Utility of obesity indicators for metabolically healthy obesity: an observational study using the Korean National Health and Nutrition Examination Survey (2009-2010)

BACKGROUND: Obese individuals who are not at an elevated risk for cardiovascular disease are described as having metabolically healthy obesity (MHO). We sought to identify clinically useful indicators of MHO. METHODS: Records of the Korean National Health and Nutrition Examination Survey (2009-2010) were used to analyze 3,770 obese subjects (body mass index ≥ 25 kg/m(2)), who were divided into metabolic syndrome and MHO groups. Persons who met less than 3 of the criteria of metabolic syndrome (MS) were defined as having MHO. We estimated age-specific prevalence rates according to the number of MS criteria that were satisfied (patients meeting 0, ≤1, and ≤2 criteria of MS). Receiver operating characteristic analysis was performed to identify the best indicators of MHO. RESULTS: The prevalence of MHO among obese patients decreased with age. When MHO was defined by the fulfillment of ≤2 criteria of MS, the areas under the curves (AUC) for waist circumference and waist-to-height ratio were 0.743 and 0.747 in men and 0.712 and 0.741 in women, respectively. Waist circumference and waist-to-height ratio were the most accurate predictors of MHO for all investigated definitions. CONCLUSIONS: Waist circumference and waist-to-height ratio provide useful indicators for diagnosing MHO, and are more accurate than body mass index, fat percentage, or weight-adjusted appendicular skeletal muscle mass in the Korean population.