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).

代謝健康的概念，特別是肥胖的概念，已經(jīng)引起了科學界的廣泛關注，并且越來越多地被用于確定心血管疾病和糖尿病相關并發(fā)癥的風險。本綜述評估了目前對代謝健康肥胖（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，我們介紹了這個概念的歷史演變。。第三，我們強調(diào)了有關MHO心血管風險的流行病學數(shù)據(jù)，與代謝健康的正常體重個體相比，使用廣泛使用的MHO定義估計MHO的心血管風險適度升高，但使用新的MHO定義可能不會升高。

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，我們討論了有關MHO所涉及的生理機制的新發(fā)現(xiàn)，以及這些知識如何幫助識別和表征MHO患者和代謝不健康的正常體重患者。最后，我們討論了MHO的概念如何用于臨床實踐中的風險分層和治療。關鍵點。

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

代謝健康肥胖（MHO）的概念在科學界引起了極大的關注。

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.

使用廣泛使用的MHO定義，與代謝健康的正常體重個體相比，MHO個體的總心血管風險適度升高。

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.

當使用MHO的新定義時，與代謝健康的正常體重個體相比，MHO個體的心血管死亡風險可能不會升高。

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.

新的遺傳數(shù)據(jù)強烈支持以下假設：身體脂肪組織分布，包括在臀股脂肪組織區(qū)室中擴大脂肪組織質(zhì)量的能力，是MHO的重要決定因素。

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

迄今為止，MHO的概念可用于臨床實踐中的風險分層和治療。

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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.

圖1：隨著時間的推移，代謝健康肥胖概念的發(fā)展。圖2：建立代謝健康肥胖新定義的過程。圖3：根據(jù)BMI和代謝健康狀況的亞組心血管風險。圖4：代謝健康穩(wěn)定性與心血管疾病風險向代謝不健康表型轉變的后果。圖。

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： 。圖6：識別和治療代謝健康和代謝高危肥胖人群的潛在策略。。

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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.

下載參考文獻致謝作者感謝德國聯(lián)邦教育和研究部（BMBF）對德國糖尿病研究中心（DZD）的資助以及肥胖表型分層以優(yōu)化未來肥胖治療（SOPHIA）項目的支持。

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.

作者感謝M.Bauer（德國波茨坦人類營養(yǎng)研究所）在文獻處理和數(shù)據(jù)提取方面的幫助，以及E.Llanaj（德國波茨坦人類營養(yǎng)研究所）在編制數(shù)字初始版本方面的幫助。作者信息作者和所屬機構德國人類營養(yǎng)研究所波茨坦-雷布呂克分子流行病學系，德國納瑟塔爾，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波茨坦大學營養(yǎng)科學研究所，Nuthetal，GermanyMatthias B.SchulzeDepartment of Internal Medicine IV，Tubingen大學醫(yī)院，Tubingen，GermanyNorbert Stefan慕尼黑亥姆霍茲中心糖尿病研究與代謝疾病研究所（IDM），德國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

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馬蒂亞斯·B·舒爾茨。道德宣言

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The authors declare no competing interests.

作者聲明沒有利益沖突。

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同行評審信息

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

《自然評論》內(nèi)分泌學感謝卡爾·拉維（CarlLavie）和另一位匿名審稿人對這項工作的同行評審做出的貢獻。

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的注釋Springer Nature在已發(fā)布的地圖和機構隸屬關系中的管轄權主張方面保持中立。相關linksUK生物庫：https://www.ukbiobank.ac.uk/Rights許可Pringer Nature或其許可方（例如協(xié)會或其他合作伙伴）根據(jù)與作者或其他權利持有人的出版協(xié)議對本文擁有專有權；本文接受稿件版本的作者自行存檔僅受此類出版協(xié)議和適用法律的條款管轄。轉載和許可本文引用本文Schulze，M.B.，Stefan，N。

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

代謝健康肥胖：從流行病學和機制到臨床意義。。

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