Hostname: page-component-76fb5796d-r6qrq Total loading time: 0 Render date: 2024-04-27T17:31:31.346Z Has data issue: false hasContentIssue false

Factors associated with normal-weight obesity in adolescents

Published online by Cambridge University Press:  28 January 2022

Bruna Clemente Cota*
Affiliation:
Departamento de Nutrição e Saúde, Universidade Federal de Viçosa (UFV), Viçosa, Minas Gerais (MG), Brazil
Felício Roberto Costa
Affiliation:
Departamento de Nutrição e Saúde, Universidade Federal de Viçosa (UFV), Viçosa, Minas Gerais (MG), Brazil
Leidjaira Lopes Juvanhol
Affiliation:
Departamento de Nutrição e Saúde, Universidade Federal de Viçosa (UFV), Viçosa, Minas Gerais (MG), Brazil
Sarah Aparecida Vieira Ribeiro
Affiliation:
Departamento de Nutrição e Saúde, Universidade Federal de Viçosa (UFV), Viçosa, Minas Gerais (MG), Brazil
Silvia Eloiza Priore
Affiliation:
Departamento de Nutrição e Saúde, Universidade Federal de Viçosa (UFV), Viçosa, Minas Gerais (MG), Brazil
Eliane Rodrigues de Faria
Affiliation:
Departamento de Nutrição, Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
Franciane Rocha de Faria
Affiliation:
Departamento de Nutrição e Saúde, Universidade Federal de Rondonópolis, Rondonópolis, Mato Grosso, Brazil
Patrícia Feliciano Pereira
Affiliation:
Departamento de Nutrição e Saúde, Universidade Federal de Viçosa (UFV), Viçosa, Minas Gerais (MG), Brazil
*
* Corresponding author: Bruna Clemente Cota, email bruna.cota@ufv.br

Abstract

A new phenotype of obesity has been studied: normal-weight obesity (NWO), which describes individuals with normal-weight by BMI and excess body fat. Despite normal-weight, individuals with NWO have a higher cardiometabolic risk. There is still a gap in the literature on the subject, especially in adolescents, as studies with this population are scarce. This study aims to investigate the sociodemographic factors, family history of chronic non-communicable diseases, body perception, lifestyle and food consumption associated with NWO in adolescents. This is a cross-sectional study, with 506 normal-weight adolescents aged 10–19 years, of both sexes. Weight and height were obtained, and BMI/age was calculated. Body fat analysis was performed using dual-energy X-ray absorptiometry. Sociodemographic data, level of physical activity, food consumption, body self-perception and lifestyle habits were also obtained. Logistic regression with hierarchical approach was used to analyse the associations. The odds of NWO are greater with age (OR = 1·14; 95 % CI = 1·04, 1·26), lower in male adolescents (OR = 0·21; 95 % CI = 0·11, 0·41) and higher in those with a history of familial dyslipidemia (OR = 1·81; 95 % CI = 1·01, 3·28). Adolescents satisfied with their body (OR = 0·30; 95 % CI 0·16, 0·56) and physically active (OR = 0·44; 95 % CI = 0·24, 0·81) have a lower odds of NWO, compared with the others. In addition, it was observed that the odds of NWO is greater among adolescents who use sweeteners (sugar substitutes) (OR = 3·84; 95 % CI = 1·70, 8·65). The factors associated with NWO were female sex, older age, positive family history of dyslipidemia, lower body satisfaction, lower level of physical activity and greater use of sweeteners.

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

World Health Organization (WHO) (2014) Global Status Report on Noncommunicable Diseases. Geneva: WHO. Noncommunicable Diseases and Mental Health, Publications on NCDs. https://www.who.int/nmh/publications/ncd-status-report-2014/en/ (accessed March 2021).Google Scholar
Pan American Health Organization/World Health Organization Conceito (n.d.) https://www.paho.org/bra/index.php?option=com_content&view=article&id=569:conceito-doencas-cronicas-nao-transmisiveis&Itemid=463 (accessed March 2021).Google Scholar
Bastos LFCS (2018) OPAS/OMS Brasil – Pan American Health Organization/World Health Organization. https://www.paho.org/bra/index.php?option=com_content&view=article&id=5638:10-principais-causas-de-morte-no-mundo&Itemid=0 (accessed March 2021).Google Scholar
World Health Organization (WHO) (2020) Obesity and Overweight. Geneva: World Health Organization, WHO Newsroom. https://www,who,int/news-room/fact-sheets/detail/obesity-and-overweight (accessed December 2020).Google Scholar
World Health Organization (WHO) (2021) Adolescent and Young Adult Health. https://www.who.int/news-room/fact-sheets/detail/adolescents-health-risks-and-solutions (accessed March 2021).Google Scholar
Group BMJP (2018) Is BMI the best measure of obesity? BMJ 361, k2293.Google Scholar
Lorenzo, AD, Martinoli, R, Vaia, F, et al. (2006) Normal weight obese (NWO) women: an evaluation of a candidate new syndrome. Nutr Metab Cardiovasc Dis 16, 513523.CrossRefGoogle ScholarPubMed
De Lorenzo, A, Del Gobbo, V, Premrov, MG, et al. (2007) Normal-weight obese syndrome: early inflammation? Am J Clin Nutr 85, 4045.CrossRefGoogle ScholarPubMed
Marques-Vidal, P, Pécoud, A, Hayoz, D, et al. (2010) Normal weight obesity: relationship with lipids, glycaemic status, liver enzymes and inflammation. Nutr Metab Cardiovasc Dis 20, 669675.CrossRefGoogle ScholarPubMed
Romero-Corral, A, Somers, VK, Sierra-Johnson, J, et al. (2010) Normal weight obesity: a risk factor for cardiometabolic dysregulation and cardiovascular mortality. Eur Heart J 31, 737746.CrossRefGoogle ScholarPubMed
Madeira, FB, Silva, AA, Veloso, HF, et al. (2013) Normal weight obesity is associated with metabolic syndrome and insulin resistance in young adults from a middle-income country. PLoS One 8, e60673.CrossRefGoogle ScholarPubMed
García-Hermoso, A, Agostinis-Sobrinho, C, Camargo-Villalba, GE, et al. (2020) Normal-weight obesity is associated with poorer cardiometabolic profile and lower physical fitness levels in children and adolescents. Nutrients 12, 1171.CrossRefGoogle ScholarPubMed
Kapoor, N, Lotfaliany, M, Sathish, T, et al. (2020) Prevalence of normal weight obesity and its associated cardio-metabolic risk factors – results from the baseline data of the Kerala Diabetes Prevention Program (KDPP). PLoS One 15, e0237974.CrossRefGoogle Scholar
Cota, BC, Suhett, LG, Leite, NN, et al. (2021) Cardiometabolic risk and health behaviors in adolescents with normal weight obesity: a systematic review. Public Health Nutr 24, 870881.CrossRefGoogle ScholarPubMed
Pereira, PF (2014) Relation of central perimetry with adiposity, cardiometabolic, inflammatory and hormonal markers on the three adolescence stages. Viçosa-MG. Thesis PhD in Nutrition Science, Federal University of Viçosa.Google Scholar
Faria, ER (2013) Comparison of different components for diagnosis of the metabolic syndrome in the adolescence. Viçosa-MG. Thesis (PhD in Nutrition Science), Federal University of Viçosa.Google Scholar
Instituto Brasileiro de Geografia E Estatística (IBGE) (2010) Censo demográfico, Viçosa, Minas Gerais, Brasil. http://www.cidades.ibge.gov.br/xtras/temas.php?lang=&codmun=317130&idtema=67&search=minas-gerais|vicosa|censo-demografico-2010:-resultados-do-universo-caracteristicas-da-populacao-e-dos-domicilios (accessed November 2020).Google Scholar
Luiz, RR & Magnanini, MMF (2003) Tamanho da Amostra em Investigações Epidemiológicas (Sample Size in Epidemiological Investigations). In Epidemiologia, pp. 295307 [Medronho, RA, Carvalho, DM, Block, KV, et al., editors]. São Paulo: Atheneu.Google Scholar
World Health Organization (WHO) (2007) Growth Reference Data for 5–19 Years. https://www.who.int/toolkits/growth-reference-data-for-5to19-years (accessed November 2020).Google Scholar
Instituto Brasileiro de Geografia e Estatística (IBGE) (Brazilian Institute of Geography and Statistics) (1996–1997) Pesquisa sobre padrões de vida (PPV) (Research on living standards). https://biblioteca.ibge.gov.br/biblioteca-catalogo.html?id=5469&view=detalhes (accessed November 2020).Google Scholar
Guedes, DP, Lopes, CC & Guedes, JERP (2005) Reprodutibilidade e validade do Questionário Internacional de Atividade Física em adolescentes (Reproducibility and validity of the International Physical Activity Questionnaire in adolescents). Rev Bras Med do Esporte 11, 151158.CrossRefGoogle Scholar
CELAFISC (n.d.) Questionário internacional de atividade física – IPAQ (International physical activity questionnaire) (versão curta). https://celafiscs.org.br/ (accessed November 2020).Google Scholar
Serra-Majem, L & Aracenta-Bartrina, J (1995) Introducción a la epidemiologia nutricional (Introduction to nutritional epidemiology). In Nutrición y Salud Pública, pp 5965 [Serra-Majem, L, Aracenta-Bartrina, J & Mataix-Verdú, J, editors]. Barcelona: Masson.Google Scholar
Olafsdottir, AS, Torfadottir, JE & Arngrimsson, SA (2016) Health behavior and metabolic risk factors associated with normal weight obesity in adolescents. PLoS One 11, e0161451 CrossRefGoogle ScholarPubMed
Lohman, TG, Roche, AF & Martorell, R (1988) Anthropometric Standardization Reference Manual. Champaign, IL: Human Kinetics Books.Google Scholar
Williams, DP, Going, SB, Lohman, TG, et al. (1992) Body fatness and risk for elevated blood pressure, total cholesterol, and serum lipoprotein ratios in children and adolescents. Am J Public Health 82, 358363.CrossRefGoogle ScholarPubMed
Victora, CG, Huttly, SR, Fuchs, SC, et al. (1997) The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. Int J Epidemiol 26, 224227.CrossRefGoogle ScholarPubMed
Cheng, S & Wiklund, P (2018) The effects of muscle mass and muscle quality on cardio-metabolic risk in peripubertal girls: a longitudinal study from childhood to early adulthood. Int J Obes 42, 648654.CrossRefGoogle ScholarPubMed
Wiklund, P, Törmäkangas, T, Shi, Y, et al. (2017) Normal-weight obesity and cardiometabolic risk: a 7-year longitudinal study in girls from prepuberty to early adulthood. Obesity 25, 10771082.CrossRefGoogle Scholar
Kim, JY, Han, S-H & Yang, B-M (2013) Implication of high-body-fat percentage on cardiometabolic risk in middle-aged, healthy, normal-weight adults. Obesity 21, 15711577.CrossRefGoogle ScholarPubMed
Marques-Vidal, P, Chiolero, A & Paccaud, F (2008) Large differences in the prevalence of normal weight obesity using various cut-offs for excess body fat. E-SPEN, Eur E-J Clin Nutr Metab 3, e159e162.CrossRefGoogle Scholar
Zhang, M, Schumann, M, Huang, T, et al. (2018) Normal weight obesity and physical fitness in Chinese university students: an overlooked association. BMC Public Health 18, 1334.CrossRefGoogle ScholarPubMed
Gallagher, D, Heymsfield, SB, Heo, M, et al. (2000) Healthy percentage body fat ranges: an approach for developing guidelines based on body mass index. Am J Clin Nutr 72, 694701.CrossRefGoogle ScholarPubMed
Kyle, UG, Genton, L, Slosman, DO, et al. (2001) Fat-free and fat mass percentiles in 5225 healthy subjects aged 15–98 years. Nutrition 17, 534541.CrossRefGoogle Scholar
Chumlea, WC, Guo, SS, Kuczmarski, RJ, et al. (2002) Body composition estimates from NHANES III bioelectrical impedance data. Int J Obes Relat Metab Disord 26, 15961609.CrossRefGoogle ScholarPubMed
Leone, A, Battezzati, A, Bedogni, G, et al. (2019) Sex- and age-related differences in the contribution of ultrasound-measured visceral and subcutaneous abdominal fat to fatty liver index in overweight and obese caucasian adults. Nutrients 11, 3008.CrossRefGoogle ScholarPubMed
Wiegman, A, Rodenburg, J, de Jongh, S, et al. (2003) Family history and cardiovascular risk in familial hypercholesterolemia: data in more than 1000 children. Circulation 107, 14731478.CrossRefGoogle ScholarPubMed
Strufaldi, MW, Souza, FI, Puccini, RF, et al. (2016) Family history of cardiovascular disease and non-HDL cholesterol in prepubescent non-obese children. Rev Da Associação Médica Bras 62, 347352.CrossRefGoogle ScholarPubMed
Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents (2011) Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: summary Report. Pediatric 128:S21356.CrossRefGoogle Scholar
Fortes, LD, Ribeiro Junior, DB, Paes, ST, et al. (2015) Satisfação corporal associada à gordura corporal e estado nutricional em jovens basquetebolistas (Body satisfaction associated with body fat and nutritional status in young basketball players). Rev Bras Educação Física e Esporte 29, 259266.CrossRefGoogle Scholar
Coqueiro, RD, Petroski, EL, Pelegrini, A, et al. (2008) Insatisfação com a imagem corporal: avaliação comparativa da associação com estado nutricional em universitários (Dissatisfaction with body image: comparative evaluation of the association with nutritional status in university students). Rev Psiquiatria do Rio Grande do Sul 30, 3138.CrossRefGoogle Scholar
Jia, A, Xu, S, Xing, Y, et al. (2018) Prevalence and cardiometabolic risks of normal weight obesity in Chinese population: a nationwide study. Nutr Metab Cardiovasc Dis 28, 10451053.CrossRefGoogle ScholarPubMed
GBD 2016 Stroke Collaborators (2019) Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 18, 439458.CrossRefGoogle Scholar
World Health Organization (WHO) (2021) Cardiovascular diseases. https://www.who.int/westernpacific/health-topics/cardiovascular-diseases (accessed January 2021).Google Scholar
World Health Organization (WHO) (2003) Diet, Nutrition and the Prevention of Chronic Diseases. https://www.who.int/dietphysicalactivity/publications/trs916/en/ (accessed January 2021).Google Scholar
World Health Organization (WHO) (s.d.) OMS e FAO anunciam estratégia integrada (WHO and FAO announce integrated strategy). https://www.who.int/dietphysicalactivity/publications/releases/pr84/en/ (accessed January 2021).Google Scholar
Männistö, S, Harald, K, Kontto, J, et al. (2014) Dietary and lifestyle characteristics associated with normal-weight obesity: the National FINRISK 2007 Study. Br J Nutr 111, 887894.CrossRefGoogle ScholarPubMed
World Health Organization (WHO) (2019) Global Action Plan on Physical Activity 2018–2030: More Active People for a Healthier World. Geneva: World Health Organization.Google Scholar
Morelli, C, Avolio, E, Galluccio, A, et al. (2020) Impact of vigorous-intensity physical activity on body composition parameters, lipid profile markers, and irisin levels in adolescents: a cross-sectional study. Nutrients 12, 742.CrossRefGoogle ScholarPubMed
World Health Organization (WHO) (s.d.) NCDs | Global Physical Activity Surveillance WHO. http://www.who.int/ncds/surveillance/steps/GPAQ/en/ (accessed January 2021).Google Scholar
Alves, CF, Silva, RD, Assis, AM, et al. (2012) Fatores associados à inatividade física em adolescentes de 10–14 anos de idade, matriculados na rede pública de ensino do município de Salvador, BA (Factors associated with physical inactivity in adolescents aged 10–14 years enrolled in public schools in the city of Salvador, BA). Rev Bras Epidemiologia 15, 858870.CrossRefGoogle Scholar
Ribeiro Vieira, P, de Faria, E, de Faria, F, et al. (2011) Factors associated with adiposity in normal weight female adolescents with adequate and high percent body fat: elaborating a risk model). Arch Latinoam Nutr 61, 279287.Google ScholarPubMed
Rosado, EL & Monteiro, JBR (2001) Obesidade e a substituição de macronutrientes da dieta (Obesity and the replacement of dietary macronutrients). Rev Nutrição 14, 145152.CrossRefGoogle Scholar
Cavalcante, AAM, Priore, SE & Franceschini, SD (2004) Estudos de consumo alimentar: aspectos metodológicos gerais e o seu emprego na avaliação de crianças e adolescentes (Food consumption studies: general methodological aspects and their use in the evaluation of children and adolescents). Rev Bras Saúde Materno Infantil 4, 229240.CrossRefGoogle Scholar
Ratelle, M, Skinner, K, Packull-McCormick, S, et al. (2020) Food frequency questionnaire assessing traditional food consumption in Dene/Métis communities, Northwest Territories, Canada. Int J Circumpolar Health 79, 1760071.CrossRefGoogle ScholarPubMed
Henríquez-Sánchez, P, Sánchez-Villegas, A, Doreste-Alonso, J, et al. (2009) Dietary assessment methods for micronutrient intake: a systematic review on vitamins. Br J Nutr 102, S1037.CrossRefGoogle ScholarPubMed
Ortiz-Andrellucchi, A, Henríquez-Sánchez, P, Sánchez-Villegas, A, et al. (2009) Dietary assessment methods for micronutrient intake in infants, children and adolescents: a systematic review. Br J Nutr 102, S87S117.CrossRefGoogle ScholarPubMed
Cade, JE, Burley, VJ, Warm, DL, et al. (2004) Food-frequency questionnaires: a review of their design, validation and utilisation. Nutr Res Rev 17, 522.CrossRefGoogle ScholarPubMed
Sugianto, R, Chan, MJ, Wong, SF, et al. (2019) Evaluation of a quantitative food frequency questionnaire for five-year-old children in an Asian population. J Acad Nutr Diet 120, 437444.CrossRefGoogle Scholar
Supplementary material: File

Cota et al. supplementary material

Table S1 and Figures S1-S2

Download Cota et al. supplementary material(File)
File 1.1 MB