Understanding the role of visceral fat in metabolically healthy versus unhealthy obesity: a sex-based analysis of the transcriptome

These findings suggest that obesity should be treated as a different entity in men and women and highlight the need of early intervention in female patients with obesity, even in the absence of comorbidities. Obesity is often linked to metabolic problems, but some patients with obesity do not show typical signs of metabolic syndrome, a situation referred to as "metabolically healthy obesity." The reasons behind this are not fully understood, but it is thought that these individuals have healthier adipose tissue that prevents the accumulation of fat in other organs. Since hormones play an important role in fat storage, we examined if there are gender differences in how adipose tissue responds to fat accumulation. In this study, we analyzed the genes that were expressed in the visceral adipose tissue of patients with obesity who were metabolically healthy (MH) and those who were metabolically unhealthy (MU). When we compared the results, we found that men and women had different gene activity patterns. For men, MH adipose tissue had less inflammation and stress compared to MU adipose tissue. However, MH women tissue showed worse signs of inflammation, fibrosis and metabolism problems than MU women. Between genders, there are several differences in the pathways that are triggered by obesity, with women having a more pathological profile. Even those processes that were common had a worst profile than in men. This suggests that women adipose tissue does not adapt equally to the increased demand for energy storage, even in the absence of metabolic abnormalities. These results suggest that obesity should be treated differently in men and women and emphasize the importance of early intervention for women, even if they do not show metabolic alterations.