW) Subjects
Hye Jin Yoo
Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.

Corresponding author (Email: deisy21@naver.com )
Abstract

Although obesity is an important risk factor for type 2 diabetes and cardiovascular diseases (CVD), the association of obesity with cardiometabolic disorders and mortality varies widely among obese individuals. Recently, unique subsets of individuals have been getting novel attention; metabolically obese but normal weight (MONW) and metabolically healthy obese (MHO) people. The MONW individuals, despite having a normal body mass index (BMI), display several risky phenotypes including reduced insulin sensitivity, high blood pressure (BP) andatherogenic lipid profiles which contribute to the increased risk of CVD. On the contrary, individuals with the MHO phenotype exhibit normal insulin sensitivity, healthy BP levels, and favorable glycemic and lipid profiles despite having high BMI. Identification of MONW and MHO individuals may facilitate more accurate risk stratification and effective intervention strategies for the prevention of CVD. This manuscript will summarize the pathogenesis and clinical implication of these various body size phenotypes.

Keywords: Obesity; Metabolic syndrome; Diabetes; Cardiovascular disease

References
1. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA 2012;307:491–497.
2. Statistics Korea. The statistics of life table 2011 [Internet]. Daejeon: Statistics Korea; c2013 [cited 2013 Mar 30].
3. Blüher M. The distinction of metabolically 'healthy' from 'unhealthy' obese individuals. Curr Opin Lipidol 2010;21:38–43.
4. Park YW, Zhu S, Palaniappan L, Heshka S, Carnethon MR, Heymsfield SB. The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988-1994. Arch Intern Med 2003;163:427–436.
5. 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;18:280–284.
6. Primeau V, Coderre L, Karelis AD, Brochu M, Lavoie ME, Messier V, Sladek R, Rabasa-Lhoret R. Characterizing the profile of obese patients who are metabolically healthy. Int J Obes (Lond) 2011;35:971–981.
7. 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;89:2569–2575.
8. Yajnik CS, Yudkin JS. The Y-Y paradox. Lancet 2004;363:163.
9. Kershaw EE, Flier JS. Adipose tissue as an endocrine organ. J Clin Endocrinol Metab 2004;89:2548–2556.
10. Albu JB, Kovera AJ, Johnson JA. Fat distribution and health in obesity. Ann N Y Acad Sci 2000;904:491–501.
11. Terry RB, Stefanick ML, Haskell WL, Wood PD. Contributions of regional adipose tissue depots to plasma lipoprotein concentrations in overweight men and women: possible protective effects of thigh fat. Metabolism 1991;40:733–740.
12. Brochu M, Tchernof A, Dionne IJ, Sites CK, Eltabbakh GH, Sims EA, Poehlman ET. What are the physical characteristics associated with a normal metabolic profile despite a high level of obesity in postmenopausal women? J Clin Endocrinol Metab 2001;86:1020–1025.
13. 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;168:1609–1616.
14. Doumatey AP, Bentley AR, Zhou J, Huang H, Adeyemo A, Rotimi CN. Paradoxical Hyperadiponectinemia is Associated With the Metabolically Healthy Obese (MHO) Phenotype in African Americans. J Endocrinol Metab 2012;2:51–65.
15. Kim TN, Park MS, Yang SJ, Yoo HJ, Kang HJ, Song W, Seo JA, Kim SG, Kim NH, Baik SH, Choi DS, Choi KM. Body size phenotypes and low muscle mass: the Korean sarcopenic obesity study (KSOS). J Clin Endocrinol Metab 2013;98:811–817.
16. Esser N, L'homme L, De Roover A, Kohnen L, Scheen AJ, Moutschen M, Piette J, Legrand-Poels S, Paquot N. Obesity phenotype is related to NLRP3 inflammasome activity and immunological profile of visceral adipose tissue. Diabetologia 2013;56:2487–2497.
17. 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–E515.
18. Kim M, Paik JK, Kang R, Kim SY, Lee SH, Lee JH. Increased oxidative stress in normal-weight postmenopausal women with metabolic syndrome compared with metabolically healthy overweight/obese individuals. Metabolism 2013;62:554–560.
19. 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;91:2906–2912.
20. Calori G, Lattuada G, Piemonti L, Garancini MP, Ragogna F, Villa M, Mannino S, Crosignani P, Bosi E, Luzi L, Ruotolo G, Perseghin G. Prevalence, metabolic features, and prognosis of metabolically healthy obese Italian individuals: the Cremona Study. Diabetes Care 2011;34:210–215.
21. Hinnouho GM, Czernichow S, Dugravot A, Batty GD, Kivimaki M, Singh-Manoux A. Metabolically healthy obesity and risk of mortality: does the definition of metabolic health matter? Diabetes Care 2013;36:2294–2300.
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;121:230–236.
23. Roberson LL, Aneni EC, Maziak W, Agatston A, Feldman T, Rouseff M, Tran T, Blaha MJ, Santos RD, Sposito A, Al-Mallah MH, Blankstein R, Budoff MJ, Nasir K. Beyond BMI: The "Metabolically healthy obese" phenotype & its association with clinical/subclinical cardiovascular disease and all-cause mortality - a systematic review. BMC Public Health 2014;14:14.
24. Soriguer F, Gutiérrez-Repiso C, Rubio-Martín E, García-Fuentes E, Almaraz MC, Colomo N, Esteva de Antonio I, de Adana MS, Chaves FJ, Morcillo S, Valdés S, Rojo-Martínez G. Metabolically healthy but obese, a matter of time? Findings from the prospective Pizarra study. J Clin Endocrinol Metab 2013;98:2318–2325.
25. 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.
26. Rhee EJ, Seo MH, Kim JD, Jeon WS, Park SE, Park CY, Oh KW, Park SW, Lee WY. Metabolic health is more closely associated with coronary artery calcification than obesity. PLoS One 2013;8:e74564.
27. Choi KM, Cho HJ, Choi HY, Yang SJ, Yoo HJ, Seo JA, Kim SG, Baik SH, Choi DS, Kim NH. Higher mortality in metabolically obese normal-weight people than in metabolically healthy obese subjects in elderly Koreans. Clin Endocrinol (Oxf) 2013;79:364–370.