Metabolic normality in overweight and obese subjects. Which parameters? Which risks

• Published in: International Journal of Obesity Vol. 35; no. 9; pp. 1208 - 1215
• Main Authors: Pataky, Z, Makoundou, V, Nilsson, P, Gabriel, R.S, Lalic, K, Muscelli, E, Casolaro, A, Golay, A, Bobbioni-Harsch, E
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.09.2011
• Subjects: Adult; Biological and medical sciences; Blood pressure; Body Composition; Body mass; Body Mass Index; C-reactive protein; C-Reactive Protein - metabolism; cardiometabolic risk factors; Cardiorespiratory; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - metabolism; Cholesterol; Chronic illnesses; Complications and side effects; Cross-Sectional Studies; Diseases; Europe - epidemiology; fasting; Female; glucose tolerance; Health Sciences; high density lipoprotein; Hormones; Humans; hyperinsulinemia; Hälsovetenskap; insulin; Insulin - blood; Insulin Resistance; insulin sensitivity; Lipids; Lipoproteins, HDL - metabolism; Lipoproteins, LDL - metabolism; low density lipoprotein cholesterol; Male; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; Metabolic diseases; metabolic normality; metabolic syndrome; Middle Aged; Nutrition and Dietetics; Näringslära; Obesity; Obesity - epidemiology; Obesity - metabolism; overweight; Physiological aspects; Prevalence; Proteins; Reference Values; risk; Risk Factors; Techniques; triacylglycerols; Triglycerides - blood; Europe; Italy; Switzerland; Serbia; Human; Obesity; Pancreatic hormone; Nutrition; Insulin sensitivity; Body weight; metabolic normality; Nutrition disorder; Cardiovascular disease; Metabolic diseases; Corporal biometry; Metabolism; Insulin; Overweight; cardiometabolic risk factors; Risk factor; Cardiovascular risk; Nutritional status
• ISSN: 0307-0565; 1476-5497; 1476-5497
• DOI: 10.1038/ijo.2010.264

Objectives: The objective of this study was to define metabolic normality and to investigate the cardiometabolic profile of metabolically normal obese. Design: Cross-sectional study conducted at 21 research centers in Europe. Subjects: Normal body weight (nbw, n=382) and overweight or obese (ow/ob, n=185) subjects free from metabolic syndrome and with normal glucose tolerance, were selected among the Relationship between Insulin Sensitivity and Cardiovascular Disease study participants. Main outcome measures: Insulin sensitivity was assessed by the clamp technique. On the basis of quartiles in nbw subjects, the limits of normal insulin sensitivity and of normal fasting insulinemia were established. Subjects with normal insulin sensitivity and fasting insulin were defined as metabolically normal. Results: Among ow/ob subjects, 11% were metabolically normal vs 37% among nbw, P<0.0001. Ow/ob subjects showed increased fasting insulin (P=0.0009), low-density lipoprotein cholesterol (LDL-cholesterol) (P=0.004), systolic (P=0.0007) and diastolic (P=0.001) blood pressure, as compared with nbw. When evaluating the contribution of body mass index (BMI), hyperinsulinemia and insulin resistance, BMI showed an isolated effect on high-density lipoprotein (P=0.007), high-sensitivity C-reactive protein (P<0.0001), systolic (P=0.002) and diastolic (P=0.008) blood pressures. BMI shared its influence with insulinemia on total cholesterol (P=0.04 and 0.003, respectively), LDL-cholesterol (P=0.003 and 0.006, respectively) and triglycerides (P=0.02 and 0.001, respectively). Conclusion: In obese subjects, fasting insulin should be taken into account in the definition of metabolic normality. Even when metabolically normal, obese subjects could be at increased risk for cardiometabolic diseases. Increased BMI, alone or with fasting insulin, is the major responsible for the less favorable cardio-metabolic profile.