High adiponectin concentrations are associated with the metabolically healthy obese phenotype

Context: In the ob/ob mice, keeping adiponectin concentrations in the physiological range (through overexpression of this gene in the adipose tissue) results in expansion of fat mass and protection against metabolic co-morbidities. Objective: The aim of the study was to test in humans whether plasma adiponectin levels, similar to those found in lean subjects, are associated with the metabolically healthy obese phenotype. Design and Setting: A cross-sectional analysis was performed of a cohort of obese and nonobese subjects aged 18-70 yr. A medical history was taken, and glucose, plasma lipids, and total adiponectin were measured. Participants: We studied 189 men and 527 women. The majority were obese (n = 470, 65.6%). The metabolically healthy obese phenotype was found in 38 men and 133 women. This is defined as a body mass index (BMI) above 30 kg/m(2) plus high-density lipoprotein cholesterol of at least 40 mg/dl in the absence of type 2 diabetes and arterial hypertension. Results: Twenty percent of the cases with a BMI above 40kg/m(2) had adiponectin concentrations above the median value of normal BMI subjects. Adiponectin levels above 12.49 mg/liter in obese women (odds ratio, 3.02; 95% confidence interval, 1.95-4.67; P < 0.001) and above 8.07 mg/liter in obese men (odds ratio, 2.14; 95% confidence interval, 1.1-4.06; P = 0.01) increased the probability of being metabolically healthy. The association remained significant (beta, 0.673 +/- 0.205, P < 0.001) in a logistic regression model (r(2) = 0.25, P < 0.001) after controlling for the confounding effect of age, insulin, and waist circumference. Conclusions: Certain obese individuals have adiponectin levels similar to those found in normal BMI subjects; this is associated with the metabolically healthy obese phenotype.