Merriam, George R.

ObjectiveIt is unclear why despite a comparable cardiometabolic risk profile, “metabolically benign” overweight/obese individuals show an elevated risk of cardiovascular disease compared to normal weight individuals.Design and MethodsIn cross‐sectional analyses, we compared levels of ectopic fat (epicardial, pericardial, and hepatic fat) and adipokines (leptin, soluble leptin receptor, and high molecular weight [HMW] adiponectin) among metabolically benign (MBO) and at‐risk overweight/obese (ARO), and metabolically benign normal weight (MBNW) women, screened for the Kronos Early Estrogen Prevention Study. We defined “metabolically benign” with ≤ 1, and “at‐risk” with ≥2 components of the metabolic syndrome.ResultsCompared to MBO women, ARO women had significantly elevated odds of being in the top tertile of epicardial fat (OR: 1.76, 95% CI: 1.04‐2.99), hepatic fat (OR: 1.90, 95% CI:1.12‐3.24) and leptin (OR: 2.15, 95% CI: 1.23‐3.76), and the bottom tertile of HMW‐adiponectin (OR: 2.90, 95% CI: 1.62‐5.19). Compared to MBNW women, MBO women had significantly higher odds of being in the top tertile of epicardial fat (OR: 5.17, 95% CI: 3.22‐8.29), pericardial fat (OR: 9.27, 95% CI: 5.52‐15.56) and hepatic fat (OR: 2.72, 95% CI: 1.77‐4.19) and the bottom tertile of HMW adiponectin levels (OR: 2.51, 95% CI: 1.60‐3.94).ConclusionsLevels of ectopic fat and the adverse adipokine profile increase on a continuum of BMI, suggesting that the metabolically benign phenotype may be a transient state.