title: The prevalence of metabolically healthy obesity: a systematic review and critical evaluation of the definitions used.
abstract: We performed a systematic review of the prevalence of metabolically healthy obesity (MHO). Medline, Web of Science and EMBASE were searched for original articles from inception to November 2013. Only prospective and cross-sectional studies were included. After screening 478 titles, we selected 55 publications, of which 27 were population-based studies and were used in the narrative synthesis. From the 27 studies, we identified 30 definitions of metabolic health, mainly based on four criteria: blood pressure, high-density lipoprotein cholesterol, triglycerides and plasma glucose. Body mass index ≥30 kg m(-2) was the main indicator used to define obesity (74% of the studies). Overall, MHO prevalence ranged between 6% and 75%. In the studies that stratified the analysis by sex, prevalence was higher in women (seven out of nine studies) and in younger ages (all four studies). One-third of the studies (n = 9) reported the response rate. Of these, four reported a response rate of ≥70% and they showed MHO prevalence estimates between 10% and 51%. The heterogeneity of MHO prevalence estimates described in this paper strengthens calls for the urgent need for a commonly established metabolic health definition.
authors.affiliation: Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil.
authors.forename: J P
authors.initials: JP
authors.lastname: Rey-López
authors.forename: L F
authors.initials: LF
authors.lastname: de Rezende
authors.forename: M
authors.initials: M
authors.lastname: Pastor-Valero
authors.forename: B H
authors.initials: BH
authors.lastname: Tess
mesh_terms: D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology*; D001823:Body Composition; D015992:Body Mass Index; D008076:Cholesterol, HDL / Q000097:blood*; D003430:Cross-Sectional Studies; D015438:Health Behavior; D006801:Humans; D009765:Obesity / Q000145:classification / Q000453:epidemiology* / Q000378:metabolism; D015995:Prevalence; D011446:Prospective Studies; D014280:Triglycerides / Q000097:blood*
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D008076:Cholesterol, HDL; D014280:Triglycerides
keywords: Epidemiology; obesity phenotype; prevalence