Diet composition and activity level of at risk and metabolically healthy obese american adults

Abstract

Obesity often clusters with other major cardiovascular disease risk factors, yet a subset of the obese appears to be protected from these risks. Two obesity phenotypes are described, 1) “metabolically healthy” obese, broadly defined as body mass index (BMI) ≥ 30 kg/m2 and favorable levels of blood pressure, lipids, and glucose; and 2) “at risk” obese, BMI ≥ 30 with unfavorable levels of these risk factors. More than 30% of obese American adults are metabolically healthy. Diet and activity determinants of obesity phenotypes are unclear. We hypothesized that metabolically healthy obese have more favorable behavioral factors, including less adverse diet composition and higher activity levels than at risk obese in the multi-ethnic group of 775 obese American adults ages 40–59 years from the International Population Study on Macro/Micronutrients and Blood Pressure (INTERMAP) cohort. In gender stratified analyses, mean values for diet composition and activity behavior variables, adjusted for age, race, and education, were compared between metabolically healthy and at risk obese. Nearly 1 in 5 (149/775, or 19%) of obese American INTERMAP participants were classified as metabolically healthy obese. Diet composition and most activity behaviors were similar between obesity phenotypes, although metabolically healthy obese women reported higher sleep duration than at risk obese women. These results do not support hypotheses that diet composition and/or physical activity account for the absence of cardiometabolic abnormalities in metabolically healthy obese.

Dietary Interventions and Changes in Cardio-Metabolic Parameters in Metabolically Healthy Obese Subjects: A Systematic Review with Meta-Analysis

“…The data from the International Population Study on Macro/Micronutrients and Blood Pressure (INTERMAP) cohort study did not support the hypothesis that diet composition accounts for the absence of cardio-metabolic abnormalities in MHO [45]. Furthermore, it has also been confirmed by Kimokoti et al [46] in the cross-sectional analysis from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Although HOMA-IR index can be slightly higher in MHO subjects than in subjects characterized by normal weight, it may also be lower compared to MUHO [21].…”

The Prevalence of Metabolically Healthy and Unhealthy Obesity according to Different Criteria

“…Using BMI to define obesity, several epidemiologic studies from America showed that the prevalence of MHO ranged from 4.0 to 9.7% and that of MUO from 9.0 to 28.5% [5, 10, 21, 37, 38]. The prevalence of MHO in Europe varied from 1.1 to 6.6% and that of MUO from 7.2 to 21.4% [32, 39-41].…”

Healthy obesity as an intermediate state of risk: a critical review

“…This seems intuitive, but several cross-sectional studies reported no difference in total physical activity between healthy and unhealthy obese groups (30,33,50), with differences in moderate-tovigorous physical activity being evident in only half (20,33) of the studies which examined this (30,51). All of these studies utilised self-reported questionnaire-based measures of physical activity duration, which are known to have low-to-moderate correlations with objective accelerometerbased activity measures (52), and for which measurement error may be highest among the obese due to inaccurate recall or social desirability biases (53).…”