title: Metabolically Healthy Obesity Is Not Associated with Food Intake in White or Black Men.
abstract: BACKGROUND
  Healthy obese individuals may be protected against adverse health outcomes. Diet and race might influence healthy obesity, but data on their roles and interactions on the phenotype are limited.
  
  
  OBJECTIVE
  We compared the food intake of metabolically healthy obese men to those of other weight status-metabolic health phenotypes.
  
  
  METHODS
  Men (n = 4855) aged ≥ 45 y with BMI ≥ 18.5 kg/m(2) and free of cardiovascular diseases, diabetes, and cancer were evaluated in a cross-sectional study of the REGARDS (REasons for Geographic And Racial Differences in Stroke) study cohort. Food intake was assessed with the use of a food frequency questionnaire. Weight status-metabolic health phenotypes were defined by using metabolic syndrome (MetS) and homeostasis model assessment of insulin resistance (HOMA-IR) criteria. Mean differences in food intake among weight status-metabolic health phenotypes were compared with the use of linear regression.
  
  
  RESULTS
  MetS-defined healthy obesity was present in 44% of white obese men and 58% of black obese men; the healthy obese phenotype, based on HOMA-IR, was equally prevalent in both white (20%) and black (21%) obese men. Among white men, MetS-defined healthy and unhealthy obesity were associated with lower wholegrain bread intake and higher consumption of red meat (P < 0.001), whereas HOMA-IR-defined healthy and unhealthy obesity were associated with lower red meat intake (P < 0.0001) compared with healthy normal weight in multivariable-adjusted analyses that adjusted for sociodemographic, lifestyle, and clinical confounders. However, results were attenuated and became nonsignificant after further adjustment for BMI. Healthy and unhealthy overweight, defined by both criteria, were associated with lower whole grain bread intake (P < 0.001) in all models. Among black men, weight status-metabolic health phenotypes were not associated with food intake in all models.
  
  
  CONCLUSIONS
  Healthy obesity in men is not associated with a healthier diet. Future studies need to consider dietary patterns, which may better inform the holistic effect of diet on healthy obesity, in prospective analyses.
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 Environmental Sciences, Harvard University Extension School, Boston, MA.
authors.forename: P K
authors.initials: PK
authors.lastname: Newby
mesh_terms: D044383:Black People; D015992:Body Mass Index; D001835:Body Weight; D003430:Cross-Sectional Studies; D003611:Dairy Products; D005247:Feeding Behavior; D006801:Humans; D007333:Insulin Resistance; D008019:Life Style; D016014:Linear Models; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology* / Q000378:metabolism; D008875:Middle Aged; D015596:Nutrition Assessment; D009765:Obesity / Q000453:epidemiology* / Q000378:metabolism; D010641:Phenotype; D015995:Prevalence; D000069466:Red Meat; D017747:Seafood; D011795:Surveys and Questionnaires; D044465:White People; D000067348:Whole Grains
keywords: diet; healthy; metabolic; obesity; phenotype