Metabolic Features of Individuals with Obesity Referred for Bariatric and Metabolic Surgery: a Cohort Study.

Background: The concept of metabolic obesity phenotypes has been proposed, but its relevance to metabolic features is unclear.

Purpose: To determine a new definition of metabolic obesity phenotype, investigate the characteristics of expressing clustered normal and abnormal metabolic parameters, and analyze factors associated with metabolic abnormalities.

Materials And Methods: Characteristics of 600 patients were analyzed. The definition of metabolic obesity phenotype includes elevated blood pressure, glucose, lipid, and uric acid levels and abnormal lipoprotein levels. Independent sample t test and a general linear model with repeated measures were applied to investigate the differences in metabolic parameters.

Results: A total of 108 (18.0%) participants were obese yet metabolically healthy, whereas 492 (82.0%) were obese and metabolically unhealthy. Body weight at baseline was significantly higher in metabolically unhealthy phenotype (P < 0.001). For non-phasic oral glucose tolerance test (OGTT) curve shape, 100% glucose, 100% C-peptide, and 95.8% insulin curves were found in the metabolically unhealthy group. Men had an increased risk for elevated lipid level than women (OR = 1.83, 1.21-2.77). Individuals with class II/III obesity had an increased risk for elevated blood pressure, glucose, and UA levels than did those with class I obesity (OR = 2.22, 1.43-3.44; OR = 1.73, 1.11-2.68; OR = 3.61, 2.29-5.69, respectively).

Conclusions: Approximately one-fifth of individuals with obesity had a metabolically healthy phenotype, and nearly one-third of individuals with class III obesity had this phenotype. Non-phasic OGTT curve shape is a meaningful predictive factor of metabolically unhealthy phenotype before bariatric surgery. Male sex and class II/III obesity are risk factors associated with specific metabolic abnormalities.