Metabolically Healthy Overweight and Obesity Is Associated with Higher Adherence to a Traditional Dietary Pattern: A Cross-Sectional Study among Adults in Lebanon

Differences in the levels of inflammatory markers between metabolically healthy obese and other obesity phenotypes in adults: A systematic review and meta-analysis

AIMS

The aim of this study was to systematically review and analyze differences in the levels of C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) comparing metabolically healthy but obese (MHO) with metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), and metabolically unhealthy obese (MUO) subjects.

DATA SYNTHESIS

We searched PubMed, Embase, Web of Science, and Scopus for studies that matched the relevant search terms. Differences in inflammatory marker levels between MHO and the other three phenotypes were pooled as standardized mean differences (SMD) or differences of medians (DM) using a random-effects model. We included 91 studies reporting data on 435,007 individuals. The CRP levels were higher in MHO than in MHNO subjects (SMD = 0.63, 95% CI: 0.49, 0.76; DM = 0.83 mg/L, 95% CI: 0.56, 1.11). The CRP levels were higher in MHO than in MUNO subjects (SMD = 0.16, 95% CI: 0.05, 0.28; DM = 0.39 mg/L, 95% CI: 0.09, 0.69). The CRP levels were lower in MHO than in MUO individuals (SMD = -0.43, 95% CI: -0.54, -0.31; DM = -0.82 mg/L, 95% CI: -1.16, -0.48). The IL-6 levels in MHO were higher than in MHNO while lower than in MUO subjects. The TNF-α levels in MHO were higher than in MHNO individuals.

CONCLUSIONS

This review provides evidence that CRP levels in MHO are higher than in MHNO and MUNO subjects but lower than in MUO individuals. Additionally, IL-6 levels in MHO are higher than in MHNO but lower than in MUO subjects, and TNF-α levels in MHO are higher than in MHNO individuals.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO number: CRD42021234948.

Body fat and muscle were associated with metabolically unhealthy phenotypes in normal weight and overweight/obesity in Yi people: A cross-sectional study in Southwest China

This study aimed to determine the association between the absolute mass, distribution, and relative ratio of body fat and muscle with the metabolically unhealthy (MU) phenotypes in normal weight and overweight/obesity in Yi people in China. The cross-sectional data from the Yi Migrants Study was used, which included 3,053 Yi people aged 20-80 years from the rural and urban sets. Participants were classified according to body mass index and metabolic status. Body composition including body fat percentage (BFP), fat mass index (FMI), visceral fat grade (VFG), muscle mass index (MMI), and muscle/fat ratio (M/F) were measured by bioelectrical impedance analysis. Restricted cubic spline and logistics regression models were used to test the associations between body composition parameters with MU phenotypes. Receiver-operating characteristic curves (ROC) were used to analyze the predictive value of MU phenotypes. Among the normal weight and overweight/obesity, 26.31% (497/1,889) and 52.15% (607/1,164) were metabolically unhealthy. Stratified by BMI, covariance analysis showed higher body fat (BFP, FMI, and VFG) and MMI in MU participants than in healthy participants. BFP, FMI, VFG, and MMI were positively associated with MU phenotypes both in normal weight and overweight/obesity after adjustment. M/F was significantly lower than MU participants and was negatively associated with MU phenotypes. BFP, FMI, VFG, and M/F could better predict MU phenotypes than BMI. We concluded that BFP, FMI, and VFG were positively associated with MU phenotypes, while M/F was negatively associated with MU phenotypes across the BMI categories in Yi people. Body fat and muscle measurement could be a valuable approach for obesity management.

Temporal trends in the prevalence of metabolically healthy overweight and obesity in Korean youth: data from the Korea National Health and Nutrition Examination Survey 2011-2019

PURPOSE

Metabolically healthy overweight/obesity (MHO) and metabolically unhealthy overweight/obesity (MUO) are distinct clinical phenotypes classified by the presence of cardiometabolic risk factors in an individual. In the present study, we investigated temporal trends in the prevalence of MHO in Korean adolescents using nationally representative data.

METHODS

Data from the Korea National Health and Nutrition Examination Survey 2011-2019 were used in this study. A total of 5,667 adolescents (3,014 boys, 53.2%) aged 10-18 years was included in this study. MHO was defined as a body mass index ≥85th percentile for the corresponding age and sex and absence of any cardiometabolic risk factors.

RESULTS

The prevalence of overweight/obesity showed an increasing trend from 18.8% (boys 17.3% and girls 20.6%) in 2011 to 23.7% (boys 24.0% and girls 23.5%) in 2019 (p for trend=0.045). The overall prevalence of MHO during 2011-2019 was 39.2%, which was higher in girls than in boys (boys 33.5%, girls 46.2%, p<0.001), and the change in prevalence of MHO from 2011 to 2019 (from 34.8% to 35.7%) was not significant. Among MUO, the most prevalent cardiometabolic risk factor was dysglycemia (48.8%), followed by elevated blood pressure (41.5%), low high-density lipoprotein cholesterol (35.0%), and high triglycerides (29.7%).

CONCLUSION

We observed a high prevalence of MHO in Korean youth with overweight/obesity. Although the prevalence of overweight/obesity increased, the prevalence of MHO was stable during 2011-2019. A risk-stratified approach based on metabolic health status can help reducing the medical and socioeconomic costs associated with obesity treatment.

Dietary fructose and its association with the metabolic syndrome in Lebanese healthy adults: a cross-sectional study

BACKGROUND

Epidemiological studies investigating the association between dietary fructose intake and the metabolic syndrome (MetS) are scarce and have produced controversial findings. This study aimed at (1) assessing total dietary fructose intake in a sample of Lebanese healthy adults, and determining the intake levels of natural vs. added fructose; (2) investigating the association of dietary fructose with MetS; and (3) identifying the socioeconomic and lifestyle factors associated with high fructose intake.

METHODS

A cross-sectional survey was conducted on a representative sample of adults living in Beirut, Lebanon (n = 283). Anthropometric and biochemical data were collected, and dietary intake was assessed using a food frequency questionnaire. Intakes of naturally-occurring fructose from fructose-containing food sources, such as fruits, vegetables, honey, were considered as "natural fructose". Acknowledging that the most common form of added sugar in commodities is sucrose or High Fructose Corn Syrup (HFCS), 50% of added sugar in food products was considered as added fructose. Total dietary fructose intake was calculated by summing up natural and added fructose intakes. Logistic regression analyses were conducted to investigate the association of total, added and natural fructose intakes with the MetS and to identify the socioeconomic predictors of high fructose intake.

RESULTS

Mean intake of total fructose was estimated at 51.42 ± 35.54 g/day, representing 6.58 ± 3.71% of energy intakes (EI). Natural and added fructose intakes were estimated at 12.29 ± 8.57 and 39.12 ± 34.10 g/day (1.78 ± 1.41% EI and 4.80 ± 3.56% EI), respectively. Participants in the highest quartile of total and added fructose intakes had higher odds of MetS (OR = 2.84, 95%CI: 1.01, 7.94 and OR = 3.18, 95%CI: 1.06, 9.49, respectively). In contrast, natural fructose intake was not associated with MetS. Age, gender and crowding index were identified as factors that may modulate dietary fructose intakes.

CONCLUSIONS

The observed association between high added fructose intake and the MetS highlights the need for public health strategies aimed at limiting sugar intake from industrialized foods and promoting healthier dietary patterns in Lebanon.

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.

Development of national dietary and lifestyle guidelines for pregnant women in Lebanon

Although a number of international diet and lifestyle guidelines during pregnancy (DLGP) exist in the literature, contextualization to low- and middle-income settings is less common. The aim of this study was to present the Lebanese DLGP and to describe the process followed for their development. A mixed-method approach was used including a review and synthesis of existing international DLGP and a consensus building nominal group technique (NGT) with a multidisciplinary group of experts (n = 11). During the meeting, participants identified the themes of the guidelines, formulated the wording of each themes' guideline and translated the guidelines to the Arabic language. Consensus was defined as an agreement of 80%. Reviewing the literature, a list of 17 main topics were found to be common themes for the DLGP. For the Lebanese DLGP, participants in the NGT meeting selected seven themes from this list: gestational weight gain, diet diversity, hydration, food safety, harmful foods, physical activity and breastfeeding. In addition, the group formulated three themes based on merging/modifying existing themes: supplementation, alcohol and smoking and religious fasting. Two context-specific new themes emerged: wellbeing and nutrition resilience. For each of the identified themes, the group agreed upon the wording of its guidelines and description. This study is the first from the Eastern Mediterranean Region to develop through consensus building, context and culture-specific dietary and lifestyle guidelines for pregnant women. Putting maternal nutrition at the heart of tackling malnutrition and its detrimental health outcomes is a core investment for a better maternal and child health.

Impact of Ramadan Fasting on Dietary Intakes Among Healthy Adults: A Year-Round Comparative Study

Religious rituals are considered among the principle factors that impact dietary behaviors and food selections. The main objective of this study is to characterize food intake among Lebanese adults observant of the fasting month of Ramadan and compare it to their intake of the rest of the year. During a year-round study, including the month of Ramadan, Lebanese adults (n = 62), completed multiple (9 to 13) 24-h dietary recalls. Information about sociodemographic and lifestyle characteristics was also obtained. Dietary intake was examined using food groups as well as energy, macro, and micronutrient consumption. Significant differences in dietary intakes were observed for 12 of the 19 food groups (expressed as a percent of total energy) during Ramadan as compared to the rest of the year. More specifically, the intakes of cereals, cereal-based products, pasta, eggs, nuts and seeds, milk and dairy, and fats and oils were lower, while vegetables, dried fruit, Arabic sweets, cakes and pastries, and sugar-sweetened-beverages intakes were higher during Ramadan as compared to the remainder of the year (p < 0.05). Such differences in food groups' intakes were reflected in nutrients intakes, including carbohydrates, cholesterol, calcium, beta-carotene, vitamin C, folate, and magnesium. The findings of this study highlighted major differences in dietary intakes between the fasting month as compared to the rest of the year. With the large number of adults who observe fasting during Ramadan, the particularities of dietary intake during Ramadan ought to be considered in the development of context and culture-specific dietary recommendations.

Lifestyle factors associated with the transition from healthy to unhealthy adiposity among black South African adults over 10 years

BACKGROUND AND AIMS

Obesity is associated with an increasing prevalence of cardiovascular diseases in Africa, but some obese individuals maintain cardiometabolic health. The aims were to track metabolically healthy overweight or obesity (MHO) over 10 years in African adults and to identify factors associated with a transition to metabolically unhealthy overweight or obesity (MUO).

METHODS AND RESULTS

The participants were the South African cohort of the international Prospective Urban and Rural Epidemiological study. From the baseline data of 1937 adults, 649 women and 274 men were followed for 10 years. The combined overweight and obesity prevalence of men (19.2%-23.8%, p = .02) and women (58%-64.7%, p < .001), and the prevalence of the metabolic syndrome in all participants (25.4%-40.2%, p < .001) increased significantly. More than a quarter (26.2%) of the women and 10.9% of men were MHO at baseline, 11.4% of women and 5.1% of men maintained MHO over 10 years, while similar proportions (12.3% of women, 4.7% of men) transitioned to MUO. Female sex, age, and total fat intake were positively associated with a transition to MUO over 10 years, while physical activity was negatively associated with the transition. HIV positive participants were more likely to be MHO at follow-up than their HIV negative counterparts.

CONCLUSIONS

One in two black adults with BMI ≥25 kg/m² maintained MHO over 10 years, while a similar proportion transitioned into MUO. Interventions should focus on lower fat intakes and higher physical activity to prevent the transition to MUO.

Examining the associations between a posteriori dietary patterns and obesity indexes: Systematic review of observational studies

BACKGROUND

Few reports on the association of population-derived dietary patterns with excess body weight, using the approach of a systematic review currently exist.

AIM

The aim of the present systematic review was to identify dietary patterns associated with body mass index (BMI), body weight (BW)/BMI change, weight status and weight loss maintenance status.

METHODS

Using MEDLINE (via PubMed) and EBSCO Host databases, we systematically reviewed studies from 1980 to 2020, which included men and women, aged ≥18 years. Primary outcome was BMI or the longitudinal change of individuals' BW or BMI, or weight status (normal weight/overweight/obesity) or weight loss maintenance status. We included observational studies, with or without a prospective design. Studies which met the inclusion criteria were evaluated based on the Newcastle-Ottawa Scale; only a posteriori dietary patterns were evaluated.

RESULTS

Twenty-six studies were eligible for inclusion in the current analysis. The results indicate a relationship between adherence to a lacto-vegetarian dietary pattern, characterized by high intake of fruits, vegetables, whole grains, unprocessed cereals, dairy and low intake of high-fat foods and sweets, and longitudinal change of individuals' BW or BMI, or the risk of overweight/obesity.

CONCLUSIONS

Promotion of this healthy dietary pattern, as an alternative to focusing on specific nutrients or foods, may be a promising approach to be included in future long-term weight maintenance interventions.

Dose-Response Relationship between Western Diet and Being Overweight among Teachers in Malaysia

The rising prevalence of overweight and obesity is partly due to nutrition transition. The reported association between dietary patterns and overweight/obesity has been controversial because of inconsistent results and weak observed associations. Although it has been hypothesized that an unhealthy diet can increase obesity risk, none of the previous studies have examined the dose-response association using nonlinear dose-response analyses. This study aimed to examine the dose-response association between major dietary patterns and overweight/obesity. This was a cross-sectional study involving teachers selected through stratified multistage sampling from public schools in three Malaysian states. Dietary intake was assessed using a food frequency questionnaire, and two major dietary patterns (Western and Prudent diet) were extracted using factor analysis. Logistic regression followed by trend analysis was used to test the difference in odds of overweight and obesity in each quintile of diet score. A further analysis using restricted cubic spline models was performed to examine the dose-response associations of dietary patterns with odds of overweight/obesity. The logistic regression analysis showed that participants with the highest quintile of Western diet score were 1.4 times more likely to be overweight/obese compared to those in the lowest quintile (95% CI: 1.11, 1.83, p-trend < 0.001). The odds of overweight/obesity showed a significant increasing trend across quintiles of Western diet among both men and women (p-trend < 0.001). In the dose-response analysis, a positive linear association (P_nonlinearity = 0.6139) was observed where overweight/obesity was more likely to occur among participants with a Western diet score greater than a mean score of zero. There was an inverse trend of odds of overweight/obesity across quintiles of Prudent diet score, significant only for men (p for trend < 0.001). Linear association was found between Prudent diet score and odds of overweight/obesity among both men (P_nonlinearity = 0.6685) and women (P_nonlinearity = 0.3684) in the dose-response analysis. No threshold at the level of adherence to Prudent diet was linked to odds of overweight/obesity. Dose-response analysis indicated that women with a Western diet score greater than zero were more likely to be overweight or obese among women. In men, higher adherence to Western diet was associated with increased odds of overweight/obesity, while greater adherence to Prudent diet decreased the odds of overweight/obesity. Promoting and enhancing the consumption of Prudent diet and limit in Western diet may be used to guide the development of evidence-based diet interventions to curb overweight and obesity.

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.

Lifestyle Habits, Dietary Factors, and the Metabolically Unhealthy Obese Phenotype in Youth

OBJECTIVE

To determine whether lifestyle habits and dietary factors at age 8-10 years predict the development of metabolically unhealthy obesity 2 years later among children who were previously metabolically healthy obese.

STUDY DESIGN

The QUebec Adipose and Lifestyle InvesTigation in Youth cohort comprises 630 youth with a parental history of obesity. Metabolically healthy obesity and metabolically unhealthy obesity were defined using cut-offs for the components of pediatric metabolic syndrome. Dietary factors, physical activity, fitness, sedentary behavior, screen time, and sleep duration were measured. Multivariable logistic regressions were used to examine associations.

RESULTS

At baseline, 48 participants with metabolically healthy obesity were identified; 2 years later, 19 became metabolically unhealthy obese and 29 remained metabolically healthy obese. Every additional daily portion of fruits and vegetables decreased the risk of converting to metabolically unhealthy obesity by 39% (OR 0.61, 95% CI 0.40-0.94). Cumulating more hours of screen time and diets high in saturated fat and sugar-sweetened beverages and low in protein were associated with a tendency to develop metabolically unhealthy obesity.

CONCLUSIONS

Fruit and vegetable intake and possibly screen time, saturated fat, sugar-sweetened beverages, and protein intake may be important targets for the prevention of cardiometabolic complications in obese children.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT03356262.

Environmental footprints of food consumption and dietary patterns among Lebanese adults: a cross-sectional study

Background

Following the release of the Sustainable Development Goals, dietary patterns and guidelines are being revised for their effect on the environment in addition to their health implications. The objective of this study was to evaluate and compare the Environmental Footprints (EFPs) of food consumption patterns among Lebanese adults.

Methods

For this study, data for adults aged > 18 years (n = 337) were drawn from a previous national survey conducted in Lebanon (2008–2009), where dietary intake was assessed using a 61-item Food Frequency Questionnaire. Dietary patterns previously derived in the study sample included: Western, Lebanese-Mediterranean and High-Protein. In this study, food consumption and dietary patterns were examined for their EFPs including water use, energy use, and greenhouse gas (GHG) emissions, using review of life cycle analyses.

Results

In the study population, the EFPs of food consumption were: water use: 2571.62 ± 1259.45 L/day; energy use: 37.34 ± 19.98 MJ/day and GHGs: 4.06 ± 1.93 kg CO2 eq / day. Among the three dietary patterns prevalent in the study population, the Lebanese-Mediterranean diet had the lowest water use and GHG per 1000 Kcal (Water (L/Kg): 443.61 ± 197.15, 243.35 ± 112.0, 264.72 ± 161.67; GHG (KG CO2 eq/day) 0.58 ± 0.32, 0.38 ± 0.24, 0.57 ± 0.37, for the Western, Lebanese-Mediterranean and High- Protein, respectively). The scores of the High-Protein dietary pattern were associated with higher odds of the three EFPs, whereas the Lebanese-Mediterranean dietary pattern was associated with lower odds of energy use. Furthermore, scores of the Western pattern were associated with higher water use.

Conclusions

The findings of this study showed that, among Lebanese adults, the Western and High-Protein dietary patterns had high EFPs, whereas the Lebanese-Mediterranean dietary pattern had lower water use and GHG emissions. Coupled to our earlier findings of the Lebanese-Mediterranean pattern’s beneficial effects on health, the findings of this study lend evidence for the notion that what is healthy for people may also be healthy for ecosystems and highlight the need for nutrition recommendations to take into consideration the nexus of water, food, energy, in addition to health.

Electronic supplementary material

The online version of this article (10.1186/s12937-018-0393-3) contains supplementary material, which is available to authorized users.

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.

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.

Association between HDL Cholesterol Levels and the Consumption of Vitamin A in Metabolically Healthy Obese Lebanese: A Cross-Sectional Study among Adults in Lebanon

OBJECTIVES

Previous studies show the association between vitamin A and elevation of plasma triglyceride concentrations. However, limited information exists on the association between vitamin A and plasma HDL cholesterol concentrations. The aim of this study is to investigate the association between plasma HDL cholesterol levels and vitamin A intake in 57 metabolically healthy obese (MHO) Lebanese.

METHODS

Out of the 112 adult obese participants who had completed anthropometric and biochemical data, 57 (22 males and 35 females) aged 18-62 years old are metabolically healthy and their data are included in this study. A valid semiquantitative food frequency questionnaire (SQFFQ) was used to test vitamin A intake among other antioxidants. The participants were recruited from the database of three dietary clinics across Lebanon.

RESULTS

Pearson's correlation coefficient was used to measure the strength of the relationship between vitamin A and plasma HDL cholesterol levels. There was a significant positive correlation (P value = 0.0225) between vitamin A consumption and HDL cholesterol serum levels in obese participants; when vitamin A levels decrease, HDL levels decrease more in female than in male participants.

CONCLUSION

The association between dietary vitamin A, a powerful antioxidant, and high HDL levels is shown in MHO but should be further exploited in future studies.

A Hypothesis: Moderate Consumption of Alcohol Contributes to Lower Prevalence of Type 2 Diabetes Due to the Scavenging of Alpha-Dicarbonyls by Dietary Polyphenols

The world is experiencing an epidemic of type-2-diabetes mellitus (T2DM). This has led to increased morbidity and mortality, explosive growth in health care budgets, and an even greater adverse, if indirect, impact on societies and economies of affected countries. While genetic susceptibility to T2DM is a major determinant of its prevalence, changes in lifestyles also play a role. One such change has been a transition from traditional diets characterized by low caloric and high nutrient density to calorie-rich but nutrient-poor Western diets. Given this, one solution to the epidemic of T2DM would be to abandon Western diets and revert to traditional eating patterns. However, traditional diets cannot provide enough calories for the increasing global population, so transition from traditional to Western foodstuffs appears to be irreversible. Consequently, the only practical solution to problems caused by these changes is to modify Western diets, possibly by supplementing them with functional foods containing nutrients that would compensate for these dietary deficits. I present in this study a hypothesis to explain why shifts from traditional to Western diets have been so problematic and to suggest nutrients that may counteract these adverse effects. I postulate that the components of traditional diets that may compensate for deficiencies of Westerns diets are scavengers of reactive α-dicarbonyls produced as unavoidable by-products of glucose and lipid metabolism. Most important among these scavengers are some plant secondary metabolites: polyphenols, phlorotannins, and carotenoids. They are found in alcoholic beverages and are abundant in seasonings, cocoa, coffee, tea, whole grains, pigmented vegetables, fruits, and berries.

A minimally processed dietary pattern is associated with lower odds of metabolic syndrome among Lebanese adults

OBJECTIVE

To (i) estimate the consumption of minimally processed, processed and ultra-processed foods in a sample of Lebanese adults; (ii) explore patterns of intakes of these food groups; and (iii) investigate the association of the derived patterns with cardiometabolic risk.

DESIGN

Cross-sectional survey. Data collection included dietary assessment using an FFQ and biochemical, anthropometric and blood pressure measurements. Food items were categorized into twenty-five groups based on the NOVA food classification. The contribution of each food group to total energy intake (TEI) was estimated. Patterns of intakes of these food groups were examined using exploratory factor analysis. Multivariate logistic regression analysis was used to evaluate the associations of derived patterns with cardiometabolic risk factors.

SETTING

Greater Beirut area, Lebanon.

SUBJECTS

Adults ≥18 years (n 302) with no prior history of chronic diseases.

RESULTS

Of TEI, 36·53 and 27·10 % were contributed by ultra-processed and minimally processed foods, respectively. Two dietary patterns were identified: the 'ultra-processed' and the 'minimally processed/processed'. The 'ultra-processed' consisted mainly of fast foods, snacks, meat, nuts, sweets and liquor, while the 'minimally processed/processed' consisted mostly of fruits, vegetables, legumes, breads, cheeses, sugar and fats. Participants in the highest quartile of the 'minimally processed/processed' pattern had significantly lower odds for metabolic syndrome (OR=0·18, 95 % CI 0·04, 0·77), hyperglycaemia (OR=0·25, 95 % CI 0·07, 0·98) and low HDL cholesterol (OR=0·17, 95 % CI 0·05, 0·60).

CONCLUSIONS

The study findings may be used for the development of evidence-based interventions aimed at encouraging the consumption of minimally processed foods.

Household food insecurity is associated with a higher burden of obesity and risk of dietary inadequacies among mothers in Beirut, Lebanon

BACKGROUND

Mixed evidence exists with respect to the association between household food insecurity (HFIS) and obesity in low-to-middle income countries (LMICs), particularly among women. This study aimed to measure socioeconomic correlates of HFIS and explores its association with dietary intake and odds of obesity among mothers in Lebanon, a middle-income country undergoing nutrition transition.

METHODS

A cross-sectional study was conducted among a representative sample of households (n = 378) in Beirut, Lebanon. Surveys were completed with mothers of children <18 years. HFIS was measured using a locally-validated, Arabic-translated Household Food Insecurity Access Scale (HFIAS). Dietary intake was assessed using the multiple pass 24-h recall method. Associations between HFIS (food vs food insecure) and socio-demographic characteristics were reported using crude and adjusted odds ratios. The odds of consuming <2/3rd Dietary Reference Intakes (DRIs) for nutrients among mothers from food secure and food insecure households were explored. In addition, logistic regression analyses were conducted to explore the association of HFIS with obesity (BMI ≥ 30 kg/m2) and at-risk waist circumference (WC ≥ 80 cm) among mothers.

RESULTS

HFIS was found among 50% of study sample and was inversely associated with household income and mother's educational level, even after adjusting for other socioeconomic variables (p < 0.01). Mothers in food insecure households reported consuming significantly less dairy products, fruits, and nuts yet more breads and sweets; and they had higher odds of consuming <2/3rd the DRI's for key micronutrients (potassium, folate, and vitamin C) compared to secure ones. Adjusting for socioeconomic correlates, food insecure mothers had 1.73 odds of obesity (95% CI: 1.02-2.92) compared to food secure mothers.

CONCLUSIONS

High HFIS prevalence was reported among urban Lebanese households. Mothers from food insecure households had a high risk of dietary inadequacy and obesity. Adequate evidence-based public health strategies are needed to reduce the vulnerability of mothers to food insecurity in LMIC settings and alleviate their risk of a high burden of nutrient insecurity and obesity.