Table 3.

Proposal of a Harmonized Definition of MHO in Adults and Youth

Adults
Definition of MHO
 Based on the facts and recommendations discussed in Table 2, a patient would be classified as MHO if (1) being obese (BMI≥30 kg/m2); plus (2) meeting 0 of the 4 MetS criteria (WC excluded), which are the following54:
  Elevated triglycerides (drug treatment for elevated triglycerides is an alternate indicator*)≥150 mg/dL (1.7 mmol/L)
  Reduced high-density lipoprotein-cholesterol (drug treatment for reduced HDL-C is an alternate indicator*)<40 mg/dL (1.0 mmol/L) in men; <50 mg/dL (1.3 mmol/L) in women
  Elevated blood pressure (antihypertensive drug treatment in a patient with a history of hypertension is an alternate indicator)Systolic ≥130 and diastolic ≥85 mm Hg
  Elevated fasting glucose (drug treatment of elevated glucose is an alternate indicator)≥100 mg/dL (5.6 mmol/L)
 Definition of Non-MHO
  A patient would be classified as non-MHO if (1) being obese (BMI≥30 kg/m2); plus (2) meeting 1–4 of the MetS criteria indicated above (WC excluded)
Youth
 Definition of MHO
  A young patient would be classified as MHO if (1) being obese (based on international BMI cut-points for youth77); plus (2) meeting 0 of the 4 MetS criteria (WC excluded) proposed by Jolliffe and Janssen,78 which are equivalent to adults’ criteria indicated above
 Definition of Non-MHO
  A patient would be classified as non-MHO if (1) being obese (based on international BMI cut-points for youth77); plus (2) meeting 1–4 of the criteria indicated above (WC excluded)
  • BMI indicates body mass index; HDL-C, high-density lipoprotein-cholesterol; MetS, metabolic syndrome; MHO, metabolically healthy but obese; and WC, waist circumference.

  • * The most commonly used drugs for elevated triglycerides and reduced HDL-C are fibrates and nicotinic acid. A patient taking 1 of these drugs can be presumed to have high triglycerides and low HDL-C. High-dose of ω-3 fatty acids presumes high triglycerides.

  • Most patients with type 2 diabetes mellitus will have the MetS by the proposed criteria.