Determinants of the transition from a cardiometabolic normal to abnormal overweight/obese phenotype in a Spanish population

Eur J Nutr. 2014 Sep;53(6):1345-53. doi: 10.1007/s00394-013-0635-2. Epub 2013 Dec 10.


Purpose: There is limited prospective evidence at population scale of the impacts of lifestyle and surrogate measures of general and abdominal adiposity on the transition of a metabolically healthy (absence of a metabolic disorder) overweight/obese (MHOO) phenotype to a metabolically abnormal overweight/obese (MAOO) phenotype. Therefore, we determined the relationship between 10-year body mass index (BMI), waist circumferences (WC), waist to height ratio (WHtR), and lifestyle changes and the transition of the MHOO phenotype.

Methods: We conducted a prospective population-based study of 3,052 male and female Spaniards aged 25-74 years who were followed from 2000 through 2009. Diet and leisure-time physical activity were recorded on validated questionnaires. Weight, height, WC, blood lipids, glycemia, and blood pressure were measured. All variables were obtained at baseline (BL) and follow-up (FL). Participants with a BMI ≥ 25 kg/m(2) and free from hypercholesterolemia, hypertriglyceridemia, diabetes, hypertension, and low HDL and high LDL cholesterol levels were characterized as the MHOO phenotype. A composite healthy lifestyle index (HLI) was constructed by including temporary changes in 3 lifestyle variables (diet, leisure-time physical activity, and smoking).

Results: Initially, 20.8% of subjects had the MHOO phenotype; 49.2% of these shifted to MAOO phenotype. In multivariate analysis, changes in BMI, WC, WHtR were positively associated (p = 0.004, p = 0.018, and p = 0.016, respectively) with this transition. One unit increase in the HLI was associated with a 33% lower risk (p = 0.025) to the MAOO phenotype transition after adjusting for age, sex, educational level, and baseline energy intake, BMI, WC, and WHtR.

Conclusions: The presence of metabolic disorders in the MHOO phenotype is predicted by an increase in anthropometric surrogate measures of general and abdominal adiposity. In contrast, a healthy lifestyle protects against a transition to the MAOO phenotype.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Blood Glucose / metabolism
  • Body Mass Index
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / prevention & control
  • Cholesterol / blood
  • Cross-Sectional Studies
  • Diet
  • Feeding Behavior*
  • Female
  • Follow-Up Studies
  • Humans
  • Life Style
  • Male
  • Metabolic Syndrome / epidemiology*
  • Metabolic Syndrome / prevention & control
  • Middle Aged
  • Motor Activity
  • Obesity / epidemiology*
  • Overweight / epidemiology*
  • Prospective Studies
  • Risk Factors
  • Spain / epidemiology
  • Surveys and Questionnaires
  • Triglycerides / blood
  • Waist Circumference
  • Waist-Hip Ratio
  • White People


  • Blood Glucose
  • Triglycerides
  • Cholesterol