title: Severity of obesity and cardiometabolic risk factors in adults: Sex differences and role of physical activity. The HERMEX study.
abstract: BACKGROUND
  The aims of this study were 1) to examine potential sex-related differences in major cardiometabolic risk factors among severe/morbid obese (body mass index [BMI]≥35) individuals; 2) to assess whether severity of obesity is associated with more adverse cardiometabolic risk factors in women and men, and 3) to assess whether being physically active (≥500 metabolic equivalents [MET-minutes per week]) may play a role in the association between severity of obesity and the cardiometabolic risk profile.
  
  
  METHODS
  A total of 886 (438 men) obese individuals participated in a population-based cross-sectional study. We categorized participants as grade I (BMI 30-34.99) and grade II/III (BMI≥35) obese. We measured markers of lipid and glucose metabolism, inflammation (high sensitivity C-reactive protein [hs-CRP]) blood pressure and renal function, as well as self-reported physical activity.
  
  
  RESULTS
  Triglycerides, insulin, HOMA-IR, systolic blood pressure and creatinine levels were higher in severe/morbid obese men than women (all, P<0.05), while women presented higher HDL cholesterol and hs-CRP (P<0.05) than men. Severe/morbid obesity was associated with higher triglycerides, hs-CRP, insulin and insulin resistance, diastolic blood pressure and higher odds of hypertension than grade I obesity both in women and men (all, P<0.05). Severe/morbid obese individuals who were physically inactive presented the least favorable cardiometabolic profile (P<0.05).
  
  
  CONCLUSIONS
  Severe/morbid obesity is associated with more adverse cardiometabolic risk factors both in women and men. Severe/morbid obese men are more affected than women regarding their cardiometabolic profile, although women presented higher inflammation. Physically inactive individuals with severe/morbid obesity had the most adverse clustered cardiometabolic risk profile.
authors.affiliation: Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain; Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain. Electronic address: asoriano@ual.es.
authors.forename: Alberto
authors.initials: A
authors.lastname: Soriano-Maldonado
authors.affiliation: Department of Physiology and Institute of Nutrition and Food Technology, Faculty of Pharmacy, University of Granada, Granada, Spain; Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Virginia A
authors.initials: VA
authors.lastname: Aparicio
authors.affiliation: Centro de Salud Villanueva Norte, Servicio Extremeño de Salud, Villanueva de la Serena, Badajoz, Spain; Hospital Don Benito Villanueva, Unidad de Investigación, Programa de Enfermedades Cardiovasculares (PERICLES), Grupo Investigación Multidisciplinar Extremeño (GRIMEX), Villanueva de la Serena, Badajoz, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Félix-Redondo
authors.affiliation: Hospital Don Benito Villanueva, Unidad de Investigación, Programa de Enfermedades Cardiovasculares (PERICLES), Grupo Investigación Multidisciplinar Extremeño (GRIMEX), Villanueva de la Serena, Badajoz, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Fernández-Bergés
mesh_terms: D000328:Adult; D000368:Aged; D055109:Ankle Brachial Index; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D003430:Cross-Sectional Studies; D015444:Exercise / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology; D018608:Ultrasonography, Doppler
keywords: Cardiovascular disease; Exercise; Inflammation; Lipid profile; Morbid obesity; Physical activity