Metabolically Healthy Obesity (MHO) vs. Metabolically Unhealthy Obesity (MUO) Phenotypes in PCOS: Association with Endocrine-Metabolic Profile, Adherence to the Mediterranean Diet, and Body Composition

Barrea, Luigi; Muscogiuri, Giovanna; Pugliese, Gabriella; de Alteriis, Giulia; Colao, Annamaria; Savastano, Silvia

doi:10.3390/nu13113925

Cited by 99Ovarian function and disordersDiabetes, Cardiovascular Risks, and LipoproteinsAdipokines, Inflammation, and Metabolic Diseases

Metabolically Healthy Obesity (MHO) vs. Metabolically Unhealthy Obesity (MUO) Phenotypes in PCOS: Association with Endocrine-Metabolic Profile, Adherence to the Mediterranean Diet, and Body Composition

Open access

Barrea, Luigi, Muscogiuri, Giovanna, Pugliese, Gabriella, de Alteriis, Giulia, Colao, Annamaria, Savastano, Silvia·2021·Nutrients

DOI 10.3390/nu13113925PMC PMC8624317

Open this paper in CoChat — free account Open PDF

Abstract

Obesity and obesity-related low-grade inflammation are common findings in polycystic ovary syndrome (PCOS), the most common endocrine-metabolic disorder-affecting women in reproductive age. The terms metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO) have been introduced to define individuals with obesity in whom cardio-metabolic risk factors are absent or present, respectively. To date, evidence investigating differences in body composition and adherence to the Mediterranean diet (MD) between MHO and MUO-PCOS women are lacking. Aim of this study was to better characterize the determinants of the metabolic health status in PCOS patients with obesity according to MHO and MUO phenotypes by evaluating endocrine-metabolic profile, inflammatory status, adherence to the MD, and body composition. The study population consisted of 94 treatment-naïve women with PCOS and obesity (BMI = 38.23 ± 6.62 kg/m2 and age = 24.12 ± 3.68 years). Compared PCOS MHO with PCOS MUO patients, the latter had higher levels of high-sensitivity C-reactive protein (hs-CRP) (p < 0.001), testosterone (p < 0.001), and insulin (p < 0.001), worse metabolic parameters, and higher Homeostatic Model Assessment of Insulin Resistance (HoMA-IR), Visceral Adiposity Index (VAI), and Fatty liver Index (FLI) (p < 0.001). Furthermore, PCOS MUO patients had lower adherence to the MD (p < 0.001) in spite of the same total energy intake (p = 0.102) as compared to PCOS MHO. The presence of MUO was associated with highest hs-CRP levels (OR = 1.49, p < 0.001), more severe hyperandrogenism and cardio-metabolic indices (p < 0.001). On the contrary, being PCOS MUO was associated with lower adherence to the MD (OR = 0.28, p < 0.001), and smaller PhAs (OR = 0.04, p < 0.001). Using a regression linear analysis model PREDIMED score entered at the first step (p < 0.001), followed by VAI (p < 0.001), and FLI (p = 0.032) in this analysis. At ROC analysis, a PREDIMED score of ≤4 (p < 0.001, AUC 0.926) could serve as a threshold for a significantly increased risk of presence the MUO-PCOS phenotype. To the best of our knowledge, this is the first study that characterized MHO and MUO-PCOS women on the basis of their adherence to the MD, body composition, and cardio-metabolic indices, providing evidence of the usefulness of adjunctive diagnostic parameters to better differentiate the MHO/MHO phenotypes in this cohort of PCOS patients with obesity.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

Integrity signals

Registry

Crossref · 10.3390/nu13113925

Cites

93 of 93 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Higher adherence to an anti-inflammatory dietary pattern is linked to lower PCOS risk.
“a higher adherence to an anti-inflammatory dietary pattern has been linked to lower PCOS risk [11,39,41].”
From Moving beyond Weight: A Narrative Review of the Dietary and Lifestyle Management for Reducing Cardiometabolic Risk in Polycystic Ovary Syndrome (PCOS) (2023) · cites this paper as [41]
The Discussion (page not specified) describes the Mediterranean diet as anti-inflammatory and reports that women with PCOS had lower adherence than BMI-matched controls. However, this paper studied dietary adherence among women who already had PCOS, not whether higher adherence was linked to a lower risk of developing PCOS. (LLM, conf=0.86)
Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Homeostasis model assessment: insulin resistance and ?-cell function from fasting plasma glucose and insulin concentrations in man
Matthews, D. R., Hosker, J. P., Rudenski, A. S., Naylor, B. A., Treacher, D. F., & Turner, R. C. (1985) · Diabetologia · doi:10.1007/bf00280883 · Cited by 31,502 · cited 1× · see citing works
“Cardio-metabolic indices, including homeostatic model assessment-insulin resistance (HoMA-IR) [44], visceral adiposity index (VAI) [45,46], and fatty liver index (FLI) [47] have been calculated.”
Method
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
Alberti, K. G. M. M., Eckel, R. H., Grundy, S. M., Zimmet, P. Z., Cleeman, J. I., Donato, K. A., Fruchart, J.-C., James, W. P. T., Loria, C. M., & Smith, S. C. (2009) · Circulation · doi:10.1161/circulationaha.109.192644 · Cited by 14,860 · see citing works
Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome
(2004) · Fertility and Sterility · doi:10.1016/j.fertnstert.2003.10.004 · Cited by 9,050 · see citing works
Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice: A Statement for Healthcare Professionals From the Centers for Disease Control and Prevention and the American Heart Association
Pearson, T. A., Mensah, G. A., Alexander, R. W., Anderson, J. L., Cannon, R. O., Criqui, M., Fadl, Y. Y., Fortmann, S. P., Hong, Y., Myers, G. L., et al. (2003) · Circulation · doi:10.1161/01.cir.0000052939.59093.45 · Cited by 6,401 · cited 1× · see citing works
“A hs-CRP levels were categorised according to cardiovascular risk category to the American Heart Association/Centers for Disease Control (hs-CRP levels ≥3 mg/L as high risk of cardiovascular disease) [43].”
Method
Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS)
The Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group (2004) · Human Reproduction · doi:10.1093/humrep/deh098 · Cited by 6,138 · cited 1× · see citing works
“In particular, eligible patients were those with a diagnosis of PCOS classified by the ESHRE/ASRM (European Society for Human Reproduction and Embryology/American Society for Reproductive Medicine) diagnosis [21].”
Background
The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population
Bedogni, G., Bellentani, S., Miglioli, L., Masutti, F., Passalacqua, M., Castiglione, A., & Tiribelli, C. (2006) · BMC Gastroenterology · doi:10.1186/1471-230x-6-33 · Cited by 3,054 · cited 2× · see citing works
“FLI is a well-established non-invasive composite proxy to assess liver steatosis [47].”
BackgroundMethod
Role of C-Reactive Protein at Sites of Inflammation and Infection
Sproston, N. R., & Ashworth, J. (2018) · Frontiers in Immunology · doi:10.3389/fimmu.2018.00754 · Cited by 3,053 · see citing works
MARKERS OF INFLAMMATION AND CARDIOVASCULAR DISEASE: APPLICATION TO CLINICAL AND PUBLIC HEALTH PRACTICE: A STATEMENT FOR HEALTHCARE PROFESSIONALS FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION AND THE AMERICAN HEART ASSOCIATION
PearsonT, A., MensahG, A., & AlexanderR, W. (2003) · Journal of Cardiopulmonary Rehabilitation · doi:10.1097/00008483-200305000-00016 · Cited by 2,937 · see citing works
Clinical assessment of body hair growth in women.
Ferriman, D., & Gallwey, J. D. (1961) · Journal of Clinical Endocrinology and Metabolism · doi:10.1210/jcem-21-11-1440 · Cited by 2,556 · cited 1× · see citing works
“The degree of hirsutism was evaluated using Ferriman-Gallwey hirsutism scoring scale, which measures nine androgen sensitive areas in the body [22].”
Method
Bioelectrical impedance analysis—part II: utilization in clinical practice
Kyle, U. G., Bosaeus, I., De Lorenzo, A. D., Deurenberg, P., Elia, M., Manuel Gómez, J., Lilienthal Heitmann, B., Kent-Smith, L., Melchior, J.-C., Pirlich, M., et al. (2004) · Clinical Nutrition · doi:10.1016/j.clnu.2004.09.012 · Cited by 2,350 · cited 2× · see citing works
“According to the European Society for Clinical Nutrition and Metabolism (ESPEN) [48], body composition measurements using a BIA phase-sensitive system (BIA 101, RJL Akern Bioresearch, Florence, Italy, 800 μA current at a single frequency of 50 kHz), as previously reported [49–51].”
Method
Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline
Legro, R. S., Arslanian, S. A., Ehrmann, D. A., Hoeger, K. M., Murad, M. H., Pasquali, R., & Welt, C. K. (2013) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-2350 · Cited by 1,919 · cited 1× · see citing works
“â Oligomenorrhea, biochemical hyperandrogenemia, and/or hyperandrogenism due to secondary aetiologies including endocrine disorders as per the Endocrine Society Clinical Practice Guidelines and previous publications [24]; â Pre-existing systemic or psychiatric disease; â Use of drugs that influence lipid or carbohydra…”
Background
Visceral Adiposity Index
Amato, M. C., Giordano, C., Galia, M., Criscimanna, A., Vitabile, S., Midiri, M., Galluzzo, A., & for the AlkaMeSy Study Group (2010) · Diabetes Care · doi:10.2337/dc09-1825 · Cited by 1,751 · cited 1× · see citing works
“In particular, VAI is an index based on a combination of anthropometric and metabolic parameters that is highly correlated with visceral adiposity measured by magnetic resonance imaging and expression of dysfunctional adipocytes [62].”
Background
The Diagnosis and Management of Tuberculous Meningitis
Thwaites, G. (2002) · Practical Neurology · doi:10.1046/j.1474-7766.2002.00085.x · Cited by 1,638
Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: a position statement
Neeland, I. J., Ross, R., Després, J.-P., Matsuzawa, Y., Yamashita, S., Shai, I., Seidell, J., Magni, P., Santos, R. D., Arsenault, B., et al. (2019) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(19)30084-1 · Cited by 1,603 · cited 1× · see citing works
“In particular, the pro-inflammatory state linked to the resultant ectopic lipid deposition and the adipose tissue dysfunction, which favors the insulin resistance in adipose tissue, skeletal muscle and liver, and features of the metabolic syndrome (MetS), represent emerging factors of global cardio-metabolic-risk [8].”
Background
A 14-Item Mediterranean Diet Assessment Tool and Obesity Indexes among High-Risk Subjects: The PREDIMED Trial
Martínez-González, M. A., García-Arellano, A., Toledo, E., Salas-Salvadó, J., Buil-Cosiales, P., Corella, D., Covas, M. I., Schröder, H., Arós, F., Gómez-Gracia, E., et al. (2012) · PLoS ONE · doi:10.1371/journal.pone.0043134 · Cited by 1,150 · cited 1× · see citing works
“As we reported earlier [35–37], the adherence to the MD was assessed by the PREvention with MEDiterranean Diet (PREDIMED) questionnaire, a brief 14-item questionnaire to able to capture the adherence to the MD in adults at high cardiovascular risk and obesity [38].”
Method
Bioelectrical phase angle and impedance vector analysis – Clinical relevance and applicability of impedance parameters
Norman, K., Stobäus, N., Pirlich, M., & Bosy-Westphal, A. (2012) · Clinical Nutrition · doi:10.1016/j.clnu.2012.05.008 · Cited by 1,049 · cited 1× · see citing works
“Altered measurements of the PhA are associated with inflammatory markers [85], are commonly used in the nutritional screening of several diseases, are an important independent predictor of mortality [86], and might represent an easy detectable marker of inflammation that avoid the collection of blood sampling and expe…”
Background
Chronic Low Grade Inflammation in Pathogenesis of PCOS
Rudnicka, E., Suchta, K., Grymowicz, M., Calik-Ksepka, A., Smolarczyk, K., Duszewska, A. M., Smolarczyk, R., & Meczekalski, B. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22073789 · Cited by 680 · cited 2× · see citing works
“Correlations have been found between increased levels of CRP and other markers of inflammation in the PCOS women compared with age- and BMI-matched controls [1].”
BackgroundResult
Bioelectrical impedance analysis: a review of principles and applications.
Kushner, R. (1992) · Journal of the American College of Nutrition · doi:10.1080/07315724.1992.12098245 · Cited by 666 · cited 1× · see citing works
“Phase angle (PhA) (◦, degrees) was obtained by the formula: Xc/R*(180/π) [52].”
Method
The prevalence of metabolic syndrome and metabolically healthy obesity in Europe: a collaborative analysis of ten large cohort studies
van Vliet‐Ostaptchouk, J. V., Nuotio, M.-L., Slagter, S. N., Doiron, D., Fischer, K., Foco, L., Gaye, A., Gögele, M., Heier, M., Hiekkalinna, T., et al. (2014) · BMC Endocrine Disorders · doi:10.1186/1472-6823-14-9 · Cited by 623 · cited 3× · see citing works
“Currently, the most used criteria to define MHO are based on the presence of ≤2 of the four diagnostic criteria for MetS according to the NCEP ATP III definition [11].”
BackgroundMethod
Body fat distribution and noncommunicable diseases in populations: overview of the 2008 WHO Expert Consultation on Waist Circumference and Waist–Hip Ratio
Nishida, C., Ko, G., & Kumanyika, S. (2010) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2009.139 · Cited by 606 · cited 1× · see citing works
“BMI was calculated by weight (kg) and height squared (m2), in accordance with the WHO’s criteria [34].”
Method
Long-term cardiometabolic disease risk in women with PCOS: a systematic review and meta-analysis
Wekker, V, van Dammen, L., Koning, A., Heida, K. Y., Painter, R. C., Limpens, J., Laven, J. S. E., Roeters van Lennep, J. E., Roseboom, T. J., & Hoek, A. (2020) · Human Reproduction Update · doi:10.1093/humupd/dmaa029 · Cited by 425 · cited 1× · see citing works
“Very recently, a systematic review of the literature reported that women with PCOS were more likely to be diagnosed with cardio-metabolic risk factors, although the extent to which increased cardio-metabolic risk was independent of obesity still remains to be resolved [5,6].”
Background
Assessment of body composition in health and disease using bioelectrical impedance analysis (BIA) and dual energy X-ray absorptiometry (DXA): a critical overview.
Marra, M., Sammarco, R., De Lorenzo, A., Iellamo, F., Siervo, M., Pietrobelli, A., Donini, L. M., Santarpia, L., Cataldi, M., Pasanisi, F., et al. (2019) · Contrast Media & Molecular Imaging · doi:10.1155/2019/3548284 · Cited by 401 · cited 2× · see citing works
“While, in a large sample of adults with obesity of both sex, MHO and MUO were characterized by differences in body composition measured with dual-energy X-ray absorptiometry (DXA) consistent between genders [15].”
Method
Visceral Adiposity Index: An Indicator of Adipose Tissue Dysfunction
Amato, M., & Giordano, C. (2014) · International Journal of Endocrinology · doi:10.1155/2014/730827 · Cited by 341 · cited 1× · see citing works
“Cardio-metabolic indices, including homeostatic model assessment-insulin resistance (HoMA-IR) [44], visceral adiposity index (VAI) [45,46], and fatty liver index (FLI) [47] have been calculated.”
Method
Comparison of body composition assessment by DXA and BIA according to the body mass index: a retrospective study on 3655 measures.
Achamrah, N., Colange, G., Delay, J., Rimbert, A., Folope, V., Petit, A., Grigioni, S., Déchelotte, P., & Coëffier, M. (2018) · PLoS ONE · doi:10.1371/journal.pone.0200465 · Cited by 337 · cited 2× · see citing works
“While, in a large sample of adults with obesity of both sex, MHO and MUO were characterized by differences in body composition measured with dual-energy X-ray absorptiometry (DXA) consistent between genders [15].”
Method
Antioxidant and Anti-Inflammatory Potential of Polyphenols Contained in Mediterranean Diet in Obesity: Molecular Mechanisms
Nani, A., Murtaza, B., Sayed Khan, A., Khan, N. A., & Hichami, A. (2021) · Molecules · doi:10.3390/molecules26040985 · Cited by 321 · cited 2× · see citing works
“In addition, in line with the well-known anti-inflammatory and anti-oxidant properties of the MD [80] we found that the MUO-PCOS with a low adherence to the MD presented also high hs-CPR levels and small PhAs, two distinctive markers of inflammation in this study.”
Background
Diagnosis of obesity and use of obesity biomarkers in science and clinical medicine
Nimptsch, K., Konigorski, S., & Pischon, T. (2018) · Metabolism · doi:10.1016/j.metabol.2018.12.006 · Cited by 317 · cited 1× · see citing works
“Nevertheless, it is widely reported that CRP represents the most studied inflammatory biomarker in different pathologic processes [88].”
Background
Adherence to the Mediterranean Diet, Dietary Patterns and Body Composition in Women with Polycystic Ovary Syndrome (PCOS)
Barrea, L., Arnone, A., Annunziata, G., Muscogiuri, G., Laudisio, D., Salzano, C., Pugliese, G., Colao, A., & Savastano, S. (2019) · Nutrients · doi:10.3390/nu11102278 · Cited by 306 · cited 1× · see citing works
“We previously reported that PCOS women had lower adherence to the MD as compared with BMI-matched controls, with an inverse association among the adherence to MD, BMI, and the clinical severity of the disease [81].”
ResultSelf-citation
Revised
Wheatley, G., & Popoola, S. O. (2020) · Research on Engineering Structures and Materials · doi:10.17515/resm2020.198me0608 · Cited by 272
Cut-off points of the visceral adiposity index (VAI) identifying a visceral adipose dysfunction associated with cardiometabolic risk in a Caucasian Sicilian population
Amato, M. C., Giordano, C., Pitrone, M., & Galluzzo, A. (2011) · Lipids in Health and Disease · doi:10.1186/1476-511x-10-183 · Cited by 263 · cited 1× · see citing works
“Cardio-metabolic indices, including homeostatic model assessment-insulin resistance (HoMA-IR) [44], visceral adiposity index (VAI) [45,46], and fatty liver index (FLI) [47] have been calculated.”
Method
Metabolically Healthy Obesity: Criteria, Epidemiology, Controversies, and Consequences
Tsatsoulis, A. A., & Paschou, S. Α. (2020) · Current Obesity Reports · doi:10.1007/s13679-020-00375-0 · Cited by 263 · see citing works
Trimethylamine-N-oxide (TMAO) as Novel Potential Biomarker of Early Predictors of Metabolic Syndrome
Barrea, L., Annunziata, G., Muscogiuri, G., Somma, C. D., Laudisio, D., Maisto, M., de Alteriis, G., Tenore, G. C., Colao, A., & Savastano, S. (2018) · Nutrients · doi:10.3390/nu10121971 · Cited by 257 · see citing works
Self-citation
The Role of Chronic Inflammation in Polycystic Ovarian Syndrome—A Systematic Review and Meta-Analysis
Aboeldalyl, S., James, C., Seyam, E., Ibrahim, E. M., Shawki, H., & Amer, S. A. K. S. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22052734 · Cited by 251 · cited 1× · see citing works
“Obesity and obesity-related low-grade inflammation are common findings in polycystic ovary syndrome (PCOS), the most common endocrine-metabolic disorder-affecting women in reproductive age [1,2].”
Background
Exploring the Validity of the 14-Item Mediterranean Diet Adherence Screener (MEDAS): A Cross-National Study in Seven European Countries around the Mediterranean Region
García-Conesa, M., Philippou, E., Pafilas, C., Massaro, M., Quarta, S., Andrade, V., Jorge, R., Chervenkov, M., Ivanova, T., Dimitrova, D., et al. (2020) · Nutrients · doi:10.3390/nu12102960 · Cited by 214 · cited 3× · see citing works
“In particular, either adherence to the MD evaluated by PREDIMED questionnaire, which was recently validated in different Mediterranean countries, including Italy [89], or the total energy intake evaluated by the seven-day food record, the gold standard among food frequency questionnaire, were not self-reported, but fa…”
Method
Metabolically Healthy Obesity and Risk of Mortality
Hinnouho, G.-M., Czernichow, S., Dugravot, A., Batty, G., Kivimaki, M., & Singh-Manoux, A. (2013) · Diabetes Care · doi:10.2337/dc12-1654 · Cited by 205 · cited 1× · see citing works
“Participants who met fewer than two of the following four criteria were considered MHO [11,26].”
Background
Nutrition Strategy and Life Style in Polycystic Ovary Syndrome—Narrative Review
Szczuko, M., Kikut, J., Szczuko, U., Szydłowska, I., Nawrocka-Rutkowska, J., Ziętek, M., Verbanac, D., & Saso, L. (2021) · Nutrients · doi:10.3390/nu13072452 · Cited by 204 · see citing works
Nutrition and immune system: from the Mediterranean diet to dietary supplementary through the microbiota
Barrea, L., Muscogiuri, G., Frías-Toral, E., Laudisio, D., Pugliese, G., Castellucci, B., Garcia-Velasquez, E., Savastano, S., & Colao, A. (2020) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2020.1792826 · Cited by 200 · cited 1× · see citing works
“MD, characterized by high consumption of extra virgin olive oil, fish, vegetables, legumes, whole-grain products, fruits, and nuts, has been demonstrated to exert relevant anti-inflammatory and anti-oxidative effects on different clinical settings, including inflammatory and immune processes [68], psoriasis [69], acne…”
BackgroundSelf-citation
Nutrition and psoriasis: is there any association between the severity of the disease and adherence to the Mediterranean diet?
Barrea, L., Balato, N., Somma, C. D., Macchia, P., Napolitano, M., Savanelli, M. C., Esposito, K., Colao, A., & Savastano, S. (2015) · Journal of Translational Medicine · doi:10.1186/s12967-014-0372-1 · Cited by 172 · cited 1× · see citing works
“MD, characterized by high consumption of extra virgin olive oil, fish, vegetables, legumes, whole-grain products, fruits, and nuts, has been demonstrated to exert relevant anti-inflammatory and anti-oxidative effects on different clinical settings, including inflammatory and immune processes [68], psoriasis [69], acne…”
BackgroundSelf-citation
Sex Differences of Vitamin D Status across BMI Classes: An Observational Prospective Cohort Study
Muscogiuri, G., Barrea, L., Somma, C. D., Laudisio, D., Salzano, C., Pugliese, G., de Alteriis, G., Colao, A., & Savastano, S. (2019) · Nutrients · doi:10.3390/nu11123034 · Cited by 134 · see citing works
Self-citation
Trimethylamine N-oxide, Mediterranean diet, and nutrition in healthy, normal-weight adults: also a matter of sex?
Barrea, L., Annunziata, G., Muscogiuri, G., Laudisio, D., Somma, C. D., Maisto, M., Tenore, G. C., Colao, A., & Savastano, S. (2018) · Nutrition · doi:10.1016/j.nut.2018.11.015 · Cited by 131 · see citing works
Self-citation
An evaluation of a colour food photography atlas as a tool for quantifying food portion size in epidemiological dietary surveys
Turconi, G., Guarcello, M., Berzolari, F. G., Carolei, A., Bazzano, R., & Roggi, C. (2005) · European Journal of Clinical Nutrition · doi:10.1038/sj.ejcn.1602162 · Cited by 131 · cited 1× · see citing works
“According of these records, the nutritionist calculated the total energy intake [42].”
Background
Are people with metabolically healthy obesity really healthy? A prospective cohort study of 381,363 UK Biobank participants
Zhou, Z., Macpherson, J., Gray, S., Gill, J., Welsh, P., Celis-Morales, C., Sattar, N., Pell, J., & Ho, F. (2021) · Diabetologia · doi:10.1007/s00125-021-05484-6 · Cited by 126 · cited 1× · see citing works
“Nevertheless, a growing body of evidence indicated that MHO individuals are not ‘healthy’, as they are at higher risk of atherosclerotic cardiovascular disease, hearth failure, and respiratory diseases and some cancers compared with non-obese individuals with a normal metabolic profile [57,58].”
Background
Does SARS-Cov-2 threaten our dreams? Effect of quarantine on sleep quality and body mass index
Barrea, L., Pugliese, G., Framondi, L., Di Matteo, R., Laudisio, D., Savastano, S., Colao, A., & Muscogiuri, G. (2020) · Journal of Translational Medicine · doi:10.1186/s12967-020-02465-y · Cited by 116 · see citing works
Self-citation
Chronotype and Adherence to the Mediterranean Diet in Obesity: Results from the Opera Prevention Project
Muscogiuri, G., Barrea, L., Aprano, S., Framondi, L., Di Matteo, R., Laudisio, D., Pugliese, G., Savastano, S., Colao, A., & on behalf of the Opera Prevention Project (2020) · Nutrients · doi:10.3390/nu12051354 · Cited by 112 · see citing works
Self-citation
Metabolically Healthy Obesity—Heterogeneity in Definitions and Unconventional Factors
Brandão, I., Martins, M. J., & Monteiro, R. (2020) · Metabolites · doi:10.3390/metabo10020048 · Cited by 110 · see citing works
Bisphenol A in polycystic ovary syndrome and its association with liver–spleen axis
Tarantino, G., Valentino, R., Somma, C. D., D’Esposito, V., Passaretti, F., Pizza, G., Brancato, V., Orio, F., Formisano, P., Colao, A., et al. (2012) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2012.04500.x · Cited by 105 · cited 1× · see citing works
“Of interest, we have previously reported that higher levels of liver/spleen index were significantly associated with the low-grade chronic inflammation in PCOS women with high plasma levels of bisphenol A, one of the most common endocrine disruptors involved in the obesity pathogenesis and the alterations of several m…”
BackgroundSelf-citation
Sleep Quality in Obesity: Does Adherence to the Mediterranean Diet Matter?
Muscogiuri, G., Barrea, L., Aprano, S., Framondi, L., Di Matteo, R., Laudisio, D., Pugliese, G., Savastano, S., & Colao, A. (2020) · Nutrients · doi:10.3390/nu12051364 · Cited by 102 · see citing works
Self-citation
Phase Angle Measurement in Healthy Human Subjects through Bio-Impedance Analysis
Kumar, S., Dutt, A., Hemraj, S., Bhat, S., & Manipadybhima, B. (2012) · Iranian Journal of Basic Medical Sciences · doi:10.22038/ijbms.2012.4938 · Cited by 102 · cited 1×
“PhA, a non-invasive bioimpedance marker, reflects cell membrane integrity and size, and it is used as a marker of body cell mass [84].”
Clinical Practice Guidelines on the Diagnosis and Management of Polycystic Ovary Syndrome: A Systematic Review and Quality Assessment Study
Wattar, B. A. A., Fisher, M., Bevington, L., Talaulikar, V., Davies, M., Conway, G., & Yasmin, E. (2021) · Journal of Clinical Endocrinology and Metabolism · doi:10.1210/clinem/dgab232 · Cited by 101 · cited 1× · see citing works
“Considering the large body of evidence that clearly indicates the association of PCOS with increased long-term cardio-metabolic risks, the assessment of cardiovascular risk profile in women with PCOS is commonly recommended [3].”
Background
The Prevalence of Metabolically Healthy and Unhealthy Obesity according to Different Criteria
Liu, C., Wang, C., Guan, S., Liu, H., Wu, X., Zhang, Z., Gu, X., Zhang, Y., Zhao, Y., Tse, L. A., et al. (2019) · Obesity Facts · doi:10.1159/000495852 · Cited by 99 · cited 4× · see citing works
“CRP, a commonly used biomarker of meta-inflammation [83], has recently been included among criteria to define the obesity phenotypes [10].”
BackgroundInfluential
Role of Nutrition and Adherence to the Mediterranean Diet in the Multidisciplinary Approach of Hidradenitis Suppurativa: Evaluation of Nutritional Status and Its Association with Severity of Disease
Barrea, L., Fabbrocini, G., Annunziata, G., Muscogiuri, G., Donnarumma, M., Marasca, C., Colao, A., & Savastano, S. (2018) · Nutrients · doi:10.3390/nu11010057 · Cited by 93 · cited 1× · see citing works
“MD, characterized by high consumption of extra virgin olive oil, fish, vegetables, legumes, whole-grain products, fruits, and nuts, has been demonstrated to exert relevant anti-inflammatory and anti-oxidative effects on different clinical settings, including inflammatory and immune processes [68], psoriasis [69], acne…”
BackgroundSelf-citation
Phase Angle: A Possible Biomarker to Quantify Inflammation in Subjects with Obesity and 25(OH)D Deficiency
Barrea, L., Muscogiuri, G., Laudisio, D., Somma, C. D., Salzano, C., Pugliese, G., de Alteriis, G., Colao, A., & Savastano, S. (2019) · Nutrients · doi:10.3390/nu11081747 · Cited by 84 · see citing works
Self-citation
Mediterranean Diet and Phase Angle in a Sample of Adult Population: Results of a Pilot Study
Barrea, L., Muscogiuri, G., Macchia, P. E., Somma, C. D., Falco, A., Savanelli, M. C., Colao, A., & Savastano, S. (2017) · Nutrients · doi:10.3390/nu9020151 · Cited by 80 · see citing works
Self-citation
Comment on Hinnouho et al. Metabolically Healthy Obesity and Risk of Mortality: Does the Definition of Metabolic Health Matter? Diabetes Care 2013;36:2294–2300
Doehner, W., & Pfeiffer, A. F. H. (2014) · Diabetes Care · doi:10.2337/dc13-2748 · Cited by 80
Phase Angle as an Easy Diagnostic Tool of Meta-Inflammation for the Nutritionist
Barrea, L., Muscogiuri, G., Pugliese, G., Laudisio, D., de Alteriis, G., Graziadio, C., Colao, A., & Savastano, S. (2021) · Nutrients · doi:10.3390/nu13051446 · Cited by 74 · cited 1× · see citing works
“Altered measurements of the PhA are associated with inflammatory markers [85], are commonly used in the nutritional screening of several diseases, are an important independent predictor of mortality [86], and might represent an easy detectable marker of inflammation that avoid the collection of blood sampling and expe…”
BackgroundSelf-citation
Impact of Nutritional Status on Gastroenteropancreatic Neuroendocrine Tumors (GEP-NET) Aggressiveness
Barrea, L., Altieri, B., Muscogiuri, G., Laudisio, D., Annunziata, G., Colao, A., Faggiano, A., & Savastano, S. (2018) · Nutrients · doi:10.3390/nu10121854 · Cited by 73 · see citing works
Self-citation
A New Light on Vitamin D in Obesity: A Novel Association with Trimethylamine-N-Oxide (TMAO)
Barrea, L., Muscogiuri, G., Annunziata, G., Laudisio, D., de Alteriis, G., Tenore, G. C., Colao, A., & Savastano, S. (2019) · Nutrients · doi:10.3390/nu11061310 · Cited by 73 · see citing works
Self-citation
Are women with polycystic ovary syndrome at increased cardiovascular disease risk later in life?
Gunning, M. N., & Fauser, B. C. J. M. (2017) · Climacteric · doi:10.1080/13697137.2017.1316256 · Cited by 72 · see citing works
Bioelectrical phase angle and psoriasis: a novel association with psoriasis severity, quality of life and metabolic syndrome
Barrea, L., Macchia, P. E., Di Somma, C., Napolitano, M., Balato, A., Falco, A., Savanelli, M. C., Balato, N., Colao, A., & Savastano, S. (2016) · Journal of Translational Medicine · doi:10.1186/s12967-016-0889-6 · Cited by 70 · see citing works
Self-citation
Differences in body composition between metabolically healthy obese and metabolically abnormal obese adults
Camhi, S. M., & Katzmarzyk, P. T. (2013) · International Journal of Obesity · doi:10.1038/ijo.2013.208 · Cited by 69 · cited 2× · see citing works
“In addition, differences in dietary pattern, such as adherence to the MD [14], and body composition [15], have been reported to further influence the metabolic risk profile of the two obesity phenotypes.”
Background
Influence of nutrition on somatotropic axis: Milk consumption in adult individuals with moderate-severe obesity
Barrea, L., Somma, C. D., Macchia, P. E., Falco, A., Savanelli, M. C., Orio, F., Colao, A., & Savastano, S. (2015) · Clinical Nutrition · doi:10.1016/j.clnu.2015.12.007 · Cited by 67 · see citing works
Self-citation
Mediterranean diet as medical prescription in menopausal women with obesity: a practical guide for nutritionists
Barrea, L., Pugliese, G., Laudisio, D., Colao, A., Savastano, S., & Muscogiuri, G. (2021) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2020.1755220 · Cited by 66 · cited 1× · see citing works
“MD, characterized by high consumption of extra virgin olive oil, fish, vegetables, legumes, whole-grain products, fruits, and nuts, has been demonstrated to exert relevant anti-inflammatory and anti-oxidative effects on different clinical settings, including inflammatory and immune processes [68], psoriasis [69], acne…”
BackgroundSelf-citation
Hirsutism: Diagnosis and management.
Brodell, L., & Mercurio, M. (2010) · Gender Medicine · doi:10.1016/j.genm.2010.04.002 · Cited by 65 · cited 1× · see citing works
“A maximum Ferriman-Gallwey score of 36 is possible but a Ferriman-Gallwey score of >7 or more was considered to be diagnostic of hirsutism [23].”
Background
Visceral adiposity index predicts the conversion of metabolically healthy obesity to an unhealthy phenotype
Kang, Y. M., Jung, C. H., Cho, Y. K., Jang, J. E., Hwang, J. Y., Kim, E. H., Lee, W. J., Park, J., & Kim, H. (2017) · PLoS ONE · doi:10.1371/journal.pone.0179635 · Cited by 65 · cited 2× · see citing works
“Both VAI and FLI have well demonstrated to represent predictive markers of the prognosis not only among MHO subjects [12,13], but also in PCOS women with obesity [59–61].”
Background
Visceral adiposity index as a predictor of clinical severity and therapeutic outcome of PCOS
Zheng, S.-H., & Li, X.-L. (2016) · Gynecological Endocrinology · doi:10.3109/09513590.2015.1111327 · Cited by 63 · see citing works
Breast cancer prevention in premenopausal women: role of the Mediterranean diet and its components
Laudisio, D., Barrea, L., Muscogiuri, G., Annunziata, G., Colao, A., & Savastano, S. (2019) · Nutrition Research Reviews · doi:10.1017/s0954422419000167 · Cited by 62 · cited 1× · see citing works
“MD, characterized by high consumption of extra virgin olive oil, fish, vegetables, legumes, whole-grain products, fruits, and nuts, has been demonstrated to exert relevant anti-inflammatory and anti-oxidative effects on different clinical settings, including inflammatory and immune processes [68], psoriasis [69], acne…”
BackgroundSelf-citation
Adherence to the Mediterranean Diet and Circulating Levels of Sirtuin 4 in Obese Patients: A Novel Association
Barrea, L., Tarantino, G., Somma, C. D., Muscogiuri, G., Macchia, P. E., Falco, A., Colao, A., & Savastano, S. (2017) · Oxidative Medicine and Cellular Longevity · doi:10.1155/2017/6101254 · Cited by 60 · see citing works
Self-citation
Fatty liver index in polycystic ovary syndrome
Lerchbaum, E., Gruber, H., Theiler‐Schwetz, V., Giuliani, A., Möller, R., Pieber, T. R., & Obermayer-Pietsch, B. M. (2011) · European Journal of Endocrinology · doi:10.1530/eje-11-0614 · Cited by 53 · see citing works
Coffee consumption, metabolic syndrome and clinical severity of psoriasis: good or bad stuff?
Barrea, L., Muscogiuri, G., Somma, C. D., Annunziata, G., Megna, M., Falco, A., Balato, A., Colao, A., & Savastano, S. (2018) · Archives of Toxicology · doi:10.1007/s00204-018-2193-0 · Cited by 52 · see citing works
Self-citation
Patient empowerment and the Mediterranean diet as a possible tool to tackle prediabetes associated with overweight or obesity: A pilot study
Muscogiuri, G., Barrea, L., Di Somma, C., Altieri, B., Vecchiarini, M., Orio, F., Spinosa, T., Colao, A., & Savastano, S. (2019) · Hormones · doi:10.1007/s42000-018-0090-9 · Cited by 48 · see citing works
Self-citation
Association of mortality and phase angle measured by different bioelectrical impedance analysis (BIA) devices.
Genton, L., Herrmann, F., Spörri, A., & Graf, C. (2017) · Clinical Nutrition · doi:10.1016/j.clnu.2017.03.023 · Cited by 48 · cited 1× · see citing works
“Altered measurements of the PhA are associated with inflammatory markers [85], are commonly used in the nutritional screening of several diseases, are an important independent predictor of mortality [86], and might represent an easy detectable marker of inflammation that avoid the collection of blood sampling and expe…”
Background
Relations of Metabolically Healthy and Unhealthy Obesity to Digital Vascular Function in Three Community‐Based Cohorts: A Meta‐Analysis
Brant, L. C. C., Wang, N., Ojeda, F., LaValley, M. P., Barreto, S. M., Benjamin, E. J., Mitchell, G. F., Vasan, R. S., Palmisano, J. N., Münzel, T. F., et al. (2017) · Journal of the American Heart Association · doi:10.1161/jaha.116.004199 · Cited by 48 · cited 1× · see citing works
“Nevertheless, a growing body of evidence indicated that MHO individuals are not ‘healthy’, as they are at higher risk of atherosclerotic cardiovascular disease, hearth failure, and respiratory diseases and some cancers compared with non-obese individuals with a normal metabolic profile [57,58].”
Background
Influence of the Mediterranean Diet on 25-Hydroxyvitamin D Levels in Adults
Barrea, L., Muscogiuri, G., Laudisio, D., Pugliese, G., de Alteriis, G., Colao, A., & Savastano, S. (2020) · Nutrients · doi:10.3390/nu12051439 · Cited by 46 · cited 1× · see citing works
“MD, characterized by high consumption of extra virgin olive oil, fish, vegetables, legumes, whole-grain products, fruits, and nuts, has been demonstrated to exert relevant anti-inflammatory and anti-oxidative effects on different clinical settings, including inflammatory and immune processes [68], psoriasis [69], acne…”
BackgroundSelf-citation
Visceral adiposity index (VAI) is related to the severity of anovulation and other clinical features in women with polycystic ovary syndrome
Androulakis, I., Kandaraki, E., Christakou, C., Karachalios, A., Marinakis, E., Paterakis, T., & Diamanti-Kandarakis, E. (2014) · Clinical Endocrinology · doi:10.1111/cen.12447 · Cited by 46 · see citing works
Cardio-Metabolic Indices and Metabolic Syndrome as Predictors of Clinical Severity of Gastroenteropancreatic Neuroendocrine Tumors
Barrea, L., Muscogiuri, G., Modica, R., Altieri, B., Pugliese, G., Minotta, R., Faggiano, A., Colao, A., & Savastano, S. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.649496 · Cited by 45 · see citing works
Self-citation
Polycystic ovary syndrome and obesity: clinical aspects and nutritional management
Frías-Toral, E., Garcia-Velasquez, E., Carignano, M. D. L. A., Veintimilla, D. R., ALVARADO-AGUILERA, I., & Litardo, N. B. (2021) · Minerva Endocrinology · doi:10.23736/s2724-6507.21.03349-6 · Cited by 41 · see citing works
Mediterranean diet and mortality risk in metabolically healthy obese and metabolically unhealthy obese phenotypes
Park, Y.-M., Steck, S. E., Fung, T. T., Zhang, J., Hazlett, L. J., Han, K., & Merchant, A. T. (2016) · International Journal of Obesity · doi:10.1038/ijo.2016.114 · Cited by 40 · cited 2× · see citing works
“In addition, differences in dietary pattern, such as adherence to the MD [14], and body composition [15], have been reported to further influence the metabolic risk profile of the two obesity phenotypes.”
Background
Phase angle and Mediterranean diet in patients with acne: Two easy tools for assessing the clinical severity of disease
Barrea, L., Donnarumma, M., Cacciapuoti, S., Muscogiuri, G., de Gregorio, L., Blasio, C., Savastano, S., Colao, A., & Fabbrocini, G. (2021) · Journal of Translational Medicine · doi:10.1186/s12967-021-02826-1 · Cited by 38 · cited 1× · see citing works
“MD, characterized by high consumption of extra virgin olive oil, fish, vegetables, legumes, whole-grain products, fruits, and nuts, has been demonstrated to exert relevant anti-inflammatory and anti-oxidative effects on different clinical settings, including inflammatory and immune processes [68], psoriasis [69], acne…”
BackgroundSelf-citation
Mediterranean diet as tool to manage obesity in menopause: A narrative review.
Pugliese, G., Barrea, L., Laudisio, D., Aprano, S., Castellucci, B., Framondi, L., di Matteo, R., Savastano, S., Colao, A., & Muscogiuri, G. (2020) · Nutrition (Burbank, Los Angeles County, Calif.) · doi:10.1016/j.nut.2020.110991 · Cited by 34 · cited 1× · see citing works
“MD, characterized by high consumption of extra virgin olive oil, fish, vegetables, legumes, whole-grain products, fruits, and nuts, has been demonstrated to exert relevant anti-inflammatory and anti-oxidative effects on different clinical settings, including inflammatory and immune processes [68], psoriasis [69], acne…”
BackgroundSelf-citation
Distinguishing Characteristics of Metabolically Healthy Versus Metabolically Unhealthy Obese Adolescent Girls with Polycystic Ovary Syndrome
Kim, J., Tfayli, H., Michaliszyn, S. F., Lee, S., & Arslanian, S. (2016) · Fertility and Sterility · doi:10.1016/j.fertnstert.2016.02.004 · Cited by 33 · cited 4× · see citing works
“MUO in adolescent girls with PCOS and found that adolescent MUO-PCOS had worse body composition, hormonal and metabolic features as compared with MHO-PCOS unmatched or pair-matched for age and BMI [18].”
BackgroundInfluential
Cardiometabolic Risks in Polycystic Ovary Syndrome: Non-Traditional Risk Factors and the Impact of Obesity
Chiu, W.-L., Boyle, J. A., Vincent, A. J., Teede, H. J., & Moran, L. (2016) · Neuroendocrinology · doi:10.1159/000455233 · Cited by 31 · cited 3× · see citing works
“Therefore, the inclusion of adjunctive criteria, such as insulin resistance and hs-CRP have been proposed to better characterize the different metabolic risk profile between MHO/MUO phenotypes, either in individuals with obesity [7,9,10] or in PCOS patients [6,18].”
Background
Somatotropic Axis and Obesity: Is There Any Role for the Mediterranean Diet?
Muscogiuri, G., Barrea, L., Laudisio, D., Somma, C. D., Pugliese, G., Salzano, C., Colao, A., & Savastano, S. (2019) · Nutrients · doi:10.3390/nu11092228 · Cited by 30 · see citing works
Self-citation
Are Dietary Indices Associated with Polycystic Ovary Syndrome and Its Phenotypes? A Preliminary Study
Cutillas-Tolín, A., Árense-Gonzalo, J. J., Mendiola, J., Adoamnei, E., Navarro-Lafuente, F., Sánchez-Ferrer, M. L., Prieto‐Sánchez, M. T., Carmona‐Barnosi, A., Vioqué, J., & Torres-Cantero, A. M. (2021) · Nutrients · doi:10.3390/nu13020313 · Cited by 26 · cited 1× · see citing works
“(2021) [82] found that the women with PCOS and a higher adherence scores to the MD had a lower BMI.”
Background
Association of the Chronotype Score with Circulating Trimethylamine N-Oxide (TMAO) Concentrations
Barrea, L., Muscogiuri, G., Pugliese, G., Graziadio, C., Maisto, M., Pivari, F., Falco, A., Tenore, G. C., Colao, A., & Savastano, S. (2021) · Nutrients · doi:10.3390/nu13051671 · Cited by 25 · see citing works
Self-citation
Chronotype: what role in the context of gastroenteropancreatic neuroendocrine tumors?
Barrea, L., Muscogiuri, G., Pugliese, G., Modica, R., Laudisio, D., Aprano, S., Faggiano, A., Colao, A., & Savastano, S. (2021) · Journal of Translational Medicine · doi:10.1186/s12967-021-03010-1 · Cited by 24 · see citing works
Self-citation
Phase Angle: Could Be an Easy Tool to Detect Low-Grade Systemic Inflammation in Adults Affected by Prader–Willi Syndrome?
Barrea, L., Pugliese, G., de Alteriis, G., Colao, A., Savastano, S., & Muscogiuri, G. (2020) · Nutrients · doi:10.3390/nu12072065 · Cited by 21 · see citing works
Self-citation
Prevalence of polycystic ovary syndrome in Chinese obese women of reproductive age with or without metabolic syndrome
Liang, P., Xi, L., Shi, J., Li, W., Zhao, S., Deng, Y., Wang, R., Sun, Y., Gu, B., Yuan, L., et al. (2017) · Fertility and Sterility · doi:10.1016/j.fertnstert.2016.12.029 · Cited by 21 · see citing works
Mediterranean diet and breast cancer risk: a narrative review.
Laudisio, D., Castellucci, B., Barrea, L., Pugliese, G., Savastano, S., Colao, A., & Muscogiuri, G. (2020) · Minerva Endocrinologica · doi:10.23736/s0391-1977.20.03266-6 · Cited by 21 · cited 1× · see citing works
“MD, characterized by high consumption of extra virgin olive oil, fish, vegetables, legumes, whole-grain products, fruits, and nuts, has been demonstrated to exert relevant anti-inflammatory and anti-oxidative effects on different clinical settings, including inflammatory and immune processes [68], psoriasis [69], acne…”
BackgroundSelf-citation
Prevalence of polycystic ovary syndrome in a metabolically healthy obese population
Mu, L., Zhao, Y., Li, R., Lai, Y., Chang, H.-M., & Qiao, J. (2019) · International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · doi:10.1002/ijgo.12824 · Cited by 18 · cited 3× · see citing works
“[19] stratified a large-scale Chinese community population of women of reproductive age according to metabolic health and obesity status, and found that the prevalence of PCOS was increased among MHO women, suggesting that MHO status is most probably not a healthy con-”
BackgroundResultInfluential
The Role of Visceral Adiposity Index as Predictor of Metabolic Syndrome in Obese and Nonobese Women with Polycystic Ovary Syndrome
de Medeiros, S. F., de Medeiros, M. A. S., Barbosa, B., & Yamamoto, M. (2020) · Metabolic Syndrome and Related Disorders · doi:10.1089/met.2020.0045 · Cited by 15 · cited 5× · see citing works
“As expected, MUO-PCOS patients presented both worse endocrine and metabolic profiles, with higher levels of testosterone, higher values of Ferriman-Gallwey score and of HoMA-IR, and higher levels of hs-CRP, as compared to their MHO-counterpart.”
BackgroundInfluential
The Sun’s Vitamin in Adult Patients Affected by Prader–Willi Syndrome
Barrea, L., Muscogiuri, G., Pugliese, G., Aprano, S., de Alteriis, G., Somma, C. D., Colao, A., & Savastano, S. (2020) · Nutrients · doi:10.3390/nu12041132 · Cited by 13 · see citing works
Self-citation
An Analysis on the Implementation of the Evidence-based PCOS Lifestyle Guideline: Recommendations from Women with PCOS
Lim, S., Wright, B., Savaglio, M., Goodwin, D., Pirotta, S., & Moran, L. (2021) · Seminars in Reproductive Medicine · doi:10.1055/s-0041-1735575 · Cited by 10 · see citing works
Utility of Liver Function Tests and Fatty Liver Index to Categorize Metabolic Phenotypes in a Mediterranean Population
Narankiewicz, D., Ruiz-Nava, J., Buonaiuto, V., Ruiz-Moreno, M. I., López-Carmona, M., Pérez-Belmonte, L., Gómez-Huelgas, R., & Bernal-López, M. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17103518 · Cited by 6 · cited 2× · see citing works
“Both VAI and FLI have well demonstrated to represent predictive markers of the prognosis not only among MHO subjects [12,13], but also in PCOS women with obesity [59–61].”
Background
What about Mediterranean diet as tool to improve sleep quality in obesity?
Barrea, L., Muscogiuri, G., Savastano, S., & Colao, A. (2021) · Minerva Endocrinologica · doi:10.23736/s2724-6507.21.03410-6 · Cited by 1 · cited 1× · see citing works
“MD, characterized by high consumption of extra virgin olive oil, fish, vegetables, legumes, whole-grain products, fruits, and nuts, has been demonstrated to exert relevant anti-inflammatory and anti-oxidative effects on different clinical settings, including inflammatory and immune processes [68], psoriasis [69], acne…”
BackgroundSelf-citation

Flagged first, then by citations

Sorted by citations

Obesity and the risk of cardiometabolic diseases
Valenzuela, P. L., Carrera-Bastos, P., Castillo-García, A., Lieberman, D. E., Santos-Lozano, A., & Lucia, A. (2023) · Nature Reviews Cardiology · doi:10.1038/s41569-023-00847-5 · Cited by 452 · see citing works
Obesity and its impact on female reproductive health: unraveling the connections
Zheng, L., Yang, L.-X., Guo, Z., Yao, N., Zhang, S., & Pu, P.-P. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1326546 · Cited by 153 · see citing works
Relationship between body composition, insulin resistance, and hormonal profiles in women with polycystic ovary syndrome
Zhang, H., Wang, W., Zhao, J., Jiao, P., Zeng, L., Zhang, H., Zhao, Y., Shi, L., Hu, H., Luo, L., et al. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.1085656 · Cited by 71 · see citing works
Modulation of the Inflammatory Response in Polycystic Ovary Syndrome (PCOS)—Searching for Epigenetic Factors
Szukiewicz, D., Trojanowski, S., Kociszewska, A., & Szewczyk, G. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms232314663 · Cited by 79 · see citing works
Ketogenic Diet as Medical Prescription in Women with Polycystic Ovary Syndrome (PCOS)
Barrea, L., Verde, L., Camajani, E., Cernea, S., Frias-Toral, E., Lamabadusuriya, D., Ceriani, F., Savastano, S., Colao, A., & Muscogiuri, G. (2023) · Current Nutrition Reports · doi:10.1007/s13668-023-00456-1 · Cited by 62 · see citing works
Self-citation
Phase angle (PhA) in overweight and obesity: evidence of applicability from diagnosis to weight changes in obesity treatment
Cancello, R., Brunani, A., Brenna, E., Soranna, D., Bertoli, S., Zambon, A., Lukaski, H. C., & Capodaglio, P. (2022) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-022-09774-1 · Cited by 71 · see citing works
Interplay between Vitamin D and Adipose Tissue: Implications for Adipogenesis and Adipose Tissue Function
Lu, S., & Cao, Z.-B. (2023) · Nutrients · doi:10.3390/nu15224832 · Cited by 43 · see citing works
The Cardiometabolic Risk in Women with Polycystic Ovarian Syndrome (PCOS): From Pathophysiology to Diagnosis and Treatment
Pililis, S., Lampsas, S., Kountouri, A., Pliouta, L., Korakas, E., Livadas, S., Thymis, J., Peppa, Μ., Kalantaridou, S., Oikonomou, E. K., et al. (2024) · Medicina · doi:10.3390/medicina60101656 · Cited by 46 · see citing works
“The Mediterranean diet likely benefits women with PCOS by lowering inflammatory and oxidative stress markers and enhancing the lipid profile, insulin sensitivity, endothelial function, and anti-atherosclerotic and anti-thrombotic properties [100].”
Background
The Impact of the Endocrine and Immunological Function of Adipose Tissue on Reproduction in Women with Obesity
Mączka, K., Stasiak, O., Przybysz, P., Grymowicz, M., & Smolarczyk, R. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25179391 · Cited by 38 · see citing works
Abdominal Obesity in Women with Polycystic Ovary Syndrome and Its Relationship with Diet, Physical Activity and Insulin Resistance: A Pilot Study
Jurczewska, J., Ostrowska, J., Chełchowska, M., Panczyk, M., Rudnicka, E., Kucharski, M., Smolarczyk, R., & Szostak-Węgierek, D. (2023) · Nutrients · doi:10.3390/nu15163652 · Cited by 37 · see citing works
“Some other authors also demonstrated that IR was a more prominent feature in overweight and obese PCOS women than in lean PCOS women; however, without distinguishing the types of body fat distribution [40,44,50,51].”
Background
Body Mass Index (BMI): Still be used?
Muscogiuri, G., Verde, L., & Colao, A. (2023) · European journal of internal medicine · doi:10.1016/j.ejim.2023.09.002 · Cited by 37
Self-citation
Adherence to the Mediterranean Diet in Women and Reproductive Health across the Lifespan: A Narrative Review
Szmidt, M. K., Granda, D., Madej, D., Sicinska, E., & Kałuża, J. (2023) · Nutrients · doi:10.3390/nu15092131 · Cited by 40 · see citing works
“6 kg/m2), cardio-metabolic risk factors were evaluated [92].”
Background
Factors of Obesity and Metabolically Healthy Obesity in Asia
Mathis, B. J., Tanaka, K., & Hiramatsu, Y. (2022) · Medicina · doi:10.3390/medicina58091271 · Cited by 34 · see citing works
“Meanwhile, MUHO associated with polycystic ovary syndrome (PCOS), an autoimmune disorder found in women that features pan-androgen hormonal dysregulation, was found in a study of 94 women to be reliant on higher testosterone levels while those with MHO and PCOS had lower androgens [96].”
Background
Physical Activity, Rather Than Diet, Is Linked to Lower Insulin Resistance in PCOS Women—A Case-Control Study
Jurczewska, J., Ostrowska, J., Chełchowska, M., Pańczyk, M., Rudnicka, E., Kucharski, M., Smolarczyk, R., & Szostak-Węgierek, D. (2023) · Nutrients · doi:10.3390/nu15092111 · Cited by 30 · see citing works
“[41] also emphasized that the exacerbation of IR measured by HOMA-IR was different due to the metabolic status of the examined PCOS women.”
Background
Obesity-associated inflammation countered by a Mediterranean diet: the role of gut-derived metabolites
Florkowski, M. R., Abiona, E., Frank, K. M., & Brichacek, A. L. (2024) · Frontiers in Nutrition · doi:10.3389/fnut.2024.1392666 · Cited by 26 · see citing works
Adherence to the Mediterranean diet as a possible additional tool to be used for screening the metabolically unhealthy obesity (MUO) phenotype
Barrea, L., Verde, L., Simancas‐Racines, D., Zambrano, A. K., Frías-Toral, E., Colao, A., Savastano, S., & Muscogiuri, G. (2023) · Journal of Translational Medicine · doi:10.1186/s12967-023-04546-0 · Cited by 27 · see citing works
“In agreement with the findings of the current study, we previously found that women with MUO phenotype and polycystic ovary syndrome (PCOS) reported lower adherence to MD than women with MHO phenotype and PCOS, despite same total energy intake [29].”
BackgroundResultSelf-citation
Obesity, Dietary Patterns, and Cardiovascular Disease: A Narrative Review of Metabolic and Molecular Pathways
Dina, C., Ţiţ, D. M., Radu, A.-F., Bungau, G., & Radu, A.-F. (2025) · Current Issues in Molecular Biology · doi:10.3390/cimb47060440 · Cited by 23 · see citing works
“…with obesity into metabolically healthy obese (MHO) and metabolically unhealthy obese (MUHO) phenotypes has been established to differentiate those who, despite excess adiposity, lack overt cardiometabolic dysfunction from those who manifest clinically relevant metabolic impairments [93].”
Changes in the global burden of polycystic ovary syndrome from 1990 to 2021
Lin, T., Xie, B.-Q., Yang, J., Xu, J.-B., & Chen, F. (2025) · Reproductive Health · doi:10.1186/s12978-025-02016-y · Cited by 22 · see citing works
“Italy’s health system, ranked second in the World Health Report 2000, as well as its efficiency [37] and greater adherence to the Mediterranean diet among the popu-lace [38, 39], likely play crucial roles in mitigating Italy’s national PCOS disease burden.”
Alteration of Branched-Chain and Aromatic Amino Acid Profile as a Novel Approach in Studying Polycystic Ovary Syndrome Pathogenesis
Paczkowska, K., Rachoń, D., Berg, A., Rybka, J., Kapczyńska, K., Bolanowski, M., & Daroszewski, J. (2023) · Nutrients · doi:10.3390/nu15194153 · Cited by 20 · see citing works
“MUO PCOS women revealed differences not only in classic metabolic parameters between those groups but also in novel markers, such as the Visceral Adiposity Index (VAI), and Fatty Liver Index (FLI) as well [29].”
Background
Obesity and breast cancer: exploring the nexus of chronic inflammation, metabolic dysregulation, and nutritional strategies
Reytor-González, C., Simancas-Racines, D., Román-Galeano, N., Campuzano-Donoso, M., Carella, A. M., Zambrano-Villacres, R., Marinelli, T., Coppola, L., Marchetti, M., Galasso, M., et al. (2025) · Food and Agricultural Immunology · doi:10.1080/09540105.2025.2521270 · Cited by 19 · see citing works
Metabolically Healthy Obesity: Are Interventions Useful?
Mathis, B. J., Tanaka, K., & Hiramatsu, Y. (2023) · Current Obesity Reports · doi:10.1007/s13679-023-00494-4 · Cited by 19 · see citing works
The association between the Mediterranean Diet and the Prime Diet Quality Score and polycystic ovary syndrome: a case control study
Ajorlouie, Z., Moshkian, P., Baghdadi, G., Amiri, R., Biglari, F., & Rahimlou, M. (2025) · BMC Nutrition · doi:10.1186/s40795-025-01067-5 · Cited by 17 · see citing works
“Insulin resistance can contribute to hyperandrogenism, a key feature of PCOS [40, 41].”
Systemic Inflammation Across Metabolic Obesity Phenotypes: A Cross-Sectional Study of Korean Adults Using High-Sensitivity C-Reactive Protein as a Biomarker
Baek, S., & Yoon, J. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms252111540 · Cited by 20 · see citing works
Moving beyond Weight: A Narrative Review of the Dietary and Lifestyle Management for Reducing Cardiometabolic Risk in Polycystic Ovary Syndrome (PCOS)
Herbert, S., & Woolf, K. (2023) · Nutrients · doi:10.3390/nu15245069 · Cited by 15 · see citing works
Influence of Mediterranean Diet on Sexual Function in People with Metabolic Syndrome: A Narrative Review
Oteri, V., Galeano, F., Panebianco, S., Piticchio, T., Moli, R. L., Frittitta, L., Vella, V., Baratta, R., Gullo, D., Frasca, F., et al. (2024) · Nutrients · doi:10.3390/nu16193397 · Cited by 13 · see citing works
Unlocking the potential: very-low-energy ketogenic therapy in obesity-related disorders
Simancas‐Racines, D., Reytor-González, C., Zambrano, A. K., Annunziata, G., Am, C., Verde, L., Frías-Toral, E., Guerra, C. V., & Hidalgo, R. (2025) · Food and Agricultural Immunology · doi:10.1080/09540105.2024.2442368 · Cited by 13 · see citing works
“Similarly, Magagnini et al. (2022), evaluated 25 women with obesity and PCOS and found that VLEKT improved BMI, sex hormone binding globulin levels, and the HOMA-IR index, reinforcing its potential for improving ovarian and metabolic function (Magagnini et al., 2022).”
Influential
Mitochondrial DNA oxidation and content in different metabolic phenotypes of women with polycystic ovary syndrome
Rojo, M., Pérez, H., Millán, A., Pautasso, M. C., Duarte, A., Abruzzese, G., Motta, A., Frechtel, G., & Cerrone, G. E. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1501306 · Cited by 13 · see citing works
Efficacy, Feasibility and Acceptability of a Mediterranean Diet Intervention on Hormonal, Metabolic and Anthropometric Measures in Overweight and Obese Women with Polycystic Ovary Syndrome: Study Protocol
Scannell, N., Moran, L., Mantzioris, E., Cowan, S., & Villani, A. M. (2022) · Metabolites · doi:10.3390/metabo12040311 · Cited by 13 · see citing works
“[79] recently reported that poor adherence to a MedDiet was associated with a ‘metabolically unhealthy obesity’ phenotype in women with PCOS, as defined through evaluation of endocrine-metabolic profiles, inflammatory status, cardiometabolic indices and body composition parameters.”
Background
The potential role of the Mediterranean Diet for the treatment and management of Polycystic Ovary Syndrome: a review of the pathophysiological mechanisms and clinical evidence.
Scannell, N., Villani, A., Moran, L., & Mantzioris, E. (2025) · Proceedings of the Nutrition Society · doi:10.1017/s0029665124007584 · Cited by 12 · see citing works
“(92) To Cutillas-Tolínetal2021 (93) To explore associations between diet quality indices and the presence of PCOS features 2021 (94) To characterise the determinants of the metabolic health status in obese women with PCOS Italy Cross-sectional n = 94 women with PCOS; aged 18-30 years, BMI ≥ 30 kg/m…”
The triglycerides and glucose index is more strongly associated with metabolically healthy obesity phenotype than the lipid and obesity indices
Weyman-Vela, Y., Guerrero-Romero, F., & Simental-Mendía, L. E. (2023) · Journal of Endocrinological Investigation · doi:10.1007/s40618-023-02201-5 · Cited by 11 · see citing works
Screening and validation of potential markers associated with uterine corpus endometrial carcinoma and polycystic ovary syndrome based on bioinformatics methods
Wu, R., Wu, C., Zhu, B.-M., Li, J., & Zhao, W.-Z. (2023) · Frontiers in Molecular Biosciences · doi:10.3389/fmolb.2023.1192313 · Cited by 11 · see citing works
PCOS and Obesity: Contraception Challenges
Męczekalski, B., Rasi, M., Battipaglia, C., Fidecicchi, T., Bala, G. P., Szeliga, A., Luisi, S., & Genazzani, A. (2025) · Open Access Journal of Contraception · doi:10.2147/oajc.s501434 · Cited by 10
“42 Given these metabolic and hormonal challenges, managing PCOS in the context of obesity requires a multifaceted approach.”
Cardiac energy depletion in a rat model of polycystic ovarian syndrome is reversed by acetate and associated with inhibitory effect of HDAC2/mTOR
Olaniyi, K. S., Areloegbe, S. E. J., & Fiemotongha, F. E. (2023) · European Journal of Pharmacology · doi:10.1016/j.ejphar.2023.176243 · Cited by 11 · see citing works
Body fat and muscle were associated with metabolically unhealthy phenotypes in normal weight and overweight/obesity in Yi people: A cross-sectional study in Southwest China
Wang, Y., Pan, L., Wan, S., Yihuo, W.-L., Yang, F., Li, Z., Yong, Z., & Shan, G. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.1020457 · Cited by 9 · see citing works
Impact of obesity on postoperative complications in colorectal cancer surgery: A systematic review and meta-analysis.
Sarno, G., Simancas-Racines, D., Gargiulo, A., Tedesco, A., Iacone, B., Reytor-González, C., Parise-Vasco, J., Iguago, J. A., Sarno, S., Frías-Toral, E., et al. (2025) · Seminars in Cancer Biology · doi:10.1016/j.semcancer.2025.05.012 · Cited by 8 · see citing works
A Pilot Study on Ad Libitum Mediterranean Diet Intervention for Women with PCOS: A Mixed-Methods Exploration of Acceptability, Adherence, and Participant Lived Experience
Scannell, N., Villani, A. M., Moran, L., Mantzioris, E., & Cowan, S. (2025) · Nutrients · doi:10.3390/nu17071105 · Cited by 6 · see citing works
Assessment of the Risk of Insulin Resistance in Workers Classified as Metabolically Healthy Obese
Samuelsson, M. G., López, P. T. T., López-González, Á., Paublini, H., Rifá, E. M.-A., & Ramírez-Manent, J. I. (2025) · Nutrients · doi:10.3390/nu17081345 · Cited by 7 · see citing works
“The most distinctive characteristic of these individuals is their higher insulin sensitivity compared to metabolically unhealthy obese (NMHO) individuals [7].”
Heavy metals in the diet: unraveling the molecular pathways linked to neurodegenerative disease risk
Guevara‐Ramírez, P., Tamayo‐Trujillo, R., Cadena-Ullauri, S., Ruiz‐Pozo, V. A., Paz‐Cruz, E., Annunziata, G., Verde, L., Frías-Toral, E., Simancas‐Racines, D., & Zambrano, A. K. (2024) · Food and Agricultural Immunology · doi:10.1080/09540105.2024.2434457 · Cited by 9 · see citing works
“…with a reduced risk of developing AD, as well as other conditions such as obesity (Muscogiuri et al., 2022), diabetes (Barrea et al., 2023), and more (Barrea et al., 2021; Barrea et al., 2021; Bianchi et al., 2021; Guasch-Ferré & Willett, 2021; Muscogiuri et al., 2019; Sciacca et al., 2023).”
Health Determinants Associated with the Mediterranean Diet: A Cross-Sectional Study
Onofre, N. S., Izquierdo, J. Q. I., & Trescastro-López, E. M. (2022) · Nutrients · doi:10.3390/nu14194110 · Cited by 7 · see citing works
A Systemic Perspective of the Link Between Microbiota and Cardiac Health: A Literature Review
Grigore, I., Ciobotaru, O. R., Hînganu, D., Gurău, G., Tutunaru, D., & Hînganu, M. V. (2025) · Life · doi:10.3390/life15081251 · Cited by 6 · see citing works
Acetate mitigates cardiac mitochondrial dysfunction in experimental model of polycystic ovarian syndrome by modulating GPCR41/43 and PROKR1
Areloegbe, S. E. J., & Olaniyi, K. S. (2023) · Biochemical and Biophysical Research Communications · doi:10.1016/j.bbrc.2023.09.061 · Cited by 6 · see citing works
Lipid accumulation product and visceral adiposity index in polycystic ovary syndrome: a systematic review and meta-analysis of observational studies
Parsaei, M., Karimi, E., Barkhordarioon, A., Yousefi, M., & Tarafdari, A. (2025) · Lipids in Health and Disease · doi:10.1186/s12944-025-02719-y · Cited by 5 · see citing works
Molecular mechanisms underlying obesity-induced memory dysfunction: a comprehensive narrative review
Golkar, A., Razazpour, F., Dalfardi, M., & Baghcheghi, Y. (2025) · Physiology & Behavior · doi:10.1016/j.physbeh.2025.115119 · Cited by 7 · see citing works
Association between metabolically healthy obesity and atrial fibrillation: A systematic review and meta-analysis of longitudinal studies.
Liu, X., Ling, J., Wu, Y.-F., Zhao, H., Hu, Y.-Z., Yan, Z.-W., Zhu, W.-G., Yu, P., Wang, J.-F., Zhang, Y., et al. (2025) · Diabetes & metabolic syndrome · doi:10.1016/j.dsx.2025.103228 · Cited by 5 · see citing works
Association of Genetic, Environmental, and Nutritional Factors With Metabolic Phenotypes of Obesity: A Scoping Review
Doost, H. D., Jounaghani, M. N., Riahi, R., Heidari-Beni, M., Hosseini, M., Sharifianjazi, F., & Kelishadi, R. (2025) · Journal of Obesity · doi:10.1155/jobe/8472196 · Cited by 5 · see citing works
Dyslipidemias associated with endocrine disorders: a position statement of the working group of the nutrition hormones and metabolism club of the italian society of endocrinology (SIE)
Muscogiuri, G., Albertelli, M., Arnaldi, G., Barrea, L., Bellastella, G., Bonomi, M., Caputo, M., Caprio, M., Cignarelli, A., Gioia, L. D., et al. (2026) · Journal of Endocrinological Investigation · doi:10.1007/s40618-026-02862-y · Cited by 4 · see citing works
Self-citation
Predicting Metabolic and Cardiovascular Healthy from Nutritional Patterns and Psychological State Among Overweight and Obese Young Adults: A Neural Network Approach
Reiván-Ortiz, G., Maraver-Capdevila, L., & Granero, R. (2025) · Nutrients · doi:10.3390/nu17162651 · Cited by 4 · see citing works
“Studies have highlighted that this latter type of obesity is linked to the accumulation of visceral fat, which negatively impacts metabolism and can lead to long-term complications, even in young people without an overtly obese physical appearance [30,31].”
Associations between adherence to a Mediterranean diet and assisted reproductive techniques outcomes: a systematic review
Martín-Manchado, L., Sánchez‐SanSegundo, M., Moya-Yeste, A. M., Sánchez, J. A. H., Tuells, J., & Zaragoza-Martí, A. (2025) · European Journal of Public Health · doi:10.1093/eurpub/ckaf100 · Cited by 4 · see citing works
“An inversely proportional association was also found between adherence to the MD pattern and the clinical severity of polycystic ovary syndrome, the most common endocrine disorder linked to female infertility [36, 37].”
Association Between Nutrition Patterns and Metabolic and Psychological State Among Young Adults.
Reiván-Ortiz, G., Granero, R., Aranda-Ramírez, M. P., & Aguirre-Quezada, M. A. (2025) · European eating disorders review · doi:10.1002/erv.3209 · Cited by 4 · see citing works
Telomere length across the spectrum of metabolic health: an analysis from the LIPIDOGEN2015 study
Banach, M., Fronczek, M., Goc, A., Lejawa, M., Boniewska-Bernacka, E., Osadnik, T., Pańczyszyn, A., Strzelczyk, J., Pawlas, N., Gierlotka, M., et al. (2024) · Archives of medical science : AMS · doi:10.5114/aoms/195465 · Cited by 4
“Univariate regression analysis showed an association between decreasing RTL and metabolic syndrome (NOMS and MUO for p=0.038 and p=0.003, respectively).”
Influential
Association between dynapenic obesity phenotypes and physical performance in middle-age and older women living in community
Arteaga-Pazmiño, C., Fonseca-Pérez, D., Balladares-Mazzini, M. B., Gálvez-Celi, J., Sánchez, J. E., & Álvarez-Córdova, L. (2024) · Frontiers in Nutrition · doi:10.3389/fnut.2024.1480284 · Cited by 4 · see citing works
Factors associated with adherence to the Mediterranean diet among medical students at a private university in Lima, Peru
Vera-Ponce, V., Valencia, J. G., Torres-Malca, J. R., Zuzunaga-Montoya, F., Zeñas-Trujillo, G. Z., Cruz-Ausejo, L., Loayza-Castro, J., & la Cruz-Vargas, J. A. D. (2023) · Electronic Journal of General Medicine · doi:10.29333/ejgm/13083 · Cited by 4 · see citing works
The Composition of Small Extracellular Vesicles (sEVs) in the Blood Plasma of Colorectal Cancer Patients Reflects the Presence of Metabolic Syndrome and Correlates with Angiogenesis and the Effectiveness of Thermoradiation Therapy
Yunusova, N., Svarovsky, D., Konovalov, A. I., Kostromitsky, D., Startseva, Z., Cheremisina, O., Afanas'ev, S., Kondakova, I., Grigor'eva, A., Vtorushin, S., et al. (2023) · Journal of Personalized Medicine · doi:10.3390/jpm13040684 · Cited by 4
“body mass index ≥30 combined with one of the additional criteria for metabolic syndrome, or isolated obesity [18].”
Background
Role of ChREBP–PPARα–FGF21 Axis in Metabolic Dysfunction of MASLD
Girón, K. M. P., Nazara, Z. H. H., Maldonado-González, M., Martínez-López, E., Muñóz, M. P. S., López, C. A. B., Aguiñaga, M., Domínguez-Rosales, J. A., Vargas-Guerrero, B., & Ruíz-Madrigal, B. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms262311425 · Cited by 3 · see citing works
“However, these findings are controversial [39–42]. hs-PCR is an inflammatory marker of innate defense that can recruit the complement system and phagocytic cells produced in the liver.”
Network study of the nutritional patterns, the metabolic and the psychological status among overweight-obese young adults
Ortiz, G. G. R., Granero, R., Icaza, D., & Maraver-Capdevila, L. (2025) · Frontiers in Nutrition · doi:10.3389/fnut.2025.1666688 · Cited by 4 · see citing works
Irruption of Network Analysis to Explain Dietary, Psychological and Nutritional Patterns and Metabolic Health Status in Metabolically Healthy and Unhealthy Overweight and Obese University Students: Ecuadorian Case
Aguirre-Quezada, M. A., & Aranda-Ramírez, M. P. (2024) · Nutrients · doi:10.3390/nu16172924 · Cited by 3 · see citing works
“In the evaluation of metabolic status, two methods were applied to classify participants into MUO and MHO [9].”
BackgroundMethod
Body Composition Indicators Jointly Predict Metabolic Unhealthy Phenotypes in Young and Middle-Aged Obese Individuals: A Cross-Sectional Quantitative Computed Tomography Study
Zhan, H., Qichun, C., Liu, T., Shi, Y., Pei, J., Zou, L., & Wang, L. (2024) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s447847 · Cited by 2 · see citing works
“21,22 A cross-sectional study in China of the Yi population showed that VAT was positively associated with MUO.”
Background
Differences of Regional Fat Distribution Measured by Magnetic Resonance Imaging According to Obese Phenotype in Koreans
Choi, H.-N., Lim, H., Kim, Y.-S., Rhee, S., & Yim, J. (2022) · Metabolic Syndrome and Related Disorders · doi:10.1089/met.2022.0044 · Cited by 3 · see citing works
Nutrition Patterns, Metabolic and Psychological State Among High-Weight Young Adults: A Network Approach
Ortiz, G. G. R., Granero, R., Maraver-Capdevila, L., & Aguirre-Quejada, A. (2026) · Nutrients · doi:10.3390/nu18010145 · Cited by 3 · see citing works
“One method is based on the criteria modified by the International Diabetes Federation [24], which defines MUO as the presence of at least two of the following cardiometabolic risk factors: elevated triglycerides ( ≥ 150 mg/dL), high fasting glucose ( ≥ 126 mg/dL), reduced HDL-cholesterol ( 45…”
Does Metabolic Status Associate With IVF Outcomes in Women Within Similar Body Mass Index Category: Evidence From a Large Cohort Study
Ding, L., Lin, X., Pan, P., Li, Y., Chen, W., He, L.-Y., Xu, Y.-S., Chang, H.-M., Yang, H.-Y., Wang, G., et al. (2025) · Journal of Diabetes · doi:10.1111/1753-0407.70132 · Cited by 2 · see citing works
The Relationship Between Obesity, Menstrual Cycle, And Polycystic Ovary Syndrome Cases
Syamsiah, S., Adelin, C., & Kundaryanti, R. (2024) · Jurnal Kebidanan Malahayati · doi:10.33024/jkm.v10i9.17492 · Cited by 2
Prevalence and Factors Related to Physical Activity in Spanish Adults with Obesity and Overweight: Analysis of the European Health Surveys for the Years 2014 and 2020
Maestre-Miquel, C., López-de-Andrés, A., Pérez-Farinós, N., Jimenez-Sierra, A., Benavente-Marín, J. C., López-Gónzalez, Á., Viñuela-Sanchez, A., & Jiménez-García, R. (2024) · Healthcare · doi:10.3390/healthcare12141382 · Cited by 2 · see citing works
““Metabol-ically unhealthy obesity” is the term used for persons with multiple cardiovascular risk factors [41], although the definition has been scientifically disputed [42].”
Background
Correlation between serum thyroid stimulating hormone level and glycolipid metabolism in patients with polycystic ovary syndrome
Chen, Z., Jing, S., & Sun, Y. (2023) · Medicine · doi:10.1097/md.0000000000036791 · Cited by 2 · see citing works
“[24] At the same time, a decrease in progesterone content leads to negative feedback regulation of the hypothalamus, which leads to the continuous release of gonadotropin-releasing hormone, resulting in an increase in luteinizing hormone (LH) levels and an increase in androstene-dione secreted by…”
Background
Preoperative Triglyceride-Glucose Index as a Predictor of Weight Loss Following Sleeve Gastrectomy: A Retrospective Cohort Study
Keyif, M. F., & Bolat, F. (2026) · Obesity Surgery · doi:10.1007/s11695-026-08643-z · Cited by 1
Mapping phenotypic heterogeneity and cardiometabolic risk in obesity using a tree-based dimensionality reduction framework
Zhao, Y., Wang, W., Wang, Z., Ma, J., Zhang, J., Shao, J., Zhou, K. S., Pan, Q., Nie, Z., Xu, G., et al. (2026) · Journal of Translational Medicine · doi:10.1186/s12967-026-07867-y
“Previous studies have identified visceral fat accumulation as a significant factor in metabolic disorders [35, 36].”
Associations Between Metabolic Heterogeneity of Obesity and Chronic Multimorbidity Progression: A Nationwide Prospective Cohort Study
Qin, J., Pan, X.-J., Wu, C., Liu, Y.-H., Zhu, M., & Li, M. (2026) · Diabetes/Metabolism Research Reviews · doi:10.1002/dmrr.70125 · Cited by 1
Clustering of overweight and obese young adults based on their nutritional patterns and psychological state
Reiván-Ortiz, G., Maraver-Capdevila, L., & Granero, R. (2025) · Health Psychology and Behavioral Medicine · doi:10.1080/21642850.2025.2596419 · Cited by 1 · see citing works
“The first was based on the modified International Diabetes Federation criteria (Barrea et al., 2021), grouping participants with at least two cardiometabolic risk factors into the MUO category and the rest into MHO.”
Integrated Transcriptomics and Single-Cell RNA Sequencing Analyses Reveal the Potential Role of Obesity-Related Genes in Polycystic Ovary Syndrome
Gong, X. (2025) · Reproductive Sciences · doi:10.1007/s43032-025-01968-7 · Cited by 1 · see citing works
Biomarkers of chronic inflammation in children with obesity and their association with complications of the disease
Skvortsova, O. V., Migacheva, N. B., & Михайлова, Е. Г. (2025) · Russian Pediatric Journal · doi:10.46563/1560-9561-2025-28-1-47-53 · Cited by 1 · see citing works
Common pathogenetic mechanisms of non-alcoholic fatty liver disease and polycystic ovary syndrome
Ilovayskaya, I. (2024) · Experimental and Clinical Gastroenterology · doi:10.31146/1682-8658-ecg-230-10-90-97 · Cited by 1 · see citing works
The Effects of Different Types of Diets on Steroid Hormone Concentrations
Dušková, M. (2023) · Physiological Research · doi:10.33549/physiolres.935209 · Cited by 3 · see citing works
Statins for women with polycystic ovary syndrome not actively trying to conceive
Xiong, T., Fraison, É., Kolibianaki, E., Costello, M., Venetis, C. A., & Kostova, E. (2023) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008565.pub3 · Cited by 2 · see citing works
Weight Loss Measurements Under the Microscope: How Type and Baseline Definition Shape Clinical Response After Metabolic-Bariatric Surgery — A 2-Year Follow-up Analysis of 17,568 Patients
Fink, M., Andrieux, G., Herrmann, S., Wei, N., Schäfer, L., Läßle, C., Tsouris, A., Fink, J. M., Marjanović, G., Fichtner‐Feigl, S., et al. (2026) · Obesity Surgery · doi:10.1007/s11695-026-08929-2
Metabolic health and cardiovascular risk among Cameroonian adults with and without obesity
Nguedjo, M., Mbiondi, O. M., Mandeng, K. F. P., Kamgain, A. D. T., Medoua, G., Ngondi, J., & Oben, J. E. (2026) · PLOS Global Public Health · doi:10.1371/journal.pgph.0006870
“Other criteria, such as insulin resistance and high-sensitivity C-reactive protein (hs-CRP), have also been proposed better to characterise the metabolically healthy profile of individuals with obesity [8].”
Insights into Metabolically Healthy Obesity—A Narrative Review
Roșca, O.-R., & Tudoran, C. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15166446
“Nevertheless, genetic predisposition interacts strongly with environmental and lifestyle factors rather than acting independently [18,24,48].”
Influential
Correlation analysis of metabolically healthy obesity and erectile dysfunction: a cross-sectional study based on the NHANES database (2001-2004).
Hou, Y.-C., Yu, G.-C., Zhang, C.-Y., Liu, J.-H., Li, R., Zhou, B., & Zhou, H. (2026) · The Aging Male · doi:10.1080/13685538.2026.2712119
Association of healthy lifestyle with coronary artery disease risk varies by weight status: a prospective cohort study
Zhang, F., Wang, Z.-F., & Zhang, H. (2026) · Frontiers in Nutrition · doi:10.3389/fnut.2026.1854100
“…have been identified: metabolically healthy obesity (MHO), characterized by a favorable metabolic profile despite high adiposity, and metabolically unhealthy obesity (MUO), which is associated with multiple metabolic abnormalities such as hypertension, dyslipidemia, and hyperglycemia (12, 13).”
DEXA-Derived Body Fat Distribution and Its Correlation With Clinical, Anthropometric, Insulin Sensitivity, Metabolic, and Hormonal Parameters Among Kashmiri Polyendocrine Metabolic Ovarian Syndrome (PMOS) Women: A Cross-Sectional Study
Yousuf, S. D., Ahmed, W., Qadir, A., Rehman, N. U., Islam, K. U., & Ganie, M. A. (2026) · Cureus · doi:10.7759/cureus.113105
Diagnostic and prognostic biomarkers in PCOS: Navigating insulin resistance, systemic inflammation, and endometrial receptivity.
El-Sehrawy, A. A., Aljumaili, O. I., Baig, M. R., Nematov, O., Sapaev, I., Badr, I. H., Smerat, A., & Basunduwah, T. S. (2026) · Clinica chimica acta; international journal of clinical chemistry · doi:10.1016/j.cca.2026.121197
Dietary Antioxidant Capacity, Inflammation, and Insulin Resistance in Women with Polycystic Ovary Syndrome: An Integrated Metabolic and Nutritional Assessment
ALATAŞ, H., Arslan, N., KESKİN, L., & Ağralı, C. (2026) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s586793 · Cited by 1 · see citing works
Associations of systemic inflammatory indices and metabolically healthy vs. unhealthy obesity in children
Bilici, M. E. (2026) · Italian Journal of Pediatrics · doi:10.1186/s13052-026-02262-1
“Circulating pro-inflammatory mediators—such as TNF-α, IL-6, and acute-phase reac-tants—increase in proportion to adipose tissue dysfunction, positioning adipose tissue as the central regulator of metabolic inflammation [3, 8–12].”
ASSESSMENT OF ADIPOKINES AND CYTOKINES AS PREDICTIVE BIOMARKERS FOR METABOLIC SYNDROME IN POLYCYSTIC OVARY SYNDROME PATIENTS
Salem, W. A. (2026) · Medical Science of Ukraine (MSU) · doi:10.32345/2664-4738.1.2026.01
Development and validation of a logistic regression model for predicting menstrual irregularity using LDL-C and age in reproductive-aged women: An analysis of NHANES Data
Zou, Y., Peng, J.-H., Li, P.-S., Xu, L., Peng, X., & Liang, R.-N. (2026) · Medicine · doi:10.1097/md.0000000000046939
“[9,10] Animal experiments have demonstrated that a high-LDL diet can induce apoptosis in ovarian granulosa cells and downregulate the expression of CYP19A1, a key enzyme involved in estradiol synthesis.”
Polycystic ovarian syndrome (PCOS) and crosstalk between PCOS and Psychological disorders
Bodke, V., & Mali, A. S. (2025) · Vita Scientia · doi:10.65116/vitascientia.v1i2.rev.02
Features of patients with infertility against the background of metabolic syndrome
Chilova, R., Siordia, A., Zholobova, M., Kovalev, M., Gadaeva, I., Kazakov, R., & Sokova, E. (2025) · Vrach · doi:10.29296/25877305-2025-07-13
Effect of Mediterranean diet adherence during the third trimester of pregnancy on maternal and newborn health outcomes
Ceylan, J. A. (2025) · Nutrition · doi:10.1016/j.nut.2025.112909
REPERCUSSÕES CARDIOMETABÓLICAS DA SÍNDROME DOS OVÁRIOS POLICÍSTICOS
Lima, R. M. N., Silva, I. M. L., Andrade, G. M., Gomes, F., de Carvalho, T. B. D., Nery, W. D. S., & Vasconcelos, Y. L. C. (2025) · Revista Foco · doi:10.54751/revistafoco.v18n4-051
The Role of Sleep Hygiene in Different Patterns of Polycystic Ovary Syndrome (PCOS): Insights from Modern and Persian Medicine
Goodarzi, L., Ahmadi, M., Ramezanirad, M., Ahmadi, F., Khosravi, A., Zadehmodarres, S., Farjami, M., & Tansaz, M. (2025) · Medical Journal of The Islamic Republic of Iran · doi:10.47176/mjiri.39.116
“Understanding the mutual relationship between obesity and PCOS is vital for developing integrated management strategies that address both metabolic and reproductive features of the syndrome (16, 18).”
Frequency of Polycystic Ovary Syndrome and “Being at Risk for Polycystic Ovary Syndrome” in Obese Adolescent Girls in Light of Current Definitions
Yüksel, Ö., Atmaca, F. G., Dursun, F., Seymen, G., Atla, P., Altun, E., Yaşar, A., & Kırmızıbekmez, H. (2025) · Journal of Clinical Research in Pediatric Endocrinology · doi:10.4274/jcrpe.galenos.2025.2024-7-31
Correlation between diet, body mass index, and lipid profile in Kosovar women treated for primary infertility
Gashi, F., Kadrija, M., Gashi, Z., Arapcheska, M., Elezaj, S., Gashi, F., Gashi, F., Elezaj, G., & Elezaj, L. (2024) · Italian Journal of Medicine · doi:10.4081/itjm.2024.1784

Authors: Barrea, L., Muscogiuri, G., Pugliese, G., de Alteriis, G., Colao, A., & Savastano, S.
Affiliations: Federico II University Hospital (IT)
Unit of Endocrinology, Dipartimento di Medicina Clinica e Chirurgia, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy
Corresponding author: Barrea, Luigi
ORCID: Barrea, Luigi
Muscogiuri, Giovanna
Pugliese, Gabriella
Colao, Annamaria
Savastano, Silvia
Venue: Nutrients
Publisher: MDPI AG
Published: 2021-11-02
Volume: 13
Issue: 11
Pages: 3925
ISSN: 2072-6643 (ISSN-L)
DOI: 10.3390/nu13113925
PMC: PMC8624317
OpenAlex: W3210303876
Cited by: 99
References: 93
Citations by year: 2026: 18 · 2025: 30 · 2024: 19 · 2023: 23 · 2022: 8
FWCI: 10.79
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (vor)
Locations: Nutrients (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics: Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
Keywords: metabolically healthy obesity, metabolically unhealthy obesity, polycystic ovary syndrome, Mediterranean diet adherence, body composition, visceral fat, insulin resistance, hyperandrogenism, C-reactive protein, low-grade inflammation, hepatic steatosis, cardiometabolic risk, women's health, energy intake, lifestyle intervention
MeSH terms: Obesity, Metabolically Benign, Cardiometabolic Risk Factors, Adult, Body Composition, C-Reactive Protein, Energy Intake, Female, Humans, Insulin, Insulin Resistance, Nutritional Status, Obesity, Phenotype, Polycystic Ovary Syndrome, Testosterone, Body Mass Index, Diet, Mediterranean, Metabolome, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

Metabolically Healthy Obesity (MHO) vs. Metabolically Unhealthy Obesity (MUO) Phenotypes in PCOS: Association with Endocrine-Metabolic Profile, Adherence to the Mediterranean Diet, and Body Composition

Abstract

Integrity signals

Claims the paper makes

Claims other papers make about this one

Self-check

Cites

Cited by

Record

About these checks