Physical Fitness can Partly Explain the Metabolically Healthy Obese Phenotype in Women

Abstract

Objective:

To investigate whether physical fitness and/or fat distribution and inflammation profile may explain why approximately 30% of the women with obesity are protected against obesity-related disorders.

Method:

10 metabolically healthy obese women and 10 age- and weight-matched women with the metabolic syndrome were enrolled. Physical fitness (VO_2max), daily physical activity levels (METs, steps per day), insulin sensitivity (clamp), body fat distribution (DXA scan) and, inflammation markers and adipokines were determined.

Results:

The metabolically healthy obese women had a 17% higher VO_2max (25.1±3.9 vs. 21.5±3.1 ml ∙ min⁻¹ ∙ kg⁻¹, p=0.04) and tended to take more steps per day (7 388±1 440 vs. 5 927±1 301, p=0.06) than women with the metabolic syndrome. Despite equivalent levels of fat mass, metabolically healthy obese women had significantly lower circulating TNF-α levels compared to women with the metabolic syndrome (3.55±3.83 vs. 0.43±0.97 ng/ml, p=0.03). No differences were seen in insulin sensitivity, adipokines, and inflammatory markers between both groups.

Conclusion:

Metabolically healthy obese women have a higher cardio-respiratory fitness and lower TNF-α levels, which may partly explain why these women are protected from the detrimental effects of obesity compared to obese women with the metabolic syndrome.

Key words

obesity - metabolic syndrome - maximal oxygen consumption - adipose tissue - inflammation

• References

• 1 Temelkova-Kurktschiev T, Stefanov T. Lifestyle and genetics in obesity and type 2 diabetes. Exp Clin Endocrinol Diabetes 2012; 120: 1-6
• 2 Wildman RP, Muntner P, Reynolds K et al. The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering: prevalence and correlates of 2 phenotypes among the US population (NHANES 1999–2004). Arch Intern Med 2008; 168: 1617-1624
• 3 Song Y, Manson JE, Meigs JB et al. Comparison of usefulness of body mass index versus metabolic risk factors in predicting 10-year risk of cardiovascular events in women. Am J Cardiol 2007; 100: 1654-1658
• 4 Isomaa B, Almgren P, Tuomi T et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001; 24: 683-689
• 5 Farrell SW, Cheng YJ, Blair SN. Prevalence of the metabolic syndrome across cardiorespiratory fitness levels in women. Obesity research 2004; 12: 824-830
• 6 Katzmarzyk PT, Church TS, Janssen I et al. Metabolic syndrome, obesity, and mortality: impact of cardiorespiratory fitness. Diabetes Care 2005; 28: 391-397
• 7 Ortega FB, Lee DC, Katzmarzyk PT et al. The intriguing metabolically healthy but obese phenotype: cardiovascular prognosis and role of fitness. Eur Heart J 2013; 34: 389-397
• 8 Bouchard DR, Langlois MF, Brochu M et al. Metabolically healthy obese women and functional capacity. Metabolic syndrome and related disorders 2011; 9: 225-229
• 9 Karelis AD, Faraj M, Bastard JP et al. The metabolically healthy but obese individual presents a favorable inflammation profile. J Clin Endocrinol Metab 2005; 90: 4145-4150
• 10 Koster A, Stenholm S, Alley DE et al. Body fat distribution and inflammation among obese older adults with and without metabolic syndrome. Obesity 2010; 18: 2354-2361
• 11 Hayes L, Pearce MS, Firbank MJ et al. Do obese but metabolically normal women differ in intra-abdominal fat and physical activity levels from those with the expected metabolic abnormalities? A cross-sectional study. BMC public health 2010; 10: 723
• 12 Brochu M, Tchernof A, Dionne IJ et al. 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: 1020-1025
• 13 Lavoie ME, Rabasa-Lhoret R, Doucet E et al. Association between physical activity energy expenditure and inflammatory markers in sedentary overweight and obese women. International journal of obesity (2005) 2010; 34: 1387-1395
• 14 Alberti KG, Eckel RH, Grundy SM et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009; 120: 1640-1645
• 15 [Anonymous] . 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) final report. Circulation 2002; 106: 3143-3421
• 16 Johnson JL, Slentz CA, Houmard JA et al. Exercise training amount and intensity effects on metabolic syndrome (from Studies of a Targeted Risk Reduction Intervention through Defined Exercise). Am J Cardiol 2007; 100: 1759-1766
• 17 Abbink EJ, De Graaf J, De Haan JH et al. Effects of pioglitazone in familial combined hyperlipidaemia. J Intern Med 2006; 259: 107-116
• 18 Orakzai RH, Orakzai SH, Nasir K et al. Association of increased cardiorespiratory fitness with low risk for clustering of metabolic syndrome components in asymptomatic men. Archives of medical research 2006; 37: 522-528
• 19 Lee S, Kuk JL, Katzmarzyk PT et al. Cardiorespiratory fitness attenuates metabolic risk independent of abdominal subcutaneous and visceral fat in men. Diabetes Care 2005; 28: 895-901
• 20 Listed N. Relationship of body size and shape to the development of diabetes in the diabetes prevention program. Obesity 2006; 14: 2107-2117
• 21 Robillard ME, Bellefeuille P, Comtois AS et al. The metabolically healthy but obese postmenopausal woman presents a favourable heart rate variability profile. Scand Cardiovasc J 2011; 45: 316-320
• 22 Balducci S, Zanuso S, Nicolucci A et al. Anti-inflammatory effect of exercise training in subjects with type 2 diabetes and the metabolic syndrome is dependent on exercise modalities and independent of weight loss. Nutr Metab Cardiovasc Dis 2010; 20: 608-617
• 23 Mourier A, Gautier JF, De Kerviler E et al. Mobilization of visceral adipose tissue related to the improvement in insulin sensitivity in response to physical training in NIDDM. Effects of branched-chain amino acid supplements. Diabetes Care 1997; 20: 385-391
• 24 Maiorana A, O’Driscoll G, Goodman C et al. Combined aerobic and resistance exercise improves glycemic control and fitness in type 2 diabetes. Diabetes Res Clin Pract 2002; 56: 115-123
• 25 Park YW, Zhu S, Palaniappan L et al. 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: 427-436
• 26 Pou KM, Massaro JM, Hoffmann U et al. Visceral and subcutaneous adipose tissue volumes are cross-sectionally related to markers of inflammation and oxidative stress: the Framingham Heart Study. Circulation 2007; 116: 1234-1241