ABC | Volume 111, Nº5, November 2018

Brief Communication Is it Possible to Easily Identify Metabolically Healthy Obese Women? Mauara Scorsatto, 1 Glorimar Rosa, 2 Aline de Castro Pimentel, 1 Ronir Raggio Luiz, 3 Gláucia Maria Moraes de Oliveira 1 Programa de Pós-Graduação em Cardiologia - Universidade Federal do Rio de Janeiro, 1 Rio de Janeiro, RJ – Brazil Instituto de Nutrição Josué de Castro - Universidade Federal do Rio de Janeiro, 2 Rio de Janeiro, RJ – Brazil Instituto de Estudos de Saúde Coletiva da Universidade Federal do Rio de Janeiro, 3 Rio de Janeiro, RJ – Brazil Keywords Cardiovascular Diseases/physiopathology; Metabolic Syndrome; Dyslipidemias; Diabetes Mellitus; Hypertension; Obesity/prevalence; Women. Mailing Address: Gláucia Maria Moraes de Oliveira • Universidade Federal do Rio de Janeiro – R. Prof. Rodolpho P. Rocco, 255 – Prédio do HU 8º andar – sala 6, UFRJ. Postal Code 21941-913, Cidade Universitária, RJ – Brazil E-mail: glauciam@cardiol.br , glauciamoraesoliveira@gmail.com Manuscript received June 05, 2018, revised manuscript July 25, 2018, accepted August 08, 2018 DOI: 10.5935/abc.20180228 Abstract Background: Obesity is recognized as a major risk factor for the development of several metabolic complications. However, some obese individuals have a favorable metabolic profile. Objective: The aim of this study was to identify an easy parameter for recognizing metabolically healthy obese (MHO) women. Methods: A total of 292 non-diabetic women with a body mass index (BMI) ≥ 30 kg/m 2 were selected, and 239 composed the final cohort. We classified the participants according to their metabolic state determined by homeostasis model assessment (HOMA) into MHO or metabolically unhealthy obese (MUO). Both groups were compared regarding biochemical, anthropometric, and body composition characteristics. Re s u l t s : The ave r age age o f t he coho r t wa s 43.9 ± 10.9 years and the average BMI was 37.2 ± 5.3 kg/m 2 . In total, 75.7% of the participants were classified as MHO by HOMA. A cutoff of 108.2 cm for waist circumference (WC) identified MHO participants with a sensitivity of 72.4% (95% confidence interval [CI]: 59.8–82.3%), specificity of 66.9% (95% CI: 59.71–73.3%), and negative likelihood ratio of 0.41 (95% CI: 0.36–0.47). Additionally, a visceral adiposity index cutoff value of 99.2 identified MHO women with a sensitivity of 89.7% (95% CI: 79.2–95.2%), specificity of 48.6% (95% CI: 41.4–55.9%), and negative likelihood ratio of 0.21 (95% CI: 0.15–0.30). Conclusion: Women classified as MHO exhibited smaller WC measurements and lower body fat percentages, as well as lower blood glucose and insulin levels. WC emerged as an easy parameter for identifying MHO women. Introduction The prevalence of obesity has increased sharply in recent decades. Between 1980 and 2013, it increased by 27% to affect 2.1 billion adults worldwide. A meta-analysis of 97 studies including over 2.88 million individuals and more than 270,000 deaths concluded that obesity is linked to a significantly higher risk of mortality from all causes, including cardiovascular diseases (CVD), when compared with normal weight. 1 According to recent data, 17% of the Brazilian population over 20 years of age is obese, and women have higher prevalence of diabetes, hypercholesterolemia, and abdominal obesity. 2 Obesity is recognized as a major risk factor for the development of several metabolic complications. However, some obese individuals have a favorable metabolic profile, characterized by normal homeostasismodel assessment (HOMA) index, blood pressure, and lipid profile. These individuals are identified as metabolically healthy obese (MHO), 1 although there is a current lack of consensus on defining MHO. Recent meta-analysis based in 40 studies showed that almost one-third of obese individuals were MHO using the definition based on the cutoffs established by the Third Report of the National Cholesterol Education Program’s Adult Treatment Panel (NCEP-ATP III) or by those of the International Diabetes Federation (IDF). 3 Among them, we have Pimentel et al., 4 whose studies on Brazilian women showed that around 70% were considered MHO according to HOMA and NCEP-ATP III criteria for the diagnosis of metabolic syndrome. We hypothesized that individuals with MUO phenotype have increased abdominal adiposity and insulin resistance. Consequently, this study was conducted to identify an easy parameter for detecting MHO women. Methods The sample comprised 239 women recruited in the municipality of São Gonçalo, State of Rio de Janeiro, Brazil. The study was approved by the Research Ethics Committee of the Clementino Fraga Filho University Hospital (Federal University of Rio de Janeiro, Brazil), under certificate number 062/10. All participants signed an informed consent form. The study included women ≥ 20 years of age with a body mass index (BMI) ≥ 30 kg/m 2 . We excluded women who smoked, used drugs or supplements of any kind (including weight loss supplements), were pregnant or nursing, or had pacemakers or metal prostheses (since they would prevent the assessment of body composition by bioimpedance). We also excluded participants who self-reported diagnosis of diabetes mellitus or use of hypoglycemic drugs. We measured participants’ weight using an electronic scale (Welmy, São Paulo, Brazil). Height was measured using a stadiometer and BMI was calculated as the weight in kg divided by the square of the height in meters. We also measured waist circumference (WC) with a tape measure, body composition 733