title: Physical Activity and Sedentary Behavior in Metabolically Healthy versus Unhealthy Obese and Non-Obese Individuals - The Maastricht Study.
abstract: Both obesity and the metabolic syndrome are associated with increased risk of cardiovascular diseases and type 2 diabetes. Although both frequently occur together in the same individual, obesity and the metabolic syndrome can also develop independently from each other. The (patho)physiology of "metabolically healthy obese" (i.e. obese without metabolic syndrome) and "metabolically unhealthy non-obese" phenotypes (i.e. non-obese with metabolic syndrome) is not fully understood, but physical activity and sedentary behavior may play a role.
  
  
  
  To examine objectively measured physical activity and sedentary behavior across four groups: I) "metabolically healthy obese" (MHO); II) "metabolically unhealthy obese" (MUO); III)"metabolically healthy non-obese" (MHNO); and IV) "metabolically unhealthy non-obese" (MUNO).
  
  
  
  Data were available from 2,449 men and women aged 40-75 years who participated in The Maastricht Study from 2010 to 2013. Participants were classified into the four groups according to obesity (BMI≥30kg/m2) and metabolic syndrome (ATPIII definition). Daily activity was measured for 7 days with the activPAL physical activity monitor and classified as time spent sitting, standing, and stepping.
  
  
  
  In our study population, 562 individuals were obese. 19.4% of the obese individuals and 72.7% of the non-obese individuals was metabolically healthy. After adjustments for age, sex, educational level, smoking, alcohol use, waking time, T2DM, history of CVD and mobility limitation, MHO (n = 107) spent, per day, more time stepping (118.2 versus 105.2 min; p<0.01) and less time sedentary (563.5 versus 593.0 min., p = 0.02) than MUO (n = 440). In parallel, MHNO (n = 1384) spent more time stepping (125.0 versus 115.4 min; p<0.01) and less time sedentary (553.3 versus 576.6 min., p<0.01) than MUNO (n = 518).
  
  
  
  Overall, the metabolically healthy groups were less sedentary and more physically active than the metabolically unhealthy groups. Therefore, physical activity and sedentary time may partly explain the presence of the metabolic syndrome in obese as well as non-obese individuals.
authors.affiliation: Department of Social medicine, Maastricht University, Maastricht, the Netherlands.|CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
authors.forename: Belle H
authors.identifier: 0000-0002-0172-0857
authors.initials: BH
authors.lastname: de Rooij
authors.affiliation: Department of Social medicine, Maastricht University, Maastricht, the Netherlands.|CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
authors.forename: Julianne D
authors.initials: JD
authors.lastname: van der Berg
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands.|Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: Carla J H
authors.initials: CJ
authors.lastname: van der Kallen
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands.|Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: Miranda T
authors.initials: MT
authors.lastname: Schram
authors.affiliation: Department of Human Movement Sciences, Maastricht University, Maastricht, the Netherlands.|School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands.
authors.forename: Hans H C M
authors.initials: HH
authors.lastname: Savelberg
authors.affiliation: CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.|Department of Internal Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands.|Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: Nicolaas C
authors.initials: NC
authors.lastname: Schaper
authors.affiliation: CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.|Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands.|Department of Epidemiology, Maastricht University, Maastricht, the Netherlands.
authors.forename: Pieter C
authors.initials: PC
authors.lastname: Dagnelie
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands.|Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: Ronald M A
authors.initials: RM
authors.lastname: Henry
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands.|Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: Abraham A
authors.initials: AA
authors.lastname: Kroon
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands.|Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: Coen D A
authors.initials: CD
authors.lastname: Stehouwer
authors.affiliation: Department of Social medicine, Maastricht University, Maastricht, the Netherlands.|CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Koster
mesh_terms: D000328:Adult; D000368:Aged; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000453:epidemiology / Q000378:metabolism* / Q000503:physiopathology; D057185:Sedentary Behavior