J Acad Nutr Diet. 2020 Dec;120(12):1963-1973.e2. doi: 10.1016/j.jand.2020.07.020. Epub 2020 Oct 1.
Individuals with normal weight obesity (NWO) have increased cardiometabolic disease and mortality risk, but factors contributing to NWO development are unknown.
The objective of this study was to determine whether diet quality scores and physical fitness levels differed between adults classified as lean, NWO, and overweight-obese. Secondary objectives of the study were to compare clinical biomarkers and food groups and macronutrient intakes between the three groups, and to test for associations between body composition components with diet quality scores and physical fitness levels.
This is a secondary data analysis from a cross-sectional study that included metropolitan university and health care system employees. Body composition was measured by dual energy x-ray absorptiometry. Individuals with a body mass index <25 kg/m and body fat >23% for men and >30% for women were classified as having NWO. Alternate Healthy Eating Index, Dietary Approaches to Stop Hypertension score, and Mediterranean Diet Score were calculated from Block food frequency questionnaires. Physical fitness was assessed by measuring maximal oxygen uptake (VO maximum) during treadmill testing.
PARTICIPANTS/SETTING: This study included 693 adults (65% women, mean age 48.9 ± 11.5 years) enrolled between 2007 and 2013 in Atlanta, GA.
The main outcome measures were Alternate Healthy Eating Index, Dietary Approaches to Stop Hypertension, and Mediterranean Diet Score diet quality scores and maximal oxygen uptake.
Multiple linear regression analyses with post hoc comparisons were used to investigate group differences in fitness, diet quality, and biomarkers. Regression analyses were also used to examine relationships between diet quality scores and fitness with body composition.
VO maximum was significantly lower in the NWO compared with the lean group (36.2 ± 0.8 mL/min/kg vs 40.2 ± 1.0 mL/min/kg; P < 0.05). Individuals with NWO reported similar diet quality to lean individuals and more favorable Alternate Healthy Eating Index and Dietary Approaches to Stop Hypertension scores than individuals with overweight-obesity (P < 0.05). Diet quality scores and physical fitness levels were inversely associated with percent body fat and visceral adipose tissue (P < 0.05), regardless of weight status. Individuals with NWO exhibited higher fasting blood insulin concentrations, insulin resistance, low-density lipoprotein cholesterol, and triglyceride levels, and significantly lower high-density lipoprotein cholesterol levels than lean individuals (P < 0.05).
Physical fitness was significantly decreased in individuals with NWO compared with lean individuals. Higher diet quality was associated with decreased total and visceral fat but did not distinguish individuals with NWO from lean individuals.
正常体重肥胖（NWO）个体存在增加的心血管代谢疾病和死亡风险，但导致 NWO 发展的因素尚不清楚。
本研究旨在确定分类为瘦、NWO 和超重肥胖的成年人之间的饮食质量评分和身体适应性水平是否存在差异。本研究的次要目的是比较三组间的临床生物标志物和食物组及宏量营养素摄入量，并检验身体成分与饮食质量评分和身体适应性水平之间的关联。
这是一项来自横断面研究的二次数据分析，包括大都市大学和医疗保健系统的员工。身体成分通过双能 X 射线吸收法进行测量。体质指数（BMI）<25kg/m²且男性体脂>23%、女性体脂>30%的个体被归类为 NWO。通过 Block 食物频率问卷计算替代健康饮食指数、停止高血压的饮食方法评分和地中海饮食评分。通过跑步机测试测量最大摄氧量（VO₂max）来评估身体适应性。
参与者/设置：本研究纳入了 2007 年至 2013 年间在佐治亚州亚特兰大市参加的 693 名成年人（65%为女性，平均年龄 48.9±11.5 岁）。
主要观察指标为替代健康饮食指数、停止高血压的饮食方法评分和地中海饮食评分的饮食质量评分和最大摄氧量。
采用多元线性回归分析结合事后比较来研究三组间适应性、饮食质量和生物标志物的差异。回归分析也用于检验饮食质量评分和身体适应性与身体成分之间的关系。
与瘦组相比，NWO 组的 VO₂max 明显更低（36.2±0.8mL/min/kg 比 40.2±1.0mL/min/kg；P<0.05）。NWO 个体报告的饮食质量与瘦个体相似，且替代健康饮食指数和停止高血压的饮食方法评分比超重肥胖个体更有利（P<0.05）。饮食质量评分和身体适应性水平与体脂百分比和内脏脂肪组织呈负相关（P<0.05），无论体重状态如何。NWO 个体的空腹胰岛素浓度、胰岛素抵抗、低密度脂蛋白胆固醇和甘油三酯水平显著升高，高密度脂蛋白胆固醇水平显著降低（P<0.05），而瘦个体则较低。
与瘦个体相比，NWO 个体的身体适应性明显下降。更高的饮食质量与总脂肪和内脏脂肪减少相关，但不能将 NWO 个体与瘦个体区分开来。
