title: Metabolic normality in overweight and obese subjects. Which parameters? Which risks?
abstract: OBJECTIVE
  The objective of this study was to define metabolic normality and to investigate the cardiometabolic profile of metabolically normal obese.
  
  
  METHODS
  Cross-sectional study conducted at 21 research centers in Europe.
  
  
  METHODS
  Normal body weight (nbw, n=382) and overweight or obese (ow/ob, n=185) subjects free from metabolic syndrome and with normal glucose tolerance, were selected among the Relationship between Insulin Sensitivity and Cardiovascular Disease study participants.
  
  
  METHODS
  Insulin sensitivity was assessed by the clamp technique. On the basis of quartiles in nbw subjects, the limits of normal insulin sensitivity and of normal fasting insulinemia were established. Subjects with normal insulin sensitivity and fasting insulin were defined as metabolically normal.
  
  
  RESULTS
  Among ow/ob subjects, 11% were metabolically normal vs 37% among nbw, P<0.0001. Ow/ob subjects showed increased fasting insulin (P=0.0009), low-density lipoprotein cholesterol (LDL-cholesterol) (P=0.004), systolic (P=0.0007) and diastolic (P=0.001) blood pressure, as compared with nbw. When evaluating the contribution of body mass index (BMI), hyperinsulinemia and insulin resistance, BMI showed an isolated effect on high-density lipoprotein (P=0.007), high-sensitivity C-reactive protein (P<0.0001), systolic (P=0.002) and diastolic (P=0.008) blood pressures. BMI shared its influence with insulinemia on total cholesterol (P=0.04 and 0.003, respectively), LDL-cholesterol (P=0.003 and 0.006, respectively) and triglycerides (P=0.02 and 0.001, respectively).
  
  
  CONCLUSIONS
  In obese subjects, fasting insulin should be taken into account in the definition of metabolic normality. Even when metabolically normal, obese subjects could be at increased risk for cardiometabolic diseases. Increased BMI, alone or with fasting insulin, is the major responsible for the less favorable cardio-metabolic profile.
authors.affiliation: Service of Therapeutic Education for Chronic Diseases, WHO Collaborating Centre, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
authors.forename: Z
authors.initials: Z
authors.lastname: Pataky
authors.forename: V
authors.initials: V
authors.lastname: Makoundou
authors.forename: P
authors.initials: P
authors.lastname: Nilsson
authors.forename: R S
authors.initials: RS
authors.lastname: Gabriel
authors.forename: K
authors.initials: K
authors.lastname: Lalic
authors.forename: E
authors.initials: E
authors.lastname: Muscelli
authors.forename: A
authors.initials: A
authors.lastname: Casolaro
authors.forename: A
authors.initials: A
authors.lastname: Golay
authors.forename: E
authors.initials: E
authors.lastname: Bobbioni-Harsch
mesh_terms: D000328:Adult; D001823:Body Composition; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000378:metabolism*; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008075:Lipoproteins, HDL / Q000378:metabolism*; D008077:Lipoproteins, LDL / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology / Q000378:metabolism*; D015995:Prevalence; D012016:Reference Values; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood
chemical_list: D007328:Insulin; D008075:Lipoproteins, HDL; D008077:Lipoproteins, LDL; D014280:Triglycerides; D002097:C-Reactive Protein