Metabolically Neutral Obesity: Terminology, Prevalence, And Meaning

Determining the leptin level in patients with abdominal obesity without signs of insulin resistance is necessary for stratifying patients into groups with normal (metabolically neutral obesity) and increased adipokine activity. Objective — To compare the prevalence of metabolic disorders and signs of cardiovascular remodeling in young and middle-aged men with "metabolically healthy" and "metabolically neutral" obesity. Material and methods — observational sample survey of 590 men aged 38.5±5.6 years was conducted. Average body weight was assessed on301 men (the control group). Obesity was determined in 289 patients: among them, the criteria for metabolic syndrome were diagnosed for 134 study participants, metabolically healthy obesity (MHO) was diagnosed in 155 men, and 86 patients from MHO with leptin levels <3.5 ng/ml constituted metabolically neutral obesity group. All patients were evaluated by a lipidogram, adipokine, glycemic profiles, and ultrasound examination of the heart and carotid arteries. Results — Criteria for metabolically neutral abdominal obesity in men were determined: weight gain >30 kg/m2 in the presence of no more than two criteria for metabolic syndrome and leptin level <3.5 ng/ml. The metabolically neutral type was characterized by a better lipid profile, which was confirmed by a lower frequency of dyslipidemia (1.7 times); the frequency of prediabetes was 7% and was half as low as in metabolically healthy obesity; atherosclerosis of the carotid arteries was 1.5 times less common in the neutral type of obesity. Conclusion — The selection of a "metabolically neutral" type of obesity is justified since it allows us to determine the stage of the disease at which the frequency of metabolic and cardiovascular disorders is still minimal and non-drug prevention is necessary.

[Obesity without diabetes: the role of hormonal regulation]

AIM

Obese patients without diabetes present an interesting phenotype to explore protective mechanisms against type 2 diabetes (T2D) development. In our study we looked for specific hormonal features of obese patients without T2D.

MATERIALS AND METHODS

We included 6 groups of patients with different metabolic profiles (n=212): controls with BMI25 kg/m2, HbA1c6%, age 30 years; patients with 25BMI30 kg/m2and HbA1c6%; patients with 25BMI30 kg/m2and HbA1c6%; patients with BMI30 kg/m2and HbA1c6% (+ Obesity - T2D) obese patients without T2D or prediabetes; patients with BMI30 kg/m2and newly-diagnosed T2D/prediabetes, HbA1c6%; patients with known history of T2D on glucose-lowering drugs with BMI30 kg/m2. Insulin, GLP-1, GIP were measured during glucose-tolerance test at 0, 30 and 120 minutes; insulin resistance (IR) was assessed by HOMA-IR.

RESULTS

Waist circumference was bigger in patients with obesity despite their metabolic profile comparing to patients without obesity (p0.001). Waist-to-hip ratio was similar in patients with different metabolic status. According to IR + Obesity - T2D group had intermediate position: IR was higher in that group comparing to people without obesity, but was less that in patients with obesity and HbA1c6% (p0.001). + Obesity - T2D group had the most potent baseline insulin secretion, assessed by НОМА-%band the highest postprandial secretion, measured by insulinogenic index among all patient groups with obesity (p0.001). There was no significant difference in GLP-1 secretion; GIP secretion was higher in patients with BMI30 kg/m2comparing to people with BMI30 kg/m2(p0.01).