Expression of Metabolic Syndrome in Women with Severe Obesity

James L. Hopkins, Paul N. Hopkins, Eliot A. Brinton, Ted D. Adams, Lance E. Davidson, M. Nazeem Nanjee, Steven Hunt

Research output: Contribution to journalArticle

3 Citations (Scopus)


Background: The prevalence of metabolic syndrome (MetS) generally rises with increasing adiposity, but tends to plateau at the highest levels of body mass index (BMI) with some individuals, even with severe obesity, expressing few or no components of MetS. We examined factors associated with the expression of MetS in severely obese women participating in a large observational study. Methods: Anthropometrics, including Heath equation-adjusted bioimpedance-determined fat-free mass (FFM) and fat mass (FM), lipids and related laboratory measurements, resting energy expenditure (REE), and respiratory quotient (RQ), were studied in 949 women with severe obesity. Results: Even though the mean BMI was 45.7 kg/m2 and all participants met MetS criteria for increased waist circumference, 30% of subjects did not have MetS. Unadjusted FM (P = 0.0011), FFM (P < 0.0001), and REE (P < 0.0001) were greater in the women with MetS. Surprisingly, in multivariate logistic regression FFM was positively associated with MetS (P = 0.0002), while FM was not (P = 0.89). Moreover, FFM, not FM, was significantly associated with all five components of MetS except for triglyceride levels. REE and RQ were higher in those with MetS, and REE was strongly associated with multiple components of MetS. Conclusions: In women with severe obesity, higher FFM and REE were paradoxically associated with increased rather than decreased risk of MetS, while FFM-adjusted FM was unrelated to MetS.

Original languageEnglish
Pages (from-to)283-290
Number of pages8
JournalMetabolic Syndrome and Related Disorders
Issue number6
Publication statusPublished - 1 Aug 2017
Externally publishedYes


  • insulin
  • liver enzymes
  • Metabolic syndrome
  • obesity

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

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  • Cite this

    Hopkins, J. L., Hopkins, P. N., Brinton, E. A., Adams, T. D., Davidson, L. E., Nanjee, M. N., & Hunt, S. (2017). Expression of Metabolic Syndrome in Women with Severe Obesity. Metabolic Syndrome and Related Disorders, 15(6), 283-290.