Abstract
Background: In 1980, Reuben Andresen observed that in certain individuals, obesity did not increase mortality, introducing an atypical phenotype called "healthy obese". Other studies reported that 10-15 % of lean individuals presented insulin resistance, hyperglycemia and dyslipidemia. The objective of this study was to evaluate biochemical and clinical characteristics of metabolic phenotypes in Maracaibo city. Methods: A descriptive, cross-sectional sub-analysis of The Maracaibo City Metabolic Syndrome Prevalence Study, with a randomized multistage sampling was performed including 1226 non diabetic individuals from both sexes. For phenotype definition, the subjects were first classified according to their BMI into Normal-Weight, Overweight and Obese; then divided in metabolically healthy and unhealthy using a two-step analysis cluster being predictive variables: HOMA2-IR, HOMA2-βcell, triglycerides. To evaluate the relationship with coronary risk, a multiple logistic regression model was performed. Results: In the studied population, 43.9% (n=538) were healthy normal weight, 5.2% (n=64) unhealthy normal weight, 17.4% (n=217) healthy obese and 33.5% (n=411) unhealthy obese subjects. Atypical phenotypes, Metabolically Unhealthy Normal-Weight (MUNW) was more frequent in males (56.3%), whereas Metabolically Unhealthy Obese (MUO) was more frequent in females (51.3%). This phenotypes had a higher coronary event risk, especially for obese individuals (MHO: OR=1.85 CI95%: 1.11-3.09; p=0.02 and MUO: OR=2.09 CI95%: 1.34-3.28; p<0.01). Conclusion: Individuals with atypical metabolic phenotypes are common in Maracaibo city. Related factors may include insulin resistance, basal glucose, and triglycerides levels. Lastly, obese subjects show a higher coronary event risk even those with normal metabolic status.
Highlights
Obesity is considered an entity with major morbi-mortality in the world since the end of the 20th century1
Around 20 years later, Ferranini et al observed that a group of certain obese nondiabetic non-hypertensive subjects presented low insulin resistance (IR) prevalence, suggesting that this subtype must have a different risk of having Type 2 Diabetes Mellitus (T2DM) and cardiovascular disease (CVD) from the IR obese; suggesting a different management for them4
Metabolic phenotypes and sociodemographic characteristics In the evaluation of the epidemiologic behavior of the metabolic phenotypes according to sex, we found that healthy normal-weight (HNW) and Metabolically Unhealthy Obese (MUO) individuals were predominately females (62.5%, n=336; 51.3%, n=211 respectively), while the atypical phenotypes were predominately males (MUNW: 56.3%, n=36; metabolically healthy obese (MHO): 52.6%, n=112. χ2=22.53, p
Summary
Obesity is considered an entity with major morbi-mortality in the world since the end of the 20th century. Multiples studies have shown its role as an independent risk factor for various cardiometabolic disorders such as hypertension (HTN), dyslipidemias, Type 2 Diabetes Mellitus (T2DM) and cardiovascular disease (CVD). Multiples studies have shown its role as an independent risk factor for various cardiometabolic disorders such as hypertension (HTN), dyslipidemias, Type 2 Diabetes Mellitus (T2DM) and cardiovascular disease (CVD)2 For this reason, the actual clinical practice catalogues the typical obese patient as an “unhealthy” patient or a patient with comorbidities. Around 20 years later, Ferranini et al observed that a group of certain obese nondiabetic non-hypertensive subjects presented low insulin resistance (IR) prevalence, suggesting that this subtype must have a different risk of having T2DM and CVD from the IR obese; suggesting a different management for them. In 1980, Reuben Andresen observed that in certain individuals, obesity did not increase mortality, introducing an atypical phenotype called “healthy obese”.
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