{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T21:35:26Z","timestamp":1789680926235,"version":"4.0.1"},"reference-count":49,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2023,12,22]],"date-time":"2023-12-22T00:00:00Z","timestamp":1703203200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Natioanl Resarch Foundation of Korea (NRF) funded by Medical Research Center","award":["RS-2023-00219563"],"award-info":[{"award-number":["RS-2023-00219563"]}]},{"name":"Korean Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare","award":["HI22C2193"],"award-info":[{"award-number":["HI22C2193"]}]},{"DOI":"10.13039\/501100002560","name":"Soonchunhyang University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002560","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>We investigated the differences in quantity and quality of skeletal muscle between metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO) individuals using abdominal CT. One hundred and seventy-two people with morbid obesity who underwent bariatric surgery and 64 healthy control individuals participated in this retrospective study. We divided the people with morbid obesity into an MHO and MUO group. In addition, nonobese metabolic healthy people were included analysis to provide reference levels. CT evaluation of muscle quantity (at the level of the third lumbar vertebra [L3]) was performed by calculating muscle anatomical cross-sectional area (CSA), which was normalized to patient height to produce skeletal muscle index (SMI). Muscle quality was assessed as skeletal muscle density (SMD), which was calculated from CT muscle attenuation. To characterize intramuscular composition, muscle attenuation was classified into three categories using Hounsfield unit (HU) thresholds: -190 HU to -30 HU for intermuscular adipose tissue (IMAT), -29 to +29 HU for low attenuation muscle (LAM), and +30 to +150 HU for normal attenuation muscle (NAM). People with morbid obesity comprised 24 (14%) MHO individuals and 148 (86%) MUO individuals. The mean age of the participants was 39.7 \u00b1 12.5 years, and 154 (65%) participants were women. MUO individuals had a significantly greater total skeletal muscle CSA than MHO individuals in the model that adjusted for all variables. Total skeletal muscle SMI, SMD, NAM index, LAM index, and IMAT index did not differ between MHO and MUO individuals for all adjusted models. Total skeletal muscle at the L3 level was not different in muscle quantity, quality, or intramuscular composition between the MHO and MUO individuals, based on CT evaluation. MHO individuals who are considered \u201chealthy\u201d should be carefully monitored and can have a similar risk of metabolic complications as MUO individuals, at least based on an assessment of skeletal muscle.<\/jats:p>","DOI":"10.1371\/journal.pone.0296073","type":"journal-article","created":{"date-parts":[[2023,12,22]],"date-time":"2023-12-22T18:31:39Z","timestamp":1703269899000},"page":"e0296073","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":15,"title":["Computed tomography evaluation of skeletal muscle quality and quantity in people with morbid obesity with and without metabolic abnormality"],"prefix":"10.1371","volume":"18","author":[{"given":"Eunsun","family":"Oh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nam-Jun","family":"Cho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heemin","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang Hyun","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyeong Kyu","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4114-4196","authenticated-orcid":true,"given":"Soon Hyo","family":"Kwon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,12,22]]},"reference":[{"issue":"1","key":"pone.0296073.ref001","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1001\/jama.2012.113905","article-title":"Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis","volume":"309","author":"KM Flegal","year":"2013","journal-title":"Jama"},{"issue":"3","key":"pone.0296073.ref002","first-page":"1020","article-title":"What are the physical characteristics associated with a normal metabolic profile despite a high level of obesity in postmenopausal women?","volume":"86","author":"M Brochu","year":"2001","journal-title":"J Clin Endocrinol Metab"},{"issue":"7","key":"pone.0296073.ref003","doi-asserted-by":"crossref","first-page":"4145","DOI":"10.1210\/jc.2005-0482","article-title":"The metabolically healthy but obese individual presents a favorable inflammation profile","volume":"90","author":"AD Karelis","year":"2005","journal-title":"J Clin Endocrinol Metab"},{"issue":"7","key":"pone.0296073.ref004","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1038\/ijo.2010.216","article-title":"Characterizing the profile of obese patients who are metabolically healthy.","volume":"35","author":"V Primeau","year":"2011","journal-title":"Int J Obes (Lond)."},{"issue":"11","key":"pone.0296073.ref005","doi-asserted-by":"crossref","first-page":"758","DOI":"10.7326\/0003-4819-159-11-201312030-00008","article-title":"Are metabolically healthy overweight and obesity benign conditions?: A systematic review and meta-analysis","volume":"159","author":"CK Kramer","year":"2013","journal-title":"Ann Intern Med"},{"issue":"12","key":"pone.0296073.ref006","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1016\/j.jacc.2017.07.763","article-title":"Metabolically Healthy Obese and Incident Cardiovascular Disease Events Among 3.5 Million Men and Women","volume":"70","author":"R Caleyachetty","year":"2017","journal-title":"J Am Coll Cardiol"},{"issue":"2","key":"pone.0296073.ref007","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1007\/s13679-020-00375-0","article-title":"Metabolically Healthy Obesity: Criteria, Epidemiology, Controversies, and Consequences.","volume":"9","author":"A Tsatsoulis","year":"2020","journal-title":"Curr Obes Rep."},{"issue":"1","key":"pone.0296073.ref008","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1007\/s00330-021-08090-7","article-title":"Abdominal periaortic and renal sinus fat attenuation indices measured on computed tomography are associated with metabolic syndrome.","volume":"32","author":"EJ Lee","year":"2022","journal-title":"Eur Radiol"},{"issue":"4","key":"pone.0296073.ref009","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1093\/ageing\/afw062","article-title":"Greater skeletal muscle fat infiltration is associated with higher all-cause mortality among men of African ancestry.","volume":"45","author":"Q Zhao","year":"2016","journal-title":"Age Ageing"},{"issue":"4","key":"pone.0296073.ref010","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1161\/ATVBAHA.112.301009","article-title":"Intramuscular fat and associations with metabolic risk factors in the Framingham Heart Study","volume":"33","author":"KE Therkelsen","year":"2013","journal-title":"Arterioscler Thromb Vasc Biol"},{"issue":"31","key":"pone.0296073.ref011","doi-asserted-by":"crossref","first-page":"12587","DOI":"10.1073\/pnas.0705408104","article-title":"The role of skeletal muscle insulin resistance in the pathogenesis of the metabolic syndrome","volume":"104","author":"KF Petersen","year":"2007","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"Suppl 2","key":"pone.0296073.ref012","doi-asserted-by":"crossref","first-page":"S157","DOI":"10.2337\/dc09-S302","article-title":"Skeletal muscle insulin resistance is the primary defect in type 2 diabetes","volume":"32","author":"RA DeFronzo","year":"2009","journal-title":"Diabetes Care"},{"issue":"1","key":"pone.0296073.ref013","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1172\/JCI88880","article-title":"Skeletal muscle inflammation and insulin resistance in obesity","volume":"127","author":"H Wu","year":"2017","journal-title":"J Clin Invest"},{"issue":"10","key":"pone.0296073.ref014","doi-asserted-by":"crossref","first-page":"3978","DOI":"10.1172\/JCI129186","article-title":"Metabolically healthy obesity: facts and fantasies","volume":"129","author":"GI Smith","year":"2019","journal-title":"J Clin Invest"},{"issue":"15","key":"pone.0296073.ref015","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1001\/archinte.168.15.1609","article-title":"Identification and characterization of metabolically benign obesity in humans","volume":"168","author":"N Stefan","year":"2008","journal-title":"Arch Intern Med"},{"issue":"5","key":"pone.0296073.ref016","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1053\/j.gastro.2008.01.075","article-title":"Liver, muscle, and adipose tissue insulin action is directly related to intrahepatic triglyceride content in obese subjects.","volume":"134","author":"KM Korenblat","year":"2008","journal-title":"Gastroenterology."},{"issue":"3","key":"pone.0296073.ref017","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1016\/j.jtcvs.2015.11.022","article-title":"Psoas muscle size as a frailty measure for open and transcatheter aortic valve replacement.","volume":"151","author":"R Paknikar","year":"2016","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"2","key":"pone.0296073.ref018","doi-asserted-by":"crossref","first-page":"e164604","DOI":"10.1001\/jamasurg.2016.4604","article-title":"Association of Radiologic Indicators of Frailty With 1-Year Mortality in Older Trauma Patients: Opportunistic Screening for Sarcopenia and Osteopenia","volume":"152","author":"SJ Kaplan","year":"2017","journal-title":"JAMA Surg"},{"issue":"7","key":"pone.0296073.ref019","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1093\/gerona\/gly183","article-title":"Opportunistic Measurement of Skeletal Muscle Size and Muscle Attenuation on Computed Tomography Predicts 1-Year Mortality in Medicare Patients","volume":"74","author":"L Lenchik","year":"2019","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"2","key":"pone.0296073.ref020","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1002\/jcsm.12039","article-title":"Sarcopenic obesity and myosteatosis are associated with higher mortality in patients with cirrhosis.","volume":"7","author":"AJ Montano-Loza","year":"2016","journal-title":"J Cachexia Sarcopenia Muscle"},{"issue":"3","key":"pone.0296073.ref021","doi-asserted-by":"crossref","first-page":"W255","DOI":"10.2214\/AJR.15.14635","article-title":"Sarcopenia: Current Concepts and Imaging Implications.","volume":"205","author":"RD Boutin","year":"2015","journal-title":"AJR Am J Roentgenol."},{"issue":"10","key":"pone.0296073.ref022","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1093\/gerona\/glz034","article-title":"Approaches to Assessment of Muscle Mass and Myosteatosis on Computed Tomography","volume":"74","author":"B Amini","year":"2019","journal-title":"A Systematic Review. J Gerontol A Biol Sci Med Sci"},{"issue":"10","key":"pone.0296073.ref023","doi-asserted-by":"crossref","first-page":"e23049","DOI":"10.2196\/23049","article-title":"Assessment of Myosteatosis on Computed Tomography by Automatic Generation of a Muscle Quality Map Using a Web-Based Toolkit: Feasibility Study.","volume":"8","author":"DW Kim","year":"2020","journal-title":"JMIR Med Inform."},{"issue":"6","key":"pone.0296073.ref024","doi-asserted-by":"crossref","first-page":"1818","DOI":"10.1016\/j.clnu.2019.07.021","article-title":"Relationship between metabolic syndrome and trunk muscle quality as well as quantity evaluated by computed tomography.","volume":"39","author":"M Tanaka","year":"2020","journal-title":"Clin Nutr"},{"issue":"1","key":"pone.0296073.ref025","doi-asserted-by":"crossref","first-page":"85","DOI":"10.2214\/AJR.20.23049","article-title":"Utilizing Fully Automated Abdominal CT-Based Biomarkers for Opportunistic Screening for Metabolic Syndrome in Adults Without Symptoms.","volume":"216","author":"PJ Pickhardt","year":"2021","journal-title":"AJR Am J Roentgenol."},{"issue":"8","key":"pone.0296073.ref026","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1002\/oby.23190","article-title":"Comparison of muscle mass and quality between metabolically healthy and unhealthy phenotypes.","volume":"29","author":"HK Kim","year":"2021","journal-title":"Obesity (Silver Spring)."},{"issue":"17","key":"pone.0296073.ref027","doi-asserted-by":"crossref","first-page":"2735","DOI":"10.1161\/CIRCULATIONAHA.105.169404","article-title":"Diagnosis and management of the metabolic syndrome: an American Heart Association\/National Heart, Lung, and Blood Institute Scientific Statement.","volume":"112","author":"SM Grundy","year":"2005","journal-title":"Circulation."},{"issue":"5","key":"pone.0296073.ref028","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1139\/H08-075","article-title":"A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care","volume":"33","author":"M Mourtzakis","year":"2008","journal-title":"Appl Physiol Nutr Metab"},{"issue":"3","key":"pone.0296073.ref029","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1111\/apha.12224","article-title":"Measurement of skeletal muscle radiation attenuation and basis of its biological variation.","volume":"210","author":"J Aubrey","year":"2014","journal-title":"Acta Physiol (Oxf)."},{"issue":"6","key":"pone.0296073.ref030","doi-asserted-by":"crossref","first-page":"2333","DOI":"10.1152\/japplphysiol.00744.2004","article-title":"Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image","volume":"97","author":"W Shen","year":"2004","journal-title":"J Appl Physiol (1985)"},{"issue":"1","key":"pone.0296073.ref031","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1186\/s12891-020-03432-w","article-title":"Paraspinal back muscles in asymptomatic volunteers: quantitative and qualitative analysis using computed tomography (CT) and magnetic resonance imaging (MRI).","volume":"21","author":"EK Khil","year":"2020","journal-title":"BMC Musculoskelet Disord"},{"key":"pone.0296073.ref032","doi-asserted-by":"crossref","first-page":"623","DOI":"10.2147\/DMSO.S194690","article-title":"MRI assessment of ectopic fat accumulation in pancreas, liver and skeletal muscle in patients with obesity, overweight and normal BMI in correlation with the presence of central obesity and metabolic syndrome.","volume":"12","author":"J Pie\u0144kowska","year":"2019","journal-title":"Diabetes Metab Syndr Obes."},{"issue":"9","key":"pone.0296073.ref033","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1177\/2047487315623884","article-title":"Metabolically healthy obesity and cardiovascular events: A systematic review and meta-analysis.","volume":"23","author":"N Eckel","year":"2016","journal-title":"Eur J Prev Cardiol"},{"issue":"6","key":"pone.0296073.ref034","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1111\/obr.12157","article-title":"Metabolically healthy obesity and risk of incident type 2 diabetes: a meta-analysis of prospective cohort studies","volume":"15","author":"JA Bell","year":"2014","journal-title":"Obes Rev"},{"issue":"6","key":"pone.0296073.ref035","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1093\/ajcn\/82.6.1210","article-title":"Independent association of insulin resistance with larger amounts of intermuscular adipose tissue and a greater acute insulin response to glucose in African American than in white nondiabetic women","volume":"82","author":"JB Albu","year":"2005","journal-title":"Am J Clin Nutr"},{"issue":"3","key":"pone.0296073.ref036","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1152\/japplphysiol.00221.2002","article-title":"Invited Review: Role of insulin in translational control of protein synthesis in skeletal muscle by amino acids or exercise","volume":"93","author":"SR Kimball","year":"2002","journal-title":"J Appl Physiol (1985)."},{"issue":"Pt 1","key":"pone.0296073.ref037","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1113\/jphysiol.2004.068841","article-title":"Differential effects of insulin and dietary amino acids on muscle protein synthesis in adult and old rats","volume":"563","author":"M Prod\u2019homme","year":"2005","journal-title":"J Physiol"},{"issue":"12","key":"pone.0296073.ref038","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1038\/ijo.2013.45","article-title":"Insulin and extremity muscle mass in overweight and obese women.","volume":"37","author":"B Leon","year":"2013","journal-title":"Int J Obes (Lond)."},{"issue":"4","key":"pone.0296073.ref039","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1002\/wdev.230","article-title":"Skeletal muscle fiber type: using insights from muscle developmental biology to dissect targets for susceptibility and resistance to muscle disease","volume":"5","author":"J Talbot","year":"2016","journal-title":"Wiley Interdiscip Rev Dev Biol"},{"issue":"6","key":"pone.0296073.ref040","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1002\/jor.1100150614","article-title":"Fibre type characteristics of the lumbar paraspinal muscles in normal healthy subjects and in patients with low back pain","volume":"15","author":"AF Mannion","year":"1997","journal-title":"J Orthop Res"},{"issue":"6","key":"pone.0296073.ref041","doi-asserted-by":"crossref","first-page":"1825","DOI":"10.2337\/diacare.26.6.1825","article-title":"Correlation between midthigh low-density muscle and insulin resistance in obese nondiabetic patients in Korea","volume":"26","author":"D Kim","year":"2003","journal-title":"Diabetes Care"},{"key":"pone.0296073.ref042","doi-asserted-by":"crossref","first-page":"110752","DOI":"10.1016\/j.nut.2020.110752","article-title":"Low-attenuation muscle is a predictor of diabetes mellitus: A population-based cohort study","volume":"74","author":"M Tanaka","year":"2020","journal-title":"Nutrition"},{"issue":"6","key":"pone.0296073.ref043","doi-asserted-by":"crossref","first-page":"R209","DOI":"10.1530\/EJE-14-0540","article-title":"Are metabolically healthy obese individuals really healthy?","volume":"171","author":"M. Bl\u00fcher","year":"2014","journal-title":"Eur J Endocrinol"},{"issue":"3","key":"pone.0296073.ref044","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1159\/000471488","article-title":"The Metabolic Phenotype in Obesity: Fat Mass, Body Fat Distribution, and Adipose Tissue Function.","volume":"10","author":"GH Goossens","year":"2017","journal-title":"Obes Facts."},{"issue":"2","key":"pone.0296073.ref045","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/S2213-8587(13)70062-7","article-title":"Metabolically healthy obesity: epidemiology, mechanisms, and clinical implications","volume":"1","author":"N Stefan","year":"2013","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"3","key":"pone.0296073.ref046","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1002\/jcsm.12533","article-title":"Lipid is heterogeneously distributed in muscle and associates with low radiodensity in cancer patients","volume":"11","author":"AS Bhullar","year":"2020","journal-title":"J Cachexia Sarcopenia Muscle"},{"issue":"1","key":"pone.0296073.ref047","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1038\/ijo.2016.151","article-title":"The individual and combined effects of obesity- and ageing-induced systemic inflammation on human skeletal muscle properties","volume":"41","author":"RM Erskine","year":"2017","journal-title":"Int J Obes (Lond)."},{"issue":"3","key":"pone.0296073.ref048","doi-asserted-by":"crossref","first-page":"9652","DOI":"10.1007\/s11357-014-9652-1","article-title":"Combined effects of body composition and ageing on joint torque, muscle activation and co-contraction in sedentary women.","volume":"36","author":"DJ Tomlinson","year":"2014","journal-title":"Age (Dordr)."},{"issue":"6","key":"pone.0296073.ref049","doi-asserted-by":"crossref","DOI":"10.14814\/phy2.12030","article-title":"Obesity decreases both whole muscle and fascicle strength in young females but only exacerbates the aging-related whole muscle level asthenia.","volume":"2","author":"DJ Tomlinson","year":"2014","journal-title":"Physiol Rep"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0296073","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,22]],"date-time":"2023-12-22T18:32:06Z","timestamp":1703269926000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0296073"}},"subtitle":[],"editor":[{"given":"Valeria","family":"Guglielmi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,12,22]]},"references-count":49,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12,22]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0296073","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,22]]}}}