Metabolically healthy obese individuals present similar chronic inflammation level but less insulin-resistance than obese individuals with metabolic syndrome.

Alberto Penas Steinhardt,Claudio Daniel González,Jorge Vilariño,Andrea Elena Iglesias Molli,Gustavo Daniel Frechtel,Gloria Edith Cerrone,Ariel Pablo López

doi:10.1371/journal.pone.0190528

Abstract

The Metabolic Syndrome (MetS) is a cluster of cardiometabolic risk factors, usually accompanied by the presence of insulin resistance (IR) and a systemic subclinical inflammation state. Metabolically healthy obese (MHO) individuals seem to be protected against cardiometabolic complications. The aim of this work was to characterize phenotypically the low-grade inflammation and the IR in MHO individuals in comparison to obese individuals with MetS and control non obese. We studied two different populations: 940 individuals from the general population of Buenos Aires and 518 individuals from the general population of Venado Tuerto; grouped in three groups: metabolically healthy non-obese individuals (MHNO), MHO and obese individuals with MetS (MSO). Inflammation was measured by the levels of hs-CRP (high-sensitivity C reactive protein), and we found that MHO presented an increase in inflammation when compared with MHNO (Buenos Aires: p<0.001; Venado Tuerto: p<0.001), but they did not differ from MSO. To evaluate IR we analyzed the HOMA (Homoeostatic Model Assessment) values, and we found differences between MHO and MSO (Buenos Aires: p<0.001; Venado Tuerto: p<0.001), but not between MHNO and MHO. In conclusion, MHO group would be defined as a subgroup of obese individuals with an intermediate phenotype between MHNO and MSO individuals considering HOMA, hs-CRP and central obesity.

Highlights

Metabolic Syndrome (MetS) is a cluster of interrelated cardiovascular and metabolic risk factors that predispose individuals to the development of aging-related diseases, such as type 2 diabetes mellitus (T2D) and cardiovascular disease (CVD)
The visceral adipose tissue is a dysfunctional tissue constituted by adipocytes and by macrophages producing proinflammatory cytokines that contribute to the state of subclinical inflammation and to the development of insulin resistance (IR), T2D and MetS
Three major issues must be considered: firstly, the initial aim of the recruitment was an epidemiological study of a general population afterward subdivided in the clinical groups, it was not made for Metabolically healthy obese (MHO) study in particular

Summary

Introduction

Metabolic Syndrome (MetS) is a cluster of interrelated cardiovascular and metabolic risk factors that predispose individuals to the development of aging-related diseases, such as type 2 diabetes mellitus (T2D) and cardiovascular disease (CVD). The visceral adipose tissue is a dysfunctional tissue constituted by adipocytes and by macrophages producing proinflammatory cytokines that contribute to the state of subclinical inflammation and to the development of IR, T2D and MetS. The behavior of this adipose tissue at visceral localization is different from that of subcutaneous adipose tissue, which presents a lower infiltration of macrophages and a lower production of proinflammatory cytokines. A higher percentage of lower-body adipose tissue was strongly associated with higher insulin sensitivity, and showed a lower risk of CVD [5] Both circulating monocytes and macrophages deposited in adipose tissue produces proinflammatory cytokines, but are able to produce antiinflammatory molecules according to the metabolic status of the individual. The immune response that produces proinflammatory cytokines (characteristic of dysfunctional adipose tissue) or anti-inflammatory molecules has a dynamic behavior according to the metabolic state [6]

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