{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T06:28:16Z","timestamp":1773901696204,"version":"3.50.1"},"reference-count":231,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2020,1,27]],"date-time":"2020-01-27T00:00:00Z","timestamp":1580083200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"FEDER \u2013 Fundo Europeu de Desenvolvimento Regional, through NORTE 2020 Programa Operacional Regional do Norte","award":["NORTE-01-0145-FEDER-000012"],"award-info":[{"award-number":["NORTE-01-0145-FEDER-000012"]}]},{"name":"Instituto de Investiga\u00e7\u00e3o e Inova\u00e7\u00e3o em Sa\u00fade","award":["UID\/BIM\/04293\/2013"],"award-info":[{"award-number":["UID\/BIM\/04293\/2013"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Metabolites"],"abstract":"<jats:p>The concept of heterogeneity among obese individuals in their risk for developing metabolic dysfunction and associated complications has been recognized for decades. At the origin of the heterogeneity idea is the acknowledgement that individuals with central obesity are more prone to developing type 2 diabetes and cardiovascular disease than those with peripheral obesity. There have been attempts to categorize subjects according to their metabolic health and degree of obesity giving rise to different obese and non-obese phenotypes that include metabolically unhealthy normal-weight (MUHNW), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO). Individuals belonging to the MHO phenotype are obese according to their body mass index although exhibiting fewer or none metabolic anomalies such as type 2 diabetes, dyslipidemia, hypertension, and\/or unfavorable inflammatory and fribinolytic profiles. However, some authors claim that MHO is only transient in nature. Additionally, the phenotype categorization is controversial as it lacks standardized definitions possibly blurring the distinction between obesity phenotypes and confounding the associations with health outcomes. To add to the discussion, the factors underlying the origin or protection from metabolic deterioration and cardiometabolic risk for these subclasses are being intensely investigated and several hypotheses have been put forward. In the present review, we compare the different definitions of obesity phenotypes and present several possible factors underlying them (adipose tissue distribution and cellularity, contaminant accumulation on the adipose tissue, dysbiosis and metabolic endotoxemia imposing on to the endocannabinoid tone and inflammasome, and nutrient intake and dietary patterns) having inflammatory activation at the center.<\/jats:p>","DOI":"10.3390\/metabo10020048","type":"journal-article","created":{"date-parts":[[2020,1,27]],"date-time":"2020-01-27T11:41:57Z","timestamp":1580125317000},"page":"48","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":85,"title":["Metabolically Healthy Obesity\u2014Heterogeneity in Definitions and Unconventional Factors"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3767-9515","authenticated-orcid":false,"given":"In\u00eas","family":"Brand\u00e3o","sequence":"first","affiliation":[{"name":"Departament of Biomedicine, Biochemistry Unit, Faculty of Medicine, University of Porto, Al. Prof. Hern\u00e2ni Monteiro, 4200-319 Porto, Portugal"},{"name":"i3S\u2014Instituto de Investiga\u00e7\u00e3o e Inova\u00e7\u00e3o em Sa\u00fade, University of Porto, 4200-135 Porto, Portugal"},{"name":"Centro de Apoio Tecnol\u00f3gico Agro Alimentar (CATAA), Zona Industrial de Castelo Branco, 6000-459 Castelo Branco, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3560-3261","authenticated-orcid":false,"given":"Maria Jo\u00e3o","family":"Martins","sequence":"additional","affiliation":[{"name":"Departament of Biomedicine, Biochemistry Unit, Faculty of Medicine, University of Porto, Al. Prof. Hern\u00e2ni Monteiro, 4200-319 Porto, Portugal"},{"name":"i3S\u2014Instituto de Investiga\u00e7\u00e3o e Inova\u00e7\u00e3o em Sa\u00fade, University of Porto, 4200-135 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1552-5507","authenticated-orcid":false,"given":"Ros\u00e1rio","family":"Monteiro","sequence":"additional","affiliation":[{"name":"Departament of Biomedicine, Biochemistry Unit, Faculty of Medicine, University of Porto, Al. Prof. Hern\u00e2ni Monteiro, 4200-319 Porto, Portugal"},{"name":"i3S\u2014Instituto de Investiga\u00e7\u00e3o e Inova\u00e7\u00e3o em Sa\u00fade, University of Porto, 4200-135 Porto, Portugal"},{"name":"Administra\u00e7\u00e3o Regional de Sa\u00fade-Norte, Unidade de Sa\u00fade Familiar Pedras Rubras, Agrupamento de Centros de Sa\u00fade Maia-Valongo, 4470-105 Maia, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2020,1,27]]},"reference":[{"key":"ref_1","unstructured":"WHO (2017). 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