Abdominal obesity and adipocyte metabolic activity: criteria for "health" and "neutrality"

The last decades of the late 20th and early 21st centuries have seen a rapid growth of non-infectious diseases such as abdominal obesity, prehypertension, hypertension, diabetes mellitus type 2. According to official data, preobesity is diagnosed in 40.1% of the adult population of Russia; 21.6% of Russians are obese; and only 36.3% of our fellow citizens have normal body weight. The combination of obesity, hypertension, diabetes mellitus type 2 and atherogenic dyslipidemia are the criteria for metabolic syndrome — a proven risk factor for progression and complicated course of cardiovascular disease. The scientific community is actively discussing about the appropriateness of singling out a group of patients with “metabolically healthy” obesity and criteria for its diagnosis, but the hormonal activity of adipose tissue is not evaluated. Leptin is involved in the metabolism of glucose and fatty acids, and leptinresistance is an important prognostic marker of the complicated obesity. On the based of our own scientific data results, the concept of “metabolically neutral” obesity - obesity with normal adipokines activity (leptin concentration < 3.5 ng/ml) without signs of insulinresistance was formulated and proposed. It was shown that in this metabolic type of obesity the prevalence of dyslipidemia was 1.7 times, prediabetes — 2 times, atherosclerosis of common carotid arteries — 1.5 times lower than in “metabolically healthy” obesity. Determining the level of leptin in uncomplicated obesity allows stratifying patients into groups with normal and increased adipokines activity. The highlighting of the “metabolically neutral” type of obesity is considered by us to be practically justified, as it allows to determine the stage of the disease at which the frequency of metabolic and cardiovascular disorders is still minimal and non-drug prevention is necessary. Exceeding the threshold of leptin level > 3.5 ng/ml in obesity may require a more aggressive lifestyle correction, and possibly an early start to drug therapy.