title: Obesity and metabolic phenotypes (metabolically healthy and unhealthy variants) are significantly associated with prevalence of elevated C-reactive protein and hepatic steatosis in a large healthy Brazilian population.
abstract: BACKGROUND
  Among the obese, the so-called metabolically healthy obese (MHO) phenotype is thought to confer a lower CVD risk as compared to obesity with typical associated metabolic changes. The present study aims to determine the relationship of different subtypes of obesity with inflammatory-cardiometabolic abnormalities.
  
  
  METHODS
  We evaluated 5,519 healthy, Brazilian subjects (43 ± 10 years, 78% males), free of known cardiovascular disease. Those with <2 metabolic risk factors (MRF) were considered metabolically healthy, and those with BMI ≥ 25 kg/m(2) and/or waist circumference meeting NCEP criteria for metabolic syndrome as overweight/obese (OW). High sensitivity C reactive protein (hsCRP) was measured to assess underlying inflammation and hepatic steatosis (HS) was determined via abdominal ultrasound.
  
  
  RESULTS
  Overall, 40% of OW individuals were metabolically healthy, and 12% normal-weight had ≥2 MRF. The prevalence of elevated CRP (≥3 mg/dL) and HS in MHO versus normal weight metabolically healthy group was 22% versus 12%, and 40% versus 8% respectively (P < 0.001). Both MHO individuals and metabolically unhealthy normal weight (MUNW) phenotypes were associated with elevated hsCRP and HS.
  
  
  CONCLUSIONS
  Our study suggests that MHO and MUNW phenotypes may not be benign and physicians should strive to treat individuals in these subgroups to reverse these conditions.
authors.affiliation: Aventura Hospital and Medical Center, Aventura, FL 33180, USA.
authors.forename: Sameer
authors.initials: S
authors.lastname: Shaharyar
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health South Florida, Miami, FL 33139, USA.
authors.forename: Lara L
authors.initials: LL
authors.lastname: Roberson
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health South Florida, Miami, FL 33139, USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Jamal
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health South Florida, Miami, FL 33139, USA.
authors.forename: Adnan
authors.initials: A
authors.lastname: Younus
authors.affiliation: Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL 33199, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health South Florida, Miami, FL 33139, USA.
authors.forename: Shozab S
authors.initials: SS
authors.lastname: Ali
authors.affiliation: Aventura Hospital and Medical Center, Aventura, FL 33180, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Zide
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health South Florida, Miami, FL 33139, USA.
authors.forename: Arthur A
authors.initials: AA
authors.lastname: Agatston
authors.affiliation: Johns Hopkins Ciccarone Center for Preventive Cardiology, Johns Hopkins University, Baltimore, MD 21287, USA.
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.affiliation: Preventive Medicine Center, Avenida Albert Einstein 627/701, 05652-900 Morumbi, SP, Brazil.
authors.forename: Raquel D
authors.initials: RD
authors.lastname: Conceição
authors.affiliation: Preventive Medicine Center, Avenida Albert Einstein 627/701, 05652-900 Morumbi, SP, Brazil ; Heart Institute (InCor) University of São Paulo Medical School Hospital & Preventive Medicine Center, Hospital Israelita Albert Einstein, 05652-900 São Paulo, SP, Brazil.
authors.forename: Raul D
authors.initials: RD
authors.lastname: Santos
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health South Florida, Miami, FL 33139, USA ; Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL 33199, USA ; Johns Hopkins Ciccarone Center for Preventive Cardiology, Johns Hopkins University, Baltimore, MD 21287, USA ; Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA.
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging; D000328:Adult; D001786:Blood Glucose; D015992:Body Mass Index; D001938:Brazil / Q000453:epidemiology; D002097:C-Reactive Protein / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000378:metabolism* / Q000517:prevention & control; D005215:Fasting; D005260:Female; D006801:Humans; D007249:Inflammation / Q000453:epidemiology / Q000209:etiology / Q000378:metabolism*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000453:epidemiology / Q000378:metabolism*; D009765:Obesity / Q000150:complications / Q000453:epidemiology / Q000378:metabolism*; D010641:Phenotype; D015995:Prevalence; D012307:Risk Factors; D014463:Ultrasonography; D055105:Waist Circumference
chemical_list: D001786:Blood Glucose; D002097:C-Reactive Protein
references.citation: Diabetes. 1999 Nov;48(11):2210-4
references.pmid: 10535456
references.citation: Circulation. 2010 Jan 19;121(2):230-6
references.pmid: 20038741
references.citation: Eur J Clin Nutr. 2010 Oct;64(10):1043-51
references.pmid: 20628408
references.citation: Int J Obes (Lond). 2015 Mar;39(3):514-9
references.pmid: 25287753
references.citation: Ann Intern Med. 2000 Jan 18;132(2):112-7
references.pmid: 10644271
references.citation: Diabetes Care. 2011 Jan;34(1):210-5
references.pmid: 20937689
references.citation: Obesity (Silver Spring). 2010 Feb;18(2):377-83
references.pmid: 19629058
references.citation: Trends Endocrinol Metab. 2000 Oct;11(8):327-32
references.pmid: 10996528
references.citation: BMC Public Health. 2014;14:14
references.pmid: 24400816
references.citation: Curr Opin Lipidol. 2010 Feb;21(1):38-43
references.pmid: 19915462
references.citation: Nat Rev Endocrinol. 2011 Dec;7(12):699-700
references.pmid: 22009160
references.citation: Dis Model Mech. 2009 May-Jun;2(5-6):231-7
references.pmid: 19407331
references.citation: J Clin Endocrinol Metab. 2006 Aug;91(8):2906-12
references.pmid: 16735483
references.citation: Diabetes Care. 2006 Feb;29(2):404-9
references.pmid: 16443895
references.citation: Circulation. 2004 Feb 17;109(6):706-13
references.pmid: 14970104
references.citation: Diabetes Nutr Metab. 2003 Jun;16(3):176-81
references.pmid: 14635735
references.citation: Obesity (Silver Spring). 2012 Mar;20(3):651-9
references.pmid: 21799477
references.citation: Endocrinol Metab (Seoul). 2015 Jun;30(2):185-94
references.pmid: 25325281
references.citation: J Clin Endocrinol Metab. 2002 Jul;87(7):3023-8
references.pmid: 12107194
references.citation: Am J Cardiol. 2007 Dec 1;100(11):1654-8
references.pmid: 18036364
references.citation: Am J Clin Nutr. 1997 Oct;66(4 Suppl):1044S-1050S
references.pmid: 9322585
references.citation: Obesity (Silver Spring). 2014 Dec;22(12):2613-20
references.pmid: 25155902
references.citation: Diabetes Care. 2007 Aug;30(8):2145-7
references.pmid: 17507694
references.citation: CMAJ. 2005 May 10;172(10):1301-5
references.pmid: 15883404