![]() We aim here to overview the underlying causes of obesity and its associated metabolic abnormalities while paying special attention to a unique subset of the obese population: the metabolically healthy but obese (MHO) individuals. Sustained and abusive accumulation of lipids in the liver induces NAFLD (highly concurrent with obesity) which may result in lipotoxicity, steatohepatitis, hepatocyte cell death, fibrosis and eventually liver cirrhosis as well as hepatocarcinoma. When the energy intake exceeds both the caloric needs of the body and its glycogen storage capacity, dietary carbohydrates and fats are first converted and stored as triglycerides (TG) in white adipose tissue (WAT) and, later on, in other tissues such as the liver. In these countries, fats typically account for 33% to 42% of dietary energy intake, with a rich proportion of long chain saturated fat. ![]() The modern prevalence of obesity and metabolic syndrome is likely due to the rise in consumption of energy-dense food, containing high amounts of fat and carbohydrates, especially in Western countries. However, the most powerful inducer of obesity and its associated adverse metabolic effects remains, by far, inappropriate food intake. Some contributing factors for obesity progression are: unfavorable genetic determinants, lack of physical activity, socio-economic status, circadian cycle disturbance, sleep deprivation, hormonal dysregulation, persistent organic pollutants and alteration of the gut microbiota. Obesity is also considered a risk factor for several other diseases such as chronic respiratory diseases and arthritis. This pathology is associated with an elevated waist circumference, a progressive state of non-alcoholic fatty liver disease (NAFLD), insulin resistance, type 2 diabetes (T2D), some types of cancers (especially in women), hypertension, cardiovascular diseases, reproductive abnormalities, dyslipidemias, psychological affections, and a severely reduced life expectancy. Most of these comorbidities are thought to be the result of aberrant body fat distribution leading to the metabolic syndrome. Obesity is a multifactorial affection with broad etiology, and multiple comorbidities. Since the 1980s, the combined prevalence of obesity and overweight increased by 28% in adults and 47% in children. Obesity is now described as a pandemic with increased prevalence in both adult and child populations. Obesity has become an international public health problem with 2.1 billion people worldwide being overweight (body mass index (BMI) ≥ 25.0) and more than half a billion among them being obese (BMI ≥ 30.0). MCT-enriched diets could therefore be used to manage metabolic diseases through modification of gut microbiota. ![]() Here, we describe how dietary medium chain triglycerides (MCT), previously found to promote lipid catabolism, energy expenditure and weight loss, can ameliorate metabolic health via their capacity to improve both intestinal ecosystem and permeability. Interestingly, recent studies suggest that an optimal healthy-like gut microbiota structure may contribute to the metabolically healthy obese (MHO) phenotype. Among many other factors, the gut microbiota is now identified as a determining factor in the pathogenesis of metabolically unhealthy obese (MUHO) individuals and in obesity-related diseases such as endotoxemia, intestinal and systemic inflammation, as well as insulin resistance. ![]() While most obese patients show several metabolic and biometric abnormalities and comorbidities, a subgroup of patients representing 3% to 57% of obese adults, depending on the diagnosis criteria, remains metabolically healthy. Obesity and associated metabolic complications, such as non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2D), are in constant increase around the world.
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