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Open AccessFeature PaperReview

Metabolically Healthy Obesity—Heterogeneity in Definitions and Unconventional Factors

1
Departament of Biomedicine, Biochemistry Unit, Faculty of Medicine, University of Porto,Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
2
i3S—Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal
3
Centro de Apoio Tecnológico Agro Alimentar (CATAA), Zona Industrial de Castelo Branco, 6000-459 Castelo Branco, Portugal
4
Administração Regional de Saúde-Norte, Unidade de Saúde Familiar Pedras Rubras, Agrupamento de Centros de Saúde Maia-Valongo, 4470-105 Maia, Portugal
*
Author to whom correspondence should be addressed.
Metabolites 2020, 10(2), 48; https://doi.org/10.3390/metabo10020048
Received: 22 December 2019 / Revised: 21 January 2020 / Accepted: 22 January 2020 / Published: 27 January 2020
(This article belongs to the Special Issue Adipose Tissue and Metabolic Health)
The concept of heterogeneity among obese individuals in their risk for developing metabolic dysfunction and associated complications has been recognized for decades. At the origin of the heterogeneity idea is the acknowledgement that individuals with central obesity are more prone to developing type 2 diabetes and cardiovascular disease than those with peripheral obesity. There have been attempts to categorize subjects according to their metabolic health and degree of obesity giving rise to different obese and non-obese phenotypes that include metabolically unhealthy normal-weight (MUHNW), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO). Individuals belonging to the MHO phenotype are obese according to their body mass index although exhibiting fewer or none metabolic anomalies such as type 2 diabetes, dyslipidemia, hypertension, and/or unfavorable inflammatory and fribinolytic profiles. However, some authors claim that MHO is only transient in nature. Additionally, the phenotype categorization is controversial as it lacks standardized definitions possibly blurring the distinction between obesity phenotypes and confounding the associations with health outcomes. To add to the discussion, the factors underlying the origin or protection from metabolic deterioration and cardiometabolic risk for these subclasses are being intensely investigated and several hypotheses have been put forward. In the present review, we compare the different definitions of obesity phenotypes and present several possible factors underlying them (adipose tissue distribution and cellularity, contaminant accumulation on the adipose tissue, dysbiosis and metabolic endotoxemia imposing on to the endocannabinoid tone and inflammasome, and nutrient intake and dietary patterns) having inflammatory activation at the center.
Keywords: adipocyte hypertrophy; metabolic inflammation; obesity phenotypes; metabolically healthy obese phenotype; metabolically unhealthy normal-weight phenotype; metabolically unhealthy obese phenotype; persistent organic pollutants; gut microbiota; inflammasome; endocannabinoid system adipocyte hypertrophy; metabolic inflammation; obesity phenotypes; metabolically healthy obese phenotype; metabolically unhealthy normal-weight phenotype; metabolically unhealthy obese phenotype; persistent organic pollutants; gut microbiota; inflammasome; endocannabinoid system
MDPI and ACS Style

Brandão, I.; Martins, M.J.; Monteiro, R. Metabolically Healthy Obesity—Heterogeneity in Definitions and Unconventional Factors. Metabolites 2020, 10, 48.

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