Skip to main content
SpringerLink
Log in

Metabolic Syndrome and Insulin Resistance in Subjects with Morbid Obesity

  • Clinical Research
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

There is evidence that a group of subjects with obesity fits the characteristics of metabolically healthy but obese population. We aimed to assess the prevalence of the metabolic syndrome (MS) in nondiabetic subjects with morbid obesity (body mass index (BMI) ≥ 40 kg/m2) and its correlation with insulin resistance.

Methods

We analyzed the data of 211 patients (55 males and 156 females) with morbid obesity and without overt diabetes, consecutive referred for weight loss management. All subjects underwent an oral glucose tolerance test, and insulin resistance was calculated by the homeostasis model assessment (HOMA) at baseline and by the oral glucose insulin sensitivity (OGIS) during the glucose and insulin curve. Clinical and biochemical features of MS were also determined.

Results

The criteria for MS were fulfilled in 74% of cases, and 10 patients had obesity as the sole feature. HOMA-R was normal in 26% of cases, whereas, OGIS was normal only in three females. HOMA-R and OGIS significantly differed in relation to the presence of MS, and a trend was observed in both tests as function of the number of factors of MS (P < 0.001). At logistic regression analysis, after adjustment for age, sex, BMI at age 20 years, present BMI, and waist circumference, OGIS was the only parameter of insulin resistance significantly associated with MS (odds ratio, 2.42; 95% confidence interval, 1.63–3.60).

Conclusions

A small number of metabolically healthy, but obese cases exist also in the subgroup of patients with morbid obesity in which insulin resistance maintains its pivotal role.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. WHO Global InfoBase team. The SuRF Report 2. Surveillance of chronic disease risk factors: country level data and comparable estimates. Geneva: World Health Organization; 2005.

    Google Scholar 

  2. Rosamond W, Flegal K, Friday G, et al. Heart disease and stroke statistics—2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2007;115:e69–171.

    Article  PubMed  Google Scholar 

  3. Wang Y, Beydoun MA. The obesity epidemic in the United States—gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiol Rev. 2007;29:6–28.

    Article  CAS  PubMed  Google Scholar 

  4. Whitlock G, Lewington S, Sherliker P, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373:1083–96.

    Article  PubMed  Google Scholar 

  5. Yusuf S, Hawken S, Ounpuu S, et al. Obesity and the risk of myocardial infarction in 27, 000 participants from 52 countries: a case-control study. Lancet. 2005;366:1640–9.

    Article  PubMed  Google Scholar 

  6. Hu FB. Obesity epidemiology. Oxford: Oxford University Press; 2008.

    Book  Google Scholar 

  7. Maison P, Byrne CD, Hales CN, et al. Do different dimensions of the metabolic syndrome change together over time? Evidence supporting obesity as the central feature. Diabetes Care. 2001;24:1758–63.

    Article  CAS  PubMed  Google Scholar 

  8. Grundy SM, Brewer HB Jr, Cleeman JI, et al. Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation. 2004;109:433–8.

    Article  PubMed  Google Scholar 

  9. Marchesini G, Melchionda N, Apolone G, et al. The metabolic syndrome in treatment-seeking obese persons. Metabolism. 2004;53:435–40.

    Article  CAS  PubMed  Google Scholar 

  10. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 1997;20:1183–97.

    Google Scholar 

  11. Bogardus C, Lillioja S, Mott DM, et al. Relationship between degree of obesity and in vivo insulin action in man. Am J Physiol. 1985;248:E286–91.

    CAS  PubMed  Google Scholar 

  12. Abbasi F, Brown BW Jr, Lamendola C, et al. Relationship between obesity, insulin resistance, and coronary heart disease risk. J Am Coll Cardiol. 2002;40:937–43.

    Article  CAS  PubMed  Google Scholar 

  13. Tilg H, Moschen AR. Inflammatory mechanisms in the regulation of insulin resistance. Mol Med. 2008;14:222–31.

    Article  CAS  PubMed  Google Scholar 

  14. Katzmarzyk PT, Janssen I, Ross R, et al. The importance of waist circumference in the definition of metabolic syndrome: prospective analyses of mortality in men. Diabetes Care. 2006;29:404–9.

    Article  PubMed  Google Scholar 

  15. St-Pierre AC, Cantin B, Mauriege P, et al. Insulin resistance syndrome, body mass index and the risk of ischemic heart disease. CMAJ. 2005;172:1301–5.

    PubMed  Google Scholar 

  16. Kip KE, Marroquin OC, Kelley DE, et al. Clinical importance of obesity versus the metabolic syndrome in cardiovascular risk in women: a report from the Women’s Ischemia Syndrome Evaluation (WISE) study. Circulation. 2004;109:706–13.

    Article  PubMed  Google Scholar 

  17. Iacobellis G, Ribaudo MC, Zappaterreno A, et al. Prevalence of uncomplicated obesity in an Italian obese population. Obes Res. 2005;13:1116–22.

    Article  PubMed  Google Scholar 

  18. Karelis AD, Brochu M, Rabasa-Lhoret R. Can we identify metabolically healthy but obese individuals (MHO)? Diabetes Metab. 2004;30:569–72.

    Article  CAS  PubMed  Google Scholar 

  19. Wildman RP, Muntner P, Reynolds K, et al. The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering: prevalence and correlates of 2 phenotypes among the US population (NHANES 1999–2004). Arch Intern Med. 2008;168:1617–24.

    Article  PubMed  Google Scholar 

  20. St-Onge MP, Janssen I, Heymsfield SB. Metabolic syndrome in normal-weight Americans: new definition of the metabolically obese, normal-weight individual. Diabetes Care. 2004;27:2222–8.

    Article  PubMed  Google Scholar 

  21. Succurro E, Marini MA, Frontoni S, et al. Insulin secretion in metabolically obese, but normal weight, and in metabolically healthy but obese individuals. Obesity (Silver Spring, Md). 2008;16:1881–6.

    Article  CAS  Google Scholar 

  22. Sims EA. Are there persons who are obese, but metabolically healthy? Metabolism. 2001;50:1499–504.

    Article  CAS  PubMed  Google Scholar 

  23. Kim SH, Abbasi F, Reaven GM. Impact of degree of obesity on surrogate estimates of insulin resistance. Diabetes Care. 2004;27:1998–2002.

    Article  PubMed  Google Scholar 

  24. Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112:2735–52.

    Article  PubMed  Google Scholar 

  25. Alberti KG, Zimmet P, Shaw J. The metabolic syndrome—a new worldwide definition. Lancet. 2005;366:1059–62.

    Article  PubMed  Google Scholar 

  26. Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from plasma fasting glucose and insulin concentrations in man. Diabetologia. 1985;28:412–9.

    Article  CAS  PubMed  Google Scholar 

  27. Bugianesi E, Pagotto U, Manini R, et al. Plasma adiponectin in nonalcoholic fatty liver is related to hepatic insulin resistance and hepatic fat content, not to liver disease severity. J Clin Endocrinol Metab. 2005;90:3498–504.

    Article  CAS  PubMed  Google Scholar 

  28. Mari A, Pacini G, Murphy E, et al. A model-based method for assessing insulin sensitivity from the oral glucose tolerance test. Diabetes Care. 2001;24:539–48.

    Article  CAS  PubMed  Google Scholar 

  29. Svegliati-Baroni G, Bugianesi E, Bouserhal T, et al. Post-load insulin resistance is an independent predictor of hepatic fibrosis in virus C chronic hepatitis and in non-alcoholic fatty liver disease. Gut. 2007;56:1296–301.

    Article  CAS  PubMed  Google Scholar 

  30. McLaughlin T, Reaven G, Abbasi F, et al. Is there a simple way to identify insulin-resistant individuals at increased risk of cardiovascular disease? Am J Cardiol. 2005;96:399–404.

    Article  CAS  PubMed  Google Scholar 

  31. Li C, Ford ES, Meng YX, et al. Does the association of the triglyceride to high-density lipoprotein cholesterol ratio with fasting serum insulin differ by race/ethnicity? Cardiovasc Diabetol. 2008;7:4.

    Article  PubMed  Google Scholar 

  32. Bonora E, Targher G, Alberiche M, et al. Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care. 2000;23:57–63.

    Article  CAS  PubMed  Google Scholar 

  33. Yki-Jarvinen H, Westerbacka J. The fatty liver and insulin resistance. Curr Mol Med. 2005;5:287–95.

    Article  CAS  PubMed  Google Scholar 

  34. Petersen KF, Dufour S, Befroy D, et al. Reversal of nonalcoholic hepatic steatosis, hepatic insulin resistance, and hyperglycemia by moderate weight reduction in patients with type 2 diabetes. Diabetes. 2005;54:603–8.

    Article  CAS  PubMed  Google Scholar 

  35. Petroni ML, Villanova N, Avagnina S, et al. Psychological distress in morbid obesity in relation to weight history. Obes Surg. 2007;17:391–9.

    Article  PubMed  Google Scholar 

  36. Karelis AD, St-Pierre DH, Conus F, et al. Metabolic and body composition factors in subgroups of obesity: what do we know? J Clin Endocrinol Metab. 2004;89:2569–75.

    Article  CAS  PubMed  Google Scholar 

  37. Brochu M, Tchernof A, Dionne IJ, et al. What are the physical characteristics associated with a normal metabolic profile despite a high level of obesity in postmenopausal women? J Clin Endocrinol Metab. 2001;86:1020–5.

    Article  CAS  PubMed  Google Scholar 

  38. Schinner S, Kempf K, Overmann H, et al. Association of impaired glucose metabolism in morbid obesity with hypoadiponectinaemia. Exp Clin Endocrinol Diabetes. 2008;116(Suppl 1):S64–9.

    Article  CAS  PubMed  Google Scholar 

  39. World Health Organization. Preventing and managing the global epidemic: report of a WHO consultation. Geneva: World Health Organization; 2000. Report No.: 894.

    Google Scholar 

  40. Karelis AD, Faraj M, Bastard JP, et al. The metabolically healthy but obese individual presents a favorable inflammation profile. J Clin Endocrinol Metab. 2005;90:4145–50.

    Article  CAS  PubMed  Google Scholar 

  41. Marchesini G, Brizi M, Bianchi G, et al. Nonalcoholic fatty liver disease: a feature of the metabolic syndrome. Diabetes. 2001;50:1844–50.

    Article  CAS  PubMed  Google Scholar 

  42. Clark JM, Brancati FL, Diehl AM. The prevalence and etiology of elevated aminotransferase levels in the United States. Am J Gastroenterol. 2003;98:960–7.

    Article  CAS  PubMed  Google Scholar 

  43. Marchesini G, Bugianesi E, Forlani G, et al. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology. 2003;37:917–23.

    Article  PubMed  Google Scholar 

  44. Angulo P. NAFLD, obesity, and bariatric surgery. Gastroenterology. 2006;130:1848–52.

    Article  PubMed  Google Scholar 

  45. Machado M, Marques-Vidal P, Cortez-Pinto H. Hepatic histology in obese patients undergoing bariatric surgery. J Hepatol. 2006;45:600–6.

    Article  PubMed  Google Scholar 

  46. Marceau P, Biron S, Hould FS, et al. Liver pathology and the metabolic syndrome X in severe obesity. J Clin Endocrinol Metab. 1999;84:1513–7.

    Article  CAS  PubMed  Google Scholar 

  47. Mathurin P, Gonzalez F, Kerdraon O, et al. The evolution of severe steatosis after bariatric surgery is related to insulin resistance. Gastroenterology. 2006;130:1617–24.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinical Dietetics, Alma Mater Studiorum University, S. Orsola-Malpighi Hospital, Bologna, Italy

    Valentina Soverini, Simona Moscatiello, Nicola Villanova, Elisabetta Ragni, Silvia Di Domizio & Giulio Marchesini

  2. Clinical Dietetics, Alma Mater Studiorum University, S. Orsola-Malpighi Hospital, Via Massarenti, 9, 40138, Bologna, Italy

    Giulio Marchesini

Authors
  1. Valentina Soverini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Simona Moscatiello
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicola Villanova
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elisabetta Ragni
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Silvia Di Domizio
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Giulio Marchesini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giulio Marchesini.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Soverini, V., Moscatiello, S., Villanova, N. et al. Metabolic Syndrome and Insulin Resistance in Subjects with Morbid Obesity. OBES SURG 20, 295–301 (2010). https://doi.org/10.1007/s11695-009-9999-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-009-9999-z

Keywords

Search

Navigation