The metabolically unhealthy obese phenotype is mainly associated with hypoadiponectinemia, hyperuricemia and high OPG/RANKL ratio

: Metabolically healthy obese (MHO) patients have a lower cardiovascular risk than obese subjects who present obesity-associated comorbidities. We aimed to compare obese patients from these two groups and study some adipokines and proinflammatory profiles. Cases and controls study with 138 individuals paired by grade of obesity and age, selected from a prospective cohort of 560 obese patients at a hospital setting. Clinical and analytical variables were analyzed including several adipokines and novel proinflammatory markers, such as osteoprotegerin (OPG), receptor-activator of nuclear factor-κB ligand (RANKL) and soluble TNF-like weak-inducer of apoptosis (TWEAK). Blood pressure, serum uric acid, triglycerides, glucose and insulin concentrations, as well as insulin resistance were higher in metabolically unhealthy obese (MUO) patients, and HDL levels were lower. Adiponectin and RANKL were lower and the ratio of OPG/RANKL higher in MUO patients, but TEAWK did not show differences. Multivariate analysis retained adiponectin, the ratio OPG/RANKL and uric acid for the presence of MUO phenotype; C-reactive protein, leptin and uric acid for the grade of obesity; and adiponectin, leptin and uric acid for sex. Serum adipokines and inflammatory markers are differently associated with gender, age and the MUO phenotype, being hypoadiponectinemia, hyperurecemia and high OPG/RANKL ratio those mainly associated with the latter.