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Identical twins study sheds light on metabolically healthy obese
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Maintaining high mitochondrial transcription and preventing inflammation in adipose tissue are associated with low liver fat and metabolically healthy obesity, according to findings in a recent research paper in Diabetologia.
Jussi Naukkarinen, MD, PhD, of the Institute for Molecular Medicine and the University of Helsinki, and colleagues aimed to study various fat depots and transcriptional pathways in subcutaneous adipose tissue (SAT) as it relates to metabolically healthy obesity.
They examined the metabolic characteristics of 16 rare young adult obesity-discordant monozygotic twin pairs (aged 22.8 to 35.8 years) to understand the link between mitochondrial function and inflammation in SAT.
“Genetic and multiple environmental factors, as well as age, sex and age of onset of weight gain, may play a role in an individual’s metabolic response to obesity,” the researchers wrote.
They identified two metabolically different subgroups based on liver fat accumulation, according to data.
Of the 16 pairs of Finnish twins, half of the obese co-twins (weight change: 17.1 kg) displayed significantly higher levels of liver fat, a 78% increase in the area under the curve (AUC) insulin during oral glucose tolerance test and C-reactive protein, significantly more interrupted lipids and a greater tendency for hypertension compared with the lean co-twin, according to data.
However, in the other half of patients (weight change: 17.4 kg) studied, obese twins did not demonstrate differences in liver fat (percent change: 8%), insulin sensitivity, C-reactive protein, lipids, hypertension or SAT transcriptomics, researchers wrote.
“Future studies of the metabolically healthy obesity phenotype may suggest new potentially druggable targets — with the most proximal intervention point perhaps being improving mitochondrial function and prevention of inflammation in adipose tissue,” researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Norbert Stefan, MD
This study nicely supports my findings previously published in 2008 that less liver fat content is among the strongest determinants of metabolically healthy obesity. The question now is what are the clinical implications of these findings? As was recently summarized by myself and colleagues in the journal Lancet Diabetes and Endocrinology, the concept of metabolically healthy obesity underscores the need to consider other metabolic and anthropometric parameters, in addition to BMI, when it comes to the prediction of metabolic diseases in obese people. Furthermore, this concept might be used in future clinical practice to design intervention strategies that are tailored in their intensity and duration based on the metabolic profile and the presence or absence of fatty liver in obese people.
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