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Do Lifestyle Choices Affect Metabolic Syndrome?

Researchers assessed dietary and exercise patterns to determine why metabolic syndrome occurs in some obese individuals and not in others.

Obesity is linked to metabolic syndrome, which is a collection of risk factors that increase the likelihood of disorders such as cardiovascular disease and diabetes. Some of these risk factors include high blood pressure and an increased waist circumference. A subgroup of obese individuals, called metabolically healthy obese, doesn’t display symptoms of metabolic disorders but are still at risk for them at a level between healthy individuals and obese individuals. To explore why these differences in metabolism exist, Slatger and colleagues examined the lifestyle choices of obese individuals in Europe.

The Lifeline Study, a prospective cohort study based in the Netherlands, gathered data between 2006 and 2013 on men and women to assess their health behaviours. It is from the data of this study that researchers extracted data on individuals 30-69 years old, with a body mass index (BMI) over 30 kg/m2 to determine which dietary patterns are associated with the metabolically healthy obese and the metabolically unhealthy obese. The results were recently published in Nutrition Journal.

Three classifications of obese were used for the study: Metabolically Healthy Obese (MHO), Metabolically Unhealthy Obese (MUO), and Intermediate Obese. The MHO group comprised of obese individuals with no metabolic syndrome risk factors, with the exception of waist circumference, and no cardiovascular disease. The MUO group comprised of obese individuals with two or more metabolic syndrome risk factors, and the Intermediate Obese group was made up of individuals with at least one metabolic syndrome risk factor.

The researchers administered Food Frequency Questionnaires (FFQ) to collect data on participant food intake and subsequently grouped the recorded foods to generate dietary patterns and quantities of food consumed per day. The completion of the Short Questionnaire to Assess Health-enhancing physical activity (SQUASH) allowed data collection on the frequency, duration, and intensity of exercise, and this information was then used to generate a score for physical activity. The study included 3,442 men, (10.2% MHO and 56% MUO) and 5,828 women (24.4% MHO and 35.3% MUO).

Dietary Patterns and Physical Activity

The researchers formed four dietary patterns  based on responses on the FFQ:

  1. Savoury snacks and sweets,
  2. Meat and alcohol,
  3. Bread, potatoes, and sweet snacks
  4. Fruits, vegetables, and fish

Both men and women who were MHO had higher scores for the savoury snacks and sweets category than their MUO counterparts. MHO women also consumed more fruits, vegetables, and fish but less meat and alcohol, and also less bread, potatoes and sweet snacks. All three groups consumed comparable amounts of energy. Compared to MUO men and women, MHO men and women participated in more moderate-vigorous physical activity.

Smoking, Alcohol Consumption and Education Level

Smoking and alcohol consumption were not common among those classified as MHO. Both men and women in this group drank less than two drinks per day. In terms of education levels, 24.8% of MHO women obtained higher education, whereas only 13.8% of MUO did. This difference was not observed among men.

In women, fruit, vegetables, and fish consumption and moderate physical activity were strongly associated with being metabolically healthy obese, and the consumption of bread, potatoes, and sweets was not. In men, high vigorous physical activity was associated with being metabolically healthy obese.

Overall, healthier dietary choices and exercise were found to be associated with metabolically healthy obese individuals. This study identifies behavioural and lifestyle patterns that may help to identify a subgroup of individuals that may best benefit from lifestyle interventions. This provides insight on possible intervention points for obese individuals to help reduce the occurrence of metabolic syndrome and thus metabolic disorders.

Written by Monica Naatey-Ahumah, BSc


(1) Slagter, S.N., Corpelejin, E., van der Klauw, M.M., Swart-Busscher, L.G., Perenboom, C.W.M, de Vries, J.H.M.,…and Vliet-Ostaptchouk, J.V. (2018). Dietary patterns and physical activity in the metabolically (un)healthy obese: the Dutch Lifelines cohort study. Nutrition Journal,17(18).
(2) Metabolic Syndrome. (n.d.). Retrieved February 21, 2018, from



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