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Association of dietary patterns with obesity and metabolically healthy obesity phenotype in Chinese population: a cross-sectional analysis of China Multi-Ethnic Cohort Study

Published online by Cambridge University Press:  10 January 2022

Dan Tang
Affiliation:
West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People’s Republic of China
Xiong Xiao
Affiliation:
West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People’s Republic of China
Liling Chen
Affiliation:
Chongqing Municipal Centre for Disease Control and Prevention, Chongqing, People’s Republic of China
Yixi Kangzhu
Affiliation:
Tibet Centre for Disease Control and Prevention, Lhasa, People’s Republic of China
Wei Deng
Affiliation:
Qingbaijiang District Centre for Disease Control and Prevention, Chengdu, People’s Republic of China
Basang
Affiliation:
Tibet University, Lhasa, People’s Republic of China
Shujuan Yang
Affiliation:
West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People’s Republic of China
Lu Long
Affiliation:
West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People’s Republic of China
Xiaofen Xie
Affiliation:
West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People’s Republic of China
Jiaojiao Lu
Affiliation:
West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People’s Republic of China
Qun Meng
Affiliation:
West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People’s Republic of China General Supervision Bureau, National Health Commission of the People’s Republic of China, Beijing, People’s Republic of China
Jianzhong Yin*
Affiliation:
School of Public Health, Kunming Medical University, Kunming, People’s Republic of China Baoshan College of Traditional Chinese Medicine, Baoshan, People’s Republic of China
Feng Hong*
Affiliation:
School of Public Health, the key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, People’s Republic of China
Xing Zhao*
Affiliation:
West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People’s Republic of China
*
*Corresponding authors: Xing Zhao, email xingzhao@scu.edu.cn Jianzhong Yin, email yinjianzhong2005@sina.com; Feng Hong, email fhong@gmc.edu.cn.
*Corresponding authors: Xing Zhao, email xingzhao@scu.edu.cn Jianzhong Yin, email yinjianzhong2005@sina.com; Feng Hong, email fhong@gmc.edu.cn.
*Corresponding authors: Xing Zhao, email xingzhao@scu.edu.cn Jianzhong Yin, email yinjianzhong2005@sina.com; Feng Hong, email fhong@gmc.edu.cn.

Abstract

Metabolically healthy obesity (MHO) might be an alternative valuable target in obesity treatment. We aimed to assess whether alternative Mediterranean (aMED) diet and Dietary Approaches to Stop Hypertension (DASH) diet were favourably associated with obesity and MHO phenotype in a Chinese multi-ethnic population. We conducted this cross-sectional analysis using the baseline data of the China Multi-Ethnic Cohort study that enrolled 99 556 participants from seven diverse ethnic groups. Participants with self-reported cardiometabolic diseases were excluded to eliminate possible reverse causality. Marginal structural logistic models were used to estimate the associations, with confounders determined by directed acyclic graph (DAG). Among 65 699 included participants, 11·2 % were with obesity. MHO phenotype was present in 5·7 % of total population and 52·7 % of population with obesity. Compared with the lowest quintile, the highest quintile of DASH diet score had 23 % decreased odds of obesity (OR = 0·77, 95 % CI 0·71, 0·83, Ptrend < 0·001) and 27 % increased odds of MHO (OR = 1·27, 95 % CI 1·10, 1·48, Ptrend = 0·001) in population with obesity. However, aMED diet showed no obvious favourable associations. Further adjusting for BMI did not change the associations between diet scores and MHO. Results were robust to various sensitivity analyses. In conclusion, DASH diet rather than aMED diet is associated with reduced risk of obesity and presents BMI-independent metabolic benefits in this large population-based study. Recommendation for adhering to DASH diet may benefit the prevention of obesity and related metabolic disorders in Chinese population.

Type
Research Article
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Nutrition Society

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Footnotes

These authors contributed equally to this work.

References

WHO (2020) Obesity and Overweight: Key Facts. http://www.who.int/mediacentre/factsheets/fs311/en/ (accessed November 2020).Google Scholar
Murray, CJL, Aravkin, AY, Zheng, P, et al. (2020) Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 396, 12231249.CrossRefGoogle Scholar
Mongraw-Chaffin, M, Foster, MC, Anderson, CAM, et al. (2018) Metabolically healthy obesity, transition to metabolic syndrome, and cardiovascular risk. J Am Coll Cardiol 71, 18571865.CrossRefGoogle ScholarPubMed
Stefan, N, Haring, HU & Schulze, MB (2018) Metabolically healthy obesity: the low-hanging fruit in obesity treatment? Lancet Diabetes Endocrinol 6, 249258.CrossRefGoogle ScholarPubMed
Magkos, F (2019) Metabolically healthy obesity: what’s in a name? Am J Clin Nutr 110, 533539.CrossRefGoogle Scholar
Gao, M, Lv, J, Yu, C, et al. (2020) Metabolically healthy obesity, transition to unhealthy metabolic status, and vascular disease in Chinese adults: a cohort study. PLoS Med 17, e1003351.CrossRefGoogle ScholarPubMed
Smith, GI, Mittendorfer, B & Klein, S (2019) Metabolically healthy obesity: facts and fantasies. J Clin Invest 129, 39783989.CrossRefGoogle ScholarPubMed
Iacobini, C, Pugliese, G, Fantauzzi, CB, et al. (2019) Metabolically healthy v. metabolically unhealthy obesity. Metab Clin Exp 92, 5160.Google Scholar
Mozaffarian, D (2016) Dietary and policy priorities for cardiovascular disease, diabetes, and obesity: a comprehensive review. Circulation 133, 187225.CrossRefGoogle ScholarPubMed
Hu, FB (2002) Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin lipidol 13, 39.CrossRefGoogle ScholarPubMed
Hosseini, Z, Whiting, SJ & Vatanparast, H (2016) Current evidence on the association of the metabolic syndrome and dietary patterns in a global perspective. Nutr Res Rev 29, 152162.CrossRefGoogle Scholar
Kastorini, CM, Milionis, HJ, Esposito, K, et al. (2011) The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534 906 individuals. J Am Coll Cardiol 57, 12991313.CrossRefGoogle ScholarPubMed
Konieczna, J, Yanez, A, Monino, M, et al. (2020) Longitudinal changes in Mediterranean diet and transition between different obesity phenotypes. Clin Nutr 39, 966975.CrossRefGoogle ScholarPubMed
Park, YM, Steck, SE, Fung, TT, et al. (2017) Mediterranean diet, Dietary Approaches to Stop Hypertension (DASH) style diet, and metabolic health in U.S. adults. Clin Nutr 36, 13011309.CrossRefGoogle ScholarPubMed
Arenaza, L, Huybrechts, I, Ortega, FB, et al. (2019) Adherence to the Mediterranean diet in metabolically healthy and unhealthy overweight and obese European adolescents: the HELENA study. Eur J Nutr 58, 26152623.CrossRefGoogle Scholar
Phillips, CM, Dillon, C, Harrington, JM, et al. (2013) Defining metabolically healthy obesity: role of dietary and lifestyle factors. PLOS ONE 8, e76188.CrossRefGoogle ScholarPubMed
Rahimi, H, Yuzbashian, E, Zareie, R, et al. (2020) Dietary approaches to stop hypertension (DASH) score and obesity phenotypes in children and adolescents. Nutr J 19, 19.CrossRefGoogle ScholarPubMed
Farhadnejad, H, Darand, M, Teymoori, F, et al. (2019) The association of Dietary Approach to Stop Hypertension (DASH) diet with metabolic healthy and metabolic unhealthy obesity phenotypes. Sci Rep 9, 17.CrossRefGoogle ScholarPubMed
Ma, S, Xi, B, Yang, L, et al. (2021) Trends in the prevalence of overweight, obesity, and abdominal obesity among Chinese adults between 1993 and 2015. Int J Obes 45, 427437.CrossRefGoogle ScholarPubMed
Huang, J, Huang, JLW, Withers, M, et al. (2018) Prevalence of metabolic syndrome in Chinese women and men: a systematic review and meta-analysis of data from 734 511 individuals. Lancet 392, S14.CrossRefGoogle Scholar
Zhao, X, Hong, F, Yin, J, et al. (2020) Cohort profile: the China Multi-Ethnic cohort (CMEC) study. Int J Epidemiol 50, 721721l.CrossRefGoogle Scholar
Shan, Z, Li, Y, Baden, MY, et al. (2020) Association between healthy eating patterns and risk of cardiovascular disease. JAMA Intern Med 180, 10901100.CrossRefGoogle ScholarPubMed
Xiao, X, Qin, Z, Lv, X, et al. (2021) Dietary patterns and cardiometabolic risks in diverse less-developed ethnic minority regions: results from the China Multi-Ethnic Cohort (CMEC) Study. Lancet Regional Health – Western Pacific 15, 100252.CrossRefGoogle ScholarPubMed
Fung, TT, Chiuve, SE, McCullough, ML, et al. (2008) Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women. Arch Intern Med 168, 713720.CrossRefGoogle ScholarPubMed
Alberti, KG, Eckel, RH, Grundy, SM, et al. (2009) Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120, 16401645.CrossRefGoogle Scholar
Ferguson, KD, McCann, M, Katikireddi, SV, et al. (2020) Evidence synthesis for constructing directed acyclic graphs (ESC-DAGs): a novel and systematic method for building directed acyclic graphs. Int J Epidemiol 49, 322329.CrossRefGoogle ScholarPubMed
Ukoumunne, OC, Williamson, E, Forbes, AB, et al. (2010) Confounder-adjusted estimates of the risk difference using propensity score-based weighting. Stat Med 29, 31263136.Google ScholarPubMed
Greifer, N (2020) WeightIt: Weighting for Covariate Balance in Observational Studies. R Package Version 0.10.2.Google Scholar
Hainmueller, J (2012) Entropy balancing for causal effects: a multivariate reweighting method to produce balanced samples in observational studies. Polit Anal 20, 2546.CrossRefGoogle Scholar
Trichopoulou, A, Bamia, C & Trichopoulos, D (2009) Anatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study. BMJ 338, b2337.CrossRefGoogle ScholarPubMed
Rey-Lopez, JP, de Rezende, LF, Pastor-Valero, M, et al. (2014) The prevalence of metabolically healthy obesity: a systematic review and critical evaluation of the definitions used. Obes Rev 15, 781790.CrossRefGoogle Scholar
Ortega, FB, Cadenas-Sanchez, C, Migueles, JH, et al. (2018) Role of physical activity and fitness in the characterization and prognosis of the metabolically healthy obesity phenotype: a systematic review and meta-analysis. Prog Cardiovasc Dis 61, 190205.CrossRefGoogle ScholarPubMed
Bluher, M (2020) Metabolically healthy obesity. Endocr Rev 41, 405420.CrossRefGoogle ScholarPubMed
Schleinitz, D, Bottcher, Y, Bluher, M, et al. (2014) The genetics of fat distribution. Diabetologia 57, 12761286.CrossRefGoogle ScholarPubMed
Loos, RJF & Kilpelainen, TO (2018) Genes that make you fat, but keep you healthy. J Intern Med 284, 450463.CrossRefGoogle ScholarPubMed
Soltani, S, Shirani, F, Chitsazi, MJ, et al. (2016) The effect of dietary approaches to stop hypertension (DASH) diet on weight and body composition in adults: a systematic review and meta-analysis of randomized controlled clinical trials. Obes Rev 17, 442454.CrossRefGoogle ScholarPubMed
Willett, WC, Sacks, F, Trichopoulou, A, et al. (1995) Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr 61, 1402S1406S.CrossRefGoogle ScholarPubMed
Trichopoulou, A, Costacou, T, Bamia, C, et al. (2003) Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348, 25992608.CrossRefGoogle Scholar
Millwood, IY, Walters, RG, Mei, XW, et al. (2019) Conventional and genetic evidence on alcohol and vascular disease aetiology: a prospective study of 500 000 men and women in China. Lancet 393, 18311842.CrossRefGoogle ScholarPubMed
Zong, G, Sun, Q, Yu, D, et al. (2014) Dairy consumption, type 2 diabetes, and changes in cardiometabolic traits: a prospective cohort study of middle-aged and older Chinese in Beijing and Shanghai. Diabetes Care 37, 5663.CrossRefGoogle ScholarPubMed
Dehghan, M, Mente, A, Rangarajan, S, et al. (2018) Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE): a prospective cohort study. Lancet 392, 22882297.CrossRefGoogle ScholarPubMed
Akhlaghi, M (2020) Dietary Approaches to Stop Hypertension (DASH): potential mechanisms of action against risk factors of the metabolic syndrome. Nutr Res Rev 33, 118.CrossRefGoogle ScholarPubMed
Appel, LJ, Sacks, FM, Carey, VJ, et al. (2005) Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial. JAMA 294, 24552464.CrossRefGoogle ScholarPubMed
Estruch, R, Martínez-González, MA, Corella, D, et al. (2019) Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol 7, e6e17.CrossRefGoogle ScholarPubMed
Estruch, R, Ros, E, Salas-Salvado, J, et al. (2018) Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med 378, e34.CrossRefGoogle ScholarPubMed
Appel, LJ, Moore, TJ, Obarzanek, E, et al. (1997) A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med 336, 11171124.CrossRefGoogle ScholarPubMed
Bendall, CL, Mayr, HL, Opie, RS, et al. (2018) Central obesity and the Mediterranean diet: a systematic review of intervention trials. Crit Rev Food Sci Nutr 58, 30703084.CrossRefGoogle ScholarPubMed
Lopes, HF, Martin, KL, Nashar, K, et al. (2003) DASH diet lowers blood pressure and lipid-induced oxidative stress in obesity. Hypertension 41, 422430.CrossRefGoogle ScholarPubMed
Shirani, F, Salehi-Abargouei, A & Azadbakht, L (2013) Effects of Dietary Approaches to Stop Hypertension (DASH) diet on some risk for developing type 2 diabetes: a systematic review and meta-analysis on controlled clinical trials. Nutrition 29, 939947.CrossRefGoogle ScholarPubMed
Jensen, MD, Ryan, DH, Apovian, CM, et al. (2014) 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults. Circulation 129, S102S138.CrossRefGoogle ScholarPubMed
Look, ARG, Pi-Sunyer, X, Blackburn, G, et al. (2007) Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial. Diabetes Care 30, 13741383.Google Scholar
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