University of Malta Medical School, Msida, Malta.
Mater Dei Hospital, Msida, Malta.
Diabetes Metab Res Rev. 2024 Feb;40(2):e3725. doi: 10.1002/dmrr.3725. Epub 2023 Oct 4.
Over the past 4 decades, research has shown that having a normal body weight does not automatically imply preserved metabolic health and a considerable number of lean individuals harbour metabolic abnormalities typically associated with obesity. Conversely, excess adiposity does not always equate with an abnormal metabolic profile. In fact, evidence exists for the presence of a metabolically unhealthy normal weight (MUHNW) and a metabolically healthy obese (MHO) phenotype. It has become increasingly recognised that different fat depots exert different effects on the metabolic profile of each individual by virtue of their location, structure and function, giving rise to these different body composition phenotypes. Furthermore, other factors have been implicated in the aetiopathogenesis of the body composition phenotypes, including genetics, ethnicity, age and lifestyle/behavioural factors. Even though to date both MHO and MUHNW have been widely investigated and documented in the literature, studies report different outcomes on long-term cardiometabolic morbidity and mortality. Future large-scale, observational and population-based studies are required for better profiling of these phenotypes as well as to further elucidate the pathophysiological role of the adipocyte in the onset of metabolic disorders to allow for better risk stratification and a personalised treatment paradigm.
在过去的 40 年中，研究表明，正常的体重并不能自动意味着保持代谢健康，相当数量的瘦人也存在与肥胖相关的代谢异常。相反，多余的脂肪并不总是等同于异常的代谢特征。事实上，存在代谢不健康的正常体重（MUHNW）和代谢健康的肥胖（MHO）表型。人们越来越认识到，不同的脂肪储存库因其位置、结构和功能的不同，对个体的代谢特征产生不同的影响，从而产生这些不同的身体成分表型。此外，其他因素也与身体成分表型的发病机制有关，包括遗传、种族、年龄和生活方式/行为因素。尽管迄今为止，MHO 和 MUHNW 在文献中都得到了广泛的研究和记录，但研究报告显示，它们在长期心血管代谢发病率和死亡率方面的结果不同。未来需要进行大规模的观察性和基于人群的研究，以更好地对这些表型进行分析，并进一步阐明脂肪细胞在代谢紊乱发病机制中的病理生理作用，以便更好地进行风险分层和个性化治疗模式。
