Inflammation and Metabolic Health

November 28th, 2012 by MorganDowney Leave a reply »

Anis Larbi, Iftikhar Alam and Tze Pin Ng have produced a truly provocative review article, Does Inflammation Determine Whether Obesity is Metabolically Healthy or Unhealthy? The Aging Perspective in Mediators of Inflammation. They start by addressing the fact that not all obesity is the same. Some adults with obesity can be metabolically healthy (MHO) while others are metabolically unhealthy (MUHO).  The difference is the presence or absence of impaired glucose tolerance, dyslipidemia, hypercuricemia and hypertension. They note that obesity has spread around the world even as the exact causes of the obesity ‘pandemic’ are still in doubt. Additionally, they view obesity as a form of chronic inflammation. The inflammatory response is due to a number of components, including cytokines and adipokines.

The authors posit that, theoretically, metabolically healthy obese (MHO) and metabolically unhealthy obese (MUHO) humans “may represent distinct subtypes of obesity that were predetermined genetically to confer different metabolic and cardiovascular risks. Another theoretical possibility is that MHO and MUHO represent transitions phases from nonobesity in the development and natural history of obesity, with MHO individuals eventually turning into MUHO. It is tempting to think over the possibility of the other way round, that is, the possibility of converting MUHO into MHO. Whether MHO or MUHO is sustained or not for substantially a longer period may depend upon a number of factors, including the levels of cytokines and/or adipokines.” They call for studies to investigate of this transition from MHO to MUHO. “The answer to this question,” they note, “may have paramount clinical and public health implications. Once the temporal is established, the course of obesity can be stopped or delayed at some stage in its natural history before it becomes “metabolically unhealthy.”

They suggest that the elderly be the focus of such studies for a number of reasons, while noting that the BMI alone, as a sole indicator of obesity, is responsible for discrepant findings. (No argument here). They also point out that in one study, inflammation could be a key factor in causing obesity-induced type 2 diabetes. Gestational diabetes is also associated with chronic subclinical inflammation.


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