代谢健康肥胖：从流行病学、机制到临床意义

AbstractThe concept of metabolic health, particularly in obesity, has attracted a lot of attention in the scientific community, and is being increasingly used to determine the risk of cardiovascular diseases and diabetes mellitus-related complications. This Review assesses the current understanding of metabolically healthy obesity (MHO).

代谢健康的概念，特别是肥胖的概念，已经引起了科学界的广泛关注，并且越来越多地被用于确定心血管疾病和糖尿病相关并发症的风险。本综述评估了目前对代谢健康肥胖（MHO）的理解。

First, we present the historical evolution of the concept. Second, we discuss the evidence for and against its existence, the usage of different definitions of MHO over the years and the efforts made to provide novel definitions of MHO. Third, we highlight epidemiological data with regard to cardiovascular risk in MHO, which is estimated to be moderately elevated using widely used definitions of MHO when compared with individuals with metabolically healthy normal weight, but potentially not elevated using a novel definition of MHO.

首先，我们介绍了这个概念的历史演变。。第三，我们强调了有关MHO心血管风险的流行病学数据，与代谢健康的正常体重个体相比，使用广泛使用的MHO定义估计MHO的心血管风险适度升高，但使用新的MHO定义可能不会升高。

Fourth, we discuss novel findings about the physiological mechanisms involved in MHO and how such knowledge helps to identify and characterize both people with MHO and those with metabolically unhealthy normal weight. Finally, we address how the concept of MHO can be used for risk stratification and treatment in clinical practice.Key points.

第四，我们讨论了有关MHO所涉及的生理机制的新发现，以及这些知识如何帮助识别和表征MHO患者和代谢不健康的正常体重患者。最后，我们讨论了MHO的概念如何用于临床实践中的风险分层和治疗。关键点。

The concept of metabolically healthy obesity (MHO) is attracting a huge amount of attention in the scientific community.

代谢健康肥胖（MHO）的概念在科学界引起了极大的关注。

Total cardiovascular risk in individuals with MHO, when compared with individuals with metabolically healthy normal weight, is moderately elevated using widely used definitions of MHO.

使用广泛使用的MHO定义，与代谢健康的正常体重个体相比，MHO个体的总心血管风险适度升高。

Cardiovascular mortality risk in individuals with MHO, when compared with individuals with metabolically healthy normal weight, might not be elevated when using a novel definition of MHO.

当使用MHO的新定义时，与代谢健康的正常体重个体相比，MHO个体的心血管死亡风险可能不会升高。

Novel genetic data strongly support the hypothesis that body adipose tissue distribution, including the ability to expand adipose tissue mass in the gluteofemoral adipose tissue compartment, is an important determinant of MHO.

新的遗传数据强烈支持以下假设：身体脂肪组织分布，包括在臀股脂肪组织区室中扩大脂肪组织质量的能力，是MHO的重要决定因素。

As of today, the concept of MHO can be used for risk stratification and treatment in clinical practice.

迄今为止，MHO的概念可用于临床实践中的风险分层和治疗。

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Fig. 1: Development of the metabolically healthy obesity concept over time.Fig. 2: Process to establish a novel definition of metabolically healthy obesity.Fig. 3: Cardiovascular risk in subgroups according to BMI and metabolic health status.Fig. 4: Consequences of stability of metabolic health versus transition to a metabolically unhealthy phenotype for cardiovascular disease risk.Fig.

图1：随着时间的推移，代谢健康肥胖概念的发展。图2：建立代谢健康肥胖新定义的过程。图3：根据BMI和代谢健康状况的亚组心血管风险。图4：代谢健康稳定性与心血管疾病风险向代谢不健康表型转变的后果。图。

5: Energy storage under positive energy balance and metabolic health.Fig. 6: Potential strategies to identify and treat metabolically healthy and metabolically at-risk people with obesity..

5： 。图6：识别和治疗代谢健康和代谢高危肥胖人群的潜在策略。。

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Download referencesAcknowledgementsThe authors acknowledge the support of funding from the German Federal Ministry of Education and Research (BMBF) to the German Centre of Diabetes Research (DZD) and the Stratification of Obesity Phenotypes to Optimize Future Obesity Therapy (SOPHIA) project.

下载参考文献致谢作者感谢德国联邦教育和研究部（BMBF）对德国糖尿病研究中心（DZD）的资助以及肥胖表型分层以优化未来肥胖治疗（SOPHIA）项目的支持。

The authors thank M. Bauer (German Institute of Human Nutrition Potsdam-Rehbruecke) for assistance in literature handling and data extraction and E. Llanaj (German Institute of Human Nutrition Potsdam-Rehbruecke) for assistance in the preparation of the initial versions of the figures.Author informationAuthors and AffiliationsDepartment of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, GermanyMatthias B.

作者感谢M.Bauer（德国波茨坦人类营养研究所）在文献处理和数据提取方面的帮助，以及E.Llanaj（德国波茨坦人类营养研究所）在编制数字初始版本方面的帮助。作者信息作者和所属机构德国人类营养研究所波茨坦-雷布吕克分子流行病学系，德国纳瑟塔尔，GermanyMatthias B。

SchulzeGerman Center for Diabetes Research, Neuherberg, GermanyMatthias B. Schulze & Norbert StefanInstitute of Nutritional Science, University of Potsdam, Nuthetal, GermanyMatthias B. SchulzeDepartment of Internal Medicine IV, University Hospital Tübingen, Tübingen, GermanyNorbert StefanInstitute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Centre Munich, Tübingen, GermanyNorbert StefanAuthorsMatthias B.

SchulzeGerman糖尿病研究中心，Neuherberg，GermanyMatthias B.Schulze＆Norbert Stefan波茨坦大学营养科学研究所，Nuthetal，GermanyMatthias B.SchulzeDepartment of Internal Medicine IV，Tubingen大学医院，Tubingen，GermanyNorbert Stefan慕尼黑亥姆霍兹中心糖尿病研究与代谢疾病研究所（IDM），德国Norbert Stefan作者Matthias B。

SchulzeView author publicationsYou can also search for this author in.

SchulzeView作者出版物您也可以在中搜索此作者。

PubMed Google ScholarNorbert StefanView author publicationsYou can also search for this author in

PubMed Google ScholarNorbert StefanView作者出版物您也可以在

PubMed Google ScholarContributionsThe authors contributed equally to all aspects of the article.Corresponding authorCorrespondence to

PubMed谷歌学术贡献作者对文章的各个方面都做出了同样的贡献。对应作者对应

Matthias B. Schulze.Ethics declarations

马蒂亚斯·B·舒尔茨。道德宣言

Competing interests

相互竞争的利益

The authors declare no competing interests.

作者声明没有利益冲突。

Peer review information

同行评审信息

Nature Reviews Endocrinology thanks Carl Lavie and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

《自然评论》内分泌学感谢卡尔·拉维（CarlLavie）和另一位匿名审稿人对这项工作的同行评审做出的贡献。

Additional informationPublisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.Related linksUK Biobank: https://www.ukbiobank.ac.uk/Rights and permissionsSpringer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.Reprints and permissionsAbout this articleCite this articleSchulze, M.B., Stefan, N.

Additional informationPublisher的注释Springer Nature在已发布的地图和机构隶属关系中的管辖权主张方面保持中立。相关linksUK生物库：https://www.ukbiobank.ac.uk/Rights许可Pringer Nature或其许可方（例如协会或其他合作伙伴）根据与作者或其他权利持有人的出版协议对本文拥有专有权；本文接受稿件版本的作者自行存档仅受此类出版协议和适用法律的条款管辖。转载和许可本文引用本文Schulze，M.B.，Stefan，N。

Metabolically healthy obesity: from epidemiology and mechanisms to clinical implications..

代谢健康肥胖：从流行病学和机制到临床意义。。

Nat Rev Endocrinol (2024). https://doi.org/10.1038/s41574-024-01008-5Download citationAccepted: 31 May 2024Published: 27 June 2024DOI: https://doi.org/10.1038/s41574-024-01008-5Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

Nat Rev Endocrinol（2024）。https://doi.org/10.1038/s41574-024-01008-5Download引文接受日期：2024年5月31日发布日期：2024年6月27日OI：https://doi.org/10.1038/s41574-024-01008-5Share本文与您共享以下链接的任何人都可以阅读此内容：获取可共享链接对不起，本文目前没有可共享的链接。复制到剪贴板。

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