Profile of individuals who are metabolically healthy obese using different definition criteria. A population-based analysis in the Spanish population.

María Teresa Martínez-Larrad,José María Ibarra Rueda,Arturo Corbatón Anchuelo,Náyade Del Prado,Manuel Serrano-Ríos,Rafael Gabriel,Maria Eugenia Saez

doi:10.1371/journal.pone.0106641

Abstract

BackgroundObesity is associated with numerous metabolic complications such as diabetes mellitus type 2, dyslipidemia, hypertension, cardiovascular diseases and several forms of cancer. Our goal was to compare different criteria to define the metabolically healthy obese (MHO) with metabolically unhealthy obese (MUHO) subjects. We applied Wildman (W), Wildman modified (WM) with insulin resistance (IR) with cut-off point ≥3.8 and levels of C- Reactive Protein (CRP) ≥3 mg/l; and Consensus Societies (CS) criteria. In these subjects cardiovascular-risk (CV-risk) was estimated by Framingham score and SCORE for MHO and MUHO.MethodsA cross-sectional study was conducted in Spanish Caucasian adults. A total of 3,844 subjects completed the study, 45% males, aged 35–74 years. Anthropometric/biochemical variables were measured. Obesity was defined as BMI: ≥30 Kg/m2.ResultsThe overall prevalence of obesity in our population was 27.5%, (23.7%/males and 30.2%/females). MHO prevalence according to W, WM, and CS definition criteria were: 9.65%, 16.29%, 39.94% respectively in obese participants. MHO has lower waist circumference (WC) measurements than MUHO. The estimated CV-risks by Framingham and SCORE Project charts were lower in MHO than MUHO subjects. WC showed high specificity and sensitivity in detecting high estimated CV risk by Framingham. However, WHR showed high specificity and sensitivity in detecting CV risk according to SCORE Project. MHO subjects as defined by any of the three criteria had higher adiponectin levels after adjustment by sex, age, WC, HOMA IR and Framingham or SCORE risks. This relationship was not found for CRP circulating levels neither leptin levels.ConclusionsMHO prevalence is highly dependent on the definition criteria used to define those individuals. Results showed that MHO subjects had less WC, and a lower estimated CV-risk than MUHO subjects. Additionally, the high adiponectin circulating levels in MHO may suggest a protective role against developing an unhealthy metabolic state.

Highlights

Obesity is a major public health problem in recent decades, because it is a key risk factor of type 2 diabetes, cardiovascular disease, dyslipidemia, hypertension, certain cancers [1,2]
We found that metabolically unhealthy obese (MUHO) individuals defined by three criteria presented higher CV-risk using either the Framingham or SCORE risk than metabolically healthy obese (MHO) subjects
Conclusions a) Overall, the prevalence of MHO observed in our population is concordant with some of the previous reported data, in literature. b) MHO and MUHO individuals differ only in terms

Summary

Introduction

Obesity is a major public health problem in recent decades, because it is a key risk factor of type 2 diabetes, cardiovascular disease, dyslipidemia, hypertension, certain cancers [1,2]. Associations and clustering of cardiometabolic risk factors, the clinical phenotype derived from metabolic syndrome (MetS) and the inflammatory biomarkers, have been widely recently used in categorizing those subjects as metabolically healthy or unhealthy [7,8]. We applied Wildman (W), Wildman modified (WM) with insulin resistance (IR) with cut-off point $3.8 and levels of C- Reactive Protein (CRP) $3 mg/l; and Consensus Societies (CS) criteria. In these subjects cardiovascular-risk (CV-risk) was estimated by Framingham score and SCORE for MHO and MUHO

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Discussion

Conclusion