Original Article 117 DOI: 10.4274/tjem.3600 Turk J Endocrinol Metab 2016;20:117-122 Introduction The worldwide prevalence of obesity has more than doubled and it has become a growing public health problem (1). Undesirable conditions, such as type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD), may accompany obesity, which may lead to a higher incidence of all-cause mortality. However, not all obese subjects show the same metabolic profiles. Some of them may exhibit a more favorable, healthy profile, which is characterized by high insulin sensitivity levels, favorable lipid profiles, satisfactory fat distribution, low hypertension incidence and low systemic inflammatory marker levels; (2) this has been termed as metabolically healthy obesity (MHO) (3). MHO subjects constitute 10-50% of all obese people on the basis of the criteria used to define MHO subjects based on the results reported by Address for Correspondence: Şule Temizkan MD, Kartal Dr. Lütf Kırdar Training and Research Hospital, Clinic of Endocrinology and Metabolic Diseases, İstanbul, Turkey Phone: +90 216 441 39 00 E-mail: suletemizkan@yahoo.com Received: 15/04/2016 Accepted: 09/09/2016 Purpose: In our study, we aimed to determine whether metabolically healthy subjects with obesity would show endothelial dysfunction (ED) when compared with insulin-resistant subjects with obesity. Material and Method: We enrolled 231 subjects with obesity (83% female) in this cross-sectional study. Brachial artery flow-mediated dilation was performed by Doppler ultrasonography and a standard 75-g oral glucose tolerance test were carried out in all participants. The subjects were stratified into tertiles based on their insulin sensitivity index values and defined as having insulin-resistant obesity if the values were in the lower tertile (n=77) or metabolically healthy obesity if the values were in the upper tertile (n=77). ED was defined as Δ flow-mediated dilation <4.5%. Results: Metabolically healthy obesity and insulin-resistant obesity groups had similar ages (39±9 vs. 40±10 years; p=0.59) and body mass index (38±5 vs. 39±5 kg/m 2 ; p=0.09). Waist circumference (101±11 vs. 106±13 cm; p=0.01), fasting blood glucose (87±9 vs. 97±13 mg/dL; p<0.001), diastolic blood pressure (79±11 vs. 82±12 mmHg; p=0.04) and uric acid levels (4.6±1.0 vs. 5.3±1.3 mg/dL; p<0.001) were lower in metabolically healthy obesity subjects, however, the incidence of ED was similar in both metabolically healthy obesity and insulin-resistant obesity subjects (80% vs. 71%; p=0.25, respectively). Discussion: The incidence of ED, assessed by flow-mediated dilation, was similar both in metabolically healthy obesity and insulin-resistant obesity subjects. In this study, we showed that subjects with obesity as defined as metabolically healthy obesity might also show ED. Keywords: Obesity, insulin resistance, flow-mediated dilatation Amaç: Çalışmamızda metabolik olarak sağlıklı obez bireylerle, insülin direnci olan bireylerin endoteyal fonksiyonlarını (ED) değerlendirmeyi amaçladık. Gereç ve Yöntem: Bu kesitsel çalışmaya 231 obez birey (%83 kadın) alınmıştır. Katılımcıların brakial arterinde Doppler ultrasonografi ile akım aracılı genişleme değerlendirildi ve tüm katılımcılara 75 gram oral glukoz tolerans testi uygulandı. Katılımcılar insülin sensitivite indekslerine göre üç gruba ayrıldı ve insülin duyarlılık indeksi değerleri alt tertildeki (n=77) bireyler insülin resistant obez grup olarak ve üst tertildeki obezler (n=77) metabolik olarak sağlıklı obez grup olarak değerlendirildi. ED Δ akım aracılı dilatasyon <%4,5 olarak tanımlandı. Bulgular: Metabolik olarak sağlıklı obez grup ve insülin resistant obez grupları benzer yaş (39±9 vs. 40±10 yıl; p=0,59) ve vücut kitle indeksine (38±5 vs. 39±5 kg/m 2 ; p=0,09) sahiptiler. Bel çevresi (101±11 vs. 106±13 cm; p=0,01), açlık kan şekeri (87±9 vs. 97±13 mg/dL; p<0,001), diyastolik kan basıncı (79±11 vs. 82±12 mmHg; p=0,04) ve ürik asit düzeyleri (4,6±1,0 vs. 5,3±1,3 mg/dL; p<0,001) metabolik olarak sağlıklı obez grup grubunda daha düşüktü bununla birlikte ED görülme sıklığı her iki grupta benzerdi (%80 vs. %71; p=0,25, sırasıyla). Tartışma: ED görülme sıklığı metabolik olarak sağlıklı değerlendirilen obez bireylerde insulin direnci olan obez bireylerdeki gibidir. Çalışmamızda metabolik olarak sağlıklı değerlendirilen obez grubun da ED’yi gösterdiği tespit edilmiştir. Anahtar kelimeler: Obezite, insülin direnci, akım aracılı dilatasyon Abstract Öz Şule Temizkan, Ayşenur Özderya, Şevin Demir*, Hilal Toplu Öztürk*, Mehmet Sargın*, Kadriye Aydın Kartal Dr. Lütfi Kırdar Training and Research Hospital, Clinic of Endocrinology and Metabolic Diseases, İstanbul, Turkey *Kartal Dr. Lütfi Kırdar Training and Research Hospital, Clinic of Family Medicine, İstanbul, Turkey Farklı Obezite Fenotiplerinde Endotelyal Fonksiyon Endothelial Function in Distinct Phenotypes of Obesity ©Copyright 2016 by Turkish Journal of Endocrinology and Metabolism Association Turkish Journal of Endocrinology and Metabolism published by Galenos Yayınevi.