Abstract
Obesity is not the same in all individuals and two different phenotypes have been described: metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO). The aim of this study was to identify factors that explain metabolic health status in a rigorously matched Spanish population. Subcutaneous and visceral fat, adipocyte size and fatty acid composition, cardiometabolic markers in serum, and lifestyle habits were assessed. Higher physical activity in the mornings (Odds Ratio (95% Confidence Interval) (OR (95% CI) = 1.54 (1.09–2.18), p = 0.01)), earlier bedtimes (8:30–10:30 pm) (OR = 2.11 (1.02–4.36), p = 0.04), a complete breakfast (OR = 1.59 (1.07–2.36), p = 0.02), and a greater number of meals per day (4.10 ± 0.05 vs. 3.93 ± 0.05, p < 0.01), were associated with the MHO phenotype. Concentrations of 20:5 n-3 eicosapentaenoic acid (0.26 ± 0.46 vs. 0.10% ± 0.11%, p = 0.04) and 18:3 n-6 gamma-linolenic acid (0.37 ± 0.24 vs. 0.23% ± 0.22%, p = 0.04) in subcutaneous adipocytes were higher and omental adipocyte size (187 094 ± 224 059 µm3 vs. 490 953 ± 229 049 µm3, p = 0.02) was lower in MHO subjects than in those with MUO. Visceral fat area differed between MHO and MUO subjects (135 ± 60 cm2 vs. 178 ± 85 cm2, p = 0.04, respectively). The study highlights specific lifestyle habits that could form part of obesity therapies, not only involving healthier eating habits but also earlier sleeping and exercise patterns.
Highlights
Healthy obese (MHO) subjects, defined as those individuals who, despite excess body fat, remain free of metabolic abnormalities and increased cardiometabolic risk, usually follow specific lifestyle habits in their daily life [1,2]
It has been demonstrated that meal timing influences glucose homeostasis [7] and late eaters have worse eating behaviors, such as skipping breakfast more frequently [8]
Shorter sleepers were seen to have higher body fat [9] and a higher risk of developing metabolic alterations [10]. These observations highlight a link between lifestyle factors and physiological traits that are considered important for maintaining health
Summary
Healthy obese (MHO) subjects, defined as those individuals who, despite excess body fat, remain free of metabolic abnormalities and increased cardiometabolic risk, usually follow specific lifestyle habits in their daily life [1,2]. They are less sedentary during the day, take more physical activity, have a higher intake of fiber [3], follow a dietary pattern that includes fruits, vegetables and fish [4], and smoke less [5].
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