The prevalence of metabolically healthy obesity according to the sample of the Moscow region

Introduction. Obesity is a major factor for cardiometabolic risk. However, there is a category of obese patients without disorders of lipid, carbohydrate metabolism and cardiovascular disease – metabolically healthy obese (MHO).

Aim. Our goal was to investigate the prevalence and characteristics of this phenotype compared to patients with metabolic syndrome (MS).

Materials and methods. To evaluate the prevalence of the MHO phenotype we analyzed 389 medical records of females aged 18–60 years with obesity. Three types of MHO criteria were used: 1) HOMA index (<2.7); 2) IDF-criteria of metabolic syndrome, 2005; 3) the BioSHaRE-EU 2013 criteria (obese patients without any symptoms of MS). We conducted a comparative analysis of anthropometry, status of lipid and carbohydrate metabolism, the functional state of the liver.

Results. The MHO prevalence was: 34.5% according to HOMA index, according to the definitions of MS 2005 – 38.6%, in BioSHaRE-EU – 9.6%. In groups of MHO and MS dyslipidemia was observed in 27.3 and 49.5% (p<0.05), hypertension in 25% and 71.6% (p<0.05), steatogepatosis in 47.7% vs 51.3% (p<0.05) of observations, respectively. Among comorbidities the gynecological pathology was most prevalent - 50.8 and 61.4% (p<0.05), disorders of carbohydrate metabolism differed significantly in frequency- 6.82 and 39.1% of patients (p<0.05). Patients with MHO had a shorter duration of the existence of obesity than MS (18.7 vs. 24 years) (p=0.0004) and less likely to have attempted to reduce weight – 85.8% and 91.6%. Average BMI, waist circumference, hip circumference, fasting glucose, total cholesterol, insulin basal, basal C-peptide, HOMA index in groups of MHO and MS differed significantly (p<0.05). Median ALT was 20 and 23.2 U/l, AST – 20 and 23 U/l, triglycerides – 1.1 and 1.8 mmol/l, high-density lipoprotein – 1.4 and 1.1 mmol/l, respectively.

Conclusions. The MHO prevalence was maximal according to the MS definitions from 2005, and minimal with BioSHaRE-EU criteria. The main analyzed indicators differed significantly in groups MHO and MS. Longer obesity existence in the MS group may suggest an instability of MHO phenotype over time.

metabolically healthy obesity, cardiometabolic risk, metabolic syndrome, insulin resistance

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