Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA.
Obesity (Silver Spring). 2014 Mar;22(3):786-94. doi: 10.1002/oby.20139. Epub 2013 Dec 20.
Nearly, a third of obese individuals, termed metabolically benign obese, have a low burden of adiposity-related cardiometabolic abnormalities, whereas a substantial proportion of normal-weight individuals possess risk factors.
In cross-sectional analyses of 699 normal weight and 1,294 overweight/obese postmenopausal women enrolled in a nested case-control stroke study ancillary to the Women's Health Initiative Observational Study, we compared levels of adiponectin, leptin, and resistin among metabolically benign normal weight, at-risk normal weight, metabolically benign obese, and at-risk obese women using components of the ATP III definition of the metabolic syndrome (metabolically benign: ≤1 of the four components; at-risk phenotype: ≥2 components or diabetes).
Overall, 382/699 normal-weight women (54.6%) and 328/1,194 overweight/obese women (27.5%) were metabolically benign. Among normal-weight women, at-risk women had higher leptin and lower adiponectin levels compared to metabolically benign women; multivariate-adjusted odds ratios were significant for having leptin (OR: 2.51; 95% CI: 1.28-5.01) and resistin (1.46; 1.03-2.07) in the top tertile and adiponectin in the bottom tertile (2.64; 1.81-3.84). Compared to metabolically benign overweight/obese women, at-risk obese women had higher odds of having leptin in the top tertile (1.62; 1.24-2.12) and adiponectin in the bottom tertile (2.78; 2.04-3.77).
Overall, metabolically benign overweight/obese women had an intermediate adipokine profile (between at-risk obese and metabolically benign normal-weight women), whereas at-risk normal-weight women had a less favorable profile compared to metabolically benign normal-weight women. As adiponectin was the only adipokine independent of BMI, it may be most likely to have a role in the etiological pathway of these phenotypes.
近三分之一的肥胖个体被称为代谢良好型肥胖，他们的脂肪相关性心血管代谢异常负担较低，而相当一部分正常体重个体存在风险因素。
在 Women's Health Initiative 观察研究的嵌套病例对照卒中研究的辅助研究中，纳入 699 名正常体重和 1294 名超重/肥胖绝经后女性进行横断面分析，我们比较了代谢良好型正常体重、存在风险的正常体重、代谢良好型肥胖和存在风险的肥胖女性的脂联素、瘦素和抵抗素水平，使用 ATP III 代谢综合征定义的四个成分之一（代谢良好型：≤4 个成分中的 1 个；存在风险表型：≥2 个成分或糖尿病）。
总体而言，699 名正常体重女性中有 382 名（54.6%）和 1194 名超重/肥胖女性中有 328 名（27.5%）为代谢良好型。在正常体重女性中，存在风险的女性与代谢良好型女性相比，瘦素水平较高，脂联素水平较低；瘦素（比值比：2.51；95%置信区间：1.28-5.01）和抵抗素（1.46；1.03-2.07）在最高三分位数和脂联素在最低三分位数的多变量调整比值比有显著差异（2.64；1.81-3.84）。与代谢良好型超重/肥胖女性相比，存在风险的肥胖女性的瘦素在最高三分位数（1.62；1.24-2.12）和脂联素在最低三分位数（2.78；2.04-3.77）的可能性更高。
总体而言，代谢良好型超重/肥胖女性的脂联素谱处于中间水平（在存在风险的肥胖和代谢良好型正常体重女性之间），而存在风险的正常体重女性与代谢良好型正常体重女性相比，脂联素谱更差。由于脂联素是唯一与 BMI 无关的脂联素，它可能最有可能在这些表型的病因途径中发挥作用。
