Metabolic phenotypes of obesity: Frequency, correlates, and change over time in a cohort of postmenopausal women.

Publication Type:

Journal Article


International journal of obesity (2005) (2016)


OBJECTIVE: The possibility that a subset of persons who are obese may be metabolically healthy-referred to as the 'metabolically healthy obese' (MHO) phenotype -- has attracted attention recently. However, few studies have followed individuals with MHO or other obesity phenotypes over time to assess change in their metabolic profiles. The aim of the present study was to examine transitions over a 6-year period among different states defined simultaneously by body mass index and presence/absence of the metabolic syndrome.

METHODS: We used repeated measurements available for a sub-cohort of participants enrolled in the Women's Health Initiative (N=3512) and followed for an average of 6 years to examine the frequency of different metabolic obesity phenotypes at baseline, the 6-year transition probabilities to other states, and predictors of the risk of different transitions. Six phenotypes were defined by cross-tabulating BMI (18.5-<25.0, 25.0-<30.0, ⩾30.0 kg/m(2)) by metabolic syndrome (yes, no). A continuous-time Markov model was used to estimate 6-year transition probabilities from one state to another.

RESULTS: Over 6 years of follow-up, one-third of women with the healthy obese phenotype transitioned to the metabolically unhealthy obese phenotype. Overall, there was a marked tendency toward increased metabolic deterioration with increasing BMI and toward metabolic improvement with lower BMI. Among metabolically healthy obese women, the 6-year probability of becoming metabolically unhealthy obese was 34 percent, whereas among unhealthy normal-weight women, the probability of 'regressing' to the metabolically healthy normal-weight phenotype was 52 percent.

CONCLUSION: The present study demonstrated substantial change in metabolic obesity phenotypes over a 6-year period. There was a marked tendency toward metabolic deterioration with greater BMI and toward metabolic improvement with lower BMI.International Journal of Obesity accepted article preview online, 17 October 2016. doi:10.1038/ijo.2016.179.