Are Abdominal Obese Metabolically Healthy Phenotype a Benign Condition? Protocol for a Systematic Review

Soraya Doustmohamadian, Farhad Hosseinpanah, Marjan Momeni


Background: The prevalence of obesity is increasing worldwide. Obesity is associated with severe health effects. Abdominal obesity has a strong association with metabolic dysfunction. A subgroup of people with central obesity has been identified without typical metabolic disorders associated with obesity that has been known metabolically healthy abdominal obese (MHAO). The purpose of this review is to evaluate the MHAO phenotype in the context of type 2 DM incidence, risk of cardiovascular diseases, and all‑cause of mortality. Methods: This is a protocol of systematic review. We will search PubMed/MEDLINE, EMBASE, Web of Science, Cochrane Library, and ProQuest. Additional studies will be identified through manual searching of reference lists. Quantitative studies evaluating abdominal obesity phenotype outcomes in adults will be included. Primary results will be assaying abdominal obesity phenotype results, including DM2 incidence, cardiovascular disease risk, and all‑cause mortality. Two reviewers will independently screen full‑text articles and abstract data. Statistical Analysis Used: Potential conflicts will be resolved through discussion. Results: The study methodological quality (or bias) will be appraised using appropriate tools. If feasible, we will conduct a random‑effects meta‑analysis. The researchers will also assess the quality of the articles independently based on Newcastle‑Ottawa scale. Conclusions: The results of this review will provide a useful reference for the effect of abdominal obesity on metabolic dysfunction and cardiovascular or all‑cause mortality


“All‑cause mortality”; abdominal obesity; cardiovascular disease; metabolically healthy

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Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of

childhood and adult obesity in the United States, 2011‑2012.

JAMA 2014;311:806‑14.

Reilly JJ, Methven E, McDowell ZC, Hacking B, Alexander D,

Stewart L, et al. Health consequences of obesity. Arch Dis Child


Hassanabadi MS, Mirhosseini SJ, Mirzaei M, Namayandeh SM,

Beiki O, Gannar F, et al. The most important predictors of

metabolic syndrome persistence after 10‑year follow‑up: YHHP

study. Int J Prev Med 2020;11:33.

Haidari F, Abiri B, Haghighizadeh M‑H, Kayedani GA,

Birgani NK. Association of hematological parameters with

obesity‑induced inflammation among young females in Ahvaz,

South‑West of Iran. Int J Prev Med 2020;11:55.

Larsson B, Svärdsudd K, Welin L, Wilhelmsen L,

Björntorp P, Tibblin G. Abdominal adipose tissue distribution,

obesity, and risk of cardiovascular disease and death: 13 year

follow up of participants in the study of men born in 1913. Br

Med J (Clin Res Ed) 1984;288:1401‑4.

Ducimetiere P, Richard J, Cambien F. The pattern of

subcutaneous fat distribution in middle‑aged men and the risk of coronary heart disease: The Paris Prospective Study. Int J


Dagenais GR, Yi Q, Mann JF, Bosch J, Pogue J, Yusuf S,

et al. Prognostic impact of body weight and abdominal obesity

in women and men with cardiovascular disease. Am Heart J


Bell JA, Kivimaki M, Hamer M. Metabolically healthy obesity

and risk of incident type 2 diabetes: A meta-analysis of

prospective cohort studies. Obes Rev 2014;15:504‑15.

Hamer M, Stamatakis E. Metabolically healthy obesity and

risk of all‑cause and cardiovascular disease mortality. J Clin

Endocrinol Metabol 2012;97:2482‑8.

Després J‑P. Health consequences of visceral obesity. Ann Med


Jacobs EJ, Newton CC, Wang Y, Patel AV, McCullough ML,

Campbell PT, et al. Waist circumference and all‑cause mortality

in a large US cohort. Arch Inter Med 2010;170:1293‑301.

Leitzmann MF, Moore SC, Koster A, Harris TB, Park Y,

Hollenbeck A, et al. Waist circumference as compared with

body‑mass index in predicting mortality from specific causes.

PLoS One 2011;6:e18582.

Doustmohamadian S, Serahati S, Barzin M, Keihani S, Azizi F,

Hosseinpanah F. Risk of all‑cause mortality in abdominal obesity

phenotypes: Tehran Lipid and Glucose Study. Nutr Metab

Cardiovasc Dis 2017;27:241‑8.

Keihani S, Hosseinpanah F, Barzin M, Serahati S,

Doustmohamadian S, Azizi F. Abdominal obesity phenotypes

and risk of cardiovascular disease in a decade of follow‑up:

The Tehran Lipid and Glucose Study. Atherosclerosis


Blüher M. The distinction of metabolically ‘healthy’from

‘unhealthy’obese individuals. Curr Opin Lipidol 2010;21:38‑43.

Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A,

Petticrew M, et al. Preferred reporting items for systematic

review and meta‑analysis protocols (PRISMA‑P) 2015:

Elaboration and explanation. BMJ 2015;50:g7647. doi: 10.1136/


Krause C, Sommerhalder K, Beer‑Borst S, Abel T. Just a subtle

difference? Findings from a systematic review on definitions

of nutrition literacy and food literacy. Health Promot Int


Scale N‑O. Wells GA, Shea B, O’Connell D, Peterson J,

Welch V, et al. The Newcastle-Ottawa Scale (NOS) for assessing

the quality of nonrandomized studies in meta-analyses. Appl Eng

Agric. 2014;18:727-34.

Hosseinpanah F, Barzin M, Sheikholeslami F, Azizi F. Effect

of different obesity phenotypes on cardiovascular events

in Tehran Lipid and Glucose Study (TLGS). Am J Cardiol


Meigs JB, Wilson PW, Fox CS, Vasan RS, Nathan DM,

Sullivan LM, et al. Body mass index, metabolic syndrome,

and risk of type 2 diabetes or cardiovascular disease. J Clin

Endocrinol Metabol 2006;91:2906‑12.

Romero‑Corral A, Somers VK, Sierra‑Johnson J, Korenfeld Y,

Boarin S, Korinek J, et al. Normal weight obesity: A risk factor

for cardiometabolic dysregulation and cardiovascular mortality.

Eur Heart J 2010;31:737‑46.

Leitzmann MF, Moore SC, Koster A, Harris TB, Park Y,

Hollenbeck A, et al. Waist circumference as compared with

body‑mass index in predicting mortality from specific causes.

PLoS One 2011;6:e18582.

Calori G, Lattuada G, Piemonti L, Garancini MP, Ragogna F,

Villa M, et al. Prevalence, metabolic features, and prognosis of

metabolically healthy obese Italian individuals: The Cremona

Study. Diabetes Care 2011;34:210‑5.

van der A DL, Nooyens AC, van Duijnhoven FJ, Verschuren MM,

Boer JM. All-cause mortality risk of metabolically healthy

abdominal obese individuals: The EPIC-MORGEN study.

Obesity 2014;22:557‑64.

Abdullah A, Stoelwinder J, Shortreed S, Wolfe R, Stevenson C,

Walls H, et al. The duration of obesity and the risk of type 2

diabetes. Public Health Nutr 2011;14:119‑26.

Eshtiaghi R, Keihani S, Hosseinpanah F, Barzin M, Azizi F.

Natural course of metabolically healthy abdominal obese adults

after 10 years of follow‑up: The Tehran Lipid and Glucose

Study. Int J Obes 2015;39:514‑9.