Department of Medicine, University of Leipzig, Germany.
Curr Opin Endocrinol Diabetes Obes. 2012 Oct;19(5):341-6. doi: 10.1097/MED.0b013e328357f0a3.
Obesity is associated with an increased risk of premature death and represents a fast growing worldwide health problem that is reaching epidemic proportions. Obesity significantly increases the risk of developing metabolic disorders, hypertension, coronary heart disease, stroke, and several types of cancer. However, a subgroup of 'healthy' obese patients seems to be protected against metabolic and cardiovascular obesity comorbidities. This review focuses on potential mechanisms underlying the healthy obese subphenotype.
Individuals with obesity typically develop type 2 diabetes, dyslipidemia, fatty liver disease, gout, hypertension, and cardiovascular disease. In the past years it became clear that up to 30% of obese patients are metabolically healthy with insulin sensitivity similar to healthy lean individuals, lower liver fat content, and lower intima media thickness of the carotid artery than the majority of metabolically 'unhealthy' obese patients. Recent studies suggest that protection against development of hepatic steatosis, ectopic fat deposition, inflammation of visceral adipose tissue, and adipose tissue dysfunction contributes to healthy obesity.
For the stratification of obesity treatment, definition of metabolically healthy or high-risk phenotypes will facilitate the identification of the obese person who will benefit the most from early lifestyle, bariatric surgery, or pharmacological interventions.
肥胖与过早死亡风险增加相关，是一种在全球范围内迅速增长的健康问题，已达到流行程度。肥胖显著增加了代谢紊乱、高血压、冠心病、中风和多种癌症的风险。然而，有一小部分“健康”肥胖患者似乎免受代谢和心血管肥胖合并症的影响。本综述重点介绍健康肥胖亚表型的潜在机制。
肥胖患者通常会出现 2 型糖尿病、血脂异常、脂肪肝疾病、痛风、高血压和心血管疾病。在过去的几年中，人们清楚地认识到，多达 30%的肥胖患者代谢健康，胰岛素敏感性与健康的瘦个体相似，肝脂肪含量较低，颈动脉内膜中层厚度也低于大多数代谢“不健康”肥胖患者。最近的研究表明，对肝脂肪变性、异位脂肪沉积、内脏脂肪组织炎症和脂肪组织功能障碍的保护有助于健康肥胖。
为了对肥胖进行分层治疗，定义代谢健康或高风险表型将有助于确定最受益于早期生活方式、减肥手术或药物干预的肥胖患者。
