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Clinical Studies and Practice

Metabolically healthy and unhealthy obesity: differential effects on myocardial function according to metabolic syndrome, rather than obesity

International Journal of Obesity volume 40, pages 153–161 (2016)Cite this article

Subjects

Abstract

Background:

The term ‘metabolically healthy obese (MHO)’ is distinguished using body mass index (BMI), yet BMI is a poor index of adiposity. Some epidemiological data suggest that MHO carries a lower risk of cardiovascular disease (CVD) or mortality than being normal weight yet metabolically unhealthy.

Objectives:

We aimed to undertake a detailed phenotyping of individuals with MHO by using imaging techniques to examine ectopic fat (visceral and liver fat deposition) and myocardial function. We hypothesised that metabolically unhealthy individuals (irrespective of BMI) would have adverse levels of ectopic fat and myocardial dysfunction compared with MHO individuals.

Subjects:

Individuals were categorised as non-obese or obese (BMI ⩾30 kg m−2) and as metabolically healthy or unhealthy according to the presence or absence of metabolic syndrome.

Methods:

Sixty-seven individuals (mean±s.d.: age 49±11 years) underwent measurement of (i) visceral, subcutaneous and liver fat using magnetic resonance imaging and proton magnetic resonance spectroscopy, (ii) components of metabolic syndrome, (iii) cardiorespiratory fitness and (iv) indices of systolic and diastolic function using tissue Doppler echocardiography.

Results:

Cardiorespiratory fitness was similar between all groups; abdominal and visceral fat was highest in the obese groups. Compared with age- and BMI-matched metabolically healthy counterparts, the unhealthy (lean or obese) individuals had higher liver fat and decreased early diastolic strain rate, early diastolic tissue velocity and systolic strain indicative of subclinical systolic and diastolic dysfunction. The magnitude of dysfunction correlated with the number of components of metabolic syndrome but not with BMI or with the degree of ectopic (visceral or liver) fat deposition.

Conclusions:

Myocardial dysfunction appears to be related to poor metabolic health rather than simply BMI or fat mass. These data may partly explain the epidemiological evidence on CVD risk relating to the different obesity phenotypes.

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Acknowledgements

The European Foundation for the Study of Diabetes (EFSD) funded this work. We are grateful to the volunteers for participating in the study and to Ms Rebecca Asher, Liverpool Clinical Trials Unit, University of Liverpool, for her significant statistical input. Funding was provided by the European Foundation for the Study of Diabetes, Rheindorfer Weg 3, 40591 Dusseldorf, Germany.

Author contributions

All authors assisted in the writing of the manuscript. In addition, RD collected and analysed the demographic, echocardiographic and cardiorespiratory exercise data. JJ cross-checked the echocardiographic data acquisition and analysis. VSS assisted with demographic and biochemical data collection and analysis. AI performed the anthropometric measurements and assisted with the biochemical data collection. VA collected the magnetic resonance imaging data. GJK analysed the magnetic resonance imaging data. MH and CD assisted in the characterisation of the patient groups. FS-M and MU processed and analysed all of the biochemical samples. MB and DJC devised the protocol for the study, and oversaw all aspects of data acquisition and analysis.

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Authors and Affiliations

  1. Department of Obesity and Endocrinology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK

    R Dobson, V S Sprung, A Irwin, C Daousi & D J Cuthbertson

  2. Department of Cardiology, University Hospital Aintree, Liverpool, UK

    M I Burgess & J Jones

  3. National Centre Sport and Exercise Medicine, Loughborough University, Loughborough, UK

    M Hamer

  4. Magnetic Resonance and Image Analysis Research Centre, University of Liverpool, Liverpool, UK

    V Adams & G J Kemp

  5. Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK

    G J Kemp

  6. Diabetes and Metabolic Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK

    F Shojaee-Moradie & M Umpleby

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  1. R Dobson
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  2. M I Burgess
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  3. V S Sprung
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Correspondence to R Dobson.

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Dobson, R., Burgess, M., Sprung, V. et al. Metabolically healthy and unhealthy obesity: differential effects on myocardial function according to metabolic syndrome, rather than obesity. Int J Obes 40, 153–161 (2016). https://doi.org/10.1038/ijo.2015.151

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