Metabolically healthy but obese women: effect of an energy-restricted diet
Metabolically healthy but obese women: effect of an energy-restricted diet
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DOI：
10.1007/s00125-008-1038-4
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发表时间：
2008-09-01
期刊：
影响因子：
8.2
通讯作者：
Rabasa-Lhoret, R.
中科院分区：
文献类型：
--
作者：
Karelis, A. D.;Messier, V.;Rabasa-Lhoret, R.
致编辑：已经确定了一个独特的肥胖个体亚组，其似乎可以防止肥胖相关的代谢紊乱[1，2]。这些个体，现在被称为“代谢健康但肥胖”（MHO）个体，显示出良好的代谢特征，其特征是高水平的胰岛素敏感性，正常的脂质和炎症特征，并且没有高血压的迹象，尽管具有过度的身体肥胖。事实上，绝经后MHO女性的代谢特征与年轻瘦女性几乎没有区别[3]。有趣的是，最近的一项纵向研究报告称，在MHO个体中观察到的保护性代谢特征与2型糖尿病和心血管疾病的发病率较低相关[4]。此外，有证据表明，MHO个体可能占肥胖人群的20-30%[5]。一个似乎尚未解决的重要问题是，MHO个体是否会从减肥中获得任何代谢益处。事实上，一些研究表明，减肥改善胰岛素敏感性和代谢异常，并降低肥胖个体患2型糖尿病的风险[6，7]。然而，试图通过饮食来实现MHO个体的体重减轻，实际上可能适得其反并且可能有害。人们甚至可能质疑是否需要积极治疗MHO个体，因为他们的代谢特征良好。因此，本研究的目的是调查6个月的能量限制饮食对胰岛素敏感性的影响，使用正常血-高胰岛素钳夹技术的MHO绝经后妇女的样本。这项研究得到了蒙特利尔大学伦理委员会的批准。在阅读并签署同意书后，每位参与者被邀请到代谢单位进行测试。然后，这些女性进入了一个为期6个月的医学监督减肥计划，旨在减少10%的体重。为了达到能量限制水平，将基线静息代谢率外推24小时（kcal/min× 1，440 min），并乘以活动因子1.4，这对应于久坐状态。此后，关于如何遵循低能量饮食的指导
To the Editor: A unique subset of obese individuals has been identified that appears to be protected against obesityrelated metabolic disturbances [1, 2]. These individuals, now known as ‘metabolically healthy but obese’(MHO) individuals, display a favourable metabolic profile, characterised by high levels of insulin sensitivity, normal lipid and inflammation profiles and no sign of hypertension, despite having excessive body fatness. In fact, the metabolic profiles of MHO postmenopausal women are virtually indistinguishable from those of young lean women [3]. Interestingly, a recent longitudinal study reported that the protective metabolic profile observed in MHO individuals was associated with lower incidences of type 2 diabetes and cardiovascular diseases [4]. Moreover, evidence suggests that MHO individuals may account for as much as 20–30% of the obese population [5].An important question that seems to be unresolved is whether MHO individuals would gain any metabolic benefit from weight loss. Indeed, several studies have shown that weight loss improves insulin sensitivity and metabolic abnormalities and reduces the risk for type 2 diabetes in obese individuals [6, 7]. However, attempts to achieve weight loss in MHO individuals, by way of diet, may be actually counterproductive and potentially harmful. One may even question the need to aggressively treat MHO individuals given their favourable metabolic profile. Therefore, the aim of the present study was to investigate the effect of a 6 month energy-restricted diet on insulin sensitivity using the euglycaemic–hyperinsulinaemic clamp technique in a sample of MHO postmenopausal women. This study was approved by the ethics committee of the University of Montreal. After reading and signing the consent form, each participant was invited to the Metabolic Unit for testing. The women then entered a medically supervised 6 month weight loss programme, which aimed to reduce body weight by 10%. To achieve a level of energy restriction, the baseline resting metabolic rate was extrapolated over a 24 h period (kcal/min× 1,440 min) and multiplied by an activity factor of 1.4, which corresponds to a sedentary state. Thereafter, instructions on how to follow a hypoenergetic diet