title: Metabolically healthy and unhealthy obesity phenotypes in the general population: the FIN-D2D Survey.
abstract: BACKGROUND
  The aim of this work was to examine the prevalence of different metabolical phenotypes of obesity, and to analyze, by using different risk scores, how the metabolic syndrome (MetS) definition discriminates between unhealthy and healthy metabolic phenotypes in different obesity classes.
  
  
  METHODS
  The Finnish type 2 diabetes (FIN-D2D) survey, a part of the larger implementation study, was carried out in 2007. The present cross-sectional analysis comprises 2,849 individuals aged 45-74 years. The MetS was defined with the new Harmonization definition. Cardiovascular risk was estimated with the Framingham and SCORE risk scores. Diabetes risk was assessed with the FINDRISK score. Non-alcoholic fatty liver disease (NAFLD) was estimated with the NAFLD score. Participants with and without MetS were classified in different weight categories and analysis of regression models were used to test the linear trend between body mass index (BMI) and various characteristics in individuals with and without MetS; and interaction between BMI and MetS.
  
  
  RESULTS
  A metabolically healthy but obese phenotype was observed in 9.2% of obese men and in 16.4% of obese women. The MetS-BMI interaction was significant for fasting glucose, 2-hour plasma glucose, fasting plasma insulin and insulin resistance (HOMA-IR)(p < 0.001 for all). The prevalence of total diabetes (detected prior to or during survey) was 37.0% in obese individuals with MetS and 4.3% in obese individuals without MetS (p < 0.001). MetS-BMI interaction was significant (p < 0.001) also for the Framingham 10 year CVD risk score, NAFLD score and estimated liver fat %, indicating greater effect of increasing BMI in participants with MetS compared to participants without MetS. The metabolically healthy but obese individuals had lower 2-hour postload glucose levels (p = 0.0030), lower NAFLD scores (p < 0.001) and lower CVD risk scores (Framingham, p < 0.001; SCORE, p = 0.002) than normal weight individuals with MetS.
  
  
  CONCLUSIONS
  Undetected Type 2 diabetes was more prevalent among those with MetS irrespective of the BMI class and increasing BMI had a significantly greater effect on estimates of liver fat and future CVD risk among those with MetS compared with participants without MetS. A healthy obese phenotype was associated with a better metabolic profile than observed in normal weight individuals with MetS.
authors.affiliation: Diabetes Prevention Unit, Division of Welfare and Health Promotion, National Institute for Health and Welfare, Helsinki, Finland. pia.pajunen@thl.fi
authors.forename: Pia
authors.initials: P
authors.lastname: Pajunen
authors.forename: Anna
authors.initials: A
authors.lastname: Kotronen
authors.forename: Eeva
authors.initials: E
authors.lastname: Korpi-Hyövälti
authors.forename: Sirkka
authors.initials: S
authors.lastname: Keinänen-Kiukaanniemi
authors.forename: Heikki
authors.initials: H
authors.lastname: Oksa
authors.forename: Leo
authors.initials: L
authors.lastname: Niskanen
authors.forename: Timo
authors.initials: T
authors.lastname: Saaristo
authors.forename: Juha T
authors.initials: JT
authors.lastname: Saltevo
authors.forename: Jouko
authors.initials: J
authors.lastname: Sundvall
authors.forename: Mauno
authors.initials: M
authors.lastname: Vanhala
authors.forename: Matti
authors.initials: M
authors.lastname: Uusitupa
authors.forename: Markku
authors.initials: M
authors.lastname: Peltonen
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005234:Fatty Liver / Q000453:epidemiology*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D008019:Life Style; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology*; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D009765:Obesity / Q000453:epidemiology*; D010641:Phenotype; D015995:Prevalence; D012307:Risk Factors