Does Inflammation Determine Metabolic Health Status in Obese and Nonobese Adults?

Study Questions:

Do inflammatory markers differ between metabolically healthy and unhealthy obese and nonobese adults?


Data from the Cork and Kerry Diabetes and Heart Disease Study (Phase II), a single-center, cross-sectional study conducted between 2010 and 2011, were used for the present analysis. The cohort comprised 2,047 men and women ages 45–74 years, who were recruited from a large primary care center in Mitchelstown, County Cork, Ireland (Mitchelstown cohort). Participants were classified as obese (body mass index ≥30 kg/m2) and nonobese (body mass index <30 kg/m2). Metabolic health status was defined using five existing metabolic health definitions based on a range of cardiometabolic abnormalities. Measures of inflammation included serum acute-phase reactants, adipocytokines, proinflammatory cytokines, and white blood cell counts.


Prevalence of cardiovascular disease and type 2 diabetes mellitus was generally lower among the metabolically healthy subjects. Examination of dietary intake and lifestyle behaviors including physical activity, smoking, and alcohol behavior revealed few differences. According to most definitions, metabolically healthy obese and nonobese individuals presented with lower concentrations of complement component 3, C-reactive protein, tumor necrosis factor-alpha, interleukin-6 (IL-6), and plasminogen activator inhibitor-1; higher adiponectin levels; and reduced white blood cell count compared to their metabolically unhealthy counterparts. Logistic regression analysis identified greater likelihood of metabolically healthy obesity among individuals with lower levels of complement component 3 (odds ratios [ORs], 2-3.5); IL-6 (ORs, 1.7-2.9), plasminogen activator inhibitor-1 (ORs, 1.7-2.9), and white blood cells (ORs, 2.1-2.5) and higher adiponectin concentrations (ORs, 2.6-4.0).


The investigators concluded that favorable inflammatory status is positively associated with metabolic health in obese and nonobese individuals. These findings are of public health and clinical significance in terms of screening and stratification based on metabolic health phenotype to identify those at greatest cardiometabolic risk for whom appropriate therapeutic or intervention strategies should be developed.


These data suggest that inflammatory status is not uniformly elevated among obese adults. These inflammatory markers may help to identify adults who have unfavorable metabolic profiles and may be at increased risk for cardiovascular events. Further research beyond cross-sectional analyses is warranted.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Smoking

Keywords: Leukocyte Count, Diabetes Mellitus, Type 2, Plasminogen Activator Inhibitor 1, Prevalence, Complement C3, Biological Markers, Troponin I, Adiponectin, Cardiovascular Diseases, Motor Activity, Obesity, Odds Ratio, Inflammation, Adipokines, Cross-Sectional Studies, Interleukin-6, Tumor Necrosis Factor-alpha, Smoking, Leukocytes, Ireland, Metabolic Syndrome X, C-Reactive Protein, Body Mass Index, Phenotype, Regression Analysis, Primary Health Care, Diabetes Mellitus, Logistic Models

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