Abstract
Background
Objective
Design
Participants/setting
Main outcome measures
Statistical analyses
Results
Conclusions
Keywords
- Schwingshackl L.
- Bogensberger B.
- Hoffmann G.
- Fargnoli J.L.
- Fung T.T.
- Olenczuk D.M.
- Chamberland J.P.
- Hu F.B.
- Mantzoros C.S.
- Schwingshackl L.
- Bogensberger B.
- Hoffmann G.
- Fargnoli J.L.
- Fung T.T.
- Olenczuk D.M.
- Chamberland J.P.
- Hu F.B.
- Mantzoros C.S.
Materials and Methods
Participants and Study Design
Body Composition Analysis and Body Composition Subgroups
Diet Quality Scores, Dietary Food Groups, and Macronutrients
Physical Fitness
Clinical, Oxidative Stress, and Inflammatory Markers
Statistical Analyses
Results
Characteristic | Lean (n = 100) | Normal Weight Obesity (n = 164) | Overweight-Obesity (n = 429) |
---|---|---|---|
←mean ± standard deviation→ | |||
Age a (y)For continuous variables, one-way analysis of variance was performed and results of Tukey post hoc analyses are denoted by superscript letters (y and z) and indicate significant differences between groups for each row. Values that are not connected by the same letter are significantly different at P < 0.05. | 43.3 ± 12.8y | 49.1 ± 11.4z | 50.0 ± 10.9z |
←n (%)→ | |||
Sex | |||
Female | 62 (62) | 122 (75) | 267 (62) |
Male | 38 (38) | 42 (26) | 162 (38) |
Race | |||
White | 81 (83) | 120 (74) | 287 (68) |
African-American, Asian, American Indian | 19 (17) | 44 (26) | 142 (32) |
Presence of chronic disease | 14 (14) | 34 (21) | 94 (22) |
College degree or higher | 90 (90) | 137 (84) | 342 (80) |
Annual household income | |||
≤$50,000 | 7 (8) | 17 (11) | 51 (12) |
>$50,000-$100,000 | 23 (26) | 37 (24) | 126 (31) |
>$100,000-$200,000 | 31 (34) | 60 (39) | 145 (35) |
>$200,000 | 29 (32) | 39 (25) | 89 (22) |
Body Composition and Fat Distribution
Body composition measure | Lean (n = 100) | Normal Weight Obesity (n = 164) | Overweight-Obesity (n = 429) |
---|---|---|---|
←mean ± standard error→ | |||
Body mass index | 22.4 ± 0.5x | 23.0 ± 0.4x | 31.3 ± 0.2y |
Body fat (%) | 22.6 ± 0.5x | 31.1 ± 0.4y | 38.1 ± 0.2z |
Lean mass (kg) | 48.5 ± 0.8x | 44.1 ± 0.6y | 52.3 ± 0.4z |
Fat mass (kg) | 14.4 ± 1.0x | 20.3 ± 0.8y | 35.0 ± 0.5z |
Waist circumference (cm) | 79.7 ± 1.9x | 85.7 ± 1.6y | 101.0 ± 0.9z |
←geometric mean (95% CI)→ | |||
Visceral adipose tissue (kg) | 0.17 (0.15-0.2)x | 0.44 (0.39-0.49)y | 1.21 (1.13-1.3)z |
Diet Quality Scores, Dietary Food Groups, and Macronutrients

Body composition measure | AHEI | DASH | MDS | VO2 max (mL/min/kg) |
---|---|---|---|---|
←β ± standard error (P value)g→ | ||||
Body mass index | –0.09 ± 0.02 (< 0.001) | –1.0 ± 0.23 (< 0.001) | –0.27 ± 0.13 (0.04) | –0.22 ± 0.06 (< 0.001) |
Body fat % | –0.16 ± 0.02 (< 0.001) | –1.54 ± 0.26 (< 0.001) | –0.73 ± 0.15 (< 0.001) | –0.35 ± 0.03 (< 0.001) |
Lean mass (kg) | –0.02 ± 0.03 (0.45) | –0.42 ± 0.29 (0.15) | 0.17 ± 0.16 (0.29) | –0.11 ± 0.04 (0.003) |
Fat mass (kg) | –0.21 ± 0.04 (< 0.001) | –2.05 ± 0.47 (< 0.001) | –0.71 ± 0.26 (0.008) | –0.52 ± 0.05 (< 0.001) |
Visceral adipose tissue (kg) | –0.02 ± 0.003 (< 0.001) | –0.18 ± 0.04 (< 0.001) | –0.06 ± 0.02 (0.003) | –0.04 ± 0.004 (< 0.001) |
Waist circumference (cm) | –0.15 ± 0.08 (0.05) | –1.00 ± 0.80 (0.21) | –0.37 ± 0.47 (0.43) | –0.63 ± 0.11 (< 0.001) |
Physical Fitness

Clinical, Oxidative Stress, and Inflammatory Markers
Biomarker | Lean (n = 100) | Normal Weight Obesity (n = 164) | Overweight-Obesity (n = 429) |
---|---|---|---|
←geometric mean (95% CI)→ | |||
Blood glucose (mg/dL) | 86.0 (83.6-88.5)x | 86.0 (84.1-88.0)x | 90.2 (89.0-91.5)y |
Insulin (μIU/mL) | 2.41 (2.07-2.8)x | 3.09 (2.74-3.48)y | 5.41 (5.03-5.82)z |
HOMA-IR | 0.51 (0.44-0.60)x | 0.66 (0.58-0.75)y | 1.21 (1.11-1.3)z |
←mean ± standard error→ | |||
Total cholesterol (mg/dL) | 185.0 ± 3.8x | 196.9 ± 3.0y | 191.7 ± 1.9xy |
Low-density lipoprotein cholesterol (mg/dL) | 98.4 ± 3.4x | 113.0 ± 2.7y | 113.0 ± 1.6y |
High-density lipoprotein cholesterol (mg/dL) | 72.1 ± 1.7x | 65.2 ± 1.3y | 56.5 ± 0.8z |
Triglyceride (mg/dL) | 72.2 ± 6.0x | 93.8 ± 4.8y | 112.4 ± 3.0z |
Systolic blood pressure (mm Hg) | 114.9 ± 1.5x | 116.9 ± 1.2x | 125.9 ± 0.7y |
Diastolic blood pressure (mm Hg) | 72.3 ± 1.1x | 75.6 ± 0.9x | 79.2 ± 0.5y |
Cysteine (μM) | 8.9 ± 0.2x | 9.2 ± 0.2x | 9.4 ± 0.1x |
Cystine (μM) | 78.7 ± 1.8x | 79.7 ± 1.4x | 87.9 ± 0.9y |
←geometric mean (95% CI)→ | |||
Glutathione (μM) | 1.77 (1.64-1.91)x | 1.76 (1.66-1.87)x | 1.5 (1.45-1.56)y |
Glutathione disulfide (μM) | 0.052 (0.045-0.06)x | 0.053 (0.048-0.06)x | 0.049 (0.045-0.052)x |
←mean ± standard error→ | |||
Eh Cysteine (mV) | –69.7 ± 0.6x | –70.3 ± 0.5x | –69.5 ± 0.3x |
Eh Glutathione (mV) | –137.3 ± 1.1x | –136.9 ± 0.8x | –134.0 ± 0.5y |
←geometric mean (95% CI)→ | |||
Cystine/glutathione ratio | 43.5 (39.8-47.7)x | 44.6 (41.5-47.8)x | 57.3 (54.8-59.8)y |
Interleukin-6 (pg/mL) | 2.51 (1.99-3.18)x | 2.54 (2.11-3.06)x | 3.1 (2.76-3.48)x |
Tumor necrosis factor-α (pg/mL) | 3.25 (2.88-3.66)x | 3.47 (3.16-3.81)x | 3.64 (3.43-3.85)x |
Interleukin-8 (pg/mL | 7.87 (6.9-8.98)x | 7.96 (7.18-8.82)x | 7.91 (7.42-8.43)x |
Interferon-γ (pg/mL) | 0.35 (0.25-0.5)x | 0.32 (0.25-0.42)x | 0.42 (0.35-0.49)x |
Discussion
- Schwingshackl L.
- Bogensberger B.
- Hoffmann G.
- Fargnoli J.L.
- Fung T.T.
- Olenczuk D.M.
- Chamberland J.P.
- Hu F.B.
- Mantzoros C.S.
- Kosmala W.
- Jedrzejuk D.
- Derzhko R.
- Przewlocka-Kosmala M.
- Mysiak A.
- Bednarek-Tupikowska G.
Conclusions
Supplementary Materials
Diet quality score or fitness measure | Lean | Normal Weight Obesity | Overweight-Obesity |
---|---|---|---|
←mean ± standard error→ | |||
Female participants | |||
Alternate Healthy Eating Index | 55.0 ± 1.5x | 51.4 ± 1.1x | 47.3 ± 0.7y |
DASH Score | 5.2 ± 0.1x | 5.0 ± 0.1x | 4.7 ± 0.1y |
Mediterranean Diet Score | 5.0 ± 0.2x | 4.4 ± 0.2xy | 4.0 ± 0.1y |
VO2 max (mL/min/kg) | 37.4 ± 1.2x | 32.6 ± 0.8y | 28.9 ± 0.5z |
Male participants | |||
Alternate Healthy Eating Index | 50.1 ± 1.9x | 48.1 ± 1.7x | 47.0 ± 1.1x |
DASH Score | 5.3 ± 0.2x | 5.3 ± 0.2x | 5.0 ± 0.1x |
Mediterranean Diet Score | 4.6 ± 0.3x | 4.6 ± 0.3x | 4.4 ± 0.2x |
VO2 max (mL/min/kg) | 44.4 ± 1.7x | 41.4 ± 1.5y | 38.1 ± 1.0y |
Food group/macronutrient variable | Lean (n = 98) | Normal Weight Obesity (n = 162) | Overweight-Obesity (n = 427) |
---|---|---|---|
←mean ± standard error→ | |||
Total fat (g) | 38.6 ± 0.7yz | 38.4 ± 0.6y | 40.4 ± 0.4z |
←geometric mean (95% CI)→ | |||
Saturated fat | 10.4 (9.8-10.9)y | 10.3 (9.9-10.7)y | 11.2 (11.0-11.5)z |
←mean ± standard error→ | |||
Monounsaturated fat | 15.4 ± 0.3x | 15.4 ± 0.3x | 16.1 ± 0.2x |
←geometric mean (95% CI)→ | |||
Polyunsaturated fat | 9.3 (8.9-9.8)x | 9.3 (8.9-9.6)x | 9.5 (9.3-9.7)x |
Trans fat | 0.9 (0.8-1)y | 0.9 (0.8-0.9)y | 1.1 (1.1-1.2)z |
←mean ± standard error→ | |||
Total carbohydrates (g) | 123.6 ± 2.0y | 125.6 ± 1.6y | 118.3 ± 1.0z |
Total grains (oz equivalents) | 2.9 ± 0.1x | 2.6 ± 0.1x | 2.8 ± 0.04x |
Whole grains | 0.9 ± 0.1y | 0.8 ± 0.04yz | 0.7 ± 0.03z |
Refined grains | 2.0 ± 0.1yz | 1.9 ± 0.1y | 2.1 ± 0.04z |
←geometric mean (95% CI)→ | |||
Total dietary fiber (g) | 12.1 (11.3-12.9)y | 11.7 (11.1-12.4)y | 10.7 (10.4-11.1)z |
Added sugars (tsp equivalents) | 5.6 (5.1-6.1)x | 5.5 (5.1-6.0)x | 5.4 (5.2-5.7)x |
Total fruits (c) | 0.8 (0.7-0.9)y | 0.8 (0.8-0.9)y | 0.6 (0.6-0.7)z |
Whole fruit | 0.6 (0.5-0.6)y | 0.6 (0.5-0.7)y | 0.4 (0.4-0.5)z |
Total vegetables (c) | 1.2 (1.1-1.3)x | 1.3 (1.2-1.4)x | 1.2 (1.1-1.2)x |
Yellow/orange | 0.08 (0.07-0.1)yz | 0.1 (0.08-0.11)y | 0.07 (0.07-0.08)z |
Dark leafy greens | 0.03 (0.02-0.03)x | 0.03 (0.02-0.03)x | 0.03 (0.02-0.03)x |
Potatoes | 0.08 (0.07-0.09)x | 0.10 (0.09-0.11)y | 0.12 (0.11-0.12)z |
Total protein (g) | 38.2 (36.8-39.7)yz | 37.2 (36.1-38.3)y | 39.5 (38.8-40.2)z |
Milk and dairy products (milk equivalents) | 0.5 (0.5-0.6)x | 0.5 (0.5-0.6)x | 0.6 (0.5-0.6)x |
Eggs (n) | 0.1 (9.6-0.2)x | 0.1 (0.1-0.1)x | 0.1 (0.1-0.2)x |
Beef, pork, and lamb (oz) | 0.3 (0.3-0.4)y | 0.4 (0.3-0.5)y | 0.5 (0.5-0.6)z |
Poultry (oz) | 0.3 (0.2-0.3)y | 0.3 (0.2-0.3)y | 0.4 (0.3-0.4)z |
Fish/seafood (oz) | 0.3 (0.3-0.4)x | 0.3 (0.2-0.4)x | 0.4 (0.3-0.4)x |
Beans/legumes/nuts/soy (servings) | 1.7 (1.4-2.0)y | 1.6 (1.4-1.8)y | 1.2 (1.1-1.3)z |
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Biography
Article info
Publication history
Footnotes
Supplementary materials: Table 3 and Table 5 are available at www.jandonline.org
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT This work is based on information from the Emory Predictive Health Institute and Center for Health Discovery and Well Being Database supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award no. UL1TR002378. Additional grant support includes NIH K01 DK102851 (to J. A. Alvarez), K24 DK096574 (to T. R. Ziegler), and P30 ES019776 (J. A. Alvarez, T. R. Ziegler, and D. P. Jones).
AUTHOR CONTRIBUTIONS M. P. Bellissimo, J. A. Alvarez, and T. R. Ziegler formulated the research question. T. R. Ziegler and D. P. Jones had leading roles in the cohort study design, implementation, and data collection. M. P. Bellissimo, J. N. Binongo, and J. A. Alvarez conducted data analyses, and E. L. Bettermann, P. H. Tran, B. H. Crain, T. J. Hartman, and E. P. Ferranti assisted in data acquisition and analyses. M. P. Bellissimo drafted the manuscript with J. A. Alvarez and T. R. Ziegler. All authors read and approved the final manuscript.