Skip to main content
Top
Published in: Obesity Surgery 9/2019

01-09-2019 | Obesity | Review Article

Metabolically Healthy Obesity and Bariatric Surgery

Authors: Adriana Florinela Cătoi, Luca Busetto

Published in: Obesity Surgery | Issue 9/2019

Login to get access

Abstract

A peculiar category of persons with obesity lacking common metabolic disturbances has been depicted and termed as metabolically healthy obesity (MHO). Yet, although MHO patients are free of obesity-associated complications, they might not be entirely precluded from developing cardio-metabolic disorders. Among patients with morbid obesity (MO) who are referred to bariatric surgery, a subset of metabolically healthy MO (MHMO) has been identified and the question arises if these patients would benefit from surgery in terms of mitigating the peril of cardio-metabolic complications. We revisited the pathophysiological mechanisms that define MHO, the currently available data on the cardio-metabolic risk of these patients and finally we reviewed the benefits of bariatric surgery and the urge to better characterize MHMO before submission to surgery.
Literature
1.
go back to reference Gonçalves CG, Glade MJ, Meguid MM. Metabolically healthy obese individuals: key protective factors. Nutrition. 2016;32(1):14–20.PubMedCrossRef Gonçalves CG, Glade MJ, Meguid MM. Metabolically healthy obese individuals: key protective factors. Nutrition. 2016;32(1):14–20.PubMedCrossRef
3.
go back to reference Primeau V, Coderre L, Karelis AD, et al. Characterizing the profile of obese patients who are metabolically healthy. Int J Obes. 2011;35:971–81.CrossRef Primeau V, Coderre L, Karelis AD, et al. Characterizing the profile of obese patients who are metabolically healthy. Int J Obes. 2011;35:971–81.CrossRef
4.
go back to reference Blüher M. Are metabolically healthy obese individuals really healthy? Eur Endocrinol. 2014;171(6):R209–19.CrossRef Blüher M. Are metabolically healthy obese individuals really healthy? Eur Endocrinol. 2014;171(6):R209–19.CrossRef
5.
go back to reference Stefan N, Häring HU, Hu FB, et al. Metabolically healthy obesity: epidemiology, mechanisms, and clinical implications. Lancet Diabetes Endocrinol. 2013;1:152–62.PubMedCrossRef Stefan N, Häring HU, Hu FB, et al. Metabolically healthy obesity: epidemiology, mechanisms, and clinical implications. Lancet Diabetes Endocrinol. 2013;1:152–62.PubMedCrossRef
7.
go back to reference Kramer CK, Zinma B, Retnakaran R. Are metabolically healthy overweight and obesity benign conditions? Ann Intern Med. 2013;159:758–69.PubMedCrossRef Kramer CK, Zinma B, Retnakaran R. Are metabolically healthy overweight and obesity benign conditions? Ann Intern Med. 2013;159:758–69.PubMedCrossRef
8.
go back to reference Stefan N, Häring HU, Schulze MB. Metabolically healthy obesity: the low-hanging fruit in obesity treatment? Lancet Diabetes Endocrinol. 2018;6(3):249–58.PubMedCrossRef Stefan N, Häring HU, Schulze MB. Metabolically healthy obesity: the low-hanging fruit in obesity treatment? Lancet Diabetes Endocrinol. 2018;6(3):249–58.PubMedCrossRef
9.
go back to reference Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRef Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRef
10.
go back to reference Heneghan HM, Nissen S, Schauer PR. Gastrointestinal surgery for obesity and diabetes: weight loss and control of hyperglycemia. Curr Atheroscler Rep. 2012;14(6):579–87.PubMedCrossRef Heneghan HM, Nissen S, Schauer PR. Gastrointestinal surgery for obesity and diabetes: weight loss and control of hyperglycemia. Curr Atheroscler Rep. 2012;14(6):579–87.PubMedCrossRef
11.
go back to reference Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications, part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15:539–53.PubMedCrossRef Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications, part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15:539–53.PubMedCrossRef
12.
go back to reference National Cholesterol Education Program (NCEP) Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report. Circulation 2002;106:3143–3421. National Cholesterol Education Program (NCEP) Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report. Circulation 2002;106:3143–3421.
13.
go back to reference Grundy SM, Brewer Jr HB, Cleeman JI, et al. Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Arterioscler Thromb Vasc Biol. 2004;24(2):e13–8.PubMed Grundy SM, Brewer Jr HB, Cleeman JI, et al. Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Arterioscler Thromb Vasc Biol. 2004;24(2):e13–8.PubMed
14.
go back to reference Alberti KG, Zimmet P, Shaw J, et al. The metabolic syndrome: a new worldwide definition. Lancet. 2005;366:1059–62.CrossRefPubMed Alberti KG, Zimmet P, Shaw J, et al. The metabolic syndrome: a new worldwide definition. Lancet. 2005;366:1059–62.CrossRefPubMed
15.
go back to reference Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome :a joint interim statement of the International Diabetes Federation Task Force on epidemiology and prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640–5.PubMedCrossRef Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome :a joint interim statement of the International Diabetes Federation Task Force on epidemiology and prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640–5.PubMedCrossRef
16.
go back to reference Maury E, Brichard SM. Adipokine dysregulation, adipose tissue inflammation and metabolic syndrome. Mol Cell Endocrinol. 2010;314:1–16.PubMedCrossRef Maury E, Brichard SM. Adipokine dysregulation, adipose tissue inflammation and metabolic syndrome. Mol Cell Endocrinol. 2010;314:1–16.PubMedCrossRef
17.
go back to reference Soares MJ, Pannu PK, Calton EK, et al. Vitamin D status and calcium intake in systemic inflammation, insulin resistance and the metabolic syndrome: an update on current evidence. Trends Food Sci Technol. 2017;62:79–90.CrossRef Soares MJ, Pannu PK, Calton EK, et al. Vitamin D status and calcium intake in systemic inflammation, insulin resistance and the metabolic syndrome: an update on current evidence. Trends Food Sci Technol. 2017;62:79–90.CrossRef
18.
go back to reference Brochu M, Tchernof A, Dionne IJ, et al. 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(3):1020–5.PubMed Brochu M, Tchernof A, Dionne IJ, et al. 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(3):1020–5.PubMed
19.
go back to reference Sims EA. Are there persons who are obese, but metabolically healthy? Metabolism. 2001;50(12):1499–504.PubMedCrossRef Sims EA. Are there persons who are obese, but metabolically healthy? Metabolism. 2001;50(12):1499–504.PubMedCrossRef
20.
go back to reference Karelis A, Brochu M, Rabasa-Lhoret R. Can we identify metabolically healthy but obese individuals (MHO)? Diabetes Metab. 2004;30:569–72.PubMedCrossRef Karelis A, Brochu M, Rabasa-Lhoret R. Can we identify metabolically healthy but obese individuals (MHO)? Diabetes Metab. 2004;30:569–72.PubMedCrossRef
21.
go back to reference Wildman RP, Muntner P, Reynolds K, et al. The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering: prevalence and correlates of 2 phenotypes among the US population (NHANES 1999–2004). Arch Intern Med. 2008;168:1617–24.PubMedCrossRef Wildman RP, Muntner P, Reynolds K, et al. The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering: prevalence and correlates of 2 phenotypes among the US population (NHANES 1999–2004). Arch Intern Med. 2008;168:1617–24.PubMedCrossRef
22.
go back to reference Aguilar-Salinas CA, Garcia EG, Robles L, et al. High adiponectin concentrations are associated with the metabolically healthy obese phenotype. J Clin Endocrinol Metab. 2008;93:4075–9.PubMedCrossRef Aguilar-Salinas CA, Garcia EG, Robles L, et al. High adiponectin concentrations are associated with the metabolically healthy obese phenotype. J Clin Endocrinol Metab. 2008;93:4075–9.PubMedCrossRef
23.
go back to reference Meigs JB, Wilson PWF, Fox CS, et al. Body mass index, metabolic syndrome, and risk of type 2 diabetes or cardiovascular disease. J Clin Endocrinol Metab. 2006;91:2906–12.PubMedCrossRef Meigs JB, Wilson PWF, Fox CS, et al. Body mass index, metabolic syndrome, and risk of type 2 diabetes or cardiovascular disease. J Clin Endocrinol Metab. 2006;91:2906–12.PubMedCrossRef
24.
go back to reference Plourde G, Karelis AD. Current issues in the identification and treatment of metabolically healthy but obese individuals. Nutr Metab Cardiovasc Dis. 2014;24(5):455–9.PubMedCrossRef Plourde G, Karelis AD. Current issues in the identification and treatment of metabolically healthy but obese individuals. Nutr Metab Cardiovasc Dis. 2014;24(5):455–9.PubMedCrossRef
25.
go back to reference Ortega FB, Lavie CJ, Blair SN. Obesity and cardiovascular disease. Circ Res. 2016;118(11):1752–70.PubMedCrossRef Ortega FB, Lavie CJ, Blair SN. Obesity and cardiovascular disease. Circ Res. 2016;118(11):1752–70.PubMedCrossRef
26.
go back to reference Velho S, Paccaud F, Waeber G, et al. Metabolically healthy obesity: different prevalences using different criteria. Eur J Clin Nutr. 2010;64:1043e51.CrossRef Velho S, Paccaud F, Waeber G, et al. Metabolically healthy obesity: different prevalences using different criteria. Eur J Clin Nutr. 2010;64:1043e51.CrossRef
27.
go back to reference van Vliet Ostaptchouk JV, Nuotio ML, Slagter SN, et al. The prevalence of metabolic syndrome and metabolically healthy obesity in Europe: a collaborative analysis of ten large cohort studies. BMC Endocr Disord. 2014;14:9.PubMedPubMedCentralCrossRef van Vliet Ostaptchouk JV, Nuotio ML, Slagter SN, et al. The prevalence of metabolic syndrome and metabolically healthy obesity in Europe: a collaborative analysis of ten large cohort studies. BMC Endocr Disord. 2014;14:9.PubMedPubMedCentralCrossRef
28.
go back to reference Goday A, Benaiges D, Parri A, et al. Can bariatric surgery improve cardiovascular risk factors in the metabolically healthy but morbidly obese patient? Surg Obes Relat Dis. 2014;10:871–6.PubMedCrossRef Goday A, Benaiges D, Parri A, et al. Can bariatric surgery improve cardiovascular risk factors in the metabolically healthy but morbidly obese patient? Surg Obes Relat Dis. 2014;10:871–6.PubMedCrossRef
29.
go back to reference Pelascini E, Disse E, Pasquer A, et al. Should we wait for metabolic complications before operating on obese patients? Gastric bypass outcomes in metabolically healthy obese individuals. Surg Obes Relat Dis. 2016;12:49–56.PubMedCrossRef Pelascini E, Disse E, Pasquer A, et al. Should we wait for metabolic complications before operating on obese patients? Gastric bypass outcomes in metabolically healthy obese individuals. Surg Obes Relat Dis. 2016;12:49–56.PubMedCrossRef
30.
go back to reference Lee CJ, Clark JM, Asamoah V, et al. Prevalence and characteristics of individuals without diabetes and hypertension who underwent bariatric surgery: lessons learned about metabolically healthy obese. Surg Obes Relat Dis. 2015;11(1):142–6.PubMedCrossRef Lee CJ, Clark JM, Asamoah V, et al. Prevalence and characteristics of individuals without diabetes and hypertension who underwent bariatric surgery: lessons learned about metabolically healthy obese. Surg Obes Relat Dis. 2015;11(1):142–6.PubMedCrossRef
31.
go back to reference Haskins IN, Chang J, Nor Hanipah Z, et al. Patients with clinically metabolically healthy obesity are not necessarily healthy subclinically: further support for bariatric surgery in patients without metabolic disease? Surg Obes Relat Dis. 2018;14:342–6.PubMedCrossRef Haskins IN, Chang J, Nor Hanipah Z, et al. Patients with clinically metabolically healthy obesity are not necessarily healthy subclinically: further support for bariatric surgery in patients without metabolic disease? Surg Obes Relat Dis. 2018;14:342–6.PubMedCrossRef
32.
go back to reference Grundy SM. Over nutrition, ectopic lipid and the metabolic syndrome. Investig Med. 2016;64:1082–6.CrossRef Grundy SM. Over nutrition, ectopic lipid and the metabolic syndrome. Investig Med. 2016;64:1082–6.CrossRef
33.
go back to reference Grundy SM. Adipose tissue and metabolic syndrome: too much, too little or neither. Eur J Clin Investig. 2015;45(11):1209–17.CrossRef Grundy SM. Adipose tissue and metabolic syndrome: too much, too little or neither. Eur J Clin Investig. 2015;45(11):1209–17.CrossRef
34.
go back to reference Blüher S, Schwarz P. Metabolically healthy obesity from childhood to adulthood—does weight status alone matter? Metabolism. 2014;63:1084–92.PubMedCrossRef Blüher S, Schwarz P. Metabolically healthy obesity from childhood to adulthood—does weight status alone matter? Metabolism. 2014;63:1084–92.PubMedCrossRef
35.
go back to reference Antonopoulos AS, Tousoulis D. The molecular mechanisms of obesity paradox. Cardiovasc Res. 2017;113:1074–86.PubMedCrossRef Antonopoulos AS, Tousoulis D. The molecular mechanisms of obesity paradox. Cardiovasc Res. 2017;113:1074–86.PubMedCrossRef
36.
go back to reference Baglioni S, Cantini G, Poli G, et al. Functional differences in visceral and subcutaneous fat pads originate from differences in the adipose stem cell. PLoS One. 2012;7:e36569.PubMedPubMedCentralCrossRef Baglioni S, Cantini G, Poli G, et al. Functional differences in visceral and subcutaneous fat pads originate from differences in the adipose stem cell. PLoS One. 2012;7:e36569.PubMedPubMedCentralCrossRef
38.
go back to reference Blüher M. Adipose tissue dysfunction contributes to obesity related metabolic diseases. Best Pract Res Clin Endocrinol Metab. 2013;27(2):163–77.PubMedCrossRef Blüher M. Adipose tissue dysfunction contributes to obesity related metabolic diseases. Best Pract Res Clin Endocrinol Metab. 2013;27(2):163–77.PubMedCrossRef
39.
go back to reference Tan CY, Vidal-Puig A. Adipose tissue expandability: the metabolic problems of obesity may arise from the inability to become more obese. Biochem Soc Trans. 2008;36:935–40.PubMedCrossRef Tan CY, Vidal-Puig A. Adipose tissue expandability: the metabolic problems of obesity may arise from the inability to become more obese. Biochem Soc Trans. 2008;36:935–40.PubMedCrossRef
40.
go back to reference Smith U, Kahn BB. Adipose tissue regulates insulin sensitivity: role of adipogenesis, de novo lipogenesis and novel lipids. J Intern Med. 2016;280(5):465–75.PubMedPubMedCentralCrossRef Smith U, Kahn BB. Adipose tissue regulates insulin sensitivity: role of adipogenesis, de novo lipogenesis and novel lipids. J Intern Med. 2016;280(5):465–75.PubMedPubMedCentralCrossRef
41.
go back to reference Blüher M. The distinction of metabolically ‘healthy’ from ‘unhealthy’ obese individuals. Curr Opin Lipidol. 2010;21(1):38–43.PubMedCrossRef Blüher M. The distinction of metabolically ‘healthy’ from ‘unhealthy’ obese individuals. Curr Opin Lipidol. 2010;21(1):38–43.PubMedCrossRef
42.
go back to reference Klöting N, Fasshauer M, Dietrich A, et al. Insulin-sensitive obesity. Am J Physiol Endocrinol Metab. 2010;299:E506–15.PubMedCrossRef Klöting N, Fasshauer M, Dietrich A, et al. Insulin-sensitive obesity. Am J Physiol Endocrinol Metab. 2010;299:E506–15.PubMedCrossRef
43.
go back to reference O’Connell J, Lynch L, Cawood TJ, et al. The relationship of omental and subcutaneous adipocyte size to metabolic disease in severe obesity. PLoS One. 2010;5:e9997.PubMedPubMedCentralCrossRef O’Connell J, Lynch L, Cawood TJ, et al. The relationship of omental and subcutaneous adipocyte size to metabolic disease in severe obesity. PLoS One. 2010;5:e9997.PubMedPubMedCentralCrossRef
44.
go back to reference McLaughlin T, Sherman A, Tsao P, et al. Enhanced proportion of small adipose cells in insulin-resistant vs insulin-sensitive obese individuals implicates impaired adipogenesis. Diabetologia. 2007;50:1707–15.PubMedCrossRef McLaughlin T, Sherman A, Tsao P, et al. Enhanced proportion of small adipose cells in insulin-resistant vs insulin-sensitive obese individuals implicates impaired adipogenesis. Diabetologia. 2007;50:1707–15.PubMedCrossRef
45.
go back to reference Alligier M, Gabert L, Meugnier E, et al. Visceral fat accumulation during lipid overfeeding is related to subcutaneous adipose tissue characteristics in healthy men. J Clin Endocrinol Metab. 2013;98:802–10.PubMedCrossRef Alligier M, Gabert L, Meugnier E, et al. Visceral fat accumulation during lipid overfeeding is related to subcutaneous adipose tissue characteristics in healthy men. J Clin Endocrinol Metab. 2013;98:802–10.PubMedCrossRef
46.
go back to reference Isakson P, Hammarstedt A, Gustafson B, et al. Impaired preadipocyte differentiation in human abdominal obesity: role of Wnt, tumor necrosis factor-alpha, and inflammation. Diabetes. 2009;58:1550–7.PubMedPubMedCentralCrossRef Isakson P, Hammarstedt A, Gustafson B, et al. Impaired preadipocyte differentiation in human abdominal obesity: role of Wnt, tumor necrosis factor-alpha, and inflammation. Diabetes. 2009;58:1550–7.PubMedPubMedCentralCrossRef
47.
go back to reference Crewe C, An YA, Scherer PE. The ominous triad of adipose tissue dysfunction: inflammation, fibrosis, and impaired angiogenesis. J Clin Invest. 2017;127:74–82.PubMedPubMedCentralCrossRef Crewe C, An YA, Scherer PE. The ominous triad of adipose tissue dysfunction: inflammation, fibrosis, and impaired angiogenesis. J Clin Invest. 2017;127:74–82.PubMedPubMedCentralCrossRef
48.
go back to reference O’Rourke RW. Molecular mechanisms of obesity and diabetes: at the intersection of weight regulation, inflammation, and glucose homeostasis. World J Surg. 2009;33:2007–13.PubMedCrossRef O’Rourke RW. Molecular mechanisms of obesity and diabetes: at the intersection of weight regulation, inflammation, and glucose homeostasis. World J Surg. 2009;33:2007–13.PubMedCrossRef
49.
go back to reference Badoud F, Perreault M, Zulyniak MA, et al. Molecular insights into the role of white adipose tissue in metabolically unhealthy normal weight and metabolically healthy obese individuals. FASEB J. 2015;29:748–58.PubMedCrossRef Badoud F, Perreault M, Zulyniak MA, et al. Molecular insights into the role of white adipose tissue in metabolically unhealthy normal weight and metabolically healthy obese individuals. FASEB J. 2015;29:748–58.PubMedCrossRef
50.
go back to reference Hoffstedt J, Arner E, Wahrenberg H, et al. Regional impact of adipose tissue morphology on the metabolic profile in morbid obesity. Diabetologia. 2010;53(12):2496–503.PubMedCrossRef Hoffstedt J, Arner E, Wahrenberg H, et al. Regional impact of adipose tissue morphology on the metabolic profile in morbid obesity. Diabetologia. 2010;53(12):2496–503.PubMedCrossRef
51.
go back to reference McLaughlin T, Lamendola C, Coghlan N, et al. Subcutaneous adipose cell size and distribution: relationship to insulin resistance and body fat. Obesity (Silver Spring). 2014;22:673–80.CrossRef McLaughlin T, Lamendola C, Coghlan N, et al. Subcutaneous adipose cell size and distribution: relationship to insulin resistance and body fat. Obesity (Silver Spring). 2014;22:673–80.CrossRef
52.
go back to reference Stefan N, Kantartzis K, Machann J, et al. Identification and characterization of metabolically benign obesity in humans. Arch Intern Med. 2008;168(15):1609–16.PubMedCrossRef Stefan N, Kantartzis K, Machann J, et al. Identification and characterization of metabolically benign obesity in humans. Arch Intern Med. 2008;168(15):1609–16.PubMedCrossRef
53.
go back to reference Macotela Y, Emanuelli B, Mori MA, et al. Intrinsic differences in adipocyte precursor cells from different white fat depots. Diabetes. 2012;61:1691–9.PubMedPubMedCentralCrossRef Macotela Y, Emanuelli B, Mori MA, et al. Intrinsic differences in adipocyte precursor cells from different white fat depots. Diabetes. 2012;61:1691–9.PubMedPubMedCentralCrossRef
54.
go back to reference Danforth Jr E. Failure of adipocyte differentiation causes type II diabetes mellitus? Nat Genet. 2000;26(1):13.PubMedCrossRef Danforth Jr E. Failure of adipocyte differentiation causes type II diabetes mellitus? Nat Genet. 2000;26(1):13.PubMedCrossRef
55.
go back to reference Lee MJ, Wu Y, Fried SK. Adipose tissue heterogeneity: implication of depot differences in adipose tissue for obesity. Compl Mol Asp Med. 2013;34(1):1–11.CrossRef Lee MJ, Wu Y, Fried SK. Adipose tissue heterogeneity: implication of depot differences in adipose tissue for obesity. Compl Mol Asp Med. 2013;34(1):1–11.CrossRef
56.
go back to reference Mathew H, Farr OM, Mantzoros CS. Metabolic health and weight: understanding metabolically unhealthy normal weight or metabolically healthy obese patients. Metabolism. 2016;65(1):73–80.PubMedCrossRef Mathew H, Farr OM, Mantzoros CS. Metabolic health and weight: understanding metabolically unhealthy normal weight or metabolically healthy obese patients. Metabolism. 2016;65(1):73–80.PubMedCrossRef
57.
go back to reference Fox CS, Massaro JM, Hoffmann U, et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation. 2007;116:39–48.PubMedCrossRef Fox CS, Massaro JM, Hoffmann U, et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation. 2007;116:39–48.PubMedCrossRef
58.
go back to reference Abraham TM, Pedley A, Massaro JM, et al. Association between visceral and subcutaneous adipose depots and incident cardiovascular disease risk factors. Circulation. 2015;132(17):1639–47.PubMedPubMedCentralCrossRef Abraham TM, Pedley A, Massaro JM, et al. Association between visceral and subcutaneous adipose depots and incident cardiovascular disease risk factors. Circulation. 2015;132(17):1639–47.PubMedPubMedCentralCrossRef
60.
go back to reference Pardina E, Ferrer R, Rossell J, et al. Diabetic and dyslipidaemic morbidly obese exhibit more liver alterations compared with healthy morbidly obese. BBA Clin. 2016;5:54–65.PubMedPubMedCentralCrossRef Pardina E, Ferrer R, Rossell J, et al. Diabetic and dyslipidaemic morbidly obese exhibit more liver alterations compared with healthy morbidly obese. BBA Clin. 2016;5:54–65.PubMedPubMedCentralCrossRef
61.
go back to reference Karelis AD, Faraj M, Bastard JP, et al. The metabolically healthy but obese individual presents a favorable inflammation profile. J Clin Endocrinol Metab. 2005;90(7):4145–50.PubMedCrossRef Karelis AD, Faraj M, Bastard JP, et al. The metabolically healthy but obese individual presents a favorable inflammation profile. J Clin Endocrinol Metab. 2005;90(7):4145–50.PubMedCrossRef
62.
go back to reference Matsuzawa Y, Funahashi T, Nakamura T. The concept of metabolic syndrome: contribution of visceral fat accumulation and its molecular mechanism. J Atheroscler Thromb. 2011;18:629–39.PubMedCrossRef Matsuzawa Y, Funahashi T, Nakamura T. The concept of metabolic syndrome: contribution of visceral fat accumulation and its molecular mechanism. J Atheroscler Thromb. 2011;18:629–39.PubMedCrossRef
63.
go back to reference Tchernof A, Despres JP. Pathophysiology of human visceral obesity: an update. Physiol Rev. 2013;93:359–404.PubMedCrossRef Tchernof A, Despres JP. Pathophysiology of human visceral obesity: an update. Physiol Rev. 2013;93:359–404.PubMedCrossRef
64.
go back to reference Messier V, Karelis AD, Prud’homme D, et al. Identifying metabolically healthy but obese individuals in sedentary postmenopausal women. Obesity. 2010;18:911–7.PubMedCrossRef Messier V, Karelis AD, Prud’homme D, et al. Identifying metabolically healthy but obese individuals in sedentary postmenopausal women. Obesity. 2010;18:911–7.PubMedCrossRef
65.
go back to reference Martínez-Larrad MT, Corbatón Anchuelo A, Del Prado N, et al. Profile of individuals who are metabolically healthy obese using different definition criteria. A population-based analysis in the Spanish population. PLoS One. 2014;9(9):e106641.PubMedPubMedCentralCrossRef Martínez-Larrad MT, Corbatón Anchuelo A, Del Prado N, et al. Profile of individuals who are metabolically healthy obese using different definition criteria. A population-based analysis in the Spanish population. PLoS One. 2014;9(9):e106641.PubMedPubMedCentralCrossRef
66.
go back to reference Alfadda AA, Masood A, Al-Naami MY, et al. A proteomics based approach reveals differential regulation of visceral adipose tissue proteins between metabolically healthy and unhealthy obese patients. Mol Cells. 2017;40(9):685–95.PubMedPubMedCentral Alfadda AA, Masood A, Al-Naami MY, et al. A proteomics based approach reveals differential regulation of visceral adipose tissue proteins between metabolically healthy and unhealthy obese patients. Mol Cells. 2017;40(9):685–95.PubMedPubMedCentral
67.
go back to reference Nazare JA, Smith JD, Borel AL, et al. Ethnic influences on the relations between abdominal subcutaneous and visceral adiposity, liver fat, and cardiometabolic risk profile: the international study of prediction of intra-abdominal adiposity and its relationship with cardiometabolic risk/intra-abdominal adiposity. Am J Clin Nutr. 2012;96:714–26.PubMedCrossRef Nazare JA, Smith JD, Borel AL, et al. Ethnic influences on the relations between abdominal subcutaneous and visceral adiposity, liver fat, and cardiometabolic risk profile: the international study of prediction of intra-abdominal adiposity and its relationship with cardiometabolic risk/intra-abdominal adiposity. Am J Clin Nutr. 2012;96:714–26.PubMedCrossRef
68.
go back to reference Kabir M, Catalano KJ, Ananthnarayan S, et al. Molecular evidence supporting the portal theory: a causative link between visceral adiposity and hepatic insulin resistance. Am J Physiol Endocrinol Metab. 2005;288(2):E454–61.PubMedCrossRef Kabir M, Catalano KJ, Ananthnarayan S, et al. Molecular evidence supporting the portal theory: a causative link between visceral adiposity and hepatic insulin resistance. Am J Physiol Endocrinol Metab. 2005;288(2):E454–61.PubMedCrossRef
69.
go back to reference Mathieu P, Boulanger MC, Després JP. Ectopic visceral fat: a clinical and molecular perspective on the cardiometabolic risk. Rev Endocr Metab Disord. 2014;15:289–98.PubMedCrossRef Mathieu P, Boulanger MC, Després JP. Ectopic visceral fat: a clinical and molecular perspective on the cardiometabolic risk. Rev Endocr Metab Disord. 2014;15:289–98.PubMedCrossRef
70.
go back to reference Tinahones FJ, Garrido-Sanchez L, Miranda M, et al. Obesity and insulin resistance-related changes in the expression of lipogenic and lipolytic genes in morbidly obese subjects. Obes Surg. 2010;20:1559–67.PubMedCrossRef Tinahones FJ, Garrido-Sanchez L, Miranda M, et al. Obesity and insulin resistance-related changes in the expression of lipogenic and lipolytic genes in morbidly obese subjects. Obes Surg. 2010;20:1559–67.PubMedCrossRef
71.
go back to reference Messier V, Karelis AD, Robillard ME, et al. Metabolically healthy but obese individuals: relationship with hepatic enzymes. Metabolism. 2010;59:20–4.PubMedCrossRef Messier V, Karelis AD, Robillard ME, et al. Metabolically healthy but obese individuals: relationship with hepatic enzymes. Metabolism. 2010;59:20–4.PubMedCrossRef
72.
go back to reference Ogorodnikova AD, Khan UI, McGinn AP, et al. Ectopic fat and adipokines in metabolically benign overweight/ obese women: the Kronos Early Estrogen Prevention Study. Obesity (Silver Spring). 2013;21:1726–33.CrossRef Ogorodnikova AD, Khan UI, McGinn AP, et al. Ectopic fat and adipokines in metabolically benign overweight/ obese women: the Kronos Early Estrogen Prevention Study. Obesity (Silver Spring). 2013;21:1726–33.CrossRef
73.
go back to reference Faria G, Gonçalves A, Cunha R, et al. Beyond central adiposity: liver fat and visceral fat area are associated with metabolic syndrome in morbidly obese patients. Int J Surg. 2015 Feb;14:75–9.PubMedCrossRef Faria G, Gonçalves A, Cunha R, et al. Beyond central adiposity: liver fat and visceral fat area are associated with metabolic syndrome in morbidly obese patients. Int J Surg. 2015 Feb;14:75–9.PubMedCrossRef
74.
go back to reference Wajchenberg BL. Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev. 2000;21:697–738.CrossRefPubMed Wajchenberg BL. Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev. 2000;21:697–738.CrossRefPubMed
75.
go back to reference Gesta S, Blüher M, Yamamoto Y, et al. Evidence for a role of developmental genes in the origin of obesity and body fat distribution. Proc Natl Acad Sci U S A. 2006;103:6676–81.PubMedPubMedCentralCrossRef Gesta S, Blüher M, Yamamoto Y, et al. Evidence for a role of developmental genes in the origin of obesity and body fat distribution. Proc Natl Acad Sci U S A. 2006;103:6676–81.PubMedPubMedCentralCrossRef
76.
go back to reference Yaghootkar H, Scott RA, White CC, et al. Genetic evidence for a normal-weight “metabolically obese” phenotype linking insulin resistance, hypertension, coronary artery disease, and type 2 diabetes. Diabetes. 2014;63(12):4369–77.PubMedPubMedCentralCrossRef Yaghootkar H, Scott RA, White CC, et al. Genetic evidence for a normal-weight “metabolically obese” phenotype linking insulin resistance, hypertension, coronary artery disease, and type 2 diabetes. Diabetes. 2014;63(12):4369–77.PubMedPubMedCentralCrossRef
77.
go back to reference Scott RA, Lagou V, Welch RP, et al. Large-scale association analyses identify new loci influencing glycemic traits and provide insight into the underlying biological pathways. Nat Genet. 2012;44:991–1005.PubMedPubMedCentralCrossRef Scott RA, Lagou V, Welch RP, et al. Large-scale association analyses identify new loci influencing glycemic traits and provide insight into the underlying biological pathways. Nat Genet. 2012;44:991–1005.PubMedPubMedCentralCrossRef
78.
go back to reference Manning AK, Hivert MF, Scott RA, et al. A genome-wide approach accounting for body mass index identifies genetic variants influencing fasting glycemic traits and insulin resistance. Nat Genet. 2012;44:659–69.PubMedPubMedCentralCrossRef Manning AK, Hivert MF, Scott RA, et al. A genome-wide approach accounting for body mass index identifies genetic variants influencing fasting glycemic traits and insulin resistance. Nat Genet. 2012;44:659–69.PubMedPubMedCentralCrossRef
79.
go back to reference Lotta LA, Gulati P, Day FR, et al. Integrative genomic analysis implicates limited peripheral adipose storage capacity in the pathogenesis of human insulin resistance. Nat Genet. 2017;49:17–26.PubMedCrossRef Lotta LA, Gulati P, Day FR, et al. Integrative genomic analysis implicates limited peripheral adipose storage capacity in the pathogenesis of human insulin resistance. Nat Genet. 2017;49:17–26.PubMedCrossRef
80.
go back to reference Trayhurn P, Wang B, Wood IS. Hypoxia and the endocrine and signalling role of white adipose tissue. Arch Physiol Biochem. 2008;114(4):267–76.PubMedCrossRef Trayhurn P, Wang B, Wood IS. Hypoxia and the endocrine and signalling role of white adipose tissue. Arch Physiol Biochem. 2008;114(4):267–76.PubMedCrossRef
81.
go back to reference Bondia-Pons I, Ryan L, Martinez JA. Oxidative stress and inflammation interactions in human obesity. J Physiol Biochem. 2012;68(4):701–11.PubMedCrossRef Bondia-Pons I, Ryan L, Martinez JA. Oxidative stress and inflammation interactions in human obesity. J Physiol Biochem. 2012;68(4):701–11.PubMedCrossRef
82.
go back to reference Weisberg SP, McCann D, Desai M, et al. Obesity is associated with macrophage accumulation in adipose tissue. JClin Invest. 2003;112:1796–808.CrossRef Weisberg SP, McCann D, Desai M, et al. Obesity is associated with macrophage accumulation in adipose tissue. JClin Invest. 2003;112:1796–808.CrossRef
83.
go back to reference Cancello R, Tordjman J, Poitou C, et al. Increased infiltration of macrophages in omental adipose tissue is associated with marked hepatic lesions in morbid human obesity. Diabetes. 2006;55:1554–61.PubMedCrossRef Cancello R, Tordjman J, Poitou C, et al. Increased infiltration of macrophages in omental adipose tissue is associated with marked hepatic lesions in morbid human obesity. Diabetes. 2006;55:1554–61.PubMedCrossRef
84.
go back to reference Harman-Boehm I, Bluher M, Redel H, et al. Macrophage infiltration into omental versus subcutaneous fat across different populations: effect of regional adiposity and the comorbidities of obesity. J Clin Endocrinol Metab. 2007;92:2240–7.PubMedCrossRef Harman-Boehm I, Bluher M, Redel H, et al. Macrophage infiltration into omental versus subcutaneous fat across different populations: effect of regional adiposity and the comorbidities of obesity. J Clin Endocrinol Metab. 2007;92:2240–7.PubMedCrossRef
85.
go back to reference Vohl MC, Sladek R, Robitaille J, et al. A survey of genes differentially expressed in subcutaneous and visceral adipose tissue in men. Obes Res. 2004;12(8):1217–22.PubMedCrossRef Vohl MC, Sladek R, Robitaille J, et al. A survey of genes differentially expressed in subcutaneous and visceral adipose tissue in men. Obes Res. 2004;12(8):1217–22.PubMedCrossRef
86.
go back to reference Cinti S, Mitchell G, Barbatelli G, et al. Adipocyte death defines macrophage localization and function in adipose tissue of obese mice and humans. J Lipid Res. 2005;46(11):2347–55.PubMedCrossRef Cinti S, Mitchell G, Barbatelli G, et al. Adipocyte death defines macrophage localization and function in adipose tissue of obese mice and humans. J Lipid Res. 2005;46(11):2347–55.PubMedCrossRef
87.
go back to reference Phillips CM, Perry IJ. Does inflammation determine metabolic health status in obese and nonobese adults? J Clin Endocrinol Metab. 2013;98:E1610–9.PubMedCrossRef Phillips CM, Perry IJ. Does inflammation determine metabolic health status in obese and nonobese adults? J Clin Endocrinol Metab. 2013;98:E1610–9.PubMedCrossRef
88.
go back to reference Koster A, Stenholm S, Alley DE, et al. Body fat distribution and inflammation among obese older adults with and without metabolic syndrome. Obesity (Silver Spring). 2010;18:2354–61.CrossRef Koster A, Stenholm S, Alley DE, et al. Body fat distribution and inflammation among obese older adults with and without metabolic syndrome. Obesity (Silver Spring). 2010;18:2354–61.CrossRef
89.
go back to reference Shin MJ, Hyun YJ, Kim OY, et al. Weight loss effect on inflammation and LDL oxidation in metabolically healthy but obese (MHO) individuals: low inflammation and LDL oxidation in MHO women. Int J Obes. 2006;30:1529–34.CrossRef Shin MJ, Hyun YJ, Kim OY, et al. Weight loss effect on inflammation and LDL oxidation in metabolically healthy but obese (MHO) individuals: low inflammation and LDL oxidation in MHO women. Int J Obes. 2006;30:1529–34.CrossRef
90.
go back to reference Wildman RP, Kaplan R, Manson JE, et al. Body size phenotypes and inflammation in the Women’s Health Initiative Observational Study. Obesity (Silver Spring). 2011;19:1482–149.CrossRef Wildman RP, Kaplan R, Manson JE, et al. Body size phenotypes and inflammation in the Women’s Health Initiative Observational Study. Obesity (Silver Spring). 2011;19:1482–149.CrossRef
91.
go back to reference Gómez-Ambrosi J, Catalán V, Rodríguez A, et al. Increased cardiometabolic risk factors and inflammation in adipose tissue in obese subjects classified as metabolically healthy. Diabetes Care. 2014;37(10):2813–21.PubMedCrossRef Gómez-Ambrosi J, Catalán V, Rodríguez A, et al. Increased cardiometabolic risk factors and inflammation in adipose tissue in obese subjects classified as metabolically healthy. Diabetes Care. 2014;37(10):2813–21.PubMedCrossRef
92.
go back to reference Iglesias Molli AE, Penas Steinhardt A, López AP, et al. Metabolically healthy obese individuals present similar chronic inflammation level but less insulin-resistance than obese individuals with metabolic syndrome. PLoS One. 2017;12(12):e0190528.PubMedPubMedCentralCrossRef Iglesias Molli AE, Penas Steinhardt A, López AP, et al. Metabolically healthy obese individuals present similar chronic inflammation level but less insulin-resistance than obese individuals with metabolic syndrome. PLoS One. 2017;12(12):e0190528.PubMedPubMedCentralCrossRef
93.
go back to reference Olefsky JM, Glass CK. Macrophages, inflammation and insulin resistance. Annu Rev Physiol. 2010;72:219–46.CrossRefPubMed Olefsky JM, Glass CK. Macrophages, inflammation and insulin resistance. Annu Rev Physiol. 2010;72:219–46.CrossRefPubMed
94.
go back to reference Jiménez A, Perea V, Corcelles R, et al. Metabolic effects of bariatric surgery in insulin-sensitive morbidly obese subjects. Obes Surg. 2013;23(4):494–500.PubMedCrossRef Jiménez A, Perea V, Corcelles R, et al. Metabolic effects of bariatric surgery in insulin-sensitive morbidly obese subjects. Obes Surg. 2013;23(4):494–500.PubMedCrossRef
95.
go back to reference Soverini V, Moscatiello S, Villanova N, et al. Metabolic syndrome and insulin resistance in subjects with morbid obesity. Obes Surg. 2010;20(3):295–301.PubMedCrossRef Soverini V, Moscatiello S, Villanova N, et al. Metabolic syndrome and insulin resistance in subjects with morbid obesity. Obes Surg. 2010;20(3):295–301.PubMedCrossRef
96.
go back to reference Cătoi AF, Pârvu AE, Andreicuț AD, et al. Metabolically healthy versus unhealthy morbidly obese: chronic inflammation, nitro-oxidative stress, and insulin resistance. Nutrients. 2018;10:1199.CrossRef Cătoi AF, Pârvu AE, Andreicuț AD, et al. Metabolically healthy versus unhealthy morbidly obese: chronic inflammation, nitro-oxidative stress, and insulin resistance. Nutrients. 2018;10:1199.CrossRef
97.
go back to reference Marques-Vidal P, Velho S, Waterworth D, et al. The association between inflammatory biomarkers and metabolically healthy obesity depends of the definition used. Eur J Clin Nutr. 2012;66:426–35.PubMedCrossRef Marques-Vidal P, Velho S, Waterworth D, et al. The association between inflammatory biomarkers and metabolically healthy obesity depends of the definition used. Eur J Clin Nutr. 2012;66:426–35.PubMedCrossRef
98.
go back to reference Ridker PM, Hennekens CH, Buring JE, et al. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000;342:836–43.PubMedCrossRef Ridker PM, Hennekens CH, Buring JE, et al. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000;342:836–43.PubMedCrossRef
99.
go back to reference Barbarroja N, López-Pedrera R, Mayas MD, et al. The obese healthy paradox: is inflammation the answer? Biochem J. 2010;430(1):141–9.PubMedCrossRef Barbarroja N, López-Pedrera R, Mayas MD, et al. The obese healthy paradox: is inflammation the answer? Biochem J. 2010;430(1):141–9.PubMedCrossRef
100.
go back to reference van Beek L, Lips MA, Visser A, et al. Increased systemic and adipose tissue inflammation differentiates obese women with T2DM from obese women with normal glucose tolerance. Metabolism. 2014;63(4):492–501.PubMedCrossRef van Beek L, Lips MA, Visser A, et al. Increased systemic and adipose tissue inflammation differentiates obese women with T2DM from obese women with normal glucose tolerance. Metabolism. 2014;63(4):492–501.PubMedCrossRef
101.
go back to reference Doumatey AP, Zhou J, Zhou M, et al. Proinflammatory and lipid biomarkers mediate metabolically healthy obesity: a proteomics study. Obesity. 2016;24(6):1257–65.PubMedCrossRef Doumatey AP, Zhou J, Zhou M, et al. Proinflammatory and lipid biomarkers mediate metabolically healthy obesity: a proteomics study. Obesity. 2016;24(6):1257–65.PubMedCrossRef
102.
go back to reference Hinnouho GM, Czernichow S, Dugravot A, et al. Metabolically healthy obesity and the risk of cardiovascular disease and type 2 diabetes: the Whitehall II cohort study. Eur Heart J. 2015;36:551–9.PubMedCrossRef Hinnouho GM, Czernichow S, Dugravot A, et al. Metabolically healthy obesity and the risk of cardiovascular disease and type 2 diabetes: the Whitehall II cohort study. Eur Heart J. 2015;36:551–9.PubMedCrossRef
103.
go back to reference Kim TJ, Shin HY, Chang Y, et al. Metabolically healthy obesity and the risk for subclinical atherosclerosis. Atherosclerosis. 2017;262:191–7.PubMedCrossRef Kim TJ, Shin HY, Chang Y, et al. Metabolically healthy obesity and the risk for subclinical atherosclerosis. Atherosclerosis. 2017;262:191–7.PubMedCrossRef
104.
go back to reference Mongraw-Chaffin M, Foster MC, Kalyani RR, et al. Obesity severity and duration are associated with incident metabolic syndrome: evidence against metabolically healthy obesity from the Multi-Ethnic Study of Atherosclerosis. J Clin Endocrinol Metab. 2016;101:4117–24.PubMedPubMedCentralCrossRef Mongraw-Chaffin M, Foster MC, Kalyani RR, et al. Obesity severity and duration are associated with incident metabolic syndrome: evidence against metabolically healthy obesity from the Multi-Ethnic Study of Atherosclerosis. J Clin Endocrinol Metab. 2016;101:4117–24.PubMedPubMedCentralCrossRef
105.
go back to reference Appelton. Diabetes and cardiovascular disease outcomes in the metabolically healthy obese phenotype. Diabetes Care. 2013;36:2388–94.CrossRef Appelton. Diabetes and cardiovascular disease outcomes in the metabolically healthy obese phenotype. Diabetes Care. 2013;36:2388–94.CrossRef
106.
go back to reference Soriguer F, Gutierrez-Repiso C, Rubio-Martin E, et al. Metabolically healthy but obese, a matter of time? Findings from the prospective Pizarra study. J Clin Endocrinol Metab. 2013;98:2318–25.PubMedCrossRef Soriguer F, Gutierrez-Repiso C, Rubio-Martin E, et al. Metabolically healthy but obese, a matter of time? Findings from the prospective Pizarra study. J Clin Endocrinol Metab. 2013;98:2318–25.PubMedCrossRef
107.
go back to reference Hamer M, Bell JA, Sabia S, et al. Stability of metabolically healthy obesity over 8 years: the English Longitudinal Study of Ageing. Eur J Endocrinol. 2015;173:703–8.PubMedCrossRef Hamer M, Bell JA, Sabia S, et al. Stability of metabolically healthy obesity over 8 years: the English Longitudinal Study of Ageing. Eur J Endocrinol. 2015;173:703–8.PubMedCrossRef
108.
go back to reference Eshtiaghi R, Keihani S, Hosseinpanah F, et al. Natural course of metabolically healthy abdominal obese adults after 10 years of follow-up: the Tehran Lipid and Glucose Study. Int J Obes. 2015;39:514–9.CrossRef Eshtiaghi R, Keihani S, Hosseinpanah F, et al. Natural course of metabolically healthy abdominal obese adults after 10 years of follow-up: the Tehran Lipid and Glucose Study. Int J Obes. 2015;39:514–9.CrossRef
109.
go back to reference Ortega FB, Lee DC, Katzmarzyk PT, et al. The intriguing metabolically healthy but obese phenotype: cardiovascular prognosis and role of fitness. Eur Heart J. 2013;34:389–97.PubMedCrossRef Ortega FB, Lee DC, Katzmarzyk PT, et al. The intriguing metabolically healthy but obese phenotype: cardiovascular prognosis and role of fitness. Eur Heart J. 2013;34:389–97.PubMedCrossRef
110.
go back to reference Garcia-Moll X. Obesity and prognosis: time to forget about metabolically healthy obesity. Eur Heart J. 2018;39(5):407–9.PubMedCrossRef Garcia-Moll X. Obesity and prognosis: time to forget about metabolically healthy obesity. Eur Heart J. 2018;39(5):407–9.PubMedCrossRef
111.
go back to reference Piepoli MF, Hoes AW, Agewall S, et al. European guidelines on cardiovascular disease prevention in clinical practice: the sixth joint task force of the European Society of Cardiology and Other Societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37:2315–81.PubMedPubMedCentralCrossRef Piepoli MF, Hoes AW, Agewall S, et al. European guidelines on cardiovascular disease prevention in clinical practice: the sixth joint task force of the European Society of Cardiology and Other Societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37:2315–81.PubMedPubMedCentralCrossRef
112.
go back to reference Lassale C, Tzoulaki I, Moons KGM, et al. Separate and combined associations of obesity and metabolic health with coronary heart disease: a pan-European case-cohort analysis. Eur J Cardiol Eur Heart J. 2018;39(5):397–406.CrossRef Lassale C, Tzoulaki I, Moons KGM, et al. Separate and combined associations of obesity and metabolic health with coronary heart disease: a pan-European case-cohort analysis. Eur J Cardiol Eur Heart J. 2018;39(5):397–406.CrossRef
114.
go back to reference Eckel N, Li Y, Kuxhaus O, et al. Transition from metabolic healthy to unhealthy phenotypes and association with cardiovascular disease risk across BMI categories in 90 257 women (the Nurses’ Health Study): 30 year follow-up from a prospective cohort study. Lancet Diabetes Endocrinol. 2018;6(9):714–24.PubMedCrossRef Eckel N, Li Y, Kuxhaus O, et al. Transition from metabolic healthy to unhealthy phenotypes and association with cardiovascular disease risk across BMI categories in 90 257 women (the Nurses’ Health Study): 30 year follow-up from a prospective cohort study. Lancet Diabetes Endocrinol. 2018;6(9):714–24.PubMedCrossRef
115.
go back to reference Kramer CK, Zinman B, Retnakaran R. Are metabolically healthy overweight and obesity benign conditions?: a systematic review and meta-analysis. Ann Intern Med. 2013;159:758–69.PubMedCrossRef Kramer CK, Zinman B, Retnakaran R. Are metabolically healthy overweight and obesity benign conditions?: a systematic review and meta-analysis. Ann Intern Med. 2013;159:758–69.PubMedCrossRef
116.
go back to reference Caleyachetty R, Thomas N, Toulis KA, et al. Metabolically healthy obese and incident cardiovascular disease events among 3·5 million men and women. J Am Coll Cardiol. 2017;70:1429–37.PubMedCrossRef Caleyachetty R, Thomas N, Toulis KA, et al. Metabolically healthy obese and incident cardiovascular disease events among 3·5 million men and women. J Am Coll Cardiol. 2017;70:1429–37.PubMedCrossRef
117.
go back to reference Eckel N, Meidtner K, Kalle-Uhlmann T, et al. Metabolically healthy obesity and cardiovascular events: a systematic review and meta-analysis. Eur J Prev Cardiol. 2016;23:956–66.PubMedCrossRef Eckel N, Meidtner K, Kalle-Uhlmann T, et al. Metabolically healthy obesity and cardiovascular events: a systematic review and meta-analysis. Eur J Prev Cardiol. 2016;23:956–66.PubMedCrossRef
118.
go back to reference Mongraw-Chaffin M, Foster MC, Anderson CAM, et al. Metabolically healthy obesity, transition to metabolic syndrome, and cardiovascular risk. J Am Coll Cardiol. 2018;71:1857–65.PubMedPubMedCentralCrossRef Mongraw-Chaffin M, Foster MC, Anderson CAM, et al. Metabolically healthy obesity, transition to metabolic syndrome, and cardiovascular risk. J Am Coll Cardiol. 2018;71:1857–65.PubMedPubMedCentralCrossRef
119.
go back to reference Bradshaw PT, Reynolds KR, Wagenknecht LE, et al. Incidence of components of metabolic syndrome in the metabolically healthy obese over 9 years follow-up: the Atherosclerosis Risk In Communities study. Int J Obes. 2018;42:295–301.CrossRef Bradshaw PT, Reynolds KR, Wagenknecht LE, et al. Incidence of components of metabolic syndrome in the metabolically healthy obese over 9 years follow-up: the Atherosclerosis Risk In Communities study. Int J Obes. 2018;42:295–301.CrossRef
120.
go back to reference Jung CH, Lee MJ, Kang YM, et al. The risk of incident type 2 diabetes in a Korean metabolically healthy obese population: the role of systemic inflammation. J Clin Endocrinol Metab. 2015;100(3):934–41.PubMedCrossRef Jung CH, Lee MJ, Kang YM, et al. The risk of incident type 2 diabetes in a Korean metabolically healthy obese population: the role of systemic inflammation. J Clin Endocrinol Metab. 2015;100(3):934–41.PubMedCrossRef
121.
go back to reference Achilike I, Hazuda HP, Fowler SP, et al. Predicting the development of the metabolically healthy obese phenotype. Int J Obes. 2015;39(2):228–34.CrossRef Achilike I, Hazuda HP, Fowler SP, et al. Predicting the development of the metabolically healthy obese phenotype. Int J Obes. 2015;39(2):228–34.CrossRef
122.
go back to reference Ricci C, Gaeta M, Rausa E, et al. Long-term effects of bariatric surgery on type II diabetes, hypertension and hyperlipidemia: a meta-analysis and meta-regression study with 5-year follow-up. Obes Surg. 2015;25(3):397–405.CrossRefPubMed Ricci C, Gaeta M, Rausa E, et al. Long-term effects of bariatric surgery on type II diabetes, hypertension and hyperlipidemia: a meta-analysis and meta-regression study with 5-year follow-up. Obes Surg. 2015;25(3):397–405.CrossRefPubMed
123.
go back to reference Benaiges D, Flores Le-Roux JA, Pedro-Botet J, et al. Sleeve gastrectomy and Roux-en-Y gastric bypass are equally effective in correcting insulin resistance. Int J Surg. 2013;11:309–13.PubMedCrossRef Benaiges D, Flores Le-Roux JA, Pedro-Botet J, et al. Sleeve gastrectomy and Roux-en-Y gastric bypass are equally effective in correcting insulin resistance. Int J Surg. 2013;11:309–13.PubMedCrossRef
124.
go back to reference Benaiges D, Flores JA, Pedro-Botet J, et al. Impact of restrictive (sleeve gastrectomy) vs hybrid bariatric surgery procedure (Roux-en-Y gastric bypass) on lipid profile. Obes Surg. 2012;22:1268–75.CrossRefPubMed Benaiges D, Flores JA, Pedro-Botet J, et al. Impact of restrictive (sleeve gastrectomy) vs hybrid bariatric surgery procedure (Roux-en-Y gastric bypass) on lipid profile. Obes Surg. 2012;22:1268–75.CrossRefPubMed
125.
go back to reference Sjöström L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.CrossRefPubMed Sjöström L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.CrossRefPubMed
126.
go back to reference Sesti G, Folli F, Perego L, et al. Effects of weight loss in metabolically healthy obese subjects after laparoscopic adjustable gastric banding and hypocaloric diet. PLoS One. 2011;6:e17737.PubMedPubMedCentralCrossRef Sesti G, Folli F, Perego L, et al. Effects of weight loss in metabolically healthy obese subjects after laparoscopic adjustable gastric banding and hypocaloric diet. PLoS One. 2011;6:e17737.PubMedPubMedCentralCrossRef
127.
go back to reference Moreno-Castellanos N, Guzmán-Ruiz R, Cano DA, et al. The effects of bariatric surgery-induced weight loss on adipose tissue in morbidly obese women depends on the initial metabolic status. Obes Surg. 2016;26(8):1757–67.PubMedCrossRef Moreno-Castellanos N, Guzmán-Ruiz R, Cano DA, et al. The effects of bariatric surgery-induced weight loss on adipose tissue in morbidly obese women depends on the initial metabolic status. Obes Surg. 2016;26(8):1757–67.PubMedCrossRef
128.
go back to reference Sjostrom L. Review of the key results from the Swedish Obese Subjects (SOS) trial—a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219–34.PubMedCrossRef Sjostrom L. Review of the key results from the Swedish Obese Subjects (SOS) trial—a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219–34.PubMedCrossRef
129.
go back to reference Ferrer R, Pardina E, Rossell J, et al. Morbidly “healthy” obese are not metabolically healthy but less metabolically imbalanced than those with type 2 diabetes or dyslipidemia. Obes Surg. 2015;25(8):1380–91.PubMedCrossRef Ferrer R, Pardina E, Rossell J, et al. Morbidly “healthy” obese are not metabolically healthy but less metabolically imbalanced than those with type 2 diabetes or dyslipidemia. Obes Surg. 2015;25(8):1380–91.PubMedCrossRef
130.
Metadata
Title
Metabolically Healthy Obesity and Bariatric Surgery
Authors
Adriana Florinela Cătoi
Luca Busetto
Publication date
01-09-2019
Publisher
Springer US
Published in
Obesity Surgery / Issue 9/2019
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-019-03964-8

Other articles of this Issue 9/2019

Obesity Surgery 9/2019 Go to the issue