Characteristics of diet patterns in metabolically obese, normal weight adults (Korean National Health and Nutrition Examination Survey III, 2005)

doi:10.1016/j.numecd.2010.09.001

Nutrition, Metabolism and Cardiovascular Diseases

Volume 22, Issue 7, July 2012, Pages 567-574

https://doi.org/10.1016/j.numecd.2010.09.001 Get rights and content

Abstract

Background and aims

Metabolically obese normal weight (MONW) subjects are a subgroup of individuals who have a normal weight and body mass index (BMI), but exhibit obesity-related abnormalities. The objective of this study was to analyze the prevalence of metabolic syndrome (MetS) and characteristics of diet patterns in MONW Koreans.

Methods and results

We analyzed the data of 3050 adults > 20 years of age with a normal BMI (18.5∼24.9 kg/m²) obtained from the Korea National Health and Nutrition Examination Survey III. Anthropometric measurements and information on health behaviors were obtained. The diagnostic criteria for MetS were defined by the International Diabetes Federation consensus. Dietary intake was assessed by the 24-h recall method. The weighted prevalence of MONW was 14.3%. The risk of MONW correlated inversely with the frequency of snacking and positively with the type of snack, particularly those with high carbohydrates.

A high carbohydrate diet (≥73.9% of energy intake) compared to a low carbohydrate diet (<59.9% of energy intake) was positively associated with the risk of MONW (OR = 2.54; 95% CI: 1.41, 4.56), whereas a high protein diet (≥17.1% of energy intake) compared to a low protein diet (<12.2% of energy intake) reduced the risk of MONW (OR = 0.60; 95% CI: 0.39, 0.92) in females, but not in males.

Conclusions

This study suggests that a reduced intake of carbohydrates and carbohydrate snacks were associated with a lower prevalence of MONW in females.

Introduction

In recent years, obesity epidemics have emerged, even in Asian countries, and obesity-related diseases have become of paramount concern [1], [2]. Metabolic syndrome (MetS), which is characterized by a cluster of risk factors for cardiovascular disease (CVD), is one of the most important obesity-related phenotypes [3]. The concept of metabolically obese, normal weight (MONW) individuals was developed in the 1970s [4]. MONW individuals have the characteristics of insulin resistance as well as hypertension and hypertriglycemia despite having a normal body mass index (BMI <25 kg/m²) [5] Accumulating evidence has suggested that MONW individuals have a higher proportion of visceral fat and lower lean body mass. Dvorak et al. [6] reported that MONW women had a similar proportion of fat-free mass, but had a higher proportion of total fat mass and body fat percentage compared to metabolically healthy, normal weight (MHNW) women. Low physical activity (PA), which results in a positive energy balance and increases total fat mass, has been reported as a characteristic of MONW individuals [7].

Dietary intake and PA play a critical role in initiating and perpetuating the progression of insulin resistance and MONW. MONW subjects may have unique dietary intake characteristics with respect to macronutrient composition and patterns of eating behaviors. A high carbohydrate diet raises fasting triglycerides (TG) and decreases high density lipoprotein–cholesterol (HDL-C), which increases the risk of CVD [8], [9]. Dietary carbohydrate also increases blood glucose levels during the postprandial period [10].

On the other hand, a high protein diet, which increases the feeling of satiety and thermogenesis, appears to be beneficial for the management of MetS [11], [12], [13]. In addition, a high protein intake has been reported to prevent the loss of lean body mass and enhances insulin sensitivity [14], [15]. Saturated fat has also been documented to deteriorate insulin sensitivity in the insulin resistant state [10].

Therefore, we investigated the prevalence of MONW and the characteristics of diet patterns in MONW individuals, in terms of the composition of macronutrients in a representative sample of Korean adults.

Section snippets

Study population

The Korea National Health and Nutrition Examination Survey III (KNHANES III) was conducted in 2005 by the Korea Ministry for Health, Welfare and Family Affairs. The KNHANES III had a multistage stratified clustered probability sampling design. For the Health Interview Survey, 600 units were randomly sampled from the 246,000 primary sampling units. In 200 of the 600 units, the Behavior, Nutrition and Health Examination Survey were administered.

Of a total of 34,145 subjects who participated in

Results

The characteristics of the study participants are presented in Table 1. The weighted prevalence of MONW individuals was 14.3%. The MONW individuals were significantly older, and had a higher BMI and waist circumference, but a lower total income, level of education, and exercise than MHNW subjects.

The association of the prevalence of MONW with characteristics of dietary patterns is shown in Table 2. The proportionate energy intake from protein was associated with a reduced risk of MONW

Discussion

In the present study, a high carbohydrate diet (≥59.9% of energy intake) compared with a low carbohydrate diet (<59.9% of energy intake) was positively associated with the risk of MONW in females. We also found that the risk of MONW correlated inversely with the frequency of snacking and positively with the type of snack, particularly those with high carbohydrates.

We applied the International Diabetes Federation consensus worldwide definition of MetS (2005), with ethnic-specific criteria for

Conflict of interest

None declared.

Acknowledgement

JC, MP designed the overall study, provided the definition of the variables, and were responsible for overseeing the data collection; MP, JC and SYO, DL, MH designed the study for this manuscript; and JC, ST were responsible for data analyses; JC,SYO and MP wrote the manuscript draft; and JC, DL, MH, SYO, BC and SP provided critical reviews.

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Citation Excerpt :
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Characteristics of diet patterns in metabolically obese, normal weight adults (Korean National Health and Nutrition Examination Survey III, 2005)

Abstract

Background and aims

Methods and results

Conclusions

Introduction

Section snippets

Study population

Results

Discussion

Conflict of interest

Acknowledgement

Lancet

Lancet

Am J Clin Nutr

Am J Clin Nutr

Metabolism

Am J Clin Nutr

Am J Clin Nutr

Regul Pept

Am J Clin Nutr

Metabolism

C-reactive protein, insulin resistance, central obesity, and coronary heart disease risk in Indian Asians from the United Kingdom compared with European whites

Circulation

Clinical guidelines on the identification, evaluation, and treatment of overweight and obese adults; executive summary. Expert panel on the identification, evaluation, and treatment of overweight in adults

Am J Clin Nutr

Phenotypic characteristics associated with insulin resistance in metabolically obese but normal weight young women

Diabetes

Effects of weight loss vs aerobic exercise training on risk factors for coronary disease in healthy, obese, middle-aged and older men. A randomized controlled trial

JAMA

Relation of high-density lipoprotein cholesterol and TG to incidence of atherosclerotic coronary artery disease (the PROCAM experience)

Am J Cardiol

Joint effects of serum triglyceride and LDL cholesterol and HDL cholesterol concentrations on coronary heart disease risk in the Helsinki heart study: implications for treatment

Circulation

Dietary treatment of the metabolic syndrome–the optimal diet

Br J Nutr

The Effects of high protein diets on thermogenesis, satiety and weight loss: a critical review

J Am Coll Nutr

How are normal, high- or low-protein diets defined?

Br J Nutr

High protein vs high carbohydrate hypoenergetic diet for the treatment of obese hyperinsulinemic subjects

Int J Obes Relat Metab Disord

The IDF consensus worldwide definition of the metabolic syndrome