title: Food intake does not differ between obese women who are metabolically healthy or abnormal.
abstract: BACKGROUND
  Metabolically healthy obesity may confer lower risk of adverse health outcomes compared with abnormal obesity. Diet and race are postulated to influence the phenotype, but their roles and their interrelations on healthy obesity are unclear.
  
  
  OBJECTIVE
  We evaluated food intakes of metabolically healthy obese women in comparison to intakes of their metabolically healthy normal-weight and metabolically abnormal obese counterparts.
  
  
  METHODS
  This was a cross-sectional study in 6964 women of the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Participants were aged 45-98 y with a body mass index (BMI; kg/m(2)) ≥18.5 and free of cardiovascular diseases, diabetes, and cancer. Food intake was collected by using a food-frequency questionnaire. BMI phenotypes were defined by using metabolic syndrome (MetS) and homeostasis model assessment of insulin resistance (HOMA-IR) criteria. Mean differences in food intakes among BMI phenotypes were compared by using ANCOVA.
  
  
  RESULTS
  Approximately one-half of obese women (white: 45%; black: 55%) as defined by MetS criteria and approximately one-quarter of obese women (white: 28%; black: 24%) defined on the basis of HOMA-IR values were metabolically healthy. In age-adjusted analyses, healthy obesity and normal weight as defined by both criteria were associated with lower intakes of sugar-sweetened beverages compared with abnormal obesity among both white and black women (P < 0.05). HOMA-IR-defined healthy obesity and normal weight were also associated with higher fruit and low-fat dairy intakes compared with abnormal obesity in white women (P < 0.05). Results were attenuated and became nonsignificant in multivariable-adjusted models that additionally adjusted for BMI, marital status, residential region, education, annual income, alcohol intake, multivitamin use, cigarette smoking status, physical activity, television viewing, high-sensitivity C-reactive protein, menopausal status, hormone therapy, and food intakes.
  
  
  CONCLUSIONS
  Healthy obesity was not associated with a healthier diet. Prospective studies on relations of dietary patterns, which may be a better indicator of usual diet, with the phenotype would be beneficial.
authors.affiliation: Department of Nutrition, School of Nursing and Health Sciences, Simmons College, Boston, MA; ruth.kimokoti@simmons.edu.
authors.forename: Ruth W
authors.initials: RW
authors.lastname: Kimokoti
authors.affiliation: Department of Biostatistics, School of Public Health, and.
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Judd
authors.affiliation: Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL;
authors.forename: James M
authors.initials: JM
authors.lastname: Shikany
authors.affiliation: Program in Gastronomy, Culinary Arts, and Wine Studies at Boston University, Boston, MA; and Program in Environmental Sciences at Harvard University Extension School, Boston, MA.
authors.forename: P K
authors.initials: PK
authors.lastname: Newby
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004435:Eating; D005247:Feeding Behavior; D005260:Female; D006706:Homeostasis; D006801:Humans; D007333:Insulin Resistance; D024821:Metabolic Syndrome / Q000150:complications / Q000378:metabolism*; D008875:Middle Aged; D015596:Nutrition Assessment; D009765:Obesity / Q000150:complications / Q000378:metabolism*; D011795:Surveys and Questionnaires
keywords: diet; healthy; metabolic; obesity; phenotype