title: Variable patterns of obesity and cardiometabolic phenotypes and their association with lifestyle factors in the Di@bet.es study.
abstract: OBJECTIVE
  Prevalence rates of "metabolically healthy obese" (MHO) subjects vary depending on the criteria used. This study examined the prevalence and characteristics of MHO subjects and metabolically abnormal normal-weight subjects and compared the findings with the NHANES 1999-2004 study. The aims of the present study were, first, to determine the prevalence rates of MHO and MNHNO subjects using the same criteria as those of the National Health and Nutrition Examination Survey (NHANES) (1999-2004) study, and second to compare the prevalence and correlates of obese subjects who are resistant to the development of adiposity-associated cardiometabolic abnormalities (CA) and normal-weight individuals who display cardiometabolic risk factor clustering between the Spanish and the US populations.
  
  
  RESULTS
  Di@bet.es study is a national, cross-sectional population-based survey of 5728 adults conducted in 2009-2010. Clinical, metabolic, sociodemographic, and anthropometric data and information about lifestyle habits, such as physical activity, smoking habit, alcohol intake and food consumption, were collected. Subjects were classified according to their body mass index (BMI) (normal-weight, <25 kg/m(2); overweight, 25-29.9 kg/m(2); and obese, >30 kg/m(2)). CA included elevated blood pressure; elevated levels of triglycerides, fasting glucose, and high-sensitivity C-reactive protein (hs-CRP); and elevated homeostasis model assessment of insulin resistance (HOMA-IR) value and low high-density lipoprotein cholesterol (HDL-c) level. Two phenotypes were defined: metabolically healthy phenotype (0-1 CA) and metabolically abnormal phenotype (≥2 CA). The prevalence of metabolically abnormal normal-weight phenotype was slightly lower in the Spanish population (6.5% vs. 8.1%). The prevalence of metabolically healthy overweight and MHO subjects was 20.9% and 7.0%, respectively, while in NHANES study it was 17.9% and 9.7%, respectively. Cigarette smoking was associated with CA in each phenotype, while moderate physical activity and moderate alcohol intake were associated with being metabolically healthy. Olive oil intake was negatively associated with the prevalence of CA.
  
  
  CONCLUSIONS
  Smoking, physical activity level, and alcohol intake contribute to the explanation of the prevalence of CA in the Spanish population, as in the US population. However in Spain, olive oil intake contributes significantly to the explanation of the variance in the prevalence of CA.
authors.affiliation: Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Spain; UGCI de Endocrinología y Nutrición, Hospital Regional Universitario, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain. Electronic address: gutierrezrepiso@gmail.com.
authors.forename: Carolina
authors.initials: C
authors.lastname: Gutiérrez-Repiso
authors.affiliation: Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Spain; UGCI de Endocrinología y Nutrición, Hospital Regional Universitario, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.
authors.forename: Federico
authors.initials: F
authors.lastname: Soriguer
authors.affiliation: Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Spain; UGCI de Endocrinología y Nutrición, Hospital Regional Universitario, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Rojo-Martínez
authors.affiliation: Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Spain; UGCI de Endocrinología y Nutrición, Hospital Regional Universitario, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: García-Fuentes
authors.affiliation: Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Spain; UGCI de Endocrinología y Nutrición, Hospital Regional Universitario, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Valdés
authors.affiliation: Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Goday
authors.affiliation: Department of Endocrinology and Nutrition, Hospital Universitario S. Carlos de Madrid, Madrid, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Calle-Pascual
authors.affiliation: Spanish Diabetes Society, Madrid, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: López-Alba
authors.affiliation: Public Health Division, Department of Health, Autonomous Government of Catalonia, Barcelona, Spain.
authors.forename: Conxa
authors.initials: C
authors.lastname: Castell
authors.affiliation: Department of Endocrinology and Nutrition, Hospital Central de Asturias, Oviedo, Spain.
authors.forename: Edelmiro
authors.initials: E
authors.lastname: Menéndez
authors.affiliation: Laboratorio de Endocrinología, Hospital Universitario San Carlos de Madrid, Madrid, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Bordiú
authors.affiliation: Department of Endocrinology and Nutrition, Hospital Central de Asturias, Oviedo, Spain.
authors.forename: Elías
authors.initials: E
authors.lastname: Delgado
authors.affiliation: Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Spain; Endocrinology and Diabetes Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, (IDIBAPS), Universitat de Barcelona (UB), Barcelona, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Ortega
authors.affiliation: Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Pascual-Manich
authors.affiliation: Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Spain; Diabetes Research Group, Hospital Universitario de Cruces, UPV-EHU, Baracaldo, Spain.
authors.forename: Inés
authors.initials: I
authors.lastname: Urrutia
authors.affiliation: Emergency Service, Hospital Nuestra Señora de los Reyes, Valverde, Tenerife, Spain.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Mora-Peces
authors.affiliation: Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Spain; Department of Endocrinology and Nutrition, Hospital Universitario Joan XXIII, Institut d'Investigacions Sanitaries Pere Virgili, Tarragona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Vendrell
authors.affiliation: Diabetes National Plan, Ministry of Health, Madrid, Spain.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Vázquez
authors.affiliation: EAP Raval Sud, Institut Català de la Salut, Red GEDAPS, Primary Care, Unitat de Suport a la Recerca (IDIAP - Fundació Jordi Gol), Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Franch
authors.affiliation: Diabetes Unit, Hospital Arnau de Vilanova, Valencia, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Girbés
authors.affiliation: Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Spain; Diabetes Research Group, Hospital Universitario de Cruces, UPV-EHU, Baracaldo, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Castaño
authors.affiliation: Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Spain; Lipids and Diabetes Laboratory, Instituto de Investigación Sanitaria del Hospital Clínico S. Carlos (IdISSC), Madrid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Serrano-Ríos
authors.affiliation: Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Spain; Lipids and Diabetes Laboratory, Instituto de Investigación Sanitaria del Hospital Clínico S. Carlos (IdISSC), Madrid, Spain.
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Martínez-Larrad
authors.affiliation: Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Spain; Department of Medicine and Endocrinology, Hospital Clínico Universitario de Valencia, Valencia, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Catalá
authors.affiliation: Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Spain; Department of Medicine and Endocrinology, Hospital Clínico Universitario de Valencia, Valencia, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Carmena
authors.affiliation: Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Spain; Endocrinology and Diabetes Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, (IDIBAPS), Universitat de Barcelona (UB), Barcelona, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Gomis
authors.affiliation: Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Spain; Biomedic Diagnostic Centre University Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: Roser
authors.initials: R
authors.lastname: Casamitjana
authors.affiliation: Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Spain; Diabetes Research Group, Hospital Universitario de Cruces, UPV-EHU, Baracaldo, Spain.
authors.forename: Sonia
authors.initials: S
authors.lastname: Gaztambide
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose; D015992:Body Mass Index; D001835:Body Weight; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003430:Cross-Sectional Studies; D004032:Diet; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D008019:Life Style; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology*; D008875:Middle Aged; D009043:Motor Activity; D009749:Nutrition Surveys; D009752:Nutritional Status; D009765:Obesity / Q000453:epidemiology*; D010641:Phenotype; D015995:Prevalence; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D014280:Triglycerides / Q000097:blood; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D007328:Insulin; D014280:Triglycerides; D002097:C-Reactive Protein
keywords: Metabolic risk factors; Metabolically abnormal normal-weight; Metabolically healthy obese; Prevalence rate; Spain