kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2017.17.3.137 kjhp-17-137 Original Article Health Behavior and Nutrient Intake in Metabolically Abnormal Overweight and Metabolically Abnormal Obesity PaeSang-Joon 1 LimHyoung-Ji 2 KimJoo-Yeon 2 KangHee-Taik 2 LeeJae-woo 2 Health Promotion Center, National Health Insurance Service Ilsan Hospital, Goyang, Korea Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea Corresponding author : Jae-woo Lee, MD Department of Family Medicine, College of Medicine, Chungbuk National University, 1 Chungdae-ro, Seowon-gu, Cheongju 28644, Korea Tel: +82-43-269-6301, Fax: +82-43-269-6675 E-mail: shrimp0611@gmail.com 012017 19012017 173137 144 24102016 31082017 Copyright © 2017 The Korean Society of Health Promotion and Disease Prevention 2017 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background:

The purpose of this study was to investigate the differences in health behaviors and dietary habits between the metabolically healthy group and the metabolically abnormal group in overweight and obese subjects based on the data of National Health and Nutrition Survey (NHANES).

 Methods:

Using the NHANES data (2007-2010), a total of 18,188 subjects were grouped into the metabolically healthy group and the abnormal group using the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) definition. Then we compared their health behaviors, dietary behaviors and nutrient intakes after adjustment for variables in overweight and obese groups.

 Results:

The proportion of metabolic abnormalities tended to increase with increasing age in both overweight and obesity groups.(P for trend <0.001) After adjusting various confounding variables, the odds ratio (95% confidence interval) of skipping any meal and breakfast for metabolically abnormality were 1.318 (1.066-1.631) and 1.354 (1.076-1.705) in male obese group and those of skipping breakfast and carbonated drink intake were 1.578 (1.168-2.133) and 1.540 (1.188-2.492) in female obese group. Daily potassium intake (P=0.032) and daily vitamin C intake (P=0.048) in the male overweight group and daily water intake (P=0.046) and daily carbohydrate intake (P=0.038) in the female overweight group were associated with metabolically abnormality.

 Conclusions:

There were differences in health behaviors and nutrient intake according to metabolically abnormality in overweight and obese groups.

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(A) Prevalence of MAOW or MAO according to age groups in men. (B) Prevalence of MAOW or MAO according to age groups in women.

Baseline characteristics of the study subjects

  Total (unweighted n=18,188) Men (unweighted n=7,351) Women (unweighted n=10,837) Pa
Age, y 43.71 (0.21) 42.91 (0.26) 44.52 (0.22) <0.0001
Monthly household income, housand won 3,457 (103.30) 3,520 (118.20) 3,393 (102.74) 0.183
Education duration, %       <0.0001
<6, y 17.67 (0.48) 11.77 (0.48) 23.68 (0.61)  
6-8, y 10.23 (0.30) 10.23 (0.42) 10.23 (0.36)  
9-11, y 40.02 (0.58) 42.07 (0.80) 37.93 (0.65)  
≥12, y 32.09 (0.66) 35.94 (0.84) 28.16 (0.67)  
Daily calorie intake, kcal/day 2,004.26 (10.12) 2,352.58 (14.59) 1,649.01 (8.92) <0.0001
Sleep duration, hours 7.54 (0.30) 7.46 (0.25) 7.62 (0.35) <0.0001
Waist circumference, mean, cm 81.10 (0.12) 84.18 (0.15) 77.96 (0.16) <0.0001
BMI, kg/m2 23.64 (0.03) 24.11 (0.05) 23.17 (0.05) <0.0001
SBP, mmHg 116.90 (0.22) 119.95 (0.26) 113.89 (0.25) <0.0001
DBP, mmHg 76.82 (0.15) 79.85 (0.19) 73.73 (0.16) <0.0001
Glucose, mg/dL 96.29 (0.22) 97.90 (0.32) 94.65 (0.25) <0.0001
Total cholesterol, mg/dL 186.81 (0.38) 187.08 (0.55) 186.53 (0.45) 0.377
HDL cholesterol, mg/dL 52.97 (0.23) 49.93 (0.34) 56.10 (0.27) <0.0001
TG, mg/dL 133.55 (1.04) 156.27 (1.79) 110.38 (0.94) <0.0001
Current smoker, % 41.47 (0.46) 71.03 (0.65) 11.33 (0.46) <0.0001
Heavy drinker, % 17.88 (0.44) 25.92 (0.66) 7.26 (0.42) <0.0001
Low physical activity, % 44.51 (0.53) 42.04 (0.74) 47.03 (0.65) <0.0001
HTN medication, % 12.35 (0.31) 11.52 (0.42) 13.19 (0.41) 0.003
Dyslipidemia medication, % 2.83 (0.14) 2.36 (0.19) 3.32 (0.20) 0.001
DM medication, % 4.54 (0.17) 4.73 (0.26) 4.33 (0.23) 0.250
MetS, % 24.31 (0.44) 29.84 (0.67) 18.68 (0.46) <0.0001

Abbreviations: BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blodd pressure; HDL, high density lipoprotein; TG, triglyceride; HTN, hypertension; DM, diabetes mellitus; MetS, metabolic syndrome. Values are expressed as means (standard deviation) or % (standard deviation).

P value from a t-test for continuous outcomes and χ

test for binary outcomes comparing a difference.

Odds ratio for metabolically abnormality of each behavior in male overweight or obesity

  Overweight (23≤ BMI <25, kg/m2) Obesity (BMI ≥ 25, kg/m2)
  Model 1 Model 2 Model 1 Model 2
Short sleep duration (<5 h) 0.744 (0.494-1.120) 0.778 (0.509-1.187) 0.996 (0.692-1.434) 0.999 (0.688-1.450)
Skip any meal (0-2 day) 1.084 (0.782-1.504) 1.087 (0.775-1.524) 1.322 (1.070-1.634) 1.318 (1.066-1.631)
Skip breakfast (0-2 day) 1.165 (0.814-1.668) 1.163 (0.807-1.676) 1.347 (1.071-1.694) 1.354 (1.076-1.705)
Skip lunch (0-2 day) 0.627 (0.347-1.133) 0.614 (0.336-1.123) 1.049 (0.721-1.525) 1.025 (0.703-1.496)
Skip dinner (0-2 day) 1.089 (0.573-2.072) 1.113 (0.574-2.156) 0.985 (0.643-1.509) 0.938 (0.610-1.441)
Eating out (≥1 times/week) High frequency of eating out (≥1 times/day) 0.970 (0.695-1.354) 1.151 (0.863-1.536) 0.938 (0.662-1.329) 1.135 (0.845-1.525) 0.860 (0.641-1.153) 1.012 (0.824-1.242) 0.852 (0.626-1.161) 1.001 (0.812-1.234)
High frequency of ramen intake (≥2 times /week) 1.137 (0.805-1.605) 1.168 (0.826-1.652) 0.922 (0.722-1.178) 0.906 (0.704-1.166)
High frequency of processed meat intake (≥2 times /week) 0.820 (0.461-1.458) 0.853 (0.480-1.516) 1.151 (0.797-1.663) 1.140 (0.791-1.641)
High frequency of carbonated drink intake (≥2 times /week) 1.079 (0.703-1.656) 1.079 (0.702-1.658) 1.140 (0.880-1.477) 1.147 (0.880-1.494)
Current smoker 1.579 (1.025-2.432) 1.575 (1.015-2.444) 1.529 (1.167-2.004) 1.557 (1.183-2.049)
Heavy drinker 1.646 (1.223-2.217) 1.708 (1.256-2.323) 1.566 (1.250-1.962) 1.557 (1.241-1.952)
Low physical activity 1.263 (0.959-1.663) 1.294 (0.979-1.712) 1.312 (1.074-1.602) 1.356 (1.107-1.660)

Abbreviation: BMI, body mass index. Odds ratios and 95% confidence intervals were calculated using weighted multivariate logistic regression analyses, compared with metabolically healthy groups. Model 1: adjusted for age, Model 2: adjusted for age, daily calorie intake, monthly household income, education level, hypertension, dyslipidemia and diabetes.

Odds ratio for metabolically abnormality of each behavior in female overweight or obesity

  Overweight (23≤ BMI <25, kg/m2) Obesity (BM I ≥ 25, kg/m2)
  Model 1 Model 2 Model 1 Model 2
Short sleep duration (<5 h) 1.386 (0.500-3.840) 1.685 (0.663-4.285) 1.145 (0.712-1.842) 1.047 (0.637-1.719)
Skip any meal (0-2 day) 1.079 (0.723-1.611) 1.049 (0.692-1.591) 1.195 (0.942-1.516) 1.249 (0.969-1.611)
Skip breakfast (0-2 day) 0.898 (0.555-1.452) 0.753 (0.446-1.270) 1.514 (1.124-2.039) 1.578 (1.168-2.133)
Skip lunch (0-2 day) 1.268 (0.676-2.379) 1.538 (0.838-2.823) 0.843 (0.559-1.270) 0.878 (0.573-1.344)
Skip dinner (0-2 day) 1.004 (0.577-1.748) 0.980 (0.558-1.722) 1.002 (0.671-1.497) 0.996 (0.662-1.500)
Eating out (≥1 times/week) 0.902 (0.624-1.304) 1.064 (0.719-1.574) 0.729 (0.580-0.916) 0.762 (0.601-0.964)
High frequency of eating out (≥1 times/day) 1.590 (0.849-2.979) 1.408 (0.748-2.649) 1.013 (0.673-1.525) 1.007 (0.663-1.530)
High frequency of ramen intake (≥2 times /week) 1.617 (0.806-3.243) 1.732 (0.869-3.451) 1.243 (0.859-1.798) 1.259 (0.869-1.823)
High frequency of proced meat intake (≥2 times /week) 0.144 (0.020-1.022) 0.168 (0.024-1.175) 1.092 (0.654-1.823) 1.040 (0.618-1.751)
High frequency of carbonated drink intake (≥2 times /week) 0.295 (0.097-0.901) 0.292 (0.096-0.891) 1.603 (1.061-2.422) 1.540 (1.029-2.305)
Current smoker 1.703 (1.003-2.891) 1.412 (0.823-2.423) 1.916 (1.336-2.748) 1.721 (1.188-2.492)
Heavy drinker 1.951 (0.972-3.914) 1.618 (0.775-3.380) 1.507 (0.961-2.361) 1.392 (0.899-2.154)
Low physical activity 1.102 (0.762-1.595) 1.080 (0.741-1.573) 1.059 (0.827-1.356) 1.048 (0.812-1.352)

Abbreviation: BMI, body mass index. Odds ratios and 95% confidence intervals were calculated using weighted multivariate logistic regression analyses, compared with metabolically healthy groups. Model 1: adjusted for age, Model 2: adjusted for age, daily calorie intake, household income, education level, hypertension, dyslipidemia and diabetes.

Difference of nutrient intake amount between metabolically health group and metabolically abnormal group in overweight or obesity

    Men     Women  
  Overweight Obesity Overweight Obesity
  (23≤ BMI <25, kg/m2) (BMI ≥ 25, kg/m2) (23≤ BMI <25, kg/m2) (BMI ≥ 25, kg/m2)
Daily intake Unadjusted Adjust Unadjusted Adjust Unadjusted Adjust Unadjusted Adjust
Water, g -109.20 (42.13)b b -50.27 (35.23) -50.39 (39.65) -16.66 (25.87) -205.50 (29.85)c -52.166 (26.03)a -65.86 (25.22)b -14.30 (19.79)
Protein, g -4.08 (2.22) 1.55 (1.53) -4.59 (2.31)a -1.04 (0.81) -8.32 (1.59)c 0.03 (0.93) -2.60 (1.30)a -0.32 (0.76)
Fat, g -5.91 (1.88)a 1.64 (1.34) -4.98 (1.92)a -1.20 (1.14) -8.36 (1.43)c 1.89 (1.13) -3.74 (1.12)b -0.04 (0.79)
Carbohydrate, g -3.94 (7.03) -4.94 (5.37) -3.21 (5.72) -5.08 (4.07) -10.58 (6.20) -7.05 (3.39)a 3.73 (4.96) -3.92 (2.76)
Calcium, mg -38.45 (19.73) -36.19 (19.23) -10.39 (17.90) -11.09 (15.10) -51.82 (19.05)b -4.42 (19.58) 2.10 (16.51) -0.99 (12.81)
Phosphorous, mg g -53.70 (29.24) -23.08 (19.82) -40.59 (29.92) -29.21 (17.48) -112.10 (25.31)c -23.96 (15.38) -28.30 (19.67) -13.04 (10.97)
Iron, mg 0.26 (0.63) 0.29 (0.65) 0.12 (0.61) -0.04 (0.54) 0.30 (0.92) 0.41 (0.93) -0.27 (0.41) -0.66 (0.38)
Sodium, mg -145.54 (185.79) -21.80 (175.48) -101.01 (171.31) -62.81 (143.30) -463.20 (174.20) a 9.83 (172.42) -139.53 (116.75) -13.14 (99.87)
Potassium, mg -191.98 (82.73)a -154.39 (71.90)a -68.92 (76.67) -82.32 (52.85) -341.18 (80.42)c -120.30 (64.76) -124.26 (66.71) -95.44 (50.12)
Vitamin A, μgRE E -109.43 (57.14) -67.75 (55.53) -36.22 (51.87) -33.88 (43.75) -147.95 (39.62)b -25.23 (41.12) -47.66 (47.09) -30.55 (51.46)
Carotene, μg -452.17 (318.97) -324.62 (318.08) -32.03 (256.89) -90.72 (211.25) -804.60 (216.63) b -257.43 (236.97) -375.19 (234.42) -420.50 (261.60)
Retinol, μg 43.46 (82.12) 75.50 (89.54) -12.78 (19.46) 2.89 (17.61) -14.18 (13.86) 11.09 (7.87) 13.22 (21.20) 35.44 (26.28)
Thiamine, mg -0.16 (0.04)b -0.07 (0.04) -0.02 (0.05) 0.03 (0.03) -0.18 (0.03)c -0.04 (0.26) -0.04 (0.03) -0.01 (0.02)
Riboflavin, mg -0.11 (0.05)a -0.02 (0.05) -0.07 (0.04) -0.02 (0.03) -0.20 (0.03)c 0.01 (0.02) -0.09 (0.03)a -0.03 (0.02)
Niacin, mg -0.93 (0.54) 0.06 (0.45) -0.73 (0.56) -0.23 (0.34) -2.14 (0.43)c -0.31 (0.31) -0.83 (0.32)a -0.32 (0.20)
Vitamin C, mg -9.59 (5.15) -10.01 (4.81)a -6.44 (4.38) -6.77 (4.10) -21.42 (4.85)c -8.77 (5.12) -9.57 (3.90)a -6.03 (3.98)

Abbreviation: BMI, body mass index. Values are presented as number (standard deviation). Adjusted for age, daily calorie intake, household income, education level, education level, hypertension, dyslipidemia and diabetes. P value from using weighted regression analyses.

P<0.05.

P<0.001.

P<0.0001.