Abstract
BackgroundDiversity in the reported prevalence of metabolically healthy obesity (MHO), suggests that modifiable factors may be at play. We evaluated differences in dietary patterns and physical activity between MHO and metabolically unhealthy obesity (MUO).MethodsCross-sectional data of 9270 obese individuals (30–69 years) of the Lifelines Cohort Study was used. MHO was defined as obesity and no metabolic syndrome risk factors and no cardiovascular disease history. MUO was defined as obesity and ≥2 metabolic syndrome risk factors. Sex-specific associations of dietary patterns (identified by principal component analysis) and physical activity with MHO were assessed by multivariable logistic regression (reference group: MUO). Analyses were adjusted for multiple covariates.ResultsAmong 3442 men and 5828 women, 10.2% and 24.4% had MHO and 56.9% and 35.3% MUO, respectively. We generated four obesity-specific dietary patterns. Two were related to MHO, and in women only. In the highest quartile (Q) of ‘bread, potatoes and sweet snacks’ pattern, odds ratio (OR) (95% CI) for MHO was 0.52 (0.39–0.70). For the healthier pattern ‘fruit, vegetables and fish’, an OR of 1.36 (1.09–1.71) in Q3 and 1.55 (1.21–1.97) in Q4 was found for MHO. For physical activity, there was a positive association between moderate physical activity and vigorous physical activity in the highest tertile and MHO in women and men, respectively (OR 1.19 (1.01–1.41) and OR 2.02 (1.50–2.71)).ConclusionThe healthier diet -characterized by ‘fruit, vegetables and fish’- and moderate physical activity in women, and vigorous physical activity in men may be related to MHO. The (refined) carbohydrate-rich ‘bread, potatoes and sweet snacks’ dietary pattern was found to counteract MHO in women.
Highlights
Diversity in the reported prevalence of metabolically healthy obesity (MHO), suggests that modifiable factors may be at play
Prevalence of metabolic health phenotypes After exclusion of participants with possible under- or over-reporting of energy intake (N = 532), implausible physical activity data (N = 875), or missing data on clinical measures (N = 94), a total of 9270 obese individuals were included in this study (86.1% from the original sample) (Fig. 1)
10% of men, and 25% of women were metabolically healthy obese. Compared to those with metabolically unhealthy obesity (MUO), we found that women with MHO had a healthier diet, rich in fruit, vegetables, fish and unsweetened fermented milk products while avoiding high sugar beverages and, savory- and sweet snackfood
Summary
Diversity in the reported prevalence of metabolically healthy obesity (MHO), suggests that modifiable factors may be at play. While the ageing process is an important factor, the BioSHaRE-EU Healthy Obesity Project (n = 28.077) reported that even the age-standardized prevalence of MHO highly varied between the European countries, 2– 19% among men and 7–28% among women, when the same diagnostic criteria for MHO were used [11]. This suggests that on top of age, sex and possibly genes, lifestyle factors are related to the transition from healthy to unhealthy. As nutrients interact with each other [16], examination of whole diets may be more suitable to gain insight into the relation between diet and metabolic health within the obese population
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