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/m 2 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.

Mediterranean diet, Dietary Approaches to Stop Hypertension (DASH) style diet, and metabolic health in U.S. adults

“…Consistent with the findings from the previous research [13,15,18], the association between high diet quality and metabolic health was not apparent in older age group, although in our analysis MDS was marginally significant with being more likely to be MHO phenotype in age-, gender-, and race/ethnicity-adjusted model. These findings suggest that other factors such as physical activity might be more important than diet in relation to metabolic abnormalities among older adults [36], which is supported by the fact that age-related changes in body composition, especially increase in visceral fat, may elevate the risk of cardiometabolic disease [37].…”

“…However, these reports have been limited to MHO phenotype [13], especially without considering dietary pattern [14], or with specific age groups [15]. A few studies have reported associations in MONW phenotype in non-US population [16], but with limited generalizability [17].…”

Cardiometabolic Health in Obese Adolescents Is Related to Length of Obesity Exposure: A Pilot Study

“…This is in agreement with reports in adults (28,29). However, a recent paper demonstrated that MHO adolescents had better dietary compliance than those with MUO (30).…”

“…Hankinson et al confirmed that women with MHO slept longer than those at risk (29). We did not find any association of sleep duration with cardiometabolic outcomes.…”

Metabolically Healthy Obesity Is Not Associated with Food Intake in White or Black Men

“…These individuals display high levels of insulin sensitivity, favorable inflammation and lipid profiles, and a low prevalence of hypertension, and are hypothesized to be protected from, or to be at substantially lower risk of, obesity-related metabolic complications, including cardiovascular diseases, type 2 diabetes, and mortality (2)(3)(4)(5)(6)(7). There is no consensus on the definition of so-called ''healthy obesity,'' and researchers have generally used insulin sensitivity denoted by low HOMA-IR, absence of metabolic syndrome (MetS) 9 , or a combination of both, to describe the phenotype (2)(3)(4)(5). MetS is a multiplex of metabolic risk factors that includes abdominal obesity, elevated blood pressure, hyperglycemia, low HDL cholesterol, and hypertriglyceridemia (8).…”