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

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Abstract

Background

Diversity 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).

Methods

Cross-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.

Results

Among 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)).

Conclusion

The 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.

Electronic supplementary material

The online version of this article (10.1186/s12937-018-0319-0) contains supplementary material, which is available to authorized users.

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Most cited references 29

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The role of exercise and physical activity in weight loss and maintenance.

Damon L. Swift, Neil Johannsen, Carl Lavie … (2014)

This review explores the role of physical activity (PA) and exercise training (ET) in the prevention of weight gain, initial weight loss, weight maintenance, and the obesity paradox. In particular, we will focus the discussion on the expected initial weight loss from different ET programs, and explore intensity/volume relationships. Based on the present literature, unless the overall volume of aerobic ET is very high, clinically significant weight loss is unlikely to occur. Also, ET also has an important role in weight regain after initial weight loss. Overall, aerobic ET programs consistent with public health recommendations may promote up to modest weight loss (~2 kg), however the weight loss on an individual level is highly heterogeneous. Clinicians should educate their patients on reasonable expectations of weight loss based on their physical activity program and emphasize that numerous health benefits occur from PA programs in the absence of weight loss. © 2014.

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The prevalence of metabolic syndrome and metabolically healthy obesity in Europe: a collaborative analysis of ten large cohort studies

Jana van Vliet-Ostaptchouk, Marja-Liisa Nuotio, Sandra Slagter … (2014)

Background Not all obese subjects have an adverse metabolic profile predisposing them to developing type 2 diabetes or cardiovascular disease. The BioSHaRE-EU Healthy Obese Project aims to gain insights into the consequences of (healthy) obesity using data on risk factors and phenotypes across several large-scale cohort studies. Aim of this study was to describe the prevalence of obesity, metabolic syndrome (MetS) and metabolically healthy obesity (MHO) in ten participating studies. Methods Ten different cohorts in seven countries were combined, using data transformed into a harmonized format. All participants were of European origin, with age 18–80 years. They had participated in a clinical examination for anthropometric and blood pressure measurements. Blood samples had been drawn for analysis of lipids and glucose. Presence of MetS was assessed in those with obesity (BMI ≥ 30 kg/m2) based on the 2001 NCEP ATP III criteria, as well as an adapted set of less strict criteria. MHO was defined as obesity, having none of the MetS components, and no previous diagnosis of cardiovascular disease. Results Data for 163,517 individuals were available; 17% were obese (11,465 men and 16,612 women). The prevalence of obesity varied from 11.6% in the Italian CHRIS cohort to 26.3% in the German KORA cohort. The age-standardized percentage of obese subjects with MetS ranged in women from 24% in CHRIS to 65% in the Finnish Health2000 cohort, and in men from 43% in CHRIS to 78% in the Finnish DILGOM cohort, with elevated blood pressure the most frequently occurring factor contributing to the prevalence of the metabolic syndrome. The age-standardized prevalence of MHO varied in women from 7% in Health2000 to 28% in NCDS, and in men from 2% in DILGOM to 19% in CHRIS. MHO was more prevalent in women than in men, and decreased with age in both sexes. Conclusions Through a rigorous harmonization process, the BioSHaRE-EU consortium was able to compare key characteristics defining the metabolically healthy obese phenotype across ten cohort studies. There is considerable variability in the prevalence of healthy obesity across the different European populations studied, even when unified criteria were used to classify this phenotype.

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Diabetes and Cardiovascular Disease Outcomes in the Metabolically Healthy Obese Phenotype

Sarah Appleton, Christopher J. Seaborn, Renuka Visvanathan … (2013)

OBJECTIVE To determine the correlates of the “metabolically healthy obese” (MHO) phenotype and the longitudinal risks of diabetes and cardiovascular disease (CVD)/stroke associated with this phenotype. RESEARCH DESIGN AND METHODS The North West Adelaide Health Study is a prospective cohort study of 4,056 randomly selected adults aged ≥18 years. Participants free of CVD/stroke and not underweight (n = 3,743) were stratified by BMI categories and metabolic risk, defined as having two or more International Diabetes Federation metabolic syndrome criteria, excluding waist circumference. RESULTS Correlates of the MHO (n = 454 [12.1%]) included smoking, socioeconomic disadvantage, and physical inactivity. Compared with metabolically healthy normal-weight subjects (n = 1,172 [31.3%]), the MHO were more likely to develop metabolic risk (15.5 vs. 33.1%, P < 0.001) and incident diabetes (odds ratio 2.09 [95% CI 0.87–5.03]) but not CVD/stroke (1.16 [0.58–2.29]) during 5.5–10.3 years of follow-up. These risks were not seen in MHO subjects maintaining metabolic health (n = 188 [67%]). Sustained metabolic health in obese participants was associated with age ≤40 years and lower waist circumference. Compared with the metabolically at-risk obese, MHO women demonstrated a significantly higher (mean [SE]) percentage of leg fat (49.9 [0.5] vs. 53.2 [0.7]) and lower waist circumference (104 [0.6] vs. 101 cm [0.8]), despite no significant differences in overall adiposity. CONCLUSIONS “Healthy” obesity was a transient state for one-third of subjects. Persistence of a MHO phenotype, which was associated with favorable outcomes, was related to younger age and a more peripheral fat distribution. The MHO phenotype may be sustained by promoting lower waist circumferences.

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Author and article information

Contributors

Sandra N. Slagter: +31-50-3611483 , s.n.slagter@umcg.nl

Eva Corpeleijn: e.corpeleijn@umcg.nl

Melanie M. van der Klauw: m.m.van.der.klauw@umcg.nl

Anna Sijtsma: a.sijtsma@lifelines.nl

Linda G. Swart-Busscher: l.g.swart@umcg.nl

Corine W. M. Perenboom: corine.perenboom@wur.nl

Jeanne H. M. de Vries: jeanne.devries@wur.nl

Edith J. M. Feskens: edith.feskens@wur.nl

Bruce H. R. Wolffenbuttel: bwo@umcg.nl

Daan Kromhout: d.kromhout@umcg.nl

Jana V. van Vliet-Ostaptchouk: j.v.van.vliet@umcg.nl

Journal

Journal ID (nlm-ta): Nutr J

Journal ID (iso-abbrev): Nutr J

Title: Nutrition Journal

Publisher: BioMed Central (London )

ISSN (Electronic): 1475-2891

Publication date (Electronic): 12 February 2018

Publication date PMC-release: 12 February 2018

Publication date Collection: 2018

Volume: 17

Electronic Location Identifier: 18

Affiliations

[1 ]Department of Endocrinology, University of Groningen, University Medical Center Groningen, HPC AA31, P.O. Box 30001, 9700 RB Groningen, The Netherlands

[2 ]Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands

[3 ]Lifelines Cohort Study, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands

[4 ]Department of Paramedical Sciences, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands

[5 ]ISNI 0000 0001 0791 5666, GRID grid.4818.5, Division of Human Nutrition, , Wageningen University, ; PO Box 17, 6700 AA Wageningen, The Netherlands

Article

Publisher ID: 319

DOI: 10.1186/s12937-018-0319-0

PMC ID: 5809859

PubMed ID: 29433580

SO-VID: 267af299-2f38-4785-b77a-19cb9419f5c8

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 26 October 2017

Date accepted : 4 January 2018

Funding

Funded by: NWO

Award ID: 175.010.2007.006

Funded by: FP7/2007-2013

Award ID: 261433

Funded by: Dutch Diabetes Research Foundation

Award ID: 2013.81.1673

Award Recipient : Jana V. van Vliet-Ostaptchouk

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ScienceOpen disciplines: Nutrition & Dietetics

Keywords: obesity,metabolic health,dietary patterns,physical activity,lifestyle

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ScienceOpen disciplines: Nutrition & Dietetics

Keywords: obesity, metabolic health, dietary patterns, physical activity, lifestyle

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

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Abstract

Background

Methods

Results

Conclusion

Electronic supplementary material

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Karger: Nutrition and Dietetics

Most cited references 29

The role of exercise and physical activity in weight loss and maintenance.

The prevalence of metabolic syndrome and metabolically healthy obesity in Europe: a collaborative analysis of ten large cohort studies

Diabetes and Cardiovascular Disease Outcomes in the Metabolically Healthy Obese Phenotype

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