{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T17:22:16Z","timestamp":1767633736387,"version":"3.48.0"},"reference-count":61,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Integrated Responsibility Centre for Obesity (CRI-O), of the S\u00e3o Jo\u00e3o Local Health Unit, Porto, Portugal"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Metabolites"],"abstract":"<jats:p>Background: There is no standardized definition for metabolic health. Overweight and obesity are often linked to metabolic dysfunction. Bariatric surgery promotes body weight loss and cardiometabolic health improvement. Objective: We aim to characterize metabolic health using distinct definitions and evaluate anthropometric and cardiometabolic features, both before and after different surgery procedures. Methods: We studied 3313 individuals from CRI-O [Porto, PT; BMI 39.56 (42.60; 46.20) kg\/m2; 36 (43; 51) y; 82.7% women] who underwent Roux-en-Y gastric bypass (RYGB; 61.7%), sleeve gastrectomy (30.9%), or gastric band (7.5%) surgery. Anthropometric and cardiometabolic features were assessed at baseline and at yearly follow-ups, up to 4 years; the same for cardiometabolic dysfunction characterization using NCEP ATP III, Karelis, Meigs, Khan, Pluemacher, and Schulze definitions. Results: Baseline metabolic health classification and metabolically unhealthy phenotype (MUH) post-surgery prevalence decrease show substantial variability depending on the definition used. Unlike relative body weight loss, the altered metabolic feature number in MUH remains unchanged. Changes in MUH prevalence do not reflect body weight loss, nor does the variation in MUH percentage fully align with changes in altered metabolic features. Blood pressure, C-reactive protein, antihypertensive medication, and HOMA-IR are key contributors to baseline MUH. Post-surgical changes in body weight, lipid profile, and C-reactive protein vary by procedure. RYGB yields greater weight loss and more often improves cardiometabolic markers. However, post-operative metabolic phenotype is independent of surgery type. Conclusions: Metabolic health phenotypes pre- and post-surgery vary by definition, and the latter are not solely driven by weight loss or surgery type. In this cohort, RYGB shows the strongest beneficial impact.<\/jats:p>","DOI":"10.3390\/metabo16010047","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T12:38:56Z","timestamp":1767616736000},"page":"47","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Metabolic Outcomes in Bariatric\/Metabolic Surgery Individuals: Impact of Metabolic Health Definition, Type of Surgery, and Follow-Up Duration\u2014An Observational, Retrospective Study"],"prefix":"10.3390","volume":"16","author":[{"given":"Anna","family":"Pluemacher","sequence":"first","affiliation":[{"name":"Faculty of Nutritional Sciences, University of Potsdam, 14476 Potsdam, Germany"},{"name":"Unit of Biochemistry, Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9356-3272","authenticated-orcid":false,"given":"Cl\u00e1udia Camila","family":"Dias","sequence":"additional","affiliation":[{"name":"Knowledge Management Unit, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"RISE-Health, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0579-9988","authenticated-orcid":false,"given":"B\u00e1rbara","family":"Peleteiro","sequence":"additional","affiliation":[{"name":"Centro de Epidemiologia Hospitalar, Unidade Local de Sa\u00fade S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"},{"name":"Departamento de Ci\u00eancias da Sa\u00fade P\u00fablica e Forenses e Educa\u00e7\u00e3o M\u00e9dica, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal"},{"name":"EPIUnit, Instituto de Sa\u00fade P\u00fablica, Universidade do Porto, 4050-600 Porto, Portugal"},{"name":"Laborat\u00f3rio para a Investiga\u00e7\u00e3o Integrativa e Translacional em Sa\u00fade Populacional (ITR), Universidade do Porto, 4050-600 Porto, Portugal"}]},{"given":"Denise","family":"Pinheiro","sequence":"additional","affiliation":[{"name":"Unit of Biochemistry, Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"}]},{"given":"Paula","family":"Freitas","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal"},{"name":"Instituto de Investiga\u00e7\u00e3o e Inova\u00e7\u00e3o em Sa\u00fade (i3S), Universidade do Porto, 4200-135 Porto, Portugal"},{"name":"Integrated Responsibility Center for Obesity (CRI-O), S\u00e3o Jo\u00e3o Local Health Unit, 4200-319 Porto, Portugal"}]},{"given":"Eduardo","family":"Lima","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal"},{"name":"Integrated Responsibility Center for Obesity (CRI-O), S\u00e3o Jo\u00e3o Local Health Unit, 4200-319 Porto, Portugal"}]},{"given":"Alexandra","family":"Leit\u00e3o","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Interna, Unidade Local de Sa\u00fade de Barcelos\/Esposende, 4754-909 Barcelos, Portugal"},{"name":"RISE-Health, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6944-2953","authenticated-orcid":false,"given":"Elisabete","family":"Martins","sequence":"additional","affiliation":[{"name":"RISE-Health, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"Servi\u00e7o de Cardiologia, ULS S. Jo\u00e3o EPE, 4200-319 Porto, Portugal"},{"name":"Department of Medicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3560-3261","authenticated-orcid":false,"given":"Maria Jo\u00e3o","family":"Martins","sequence":"additional","affiliation":[{"name":"Unit of Biochemistry, Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"Instituto de Investiga\u00e7\u00e3o e Inova\u00e7\u00e3o em Sa\u00fade (i3S), Universidade do Porto, 4200-135 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,5]]},"reference":[{"key":"ref_1","unstructured":"WHO (2024, February 03). At Least One in Eight People Now Obese. Available online: https:\/\/news.un.org\/en\/story\/2024\/02\/1147107."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1038\/s41574-024-01008-5","article-title":"Metabolically healthy obesity: From epidemiology and mechanisms to clinical implications","volume":"20","author":"Schulze","year":"2024","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2000","DOI":"10.1001\/jama.2023.19897","article-title":"Obesity Management in Adults: A Review","volume":"330","author":"Schwartz","year":"2023","journal-title":"JAMA"},{"key":"ref_4","unstructured":"World Health Organization (1999). Obesity: Preventing and Managing the Global Epidemic: Report of a WHO Consultation."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1007\/s11695-020-04967-6","article-title":"Effectiveness of Bariatric Surgery in Patients with the Metabolically Healthy Obese Phenotype","volume":"31","author":"Genua","year":"2021","journal-title":"Obes. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.ejim.2023.02.025","article-title":"Metabolically healthy obesity: Misleading phrase or healthy phenotype?","volume":"111","author":"Tanriover","year":"2023","journal-title":"Eur. J. Intern. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2097","DOI":"10.1016\/j.soard.2021.06.020","article-title":"Surgical, metabolic, and prognostic outcomes for Roux-en-Y gastric bypass versus sleeve gastrectomy: A systematic review","volume":"17","author":"Meneses","year":"2021","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Sedaghat, Z., Khodakarim, S., Nejadghaderi, S.A., and Sabour, S. (2024). Association between metabolic syndrome and myocardial infarction among patients with excess body weight: A systematic review and meta-analysis. BMC Public Health, 24.","DOI":"10.1186\/s12889-024-17707-7"},{"key":"ref_9","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":"Eckel","year":"2016","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1007\/s11154-023-09813-5","article-title":"Obesity phenotypes and cardiovascular risk: From pathophysiology to clinical management","volume":"24","author":"Preda","year":"2023","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e70020","DOI":"10.1002\/clc.70020","article-title":"Association Between Overweight\/Obesity Metabolic Phenotypes Defined by Two Criteria of Metabolic Abnormality and Cardiovascular Diseases: A Cross-Sectional Analysis in a Chinese Population","volume":"47","author":"Qiu","year":"2024","journal-title":"Clin. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e13656","DOI":"10.1111\/obr.13656","article-title":"Risk of incident chronic kidney disease in metabolically healthy obesity and metabolically unhealthy normal weight: A systematic review and meta-analysis","volume":"25","author":"Iqbal","year":"2024","journal-title":"Obes. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1097\/MCP.0000000000001073","article-title":"Obesity-related asthma: New insights leading to a different approach","volume":"30","author":"Witte","year":"2024","journal-title":"Curr. Opin. Pulm. Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Chen, Y., Chen, L., Ye, L., Jin, J., Sun, Y., Zhang, L., Zhao, S., Zhang, Y., Wang, W., and Gu, W. (2021). Association of Metabolic Syndrome with Prevalence of Obstructive Sleep Apnea and Remission After Sleeve Gastrectomy. Front. Physiol., 12.","DOI":"10.3389\/fphys.2021.650260"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"238","DOI":"10.4143\/crt.2023.539","article-title":"Association between Metabolically Healthy Status and Risk of Gastrointestinal Cancer","volume":"56","author":"Cui","year":"2024","journal-title":"Cancer Res. Treat."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e70019","DOI":"10.1002\/osp4.70019","article-title":"Metabolic obesity phenotypes and thyroid cancer risk: A systematic exploration of the evidence","volume":"10","author":"Hedayati","year":"2024","journal-title":"Obes. Sci. Pract."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1480","DOI":"10.1038\/s41416-024-02857-7","article-title":"Association of metabolic obesity phenotypes with risk of overall and site-specific cancers: A systematic review and meta-analysis of cohort studies","volume":"131","author":"Aune","year":"2024","journal-title":"Br. J. Cancer"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1910","DOI":"10.2337\/dc09-0943","article-title":"Short-term dynamics and metabolic impact of abdominal fat depots after bariatric surgery","volume":"32","author":"Weiss","year":"2009","journal-title":"Diabetes Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1016\/j.soard.2014.04.022","article-title":"Can bariatric surgery improve cardiovascular risk factors in the metabolically healthy but morbidly obese patient?","volume":"10","author":"Goday","year":"2014","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.soard.2015.04.024","article-title":"Should we wait for metabolic complications before operating on obese patients? Gastric bypass outcomes in metabolically healthy obese individuals","volume":"12","author":"Pelascini","year":"2016","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1007\/s11695-019-04182-y","article-title":"Effects of bariatric surgery in different obesity phenotypes: Tehran Obesity Treatment Study (TOTS)","volume":"30","author":"Barzin","year":"2020","journal-title":"Obes. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1016\/j.numecd.2022.12.017","article-title":"Changes in abdominal fat depots after bariatric surgery are associated with improved metabolic profile","volume":"33","author":"Lee","year":"2023","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/978-3-031-63657-8_1","article-title":"The Definition and Prevalence of Obesity and Metabolic Syndrome: Correlative Clinical Evaluation Based on Phenotypes","volume":"1460","author":"Engin","year":"2024","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1016\/j.soard.2024.08.026","article-title":"Preoperative nonalcoholic steatohepatitis and resolution of metabolic comorbidities after bariatric surgery","volume":"20","author":"Storms","year":"2024","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1007\/s11695-012-0817-7","article-title":"Metabolic effects of bariatric surgery in insulin-sensitive morbidly obese subjects","volume":"23","author":"Perea","year":"2013","journal-title":"Obes. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.1016\/j.soard.2021.07.021","article-title":"Bariatric surgery improves metabolic and nonalcoholic fatty liver disease markers in metabolically healthy patients with morbid obesity at 5 years","volume":"17","author":"Goday","year":"2021","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Luna, M., Pereira, S., Saboya, C., and Ramalho, A. (2024). Relationship between Body Adiposity Indices and Reversal of Metabolically Unhealthy Obesity 6 Months after Roux-en-Y Gastric Bypass. Metabolites, 14.","DOI":"10.3390\/metabo14090502"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Sesti, G., Folli, F., Perego, L., Hribal, M.L., and Pontiroli, A.E. (2011). Effects of weight loss in metabolically healthy obese subjects after laparoscopic adjustable gastric banding and hypocaloric diet. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0017737"},{"key":"ref_29","unstructured":"By-Band-Sleeve Collaborative Group (2025). Roux-en-Y gastric bypass, adjustable gastric banding, or sleeve gastrectomy for severe obesity (By-Band-Sleeve): A multicentre, open label, three-group, randomised controlled trial. Lancet Diabetes Endocrinol., 13, 410\u2013426."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Brand\u00e3o, I., Martins, M.J., and Monteiro, R. (2020). Metabolically Healthy Obesity-Heterogeneity in Definitions and Unconventional Factors. Metabolites, 10.","DOI":"10.3390\/metabo10020048"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1186\/s10020-024-01019-y","article-title":"The interplay of factors in metabolic syndrome: Understanding its roots and complexity","volume":"30","author":"Islam","year":"2024","journal-title":"Mol. Med."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Ion, R.M., Sibianu, M., Hutanu, A., Beresescu, F.G., Sala, D.T., Flavius, M., Rosca, A., Constantin, C., Scurtu, A., and Moriczi, R. (2023). A Comprehensive Summary of the Current Understanding of the Relationship between Severe Obesity, Metabolic Syndrome, and Inflammatory Status. J. Clin. Med., 12.","DOI":"10.3390\/jcm12113818"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"(2002). National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation, 106, 3143\u20133421.","DOI":"10.1161\/circ.106.25.3143"},{"key":"ref_34","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":"Grundy","year":"2005","journal-title":"Circulation"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"(2001). Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA, 285, 2486\u20132497.","DOI":"10.1001\/jama.285.19.2486"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Fahed, G., Aoun, L., Bou Zerdan, M., Allam, S., Bou Zerdan, M., Bouferraa, Y., and Assi, H.I. (2022). Metabolic Syndrome: Updates on Pathophysiology and Management in 2021. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23020786"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1111\/j.1462-8902.2004.00377.x","article-title":"Clinical markers for the identification of metabolically healthy but obese individuals","volume":"6","author":"Karelis","year":"2004","journal-title":"Diabetes Obes. Metab."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1016\/S1262-3636(07)70156-8","article-title":"Can we identify metabolically healthy but obese individuals (MHO)?","volume":"30","author":"Karelis","year":"2004","journal-title":"Diabetes Metab."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2906","DOI":"10.1210\/jc.2006-0594","article-title":"Body mass index, metabolic syndrome, and risk of type 2 diabetes or cardiovascular disease","volume":"91","author":"Meigs","year":"2006","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.atherosclerosis.2011.01.007","article-title":"Burden of subclinical cardiovascular disease in \u201cmetabolically benign\u201d and \u201cat-risk\u201d overweight and obese women: The Study of Women\u2019s Health Across the Nation (SWAN)","volume":"217","author":"Khan","year":"2011","journal-title":"Atherosclerosis"},{"key":"ref_41","unstructured":"GBD 2021 Diabetes Collaborators (2023). Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: A systematic analysis for the Global Burden of Disease Study 2021. Lancet, 402, 203\u2013234."},{"key":"ref_42","unstructured":"World Health Organization (2025, December 02). Hypertension. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/hypertension."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"American Diabetes Association Professional Practice Committee (2025). 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes\u20142025. Diabetes Care, 48, S27\u2013S49.","DOI":"10.2337\/dc25-S002"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1007\/BF00280883","article-title":"Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man","volume":"28","author":"Matthews","year":"1985","journal-title":"Diabetologia"},{"key":"ref_45","unstructured":"Pl\u00fcmacher, A., Dias, C.C., Peleteiro, B., Freitas, P., Fortuna, I., Lima, E., Martins, E., and Martins, M.J. (2024, January 25). Defining metabolic health in obesity\u2014Comparison of obesity phenotype definitions along with calcium and magnesium levels in obese patients undergoing bariatric surgery. Proceedings of the Met\u2013Con 24: 2nd Conference of the Doctoral Programme in Metabolism\u2014Clinical and Experimental, Porto, Portugal."},{"key":"ref_46","unstructured":"Pl\u00fcmacher, A., Dias, C.C., Peleteiro, B., Freitas, P., Fortuna, I., Lima, E., Martins, E., and Martins, M.J. (2025, January 7\u20139). Metabolic health before and after bariatric surgery: The impact of metabolic health definition (abstract 22621). Proceedings of the IJUP\u201925, Porto, Portugal."},{"key":"ref_47","unstructured":"Pl\u00fcmacher, A., and Martins, M.J. (2025, January 9\u201310). Obesity phenotypes in individuals undergoing bariatric surgery. Proceedings of the Heart Team 2025: Joint Meeting of the Study Groups on Heart Failure (GEIC), Pulmonary Hypertension (GEHP), and Congenital Heart Diseases (GECC), Porto, Portugal."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"van Vliet-Ostaptchouk, J.V., Nuotio, M.L., Slagter, S.N., Doiron, D., Fischer, K., Foco, L., Gaye, A., G\u00f6gele, M., Heier, M., and Hiekkalinna, T. (2014). The prevalence of metabolic syndrome and metabolically healthy obesity in Europe: A collaborative analysis of ten large cohort studies. BMC Endocr. Disord., 14.","DOI":"10.1186\/1472-6823-14-9"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Mart\u00ednez-Larrad, M.T., Corbat\u00f3n Anchuelo, A., Del Prado, N., Ibarra Rueda, J.M., Gabriel, R., and Serrano-R\u00edos, M. (2014). Profile of individuals who are metabolically healthy obese using different definition criteria. A population-based analysis in the Spanish population. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0106641"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/j.soard.2017.11.032","article-title":"Patients with clinically metabolically healthy obesity are not necessarily healthy subclinically: Further support for bariatric surgery in patients without metabolic disease?","volume":"14","author":"Haskins","year":"2018","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"3966","DOI":"10.1007\/s11695-019-04067-0","article-title":"Metabolic Features of Individuals with Obesity Referred for Bariatric and Metabolic Surgery: A Cohort Study","volume":"29","author":"Li","year":"2019","journal-title":"Obes. Surg."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.1177\/00031348241241621","article-title":"Prevalence, Risk Factors, and Metabolic Characteristics of Metabolically Healthy Obesity in Patients Seeking Bariatric Surgery: A Cohort Study","volume":"90","author":"Zheng","year":"2024","journal-title":"Am. Surg."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.soard.2014.06.012","article-title":"Prevalence and characteristics of individuals without diabetes and hypertension who underwent bariatric surgery: Lessons learned about metabolically healthy obese","volume":"11","author":"Lee","year":"2015","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1089\/met.2018.0083","article-title":"Metabolic Health in Severely Obese Subjects: A Descriptive Study","volume":"17","author":"Worm","year":"2019","journal-title":"Metab. Syndr. Relat. Disord."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"S32","DOI":"10.1038\/ijosup.2016.8","article-title":"Bariatric surgery and obesity: Influence on the incretins","volume":"6","year":"2016","journal-title":"Int. J. Obes. Suppl."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1007\/s13679-017-0276-5","article-title":"Potential Hormone Mechanisms of Bariatric Surgery","volume":"6","author":"Dimitriadis","year":"2017","journal-title":"Curr. Obes. Rep."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1508","DOI":"10.1002\/oby.24059","article-title":"Age of obesity onset affects subcutaneous adipose tissue cellularity differently in the abdominal and femoral region","volume":"32","author":"Murphy","year":"2024","journal-title":"Obesity"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1859","DOI":"10.1038\/s41366-022-01192-2","article-title":"Adipocyte size, adipose tissue fibrosis, macrophage infiltration and disease risk are different in younger and older individuals with childhood versus adulthood onset obesity","volume":"46","author":"Turner","year":"2022","journal-title":"Int. J. Obes."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1097\/SLA.0000000000000686","article-title":"Metabolic score: Insights on the development and prediction of remission of metabolic syndrome after gastric bypass","volume":"260","author":"Faria","year":"2014","journal-title":"Ann. Surg."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1001\/archinte.168.15.1617","article-title":"The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering: Prevalence and correlates of 2 phenotypes among the US population (NHANES 1999\u20132004)","volume":"168","author":"Wildman","year":"2008","journal-title":"Arch. Intern. Med."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1640","DOI":"10.1161\/CIRCULATIONAHA.109.192644","article-title":"Harmonizing the metabolic syndrome: A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity","volume":"120","author":"Alberti","year":"2009","journal-title":"Circulation"}],"container-title":["Metabolites"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2218-1989\/16\/1\/47\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T13:02:39Z","timestamp":1767618159000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2218-1989\/16\/1\/47"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,5]]},"references-count":61,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["metabo16010047"],"URL":"https:\/\/doi.org\/10.3390\/metabo16010047","relation":{},"ISSN":["2218-1989"],"issn-type":[{"value":"2218-1989","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,5]]}}}