The Definition of Metabolically Healthy Obesity

Hae Kyung Yang; Seung-Hwan Lee

doi:10.4093/jkd.2014.15.1.17

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Yang and Lee: The Definition of Metabolically Healthy Obesity

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J Korean Diabetes 2014;15(1):17-20.

Published online: 10 January 2014

DOI: https://doi.org/10.4093/jkd.2014.15.1.17

The Definition of Metabolically Healthy Obesity

Hae Kyung Yang, Seung-Hwan Lee

Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St.Mary's Hospital, The Catholic University of Korea, Seoul, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Body mass index, Diagnosis, Insulin resistance, Obesity

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Table 1.

Various criteria used for defining metabolically healthy obesity (MHO)

	Karelis et al.[14]	Meigs et al.[6]	Meigs et al.[6]	Wildman et al.[3]	Aguilar-Salinas et al.[16]	Lynch et al.[15]	Lee et al.[12]
Study population BMI (kg/m ²) a	Canada, n = 154 (0% M)	US, n = 2,902 (45% M) ≥ 30	US, n = 2,902 (45% M) ≥ 30	US, n = 5,440 (47.9% M) ≥ 30	Mexico, n = 716 (26.4% M) ≥ 30	Ireland, n = 52 (23% M) ≥ 30 K	≥ 25 Korea, n = 8,987 (40.4% M)
Blood pressure (mmHg)	–	SBP ≥ 130 or DBP ≥ 80 or treatment	–	SBP ≥ 130 or DBP ≥ 85 or treatment	SBP ＜ 140 and DBP ＜ 90 and no treatment	SBP ≤ 130 and DBP ≤ 85 and no treatment
Triglycerides (mg/dL)	＜ 150	≥ 150	–	≥ 150	–	–
HDL-cholesterol (mg/dL)	≥ 50 and no treatment	＜ 40 (M) ＜ 50 (F)	–	＜ 40 (M) ＜ 50 (F) or no treatment	≥ 40	–
LDL-cholesterol (mg/dL)	＜ 100 and no treatment	–	–	–	–	–
Total cholesterol (mg/dL)	＜ 200	–	–	–	–	–
TG/HDL ratio	–	–	–	–	–	≤ 1.65 (M) ≤ 1.32 (F) and no treatment
Fasting glucose (mg/dL)	–	≥ 100 or treatment	–	≥ 100 or treatment	＜ 126 and no treatment	≤ 100 and no treatment
HOMA-IR	＜ 1.95	–	＜ 75 ^th percentile	≥ 90 ^th percentile	–	–	＜ 25 ^th percentile
Other	–	Waist ≥ 102 cm (M) ≥ 88 cm (F)	–	CRP ≥ 90 ^th percentile	–	No history of cardiovascular, respiratory or metabolic disease
Criteria for MHO	≥ 4 of the above	＜ 3 of the above	All	＜ 2 of the above	All	All	All

^a Criteria for obesity used in each study. BMI, body mass index; CRP, C-reactive protein; DBP, diastolic blood pressure; HDL, high-density lipoprotein; F, female; HOMA-IR, homeostasis model assessment of insulin resistance; LDL, low-density lipoprotein; M, male; SBP, systolic blood pressure. Adapted from Velho et al. Eur J Clin Nutr 2010;64:1043–51[17].

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