Dietary patterns and physical activity in the metabolically (un)healthy obese: the Dutch Lifelines cohort study

Metabolic phenotyping in people living with obesity: Implications for dietary prevention

Given the increasing number of people living with obesity and related chronic metabolic disease, precision nutrition approaches are required to increase the effectiveness of prevention strategies. This review addresses these approaches in different metabolic phenotypes (metabotypes) in obesity. Although obesity is typically associated with an increased cardiometabolic disease risk, some people with obesity are relatively protected against the detrimental effects of excess adiposity on cardiometabolic health, also referred to as 'metabolically healthy obesity' (MHO). Underlying mechanisms, the extent to which MHO is a transient state as well as lifestyle strategies to counteract the transition from MHO to metabolically unhealthy obesity (MUO) are discussed. Based on the limited resources that are available for dietary lifestyle interventions, it may be reasonable to prioritize interventions for people with MUO, since targeting high-risk patients for specific nutritional, lifestyle or weight-loss strategies may enhance the cost-effectiveness of these interventions. Additionally, the concept of tissue insulin resistant (IR) metabotypes is discussed, representing distinct etiologies towards type 2 diabetes (T2D) as well as cardiovascular disease (CVD). Recent evidence indicates that these tissue IR metabotypes, already present in individuals with obesity with a normal glucose homeostasis, respond differentially to diet. Modulation of dietary macronutrient composition according to these metabotypes may considerably improve cardiometabolic health benefits. Thus, nutritional or lifestyle intervention may improve cardiometabolic health, even with only minor or no weight loss, which stresses the importance of focusing on a healthy lifestyle and not on weight loss only. Targeting different metabotypes towards T2D and cardiometabolic diseases may lead to more effective lifestyle prevention and treatment strategies. Age and sex-related differences in tissue metabotypes and related microbial composition and functionality (fermentation), as important drivers and/or mediators of dietary intervention response, have to be taken into account. For the implementation of these approaches, more prospective trials are required to provide the knowledge base for precision nutrition in the prevention of chronic metabolic diseases.

Macronutrient quality and the incidence of metabolically unhealthy phenotypes in adults with normal weight and overweight/obesity

OBJECTIVE

We aimed to investigate the associations of macronutrient quality indices with the incident metabolically unhealthy normal weight (MUNW) and metabolically unhealthy overweight/obesity (MUO) phenotypes.

METHODS

This prospective study included 512 metabolically healthy normal weight and 787 metabolically healthy overweight/obese adults from the third study examination of the Tehran Lipid and Glucose Study. The participants were followed through the sixth study examination. Diet was measured with a food frequency questionnaire. The macronutrient quality index (MQI), carbohydrate quality index (CQI), fat quality index (FQI), and healthy plate quality index (HPPQI) were calculated. Hazard ratio (HR) and 95 % confidence interval (95 % CI) were estimated for incident unhealthy phenotypes using Cox regression.

RESULTS

After controlling all possible confounding factors, a one-point higher HPPQI was linked to a 28 % lower risk of MUNW (HR = 0.72; 95 % CI = 0.59, 0.87). Compared to the lowest quartile, the incident MUNW was also lower in the two last quartiles of the HPPQI. A one-unit increase in MQI was associated with a 5 % lower incident MUO (HR = 0.95; 95 % CI = 0.92, 0.99). The incident MUO was also higher for the highest compared to the lowest MQI quartile. In quartiles 2-4 of the HPPQI, incident MUO was lower with respective HRs (95 % CI) of 0.71 (0.54, 0.93), 0.60 (0.45, 0.80), and 0.66 (0.50, 0.86) in the fully-adjusted model.

CONCLUSIONS

A higher overall macronutrient quality was independently associated with a lower incident MUO. A higher dietary protein quality was related to a lower risk for MUNW and MUO.

Obesity and the risk of cardiometabolic diseases

The prevalence of obesity has reached pandemic proportions, and now approximately 25% of adults in Westernized countries have obesity. Recognized as a major health concern, obesity is associated with multiple comorbidities, particularly cardiometabolic disorders. In this Review, we present obesity as an evolutionarily novel condition, summarize the epidemiological evidence on its detrimental cardiometabolic consequences and discuss the major mechanisms involved in the association between obesity and the risk of cardiometabolic diseases. We also examine the role of potential moderators of this association, with evidence for and against the so-called 'metabolically healthy obesity phenotype', the 'fatness but fitness' paradox or the 'obesity paradox'. Although maintenance of optimal cardiometabolic status should be a primary goal in individuals with obesity, losing body weight and, particularly, excess visceral adiposity seems to be necessary to minimize the risk of cardiometabolic diseases.

Inflammatory markers may mediate the relationship between processed meat consumption and metabolic unhealthy obesity in women: a cross sectional study

Metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUHO) are known to be affected by diet and inflammatory factors (such as TGF-β1, IL-β1, MCP1). We sought to survey that consume of processed meat could effect on MHO and MUHO phenotypes, mediated through inflammatory markers, in overweight and obese Iranian women. The current cross-sectional study was done on 224 women 18-48 years, with a body mass index (BMI) ≥ 25 kg/m². A 147- item food frequency questionnaire (FFQ) was used to evaluate dietary intake. In all participants, anthropometric indices and biochemical factors, as well as metabolic health phenotypes based on Karelis score, were evaluated. According to results, 22.6% of participants had MHO and 75.7% had MUHO phenotypes. There was an association between higher adherence to processed meats and increasing odds of MUHO phenotype in Iranian women (OR:2.54; 95% CI 0.009, 7.51; P = 0.05). Moreover, we found that the relation can be affected by agents such as TGF-β1, IL-β1, and MCP1; however, more research is needed to confirm these results and finding.

Metabolically healthy obesity: Misleading phrase or healthy phenotype?

Obesity is a heterogenous condition with multiple different phenotypes. Among these a particular subtype exists named as metabolically healthy obesity (MHO). MHO has multiple definitions and its prevalence varies according to study. The potential mechanisms underlying the pathophysiology of MHO include the different types of adipose tissue and their distribution, the role of hormones, inflammation, diet, the intestinal microbiota and genetic factors. In contrast to the negative metabolic profile associated with metabolically unhealthy obesity (MUO), MHO has relatively favorable metabolic characteristics. Nevertheless, MHO is still associated with many important chronic diseases including cardiovascular disease, hypertension, type 2 diabetes, chronic kidney disease as well as certain types of cancer and has the risk of progression into the unhealthy phenotype. Therefore, it should not be considered as a benign condition. The major therapeutic alternatives include dietary modifications, exercise, bariatric surgery and certain medications including glucagon-like peptide-1 (GLP-1) analogs, sodium-glucose cotransporter-2 (SGLT-2) inhibitors and tirzepatide. In this review, we discuss the significance of MHO while comparing this phenotype with MUO.

Association of legumes and nuts consumption with metabolic health status in Iranian overweight and obese adolescents

Limited data are available on the association of legumes and nuts consumption with health status in pediatrics. So, we assessed the relation of legumes and nuts intake with metabolic health status in Iranian adolescents. A random sample of overweight/obese adolescents aged 12 to 18 years was included in this cross-sectional study. Dietary intakes were gathered using a validated 147-item food frequency questionnaire (FFQ). We measured metabolic indices including blood pressure, lipid profile, glycemic and anthropometrics indices. Two strategies were used for classification of adolescents to metabolically healthy obese (MHO) or unhealthy obese (MUO): International Diabetes Federation (IDF) and combination of IDF with Homeostasis Model Assessment Insulin Resistance (HOMA-IR). Information on 203 overweight/obese adolescents (50.2% girls and 49.8% boys) with an average age of 13.98 (± 1.61) years and a mean weight of 73.48 (± 11.60) kg/m² was evaluated. Based on the IDF and IDF/HOMA-IR definition, higher consumption of legumes and nuts consumption was related to a 66% and 61% decreased odds of MUO in crude model (OR = 0.34, 95%CI 0.17-0.69), (OR = 0.39, 95%CI 0.19-0.80); but in fully-adjusted model, these relations disappeared. After adjustment for potential cofounders, an inverse association was found between legumes and nuts consumption and odds of hyperglycemia (OR = 0.35, 95%CI 0.16-0.78). Moreover, although inverse significant associations were found between legumes and nuts consumption and odds of MUO in girls and overweight subjects in crude models, these associations disappeared after adjustment for all confounders. After taking potential confounders into account, no significant association was found between consumption of legumes and nuts and MUO in Iranian adolescents. The findings should be affirmed by further prospective studies.

Association of metabolically healthy obesity in young adulthood with myocardial structure and function

BACKGROUND

Obesity is major cause of cardiovascular diseases. Metabolically healthy obesity (MHO) may increase heart failure risk early in life, and may be reflected in impaired cardiac structure and function. Therefore, we aimed to examine the relationship between MHO in young adulthood and cardiac structure and function.

METHODS

A total of 3066 participants from the Coronary Artery Risk Development in Young Adults (CARDIA) study were included, who completed echocardiography in young adulthood and middle age. The participants were grouped by obesity status (body mass index ≥30 kg/m²) and poor metabolic health (≥2 criteria for metabolic syndrome) into four metabolic phenotypes as follows: metabolically healthy non-obesity (MHN), MHO, metabolically unhealthy non-obesity (MUN), metabolically unhealthy obesity (MUO). The associations of the metabolic phenotypes (MHN serving as the reference) with left ventricular (LV) structure and function were evaluated using multiple linear regression models.

RESULTS

At baseline, mean age was 25 years, 56.4% were women, and 44.7% were black. After a follow-up 25 years, MUN in young adulthood was associated with worse LV diastolic function (E/é ratio, β [95% CI], 0.73 [0.18, 1.28]), worse systolic function (global longitudinal strain [GLS], 0.60 [0.08, 1.12]) in comparison with MHN. MHO and MUO were associated with LV hypertrophy (LV mass index, 7.49 g/m² [4.63, 10.35]; 18.23 g/m² [12.47, 23.99], respectively), worse diastolic function (E/é ratio, 0.67 [0.31, 1.02]; 1.47 [0.79, 2.14], respectively), and worse systolic function (GLS, 0.72 [0.38, 1.06]; 1.35 [0.64, 2.05], respectively) in comparison with MHN. These results were consistent in several sensitivity analyses.

CONCLUSIONS

In this community-based cohort using data from the CARDIA study, obesity in young adulthood was significantly associated with LV hypertrophy, worse systolic and diastolic function regardless of metabolic status. Relationship of Baseline Metabolic Phenotypes with Young Adulthood and Midlife Cardiac Structure and Function. Adjusted for year 0 covariates: age, sex, race, educational level, smoking status, drinking status, and physical activity; metabolically healthy non-obesity was used as a reference category for comparison. ^† Criteria for metabolic syndrome are listed in Supplementary Table S6. MUN metabolically unhealthy non-obesity, MHO metabolically healthy obesity, LVMi left ventricular mass index, LVEF left ventricular ejection fraction, E/A early to late peak diastolic mitral flow velocity ratio, E/é mitral inflow velocity to early diastolic mitral annular velocity, CI confidence interval.

Lack of association between metabolic phenotype and food consumption by degree of food processing: results from the Study of Workers' Health (ESAT)

Introduction

Introduction: an increase in the consumption of processed and ultra-processed foods may predispose to metabolic abnormalities. Objective: to verify the association of food consumption with metabolic phenotype in workers from a quaternary hospital in Rio de Janeiro, Brazil. Methods: workers of both sexes aged > 18 years were eligible. A food frequency questionnaire and the NOVA classification were used in the food consumption analysis. Metabolic phenotype considered the presence of at least one metabolic alteration (blood glucose, serum lipids, and blood pressure) combined with BMI (eutrophic or excess weight) as follows: 1) metabolically healthy eutrophic (MHE); 2) metabolically unhealthy eutrophic (MUE); 3) metabolically healthy excess weight (MHEW); 4) metabolically unhealthy excess weight (MUEW). Results: from the included 160 participants (mean age, 45.2 ± 1.1 years; 59.4 %, women), 21.9 % self-reported arterial hypertension and 4.4 % diabetes. Most presented excess weight (74.6 %), with approximately 40 % being obese. The MUEW phenotype had higher body fat percentage and central adiposity represented by higher WC and VFA in comparison to the other phenotypes. The lean body mass was similar between the groups. The median of ultra-processed foods was 32.4 % for eutrophic, 32.7 % for overweight, and 34.3 % for obese subjects. No significant associations were observed between ultra-processed food consumption and metabolically unhealthy eutrophic (OR: 1.01; 95 % CI: 0.96-1.06), metabolically healthy excess weight (OR: 1.03; 95 % CI: 0.98-1.08), and metabolically unhealthy excess weight (OR: 1.00; 95 % CI: 0.96-1.05) in comparison to metabolically healthy eutrophic. Conclusion: consumption of ultra-processed food was high. In this cross-sectional analysis, no association of metabolic phenotypes with consumption of food groups according to degree of food processing were observed.

Association of major dietary patterns and different obesity phenotypes in Southwest China: the China Multi-Ethnic Cohort (CMEC) Study

PURPOSE

Dietary behavior is an important part of lifestyle interventions for obesity and its cardiovascular comorbidities. However, little is known about associations between dietary patterns and obesity phenotypes in Southwest China, a region with unique dietary patterns and significant heterogeneity in obesity.

METHODS

Data from the baseline survey of the China Multi-Ethnic Cohort in Southwest China were analyzed (n = 64,448). Dietary intakes during the past year were measured with the semi-quantitative Food Frequency Questionnaire (s-FFQ). Principal component factor analysis (PCFA) was used to identify dietary patterns. Multinomial logistic regressions were used to examine the associations between dietary patterns and obesity phenotypes and stratified analyses were performed to assess whether the associations differed across demographic variables.

RESULTS

Three dietary patterns were identified and then named according to their apparent regional gathering characteristics: the Sichuan Basin dietary pattern (characterized by high intakes of various foods), the Yunnan-Guizhou Plateau dietary pattern (characterized by agricultural lifestyles), and the Qinghai-Tibet Plateau dietary pattern (characterized by animal husbandry lifestyles), respectively. Higher adherence to the Sichuan Basin dietary pattern was positively associated with metabolically healthy overweight/obesity (MHO, OR 1.13, 95% CI 1.05-1.21) but negatively associated with metabolically unhealthy normal weight (MUNW, OR 0.78, 95% CI 0.65-0.95). Higher adherence to the other two dietary patterns was positively associated with MHO and metabolically unhealthy overweight/obesity (MUO). Besides, differences in socioeconomic status also affected the relationship between dietary patterns and obesity phenotypes.

CONCLUSIONS

Adherence to the more diverse Sichuan basin dietary pattern performed a mixed picture, while the other two may increase the risk of obesity phenotypes, which indicates nutritional interventions are urgently needed.

Role of physical activity and cardiorespiratory fitness in metabolically healthy obesity: a narrative review

Obesity has been associated with a multitude of metabolic disorders, often clustering with risk factors of cardiovascular disease and type 2 diabetes mellitus, hypertension, dyslipidaemia. Overall, obesity is a worldwide, growing health concern. However, a subgroup of obese individuals with a low burden of metabolic abnormalities have been identified and described as metabolically healthy obese (MHO). Whether the MHO phenotype is protective against obesity-related metabolic disorders in the long-term is presently unclear, and current research examining the potential transition has yielded inconsistent results. In this current narrative review, we aim to provide insights on the role of physical activity (PA) and cardiorespiratory fitness (CRF) in MHO. Lifestyle factors such as PA and CRF may influence the MHO phenotype. Limited studies have characterised energy expenditure and CRF in MHO and metabolically unhealthy obese. However, higher levels of PA, less sedentary behaviour and higher CRF have been observed in MHO individuals. Considering the multiple benefits of PA, it is high time to advocate this lifestyle change beyond its influence on energy balance in a weight loss programme to improve cardiovascular and metabolic risk factors irrespective of body weight and fat mass changes. Improved CRF via increased PA, especially exercise participation, while avoiding weight gain is not only a realistic goal, but should be the primary intervention for MHO populations to prevent the transition to an abnormal metabolic state.

Do lifestyle factors and quality of life differ in people with metabolically healthy and unhealthy obesity?

BACKGROUND AND OBJECTIVES

Although obesity is typically associated with metabolic co-morbidities, some people with obesity do not develop metabolic abnormalities. We evaluated whether modifiable lifestyle factors (i.e., physical activity, dietary composition, and sleep characteristics) can help explain why some people with obesity are metabolically healthy (MHO) and whether metabolically unhealthy obesity (MUO) affects quality of life (QOL).

SUBJECTS/METHODS

Physical activity and sleep characteristics were assessed by using tri-axial accelerometers and dietary intake, sleep quality, and QOL were evaluated by using validated questionnaires in people stratified into three groups: (1) lean with normal glucose tolerance, plasma triglyceride (TG) concentration and intrahepatic TG (IHTG) content (metabolically healthy lean [MHL]; n = 20); (2) obesity and normal glucose tolerance, plasma TG concentration and IHTG content (MHO; n = 36); and (3) obesity with abnormal glucose metabolism and hepatic steatosis (MUO; n = 43).

RESULTS

People with MHO performed ~45-min more light-intensity physical activity/day than the MHL and MUO groups (P < 0.05). QOL, particularly the physical function domain, was higher in the MHO than the MUO group (P < 0.05). Although self-reported intake of starch, dairy, and cured meats were higher in the MUO than the MHO group (P < 0.02), the absolute differences were small and unlikely to have metabolic effects. No differences were found in sleep duration or quality between groups.

CONCLUSIONS

These data suggest physical activity, but not sleep or dietary intake, contribute to better metabolic health in people with MHO than those with MUO, and that QOL is lower in people with MUO than those with MHO.

Association of Lifelines Diet Score (LLDS) and metabolically unhealthy overweight/obesity phenotypes in women: a cross-sectional study

Background

Previous studies have shown the association of a number of dietary quality scores with metabolically phenotypes of obesity. Recently, the Lifelines Diet Score (LLDS), which is a fully food-based score based on the 2015 Dutch dietary guidelines and underlying international literature, has been proposed as a tool for assessing the quality of the diet. Therefore, this study was performed to investigate the association between LLDS and metabolically healthy/unhealthy overweight and obesity (MHO/MUHO) phenotypes.

Methods

This study was performed on 217 women, aged 18–48 years old. For each participant anthropometric values, biochemical test and body composition were evaluated by standard protocols and methods. The LLDS was determined based on 12 components using a valid and reliable food frequency questionnaire (FFQ) containing 147 items. The metabolically healthy (MH) was evaluated using the Karelis criteria.

Results

Among the total participants in this study, 31.3% of the subjects were MHO while 68.7% were MUHO. After adjustment for potential confounding variables (age, energy intake, and physical activity), participants in highest LLDS tertile had a lower odds of MUHO compared with those in the lowest tertile (OR: 1.18; 95% CI: 0.23, 5.83; P-trend = 0.03). Also, after further adjustment with BMI, provided only small changes in "OR" and did not attenuate the significance (OR: 1.28; 95% CI: 0.23, 6.91; P-trend = 0.02).

Conclusions

The present evidence indicates that individuals with higher adherence to the LLDS had lower odds of metabolically unhealthy (MUH).

Trends in the Prevalence of Obesity and Its Phenotypes Based on the Korea National Health and Nutrition Examination Survey from 2007 to 2017 in Korea

This study used data from the Korea National Health and Nutrition Examination Survey IV-VII from 2007 to identify the prevalence of obesity and its phenotypes (metabolically unhealthy obesity [MUO] and metabolically healthy obesity [MHO]) and their secular changes. The prevalence of obesity in Korea increased with significant secular changes observed (β=0.326, P trend <0.01) between 2007 and 2017, and especially in men (β=0.682, P trend <0.001) but not in women. The changes in the prevalence of obesity during the study period were different between men and women (P=0.001). The prevalence of MUO significantly increased only in men (β=0.565, P trend <0.01), while that of MHO increased only in women (β=0.179, P<0.05), especially in the younger age group (β=0.308, P<0.01).

Metabolically healthy obesity: Is it really healthy for type 2 diabetes mellitus?

Metabolically healthy obese (MHO) individuals are reported to have a lower risk of developing cardiovascular diseases in comparison with individuals with metabolic syndrome. However, the association between MHO and type 2 diabetes (T2DM) is still controversial. Some studies indicated that MHO is a favorable phenotype for T2DM, but more studies showed that MHO individuals have an increased risk of developing T2DM compared with metabolically healthy normal-weight individuals, especially among those who would acquire metabolically unhealthy obesity. This has been supported by finding insulin resistance and low-grade inflammatory responses in MHO individuals with a tendency for impaired beta-cell dysfunction. Studies also showed that liver fat accumulation increased the risk of incidence of T2DM in MHO. Here, we reviewed current literature on the relationship between MHO and T2DM, discussed the determinants for the development of diabetes in MHO, and summarized the measures for the prevention of T2DM in MHO.

Describing Transitions in Adherence to Physical Activity Self-monitoring and Goal Attainment in an Online Behavioral Weight Loss Program: Secondary Analysis of a Randomized Controlled Trial

Background

Standard behavioral weight loss interventions often set uniform physical activity (PA) goals and promote PA self-monitoring; however, adherence remains a challenge, and recommendations may not accommodate all individuals. Identifying patterns of PA goal attainment and self-monitoring behavior will offer a deeper understanding of how individuals adhere to different types of commonly prescribed PA recommendations (ie, minutes of moderate-to-vigorous physical activity [MVPA] and daily steps) and guide future recommendations for improved intervention effectiveness.

Objective

This study examined weekly patterns of adherence to step-based and minute-based PA goals and self-monitoring behavior during a 6-month online behavioral weight loss intervention.

Methods

Participants were prescribed weekly PA goals for steps (7000-10,000 steps/day) and minutes of MVPA (50-200 minutes/week) as part of a lifestyle program. Goals gradually increased during the initial 2 months, followed by 4 months of fixed goals. PA was self-reported daily on the study website. For each week, participants were categorized as adherent if they self-monitored their PA and met the program PA goal, suboptimally adherent if they self-monitored but did not meet the program goal, or nonadherent if they did not self-monitor. The probability of transitioning into a less adherent status was examined using multinomial logistic regression.

Results

Participants (N=212) were predominantly middle-aged females with obesity, and 67 (31.6%) self-identified as a racial/ethnic minority. Initially, 73 (34.4%) participants were categorized as adherent to step-based goals, with 110 [51.9%] suboptimally adherent and 29 [13.7%] nonadherent, and there was a high probability of either remaining suboptimally adherent from week to week or transitioning to a nonadherent status. However, 149 (70.3%) participants started out adherent to minute-based goals (34 [16%] suboptimally adherent and 29 [13.7%] nonadherent), with suboptimally adherent seen as the most variable status. During the graded goal phase, participants were more likely to transition to a less adherent status for minute-based goals (odds ratio [OR] 1.39, 95% CI 1.31-1.48) compared to step-based goals (OR 1.24, 95% CI 1.17-1.30); however, no differences were seen during the fixed goal phase (minute-based goals: OR 1.06, 95% CI 1.05-1.08; step-based goals: OR 1.07, 95% CI 1.05-1.08).

Conclusions

States of vulnerability to poor PA adherence can emerge rapidly and early in obesity treatment. There is a window of opportunity within the initial 2 months to bring more people toward adherent behavior, especially those who fail to meet the prescribed goals but engage in self-monitoring. Although this study describes the probability of adhering to step- and minute-based targets, it will be prudent to determine how individual characteristics and contextual states relate to these behavioral patterns, which can inform how best to adapt interventions.

Trial Registration

ClinicalTrials.gov NCT02688621; https://clinicaltrials.gov/ct2/show/NCT02688621

Association Between Dietary Patterns and Different Metabolic Phenotypes in Japanese Adults: WASEDA'S Health Study

Although many studies have reported that a posteriori dietary pattern is associated with metabolic health, there is little evidence of an association between dietary patterns and different metabolic phenotypes. The present study aimed to examine the association between major dietary patterns and different metabolic phenotypes (metabolically healthy non-obese [MHNO], metabolically unhealthy non-obese [MUNO], metabolically healthy obese [MHO], and metabolically unhealthy obese [MUO]) in middle-aged and elderly Japanese adults. This cross-sectional study enrolled 2,170 Japanese adults aged ≥40 years. The four different metabolic phenotypes were determined based on the presence of obesity, abdominal obesity, hypertension, hyperglycemia, and dyslipidemia. The major dietary patterns were determined using principal component analysis based on energy-adjusted food intake. Two dietary patterns were identified: the healthy dietary pattern, which was characterized by a high intake of vegetables, fruits, potatoes, soy products, mushrooms, seaweeds, and fish; and the alcohol dietary pattern, which was characterized by a high intake of alcoholic beverages, liver, chicken, and fish. The healthy dietary pattern was associated with the MHNO and MHO phenotypes (MUNO and MUO as reference groups, respectively), and the multivariate-adjusted odds ratios (ORs) (95% confidence intervals [CIs]) in the highest quartile of healthy dietary pattern score with the lowest quartile as the reference category were 2.10 (1.40–3.15) and 1.86 (1.06–3.25), respectively. Conversely, the alcohol dietary pattern was inversely associated with the MHNO and MHO phenotypes, while the multivariate-adjusted ORs (95% CIs) in the highest quartile of the alcohol dietary pattern score with the lowest quartile as the reference category were 0.63 (0.42–0.94) and 0.45 (0.26–0.76), respectively. There were no significant interactions between sex and healthy/alcohol dietary patterns in the prevalence of the MHNO and MHO phenotypes. In conclusion, the present study's findings suggest that major dietary patterns are associated with different metabolic phenotypes in middle-aged and elderly Japanese adults. These findings provide useful evidence for maintaining metabolic health through diet regardless of obesity status.

Dietary determinants of healthy/unhealthy metabolic phenotype in individuals with normal weight or overweight/obesity: a systematic review

Objectives: Nutritional factors are amongst the major determinants in the onset and development of obesity and metabolic complications. Nevertheless, the dietary determinants of metabolic health are not completely elucidated. The aim of this systematic review is to investigate nutritional and dietary factors that may contribute to metabolic heterogeneity in individuals with obesity or normal weight. Methods: A literature search was performed in PubMed, Scopus, EMBASE, and google scholar databases until August 2021, to locate studies that examined metabolic health and its association with intakes of specific foods or food groups, nutrient intakes or status, as well as adherence to certain dietary patterns. Two researchers had independently screened titles and abstracts, examined full-text studies, conducted data extraction, and evaluated their quality using the Newcastle-Ottawa Scale. Results: Twenty-seven studies, with a total of 39518 subjects, were included. Of these studies, 11 articles evaluated the association between different dietary patterns and metabolic phenotypes, while 15 had investigated the association of single food/nutrients intakes or nutrient status with metabolic phenotype, and one paper evaluated the association of dietary inflammatory index with metabolic health. The findings of these studies propose that healthy dietary patterns such as the Mediterranean pattern, Dietary Approaches to Stop Hypertension, and population-derived patterns (such as the "Healthy" and "Fruit and vegetable" patterns) were associated with higher odds of the metabolically healthy phenotype. Higher intakes of fruits, vegetables, dairy products, coffee/tea, vitamin D, magnesium, and flavonoids, were suggested to lower the risk of developing metabolically unhealthy phenotype, while, higher consumption of saturated fat, carbohydrate and sugar-sweetened beverages, fast foods, organ meats, and a pro-inflammatory diet increased the risk. Conclusion: Results from published studies, which were mostly cross-sectional, suggest that higher adherence to unhealthier dietary patterns, characterized by the consumption of refined and processed foods, was associated with a lower likelihood of having a healthy metabolic phenotype, while the opposite was observed for healthier dietary patterns. Findings may be used in developing nutritional strategies aimed at improving metabolic health in the population.

Adherence to Mediterranean Diet and Its Association with Metabolic Health Status in Overweight and Obese Adolescents

BACKGROUND

Obesity is becoming more prevalent around the world and greatly contributes to chronic disease progression. Previous studies have investigated individual food groups in relation to metabolic health status of adolescents, mainly in Western countries. Limited data are available on the association between dietary patterns and metabolic health in Middle East nations, where childhood overweight/obesity is increasing drastically. Therefore, we investigated the relationship between the Mediterranean diet and metabolic health status among Iranian adolescents.

METHODS

This cross-sectional study was conducted on 203 overweight/obese adolescents. Dietary intakes were evaluated by a validated food frequency questionnaire. Anthropometric parameters and blood pressure were measured. Fasting blood samples were obtained to determine circulating insulin, glucose, and lipid profile. Two different methods were applied to classify participants as metabolically healthy obese (MHO) or unhealthy obese (MUO): International Diabetes Federation (IDF) criteria and IDF along with insulin resistance (HOMA-IR) criteria.

RESULTS

A total of 79 (38.9%) and 67 (33.0%) adolescents were, respectively, categorized as MUO, based on IDF and IDF/HOMA definitions. Considering IDF criteria, higher adherence to the Mediterranean diet was related to lower odds of being MUO, both in the crude (OR: 0.17; 95%CI: 0.08-0.37) and fully adjusted model (OR: 0.33; 95% CI: 0.13-0.84). Excluding each component from the score made the association insignificant, except for two components of meat and dairy products. Based on the IDF/HOMA-IR criteria, there was no significant association between Mediterranean diet score and MUO, after considering all potential confounders (OR: 0.47; 95% CI: 0.17-1.30).

CONCLUSIONS

We found an inverse association between the Mediterranean diet and odds of MUO among Iranian adolescents, based on IDF criteria. No significant relation was found when MUO was defined based on HOMA-IR/IDF criteria. Further prospective cohort studies are needed to confirm these findings.

Distinguishing early patterns of physical activity goal attainment and weight loss in online behavioral obesity treatment using latent class analysis

Physical activity (PA) goal adherence is consistently associated with greater weight loss during behavioral obesity treatment, and early weight loss response predicts future weight loss success. However, it remains unclear which behaviors during the initial weeks of treatment distinguish responders from nonresponders and might be effective targets for improving treatment outcomes. To characterize subgroups with distinct patterns of PA goal adherence during the initial 2 months of an online, group-based weight control program and determine associations between these patterns and 6-month weight loss. Participants received an online behavioral obesity intervention with PA goals and daily self-monitoring. Weekly adherence to step goals and moderate-to-vigorous PA (MVPA) minute goals based on self-monitoring records were examined using latent class analysis. Body weight was objectively measured at 0, 2, and 6 months. Participants (N = 212; 91.5% female, 31.6% race/ethnic minority, mean body mass index: 35.8 ± 5.9 kg/m2) clustered into three subgroups based on early goal attainment: "Both PA Goals," "MVPA Goals Only," and "Neither PA Goal." The "Both PA Goals" class had significantly greater 6-month weight loss (estimated mean weight loss [95% CI]: -9.4% [7.4 to 11.5]) compared to the "MVPA Goals Only" (-4.8% [3.4 to 6.1]) and "Neither PA Goal" classes (-2.5% [1.4 to 3.6]). Individuals meeting both PA goals early in treatment achieve greater weight losses than those meeting MVPA but not step goals, pointing to the need to explore factors associated with nonadherence to each of the PA goals to better understand these potential targets for treatment refinement and adaptive interventions.

Quality of Life of Physically Active and Inactive Women Who Are Older after Surgery for Stress Urinary Incontinence Using a Transobturator Tape (TOT)

Urinary incontinence is a major health problem. According to various authors, it concerns 30–40% of the population and grows with age, affecting approximately 50% of women aged over 70. According to the recommendations of the International Continence Society, the treatment of urinary incontinence should commence with conservative treatment and, above all, with physiotherapy. If the conservative treatment fails or the level of urinary incontinence is too high, surgery is recommended. With regard to female patients examined at work, the TOT method was applied. The aim of this study was to assess the relationship between regular physical activity and the quality of life of women aged 65–87 who underwent surgical treatment for stress urinary incontinence (SUI) using the TOT method. The study group involved 60 postmenopausal women, patients of the Department of Gynaecology of the Hospital of Ministry of the Interior and Administration in Wroclaw, with SUI diagnosed during ultrasonography. The female patients were surveyed before and 12 months after the surgery using standardised IPAQ and WHOQOL-BREF.FL questionnaires. Significant positive relationships between quality of life and physical activity before and 12 months after the surgery were demonstrated in the somatic and social domains. Physically active postmenopausal women presented higher values in all domains and total quality of life according to the WHOQOL-BREF compared with physically inactive women, both before and 12 months after the procedure using the TOT method.

Influence of dietary patterns on the metabolically healthy obesity phenotype: A systematic review

AIMS

In many individuals (35%) obesity is not accompanied by cardiometabolic disorders, a condition referred to as metabolically healthy obesity. Since the effectiveness of dietary interventions for this condition is not well established, this study reviews the influence of dietary patterns on the phenotype of metabolically healthy obesity in adults and elderly.

DATA SYNTHESIS

The review was carried out following the PRISMA guidelines and registered in the PROSPERO. The search was conducted in the MEDLINE, SCOPUS, Web of Science, Science Direct, LILACS, and SciELO databases. A total of 236 articles were identified, seven of which were selected for synthesis after application of the eligibility criteria.

CONCLUSIONS

The overall result found out in this synthesis was that the greater adherence to healthy eating patterns was considered a preventive to the transition from metabolically healthy obesity to metabolic unhealthy obese phenotypes, by improving metabolic health, and reducing the risk of cardiovascular disease and mortality from all causes. In contrast, unhealthy eating patterns resulted in increased inflammation and risks of developing noncommunicable diseases. This review indicates that adherence to healthy eating patterns may interfere with metabolic phenotypes of obesity and positively affect metabolically healthy obesity.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42020159783.

Dietary Patterns as Characterized by Food Processing Levels and Their Association with the Health Outcomes of Rural Women in East Africa

Overweight and obesity are rapidly rising in Sub-Saharan Africa including in rural areas. However, most studies focus on urban centers, and have attributed this epidemic to the consumption of processed foods without their clear characterization. This study investigated food intake patterns defined by food processing levels and their association with overweight/obesity in rural areas. Four 24-h dietary recalls, anthropometric measurements, and socio-demographic characteristics were collected from 1152 women in Kenya, Tanzania, and Uganda. The PCA method was used to extract patterns characterized by food processing levels. The association between patterns and overweight/obesity was ascertained with regression models. The overweight/obesity rate was 47%, 42%, 26%, and 38% in Kenya, Tanzania, Uganda, and East Africa (as pooled data), respectively. Several patterns were identified, yet a "plant-based pattern" largely characterized by unprocessed and minimally processed foods and a "purchase pattern" mainly distinguished by highly processed foods were dominant. The "plant-based pattern" was inversely or not associated with overweight/obesity, while the "purchase pattern" had a positive association or no association. A clear distinction on processed foods as healthy and unhealthy should be made based on their nutrient provision to avoid their mischaracterization as unhealthy. Policies to reverse consumption of unhealthy processed foods while promoting healthy ones should be pursued.

Prediction of Metabolic Disorders Using NMR-Based Metabolomics: The Shanghai Changfeng Study

A metabolically healthy status, whether obese or not, is a transient stage with the potential to develop into metabolic disorders during the course of life. We investigated the incidence of metabolic disorders in 1078 metabolically healthy Chinese adults from the Shanghai Changfeng Study and looked for metabolites that discriminated the participants who would develop metabolic disorders in the future. Participants were divided into metabolically healthy overweight/obesity (MHO) and metabolically healthy normal weight (MHNW) groups according to their body mass index (BMI) and metabolic status. Their serum metabolomic profile was measured using a ¹H nuclear magnetic resonance spectrometer (¹H-NMR). The prevalence of diabetes, hypertriglyceridemia, hypercholesterolemia and metabolic syndrome was similar between the MHNW and MHO participants at baseline. After a median of 4.2 years of follow-up, more MHO participants became metabolically unhealthy than MHNW participants. However, a subgroup of MHO participants who remained metabolically healthy (MHO → MHO) had a similar prevalence of metabolic disorders as the MHNW participants at the follow-up examination, despite a significant reduction in their serum concentrations of high-density lipoprotein (HDL) and an elevation in valine, leucine, alanine and tyrosine. Further correlation analysis indicated that serum intermediate-density lipoprotein (IDL) and very low-density lipoprotein cholesterol (VLDL-CH) might be involved in the transition from metabolically healthy to unhealthy status and could be valuable to identify the MHNW and MHO with increased metabolic risks.

Gut microbiota of adults with different metabolic phenotypes

OBJECTIVE

The aim of this study was to investigate the gut microbiota of individuals with different metabolic phenotypes and to compare their characteristics.

METHODS

This was a cross-sectional study with 109 adults, classified according to metabolic status, by body mass index, and homeostasis model assessment. Anthropometric and biochemical characteristics and blood pressure were evaluated. Level of physical activity was evaluated by means of a questionnaire, and dietary consumption was evaluated using a 3-d food record. Feces samples were collected from each participant, and gut microbiota profile was analyzed by sequencing of the 16S rRNA gene. The Kruskal-Wallis and χ² tests were used, according to the scale of measurement of the variables, on the statistical program SPSS version 25, with significance level of 5%.

RESULTS

Significantly lower values of saturated fat intake and fasting glycemia were observed in metabolically healthy individuals who were overweight and obese compared with their unhealthy counterparts. Diversity and richness of bacterial communities were lower in individuals who were obese and in the unhealthy phenotype. The genus Eubacterium rectale and genera of the family Prevotellaceae were more abundant in the metabolically healthy obese and metabolically healthy overweight groups than in the metabolically healthy normal weight one, whereas Bifidobacterium was more abundant in the metabolically healthy normal weight group. The genera Coprococcus and Ruminococcus were more abundant in the metabolically healthy overweight group than in the metabolically unhealthy overweight one.

CONCLUSIONS

We observed distinct characteristics in the gut microbiota of different metabolic phenotypes. The intestines of individuals with unhealthy phenotypes hosted inflammation-associated microbiota, with lower butyrate production potential and reduced bacterial diversity.

Healthy Obese Subjects Differ in Chronotype, Sleep Habits, and Adipose Tissue Fatty Acid Composition from Their Non-Healthy Counterparts

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.

A systematic review of the determinants of seafood consumption

Although seafood is considered to be an important part of a balanced diet, many national food consumption surveys suggest that seafood is not consumed in sufficient amounts. As consumers are moving to diversify their diet from animal-based protein, it is important to understand the factors influencing consumption of marine foods. This review aims to assess the characteristics of seafood consumers as well as the influences on seafood consumption in Europe, USA, Canada, Australia and New Zealand. Systematic search strategies were used to identify relevant journal articles from three electronic databases (PubMed, Web of Science and Embase). Three searches were carried out and identified 4405 unique publications from which 121 met the criteria for the review process. The reviewed studies revealed that seafood consumers were more likely to be older, more affluent and more physically active and were less likely to smoke compared with non-seafood consumers. Sex and BMI did not appear to have a directional association with seafood consumption. The most commonly reported barriers to seafood consumption were cost, followed by sensory or physical barriers, health and nutritional beliefs, habits, availability and cooking skills. The most commonly reported influences were beliefs about the contribution of seafood to health, environmental influences and personal preferences. Based on the findings of this review, future intervention strategies to increase seafood consumption may need to consider affordability and education in terms of health, nutrition and cooking skills. More research is needed to explore the effectiveness of specific interventions at increasing the consumption of seafood.

Metabolically healthy obesity: facts and fantasies

Although obesity is typically associated with metabolic dysfunction and cardiometabolic diseases, some people with obesity are protected from many of the adverse metabolic effects of excess body fat and are considered "metabolically healthy." However, there is no universally accepted definition of metabolically healthy obesity (MHO). Most studies define MHO as having either 0, 1, or 2 metabolic syndrome components, whereas many others define MHO using the homeostasis model assessment of insulin resistance (HOMA-IR). Therefore, numerous people reported as having MHO are not metabolically healthy, but simply have fewer metabolic abnormalities than those with metabolically unhealthy obesity (MUO). Nonetheless, a small subset of people with obesity have a normal HOMA-IR and no metabolic syndrome components. The mechanism(s) responsible for the divergent effects of obesity on metabolic health is not clear, but studies conducted in rodent models suggest that differences in adipose tissue biology in response to weight gain can cause or prevent systemic metabolic dysfunction. In this article, we review the definition, stability over time, and clinical outcomes of MHO, and discuss the potential factors that could explain differences in metabolic health in people with MHO and MUO - specifically, modifiable lifestyle factors and adipose tissue biology. Better understanding of the factors that distinguish people with MHO and MUO can produce new insights into mechanism(s) responsible for obesity-related metabolic dysfunction and disease.

Empirically derived dietary patterns and obesity among Iranian Adults: Yazd Health Study-TAMYZ and Shahedieh cohort study

The aim was to determine the relationship between dietary patterns derived by principal component analysis (PCA) in association with obesity from a large group of Iranian adults in the urban and suburb areas. A cross-sectional study was conducted on 10,693 Iranian adults. The data were collected from two cohort studies: Shahedieh city annexed to Yazd area as well as Yazd Health Study (YaHS)-TAMYZ (Yazd Nutrition Survey in Persian) in urban area. Dietary intakes were assessed using a validated semi-quantitative food frequency questionnaire. The PCA was applied to identify the dietary patterns. Multiple logistic regressions were run to assess the relationship between dietary patterns and obesity. In Shahedieh cohort study, three major dietary patterns were identified traditional, unhealthy, and prudent pattern. Prudent pattern was associated with lower odds of obesity (OR: 0.68; 95% CI: 0.53, 0.88). Higher adherence to the unhealthy (OR: 1.24; 95% CI: 1.02, 1.50) and traditional (OR: 1.38; 95% CI: 1.11, 1.72) patterns was related to greater odds of obesity. Moreover, we identified traditional and unhealthy dietary patterns in YaHS study. Higher adherence to the unhealthy dietary pattern was associated with greater odds of obesity (OR: 1.21 95% CI: 1.02, 1.44). Greater adherence to unhealthy dietary patterns was associated with higher odds of obesity in participants. Greater adherence to traditional and prudent dietary patterns increased and decreased the obesity odds, respectively. Further prospective studies are needed to find out the causal relationship between the variables.

Dietary Patterns Based on Estimated Glomerular Filtration Rate and Kidney Function Decline in the General Population: The Lifelines Cohort Study

No specific dietary patterns have been established that are linked with loss of kidney function. We aimed to identify an estimated glomerular filtration rate-based dietary pattern (eGFR-DP) and to evaluate its association with eGFR decline and chronic kidney disease (CKD) incidence in the general population. We included 78,335 participants from the Lifelines cohort in the Northern Netherlands. All participants had an eGFR >60 mL/min/1.73 m² at baseline and completed a second visit five years later. The eGFR-DP was constructed at baseline using a 110-item food frequency questionnaire by reduced rank regression, stratified by sex. Logistic regression was performed to evaluated the association between the eGFR-DP score and either a ≥20% eGFR decline or incident CKD. Among women, eGFR-DP were characterized by high consumption of egg, cheese, and legumes and low consumption of sweets, white meat, and commercially prepared dishes. In men, eGFR-DP were characterized by high consumption of cheese, bread, milk, fruits, vegetables, and beer and low consumption of white and red meat. A higher eGFR-DP score was associated with a lower risk of a ≥20% eGFR decline (OR 4th vs. 1st quartile, women: 0.79 [95% CI: 0.73-0.87]; men: 0.67 [0.59-0.76]). The association between the eGFR-DP score and CKD incidence was lost upon adjustment for baseline eGFR. Our results provide support for dietary interventions to prevent kidney function decline in the general population.

Dietary determinants of unhealthy metabolic phenotype in normal weight and overweight/obese adults: results of a prospective study

We aimed to investigate associations of dietary intakes with unhealthy metabolic phenotype development, in normal weight and overweight/obese adults separately. A total of 1114 individuals, aged ≥19 years, with healthy phenotype in the third examination cycle of Tehran Lipid and Glucose Study were followed until the fifth examination. Dietary intakes were estimated using the food frequency questionnaires, collected during the study. The participants were grouped as normal weight and overweight/obese according to the baseline body mass index (BMI). Unhealthy metabolic status was determined as having more than one component of metabolic syndrome using the Joint Interim Statement. Regardless of BMI, higher intakes of magnesium, dairy products, poultry, apples/pears, citrus fruits, and tea/coffee decreased the risk of developing unhealthy phenotype, while higher intakes of fast foods, organ meats, and potatoes increased the risk. Food intake can influence the transition to unhealthy phenotype in metabolically healthy adults, irrespective of the BMI status.

Association of major dietary patterns and different metabolic phenotypes: a population-based study of northwestern Iran

BACKGROUND

Finding the relationship between the major dietary patterns and cardiometabolic phenotypes could be used for planning prevention programs based on the cultural and dietary habits to prevent transient from a metabolically healthy state to an unhealthy state. So, we aimed to assess the association between dietary patterns and cardiometabolic phenotypes in the northwestern population of Iran.

METHOD

In the present cross-sectional and population-based study, 504 adults sampled by cluster sampling in East-Azerbaijan, Iran. Factor analysis was used for determining the dietary pattern. Metabolic phenotypes were determined according to body mass index (BMI) cut-off point (25 kg/m²), and the presence of the metabolic syndrome. The independent sample t-test, one-way ANOVA, chi-square, and multinomial regression were used for statistical analysis.

RESULTS

In both adjusted (OR: 2.24, 95% CI: 1.17, 4.31) and unadjusted models (OR: 3.14, 95% CI: 1.54, 5.42), the last tertile of the animal dietary pattern was associated with metabolically healthy obese (MHO) phenotypes. After adjusting, the last tertile of the animal dietary pattern was significantly associated with an increase of metabolically unhealthy obese (MUHO) phenotype (OR: 2.61, 95% CI: 1.18, 5.76).

CONCLUSION

In the present study, the animal dietary pattern was associated with MHO and MUHO phenotypes. It is suggested that some measures should be taken to strengthen nutrition education for the population and advocate a balanced diet to improve the condition.

Associations of Nutrient Patterns with the Prevalence of Metabolic Syndrome: Results from the Baseline Data of the Japan Multi-Institutional Collaborative Cohort Study

: The association between nutrient patterns and metabolic syndrome (MetS) has not been examined in a Japanese population. A cross-sectional study was performed on 30,108 participants (aged 35-69 years) in the baseline survey of the Japan Multi-Institutional Collaborative Cohort Study. Dietary intake was assessed using a 46-item food frequency questionnaire. MetS was diagnosed according to the Joint Interim Statement Criteria of 2009, using body mass index instead of waist circumference. Factor analysis was applied to energy-adjusted intake of 21 nutrients, and three nutrient patterns were extracted: Factor 1 (fiber, potassium and vitamins pattern); Factor 2 (fats and fat-soluble vitamins pattern); and Factor 3 (saturated fatty acids, calcium and vitamin B₂ pattern). In multiple logistic regression analysis adjusted for sex, age, and other potential confounders, Factor 1 scores were associated with a significantly reduced odds ratio (OR) of MetS and all five components. Factor 2 scores were associated with significantly increased prevalence of MetS, obesity, and high blood pressure. Factor 3 scores were significantly associated with lower OR of MetS, high blood pressure, high serum triglycerides and low HDL cholesterol levels. Analysis of nutrient patterns may be useful to assess the overall quality of diet and its association with MetS.

Correlates of and Body Composition Measures Associated with Metabolically Healthy Obesity Phenotype in Hispanic/Latino Women and Men: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

BACKGROUND

Individuals with "metabolically healthy obesity" (MHO) phenotype (i.e., obesity and absence of cardiometabolic abnormalities: favorable levels of blood pressure, lipids, and glucose) experience lower risk of cardiovascular disease compared with those with "metabolically at-risk obesity" (MAO) phenotype (i.e., obesity with concurrent cardiometabolic abnormalities). Among Hispanic/Latino women and men with obesity, limited data exist on the correlates of and body composition measures associated with obesity phenotypes.

METHODS

Data from the Hispanic Community Health Study/Study of Latinos (2008-2011) were used to estimate the age-adjusted distribution of obesity phenotypes among 5,426 women and men (aged 20-74 years) with obesity (BMI ≥ 30 kg/m²) and to compare characteristics between individuals with MHO and MAO phenotypes. Weighted Poisson regression models were used to examine cross-sectional associations between 1-standard deviation (SD) increase in body composition measures (i.e., body fat percentage, waist circumference, and body lean mass) and MHO phenotype prevalence.

RESULTS

The age-adjusted proportion of the MHO phenotype was low (i.e., 12.5% in women and 6.5% in men). In bivariate analyses, women and men with the MHO phenotype were more likely to be younger, have higher education and acculturation levels, report lower lifetime cigarette use, and have fasting insulin and waist circumference levels than MAO. Adjusting for sociodemographic and lifestyle factors, among women, each 1-SD increase in body fat percentage, waist circumference, and lean body mass was, respectively, associated with a 21%, 33%, and 31% lower prevalence of the MHO phenotype. Among men, each 1-SD increase in waist circumference and lean body mass was, respectively, associated with a 20% and 15% lower prevalence of the MHO phenotype.

CONCLUSIONS

We demonstrated that higher waist circumference and higher lean body mass were independently associated with a lower proportion of the MHO phenotype in Hispanic/Latino women and men. Findings support the need for weight reduction interventions to manage cardiometabolic health among Hispanics/Latinos.

Mediterranean diet, weight status and physical activity in schoolchildren of the Region of Murcia

INTRODUCTION

Childhood and adolescence are key stages to promote a healthy lifestyle.

OBJECTIVE

To analyze the relationship between weight status, physical activity and the Mediterranean diet in schoolchildren in the Region of Murcia.

METHODS

Cross-sectional descriptive study with 520 schoolchildren aged 8-17 years. The weight status was calculated through the body mass index. The Mediterranean diet was found through the KIDMED questionnaire and physical activity was estimated using the IPAQ-C and IPAQ-A questionnaires.

RESULTS

The Mediterranean diet is not significantly associated with sex (P<.537) or weight status (P<.417) but it maintains a relationship of dependence with age (P<.010) and the level of physical activity (P<.000). Schoolchildren in normal weight and assets have a greater follow-up to the Mediterranean diet than their overweight and sedentary peers (P<.000).

CONCLUSION

The Fat but fit phenomenon applied to the Mediterranean diet is confirmed.

Prevalence and predictors of metabolically healthy obesity in adolescents: findings from the national "Jeeluna" study in Saudi-Arabia

BACKGROUND

Obese children and adolescents may vary with respect to their health profile, an observation that has been highlighted by the characterization of metabolically healthy obesity (MHO). The objectives of this study were to examine the prevalence of MHO amongst obese adolescents in Saudi-Arabia, and investigate the anthropometric, socio-demographic, and lifestyle predictors of MHO in this age group.

METHODS

A national cross-sectional school-based survey (Jeeluna) was conducted in Saudi-Arabia in 2011-2012 (n = 1047 obese adolescents). Anthropometric, blood pressure and biochemical measurements were obtained. A multicomponent questionnaire covering socio-demographic, lifestyle, dietary, psychosocial and physical activity characteristics was administered. Classification of MHO was based on two different definitions. According to the first definition, subjects were categorized as MHO based on the absence of the following traditional cardiometabolic risk (CR) factors: systolic blood pressure (SBP) or diastolic blood pressure (DBP) >90th percentile for age, sex, and height; triglycerides (TG) > 1.25 mmol/L; high density lipoprotein-cholesterol (HDL-C) ≤1.02 mmol/L; glucose ≥5.6 mmol/L. The second definition of MHO was based on absence of any cardiometabolic risk factor, according to the International Diabetes Federation (IDF) criteria.

RESULTS

The prevalence of MHO ranged between 20.9% (IDF) and 23.8% (CR). Subjects with MHO were younger, less obese, had smaller waist circumference (WC) and were more likely to be females. Based on stepwise logistic regression analyses, and according to the IDF definition, body mass index (BMI) (OR = 0.89, 95% CI: 0.84-0.93) and WC (OR = 0.97, 95% CI: 0.96-0.98) were the only significant independent predictors of MHO. Based on the CR definition, the independent predictors of MHO included female gender (OR = 1.76, 95% CI: 1.29-2.41), BMI (OR = 0.97, 95% CI: 0.94-1.00), and weekly frequency of day napping (OR = 1.06, 95% CI: 1.00-1.12). Analysis by gender showed that vegetables' intake and sleep indicators were associated with MHO in boys but not in girls.

CONCLUSION

The study showed that one out of five obese adolescents is metabolically healthy. It also identified anthropometric factors as predictors of MHO and suggested gender-based differences in the association between diet, sleep and MHO in adolescents. Findings may be used in the development of intervention strategies aimed at improving metabolic heath in obese adolescents.

Dietary pattern is associated with obesity in Chinese children and adolescents: data from China Health and Nutrition Survey (CHNS)

BACKGROUND

Associations of dietary patterns in Chinese adolescents and children with later obesity have not previously been investigated. The purpose of the present study was to evaluate the associations between dietary patterns and the risk of obesity in Chinese adolescents and children by using a longitudinal design.

METHODS

Data from the China Health and Nutrition Survey (CHNS), a nationally representative survey, were used for our analysis. 489 participants 6-14 years of age were followed from 2006 to 2011. Factor analysis was used to identify the dietary patterns in Chinese adolescents and children. Ordered logistic regression models were used to examine the association between dietary patterns and later obesity.

RESULTS

Two dietary patterns were revealed by factor analysis, the traditional Chinese dietary pattern (with high intake of rice, vegetables, poultry, pork and fish and the modern dietary pattern (with high intake of wheat, processed meat and fast food). Children in the highest quartile and the second-highest quartile of the traditional Chinese dietary pattern was inversely associated with later obesity compared with children in the lowest quartile over 5 years (OR = 0.19, 95%CI: 0.09, 0.40 for Q4; OR = 0.47, 95%CI: 0.33, 0.67 for Q3); Children in the highest quartile of the modern dietary pattern was positively associated with later obesity compared with children in the lowest quartile over 5 years (OR = 2.02, 95%CI: 1.17, 3.48).

CONCLUSIONS

Dietary patterns in Chinese adolescents and children are associated with later obesity. These findings further confirm the importance of children's dietary patterns in later obesity and lay groundwork for dietary culture-specific interventions targeted at reducing rates of obesity in children and adolescents.

Role of Physical Activity and Fitness in the Characterization and Prognosis of the Metabolically Healthy Obesity Phenotype: A Systematic Review and Meta-analysis

The aims of the present article are to systematically review and meta-analyze the existing evidence on: 1) differences in physical activity (PA), sedentary behavior (SB), cardiorespiratory fitness (CRF) and muscular strength (MST) between metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO); and 2) the prognosis of all-cause mortality and cardiovascular disease (CVD) mortality/morbidity in MHO individuals, compared with the best scenario possible, i.e., metabolically healthy normal-weight (MHNW), after adjusting for PA, SB, CRF or MST. Our systematic review identified 67 cross-sectional studies to address aim 1, and 11 longitudinal studies to address aim 2. The major findings and conclusions from the current meta-analysis are: 1) MHO individuals are more active, spend less time in SB, and have a higher level of CRF (yet no differences in MST) than MUO individuals, suggesting that their healthier metabolic profile could be at least partially due to these healthier lifestyle factors and attributes. 2) The meta-analysis of cohort studies which accounted for PA (N = 10 unique cohorts, 100% scored as high-quality) support the notion that MHO individuals have a 24-33% higher risk of all-cause mortality and CVD mortality/morbidity compared to MHNW individuals. This risk was borderline significant/non-significant, independent of the length of the follow-up and lower than that reported in previous meta-analyses in this topic including all type of studies, which could be indicating a modest reduction in the risk estimates as a consequence of accounting for PA. 3) Only one study has examined the role of CRF in the prognosis of MHO individuals. This study suggests that the differences in the risk of all-cause mortality and CVD mortality/morbidity between MHO and MHNW are largely explained by differences in CRF between these two phenotypes.