Association between a healthy lifestyle and general obesity and abdominal obesity in an elderly population at high cardiovascular risk

doi:10.1016/j.ypmed.2011.06.008

Preventive Medicine

Volume 53, Issue 3, 1 September 2011, Pages 155-161

https://doi.org/10.1016/j.ypmed.2011.06.008 Get rights and content

Abstract

Background

Diet, smoking and physical activity are important modifiable lifestyle factors that can influence body weight and fat accumulation. We assessed the relationship between lifestyle and obesity risk in a baseline analysis of the PREDIMED study, a randomized dietary primary prevention trial conducted in Spain.

Methods

7000 subjects at high cardiovascular risk were assessed cross-sectionally. A healthy lifestyle pattern (HLP) was determined using a score including: adherence to the Mediterranean diet, moderate alcohol consumption, expending ≥ 200 kcal/day in leisure-time physical activity, and non-smoking.

Results

Inverse linear trends were observed between the HLP-score and body-mass-index (BMI) or waist circumference (p < 0.001). The BMI and waist circumference of participants with a HLP-score = 4 were, respectively, 1.3 kg/m² (95% CI: 0.9 to 1.7) and 4.3 cm (3.1 to 5.4) lower than those of subjects with an HLP ≤ 1. The odds ratios of general obesity and abdominal obesity for an HLP score of 4 compared to an HPL score ≤ 1 were 0.50 (0.42 to 0.60) and 0.51 (0.41 to 0.62), respectively

Conclusion

A combination of four healthy lifestyle behaviors was associated with a lower prevalence of general obesity and abdominal obesity in Mediterranean elderly subjects at high cardiovascular risk.

Research highlights

► To explore the relationship between a healthy lifestyle and the risk of obesity. ► To explore the relationship between lifestyle and the risk of abdominal obesity. ► We report an inverse linear trend between healthy lifestyle factors and obesity. ► We report an inverse linear trend between lifestyle factors and abdominal obesity.

Introduction

Obesity has reached epidemic proportions globally, with a deep negative impact on public health (World Health Organization, 2006). Several epidemiological studies have associated obesity with the incidence of multiple co-morbidities such as type-2 diabetes, hypertension, cardiovascular disease and cancer (Guh et al., 2009), and also with increased cardiovascular mortality (Flegal et al., 2007) and all-cause mortality (Adams et al., 2006). Fat distribution, not only total body fat, has a significant impact on the development of obesity comorbidities and it is considered as a better predictor of disease than body mass index (BMI) (Canoy et al., 2007, Heber, 2010, Lee et al., 2008). Nevertheless, presently it is accepted that both general and abdominal adiposity, measured by the BMI and waist circumference (WC), respectively, are associated with the risk of various chronic diseases and total mortality (Pischon et al., 2008).

Changes in dietary patterns and other lifestyle factors have been held responsible for the obesogenic environment of modern industrialized societies (Heber, 2010). Epidemiological studies have established an association between BMI or body fat distribution and modifiable lifestyle factors, such as dietary habits, alcohol consumption, physical activity and smoking (Atlantis et al., 2008, Koh-Banerjee et al., 2003, Lahti-Koski et al., 2002, Leite and Nicolosi, 2006, Ong et al., 2009, Romaguera et al., 2010, Travier et al., 2009, Wilsgaard et al., 2005). However, in these studies all lifestyle factors were individually associated with obesity and/or abdominal obesity, while their potential combined effects were not assessed. We hypothesized that evaluating the combined effect of these healthier lifestyle factors could provide useful information to better understand the interplay of diet and lifestyle factors. It has previously been reported that the combination of various lifestyle factors is associated with lower rates of mortality (Khaw et al., 2008, Knoops et al., 2004, Kvaavik et al., 2010), stroke (Myint et al., 2009) and colorectal cancer (Kirkegaard et al., 2010), but the role of the combined impact of favorable lifestyle factors on obesity and body fat distribution is less well-documented. To our knowledge, only one cross-sectional study conducted in the Framingham cohort evaluated the effect of the combination of healthy lifestyle factors on adiposity (Molenaar et al., 2009), but its authors did not include the diet item in the lifestyle pattern that they defined.

The purpose of the present study was to assess the relationship between compliance with a healthy lifestyle pattern (HLP) and the odds of prevalent general obesity or abdominal obesity in a cross-sectional analysis of an elderly population at high cardiovascular risk living in a Mediterranean country. We also assessed how each of these lifestyle factors that made up the HLP-score was associated with obesity prevalence.

Section snippets

Subjects

The present study was conducted within the frame of the PREDIMED Study, a large, parallel-group, multicenter, randomized, controlled clinical trial aiming to assess the effects of two traditional Mediterranean Diets (MedD) enriched with nuts or virgin olive oil compared to a low-fat (control) diet on the primary prevention of cardiovascular disease. The design and methods of the PREDIMED trial have been reported elsewhere (Estruch et al., 2006, Martínez-González et al., 2010). Briefly,

Results

Of the 7447 PREDIMED participants, 31 were excluded from the present study because of incomplete data. 216 subjects were also excluded because their age or BMI was out of predefined ranges for inclusion in the study. Thus the total sample considered for the cross-sectional general obesity analysis was 7200 subjects. Because baseline WC measurements were missing in 200 subjects, only 7000 subjects entered the abdominal obesity cross-sectional analyses.

Table 1 shows baseline characteristics of

Discussion

The results of this cross-sectional study of an elderly Mediterranean population at high cardiovascular risk show that a healthy lifestyle (defined as a MedD pattern, moderate alcohol consumption, daily physical activity and nonsmoking) is inversely and linearly associated with a lower prevalence of general obesity and abdominal obesity. These results concur with those recently reported from the Framingham cohort using the Recommended Dietary Guidelines for Americans as an index of a healthy

Conclusion

In summary, the present study shows that a Mediterranean-type diet, moderate alcohol consumption, daily physical activity and nonsmoking, all of which are easily modifiable lifestyle habits, are associated with a lower prevalence of general obesity and abdominal obesity. Although longitudinal analysis regarding the benefits of a healthier lifestyle on incidence of general obesity and abdominal obesity should be conducted in the future, our findings are relevant to the design of public health

Conflict of interest statement

The authors declare no conflict of interest.

Acknowledgments

We thank all the participants of the PREDIMED study. This project has been funded by the Spanish Ministry of Health (Instituto de Salud Carlos III, Fondo de Investigaciones Sanitarias) projects PI051839, PI070240, PI070954, G03/140, RD06/0045 FEDER (Fondo Europeo de Desarrollo Regional). CIBERobn is an initiative of Instituto de Salud Carlos III, Spain. None of the funding sources played a role in the experimental design, the collection, analysis or interpretation of data, the writing of the

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^☆: International Standard Randomized Controlled Trial Number (ISRCTN): 35739639.

¹: On behalf of the PREDIMED Study Investigators.

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Association between a healthy lifestyle and general obesity and abdominal obesity in an elderly population at high cardiovascular risk☆

Abstract

Background

Methods

Results

Conclusion

Research highlights

Introduction

Section snippets

Subjects

Results

Discussion

Conclusion

Conflict of interest statement

Acknowledgments

Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old

N. Engl. J. Med.

Lifestyle factors associated with age-related differences in body composition: the Florey Adelaide Male Aging Study

Am. J. Clin. Nutr.

A cross-sectional analysis of physical activity and obesity indicators in European participants of the EPIC-PANACEA study

Int. J. Obes.

Effect of smoking on body weight: longitudinal analysis of the SUN cohort

Rev. Esp. Cardiol.

Adherence to the Mediterranean diet, long-term weight change, and incident overweight or obesity: the Seguimiento Universidad de Navarra (SUN) cohort

Am. J. Clin. Nutr.

Hypolipidemic effects of proanthocyanidins and their underlying biochemical and molecular mechanisms

Mol. Nutr. Food Res.

Body fat distribution and risk of coronary heart disease in men and women in the European prospective investigation into cancer and nutrition in Norfolk cohort: a population-based prospective study

Circulation

Clustering of risk behaviors with cigarette consumption: a population-based survey

Prev. Med.

Association of cigarettes smoked daily with obesity in a general adult population

Obesity (Silver Spring).

Consequences of smoking for body weight, body fat distribution, and insulin resistance

Am. J. Clin. Nutr.

Validation of the Minnesota Leisure Time Physical Activity Questionnaire in Spanish men. The MARATHOM investigators

Am. J. Epidemiol.

Validation of the Minnesota Leisure Time Physical Activity Questionnaire in Spanish Women. Investigators of the MARATDON group

Med. Sci. Sports Exerc.

Different effects of red wine and gin consumption on inflammatory biomarkers of atherosclerosis: a prospective randomized crossover trial. Effects of wine on inflammatory markers

Atherosclerosis

Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial

Ann. Intern. Med.

Relative validity of a semi-quantitative food-frequency questionnaire in an elderly Mediterranean population of Spain

Br. J. Nutr.

Cause-specific excess deaths associated with underweight, overweight, and obesity

JAMA.

The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis

BMC Public Health

National Institute on Alcohol Abuse and Alcoholism report on moderate drinking

Alcohol. Clin. Exp. Res.

An integrative view of obesity

Am. J. Clin. Nutr.

Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study

PLoS Med.

Association of adherence to lifestyle recommendations and risk of colorectal cancer: a prospective Danish cohort study

BMJ

Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project

JAMA.

Prospective study of the association of changes in dietary intake, physical activity, alcohol consumption, and smoking with 9-y gain in waist circumference among 16 587 US men

Am. J. Clin. Nutr.

Influence of individual and combined health behaviors on total and cause-specific mortality in men and women: the United Kingdom health and lifestyle survey

Arch. Intern. Med.