We estimated the prevalence of metabolically obese nonobese (MONO), metabolically obese obese (MOO), and metabolically healthy obese (MHO) individuals and correlated this with the prevalence of coronary artery disease (CAD) compared to metabolically healthy nonobese (MHNO) in urban South Indians.
Method:
Study subjects (n = 2350) were recruited from the Chennai Urban Rural Epidemiology Study. Generalized obesity was defined as a body mass index (BMI) ≥25 kg/m2, based on the World Health Organization Asia Pacific guidelines. Metabolic syndrome (MS) was diagnosed based on the South Asian Modified-National Cholesterol Education Programme criteria. Coronary artery disease was defined by known myocardial infarction or Q waves on resting electrocardiogram.
Results:
Metabolically obese nonobese was defined as nonobese subjects (BMI < 25 kg/m2) with MS, MOO as obesity (BMI = 25 kg/m2) with MS, MHO as obese subjects (BMI = 25 kg/m2) with no MS, and MHNO as no obesity or MS. Metabolically obese nonobese was identified in 355 (15.1%), MOO in 348 (14.8%), MHO in 312 (13.3%), and MHNO in 1335 (56.8%) subjects. The prevalence of CAD among the MONO, MOO, MHO, and MHNO was 5.5%, 4.2%, 1.4%, and 2.6%. However, when age standardization was done, there was no statistically significant increase in the risk of CAD among MONO [odds ratio (OR) = 1.300, 95% confidence interval (CI) 0.706–2.394, p = .339], MOO (OR = 1.651, 95% CI 0.852–3.199, p = .137), and MHO (OR = 0.524, 95% CI 0.250–2.130, p = .564) groups compared to MHNO, perhaps due to small numbers.
Conclusion:
Metabolic obesity may have different clinical implications than phenotypic obesity.
KarelisADSt PierreDHConusFRabasa-LhoretRPoehlmanET. Metabolic and body composition factors in subgroups of obesity: What do we know?J Clin Endocrinol Metab.2004;89 (6): 2569–75.
2.
RudermanNBSchneiderSHBerchtoldP. The “metabolically-obese,” normal-weight individual. Am J Clin Nutr.1981;34 (8): 1617–21.
3.
ZavaroniIBonoraEPagliaraMDall'AglioELuchettiLBuonannoGBonatiPABergonzaniMGnudiLPasseriMReavenG. Risk factors for coronary artery disease in healthy persons with hyperinsulinemia and normal glucose tolerance. N Engl J Med.1989;320 (11): 702–6.
4.
RudermanNChisholmDPi-SunyerXSchneiderS. The metabolically obese, normal-weight individual revisited. Diabetes.1998;47 (5): 699–713.
5.
DvorakRVDeNinoWFAdesPAPoehlmanET. Phenotypic characteristics associated with insulin resistance in metabolically obese but normal-weight young women. Diabetes.1999;48 (11): 2210–4.
6.
GrundySMBrewerHBJrCleemanJISmithSCJrLenfantC, American Heart Association, National Heart, Lung, and Blood Institute. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation.2004;109 (3): 433–8.
7.
FerranniniENataliABellPCavallo-PerinPLalicNMingroneG. Insulin resistance and hypersecretion in obesity. European Group for the Study of Insulin Resistance (EGIR). J Clin Invest.1997;100 (5): 1166–73.
8.
BonoraEKiechlSWilleitJOberhollenzerFEggerGTargherGAlbericheMBonadonnaRCMuggeoM. Prevalence of insulin resistance in metabolic disorders: The Bruneck Study. Diabetes.1998;47 (10): 1643–9.
9.
BrochuMTchernofADionneIJSitesCKEltabbakhGHSimsEAPoehlmanET. 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.
10.
KarelisADFarajMBastardJ PSt-PierreDHBrochuMPrud'hommeDRabasa-LhoretR. The metabolically healthy but obese individual presents a favorable inflammation profile. J Clin Endocrinol Metab.2005;90 (7): 4145–50.
11.
MeigsJBWilsonPWFoxCSVasanRSNathanDMSullivanLMD'AgostinoRB. Body mass index, metabolic syndrome, and risk of type 2 diabetes or cardiovascular disease. J Clin Endocrinol Metab.2006;91 (8): 2906–12.
12.
DeepaMPradeepaRRemaMMohanADeepaRShanthiraniSMohanV. The Chennai Urban Rural Epidemiology Study (CURES)–study design and methodology (urban component) (CURES-1). J Assoc Physicians India.2003;51: 863–70.
13.
AlbertiKGZimmetPZ. 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 (7): 539–53.
14.
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care.2004;27Suppl 1: S5–10.
15.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the 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). JAMA.2001;285 (19): 2486–97.
16.
EnasEAMohanVDeepaMFarooqSPazhoorSChennikkaraH. The metabolic syndrome and dyslipidemia among Asian Indians: A population with high rates of diabetes and premature coronary artery disease. J Cardiometab Syndr.2007;2 (4): 267–75.
17.
AnandSSYusufSVuksanVDevanesenSTeoKKMontaguePAKelemenLYiCLonnEGersteinHHegeleRAMcQueenM. Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: The Study of Health Assessment and Risk in Ethnic Groups (SHARE). Lancet.2000;356 (9226): 279–84.
18.
LeeK. Metabolically obese but normal weight (MONW) and metabolically healthy but obese (MHO) phenotypes in Koreans: Characteristics and health behaviors. Asia Pac J Clin Nutr.2009;18 (2): 280–4.
19.
MohanVDeepaMFarooqSNarayanKMDattaMDeepaR. Anthropometric cut points for identification of cardiometabolic risk factors in an urban Asian Indian population. Metabolism.2007;56 (7): 961–8.
20.
HadaeghFZabetianAHaratiHAziziF. Metabolic syndrome in normal-weight Iranian adults. Ann Saudi Med.2007;27 (1): 18–24.
21.
TsaiCH. Metabolic syndrome in non-obese Taiwanese: New definition of metabolically obese, normal-weight individual. Chin Med J (Engl).2009;122 (21): 2534–9.
22.
ParkYWZhuSPalaniappanLHeshkaSCarnethonMRHeymsfeldSB. The metabolic syndrome: Prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988–1994. Arch Intern Med.2003;163 (4): 427–36.
23.
St-OngeMPJanssenIHeymsfeldSB. Metabolic syndrome in normal-weight Americans: New definition of the metabolically obese, normal-weight individuals. Diabetes Care.2004;27 (9): 2222–8.
24.
IacobellisGRibaudoMCZappaterrenoAIannucciC VLeonettiF. Prevalence of uncomplicated obesity in an Italian obese population. Obes Res.2005;13 (6): 1116–22.
25.
KarelisADBrochuMRabasa-LhoretR. Can we identify metabolically healthy but obese individuals (MHO)?Diabetes Metab.2004;30 (6): 569–72.
26.
VelhoSPaccaudFWaeberGVollenweiderPMarques-VidalP. Metabolically healthy obesity: Different prevalence using different criteria. Eur J Clin Nutr.2010;64 (10): 1043–51.
27.
TermizyH MMafauzyM. Metabolic syndrome and its characteristics among obese patients attending an obesity clinic. Singapore Med J.2009;50 (4): 390–4.
28.
LeeWJChenHHWangWWeiPLLinCMHuangMT. Metabolic syndrome in obese patents referred for weight reduction surgery in Taiwan. J Formos Med Assoc.2003;102 (7): 459–64.
29.
MarchesiniGMelchiondaNApoloneGCuzzolaroMMannucciECoricaFGrossiE, QUOVADIS Study Group. The metabolic syndrome in treatment-seeking obese persons. Metabolism.2004;53 (4): 435–40.
30.
MaSCutterJTanCEChewSKTaiES. Associations of diabetes mellitus and ethnicity with mortality in a multiethnic Asian population: Data from the 1992 Singapore National Health survey. Am J Epidemiol.2003;158 (6): 543–52.
31.
OfazHOzbeyNMantarFGenchellacHMercanogluFSencerEMolvalilarSOrhan. Determination of endothelial function and early atherosclerotic changes in healthy obese women. Diabetes Nutr Metab.2003;16 (3): 176–81.
32.
BenjaminEJLarsonMGKeyesMJMitchellGFVasanRSKeaneyJFJrLehmanBTFanSOsypiukEVitaJA. Clinical correlates and heritability of flow-mediated dilation in the community: The Framingham Heart Study. Circulation.2004;109 (5): 613–9.
