Adherence to the Mediterranean diet and binge eating behavior in metabolically obese normal weight Italian women

The category of Metabolically Obese Normal Weight (MONW) subjects has been proposed because they exhibit most of the abnormalities associated with obesity despite being normal-weight. The contribution of altered body fat to MONW phenotype is established but that of dietary pattern, eating behavior and physical activity is not. 116 MONW women (HOMA-R > 1.69) were matched with 164 non-MONW women (HOMA-R ≤ 1.69) using coarsened exact matching (CEM) on body mass index (BMI) and age. Weight, height, waist circumference and skinfolds (triceps, biceps, subscapular and suprailiac) were measured. Resting energy expenditure (REE) was measured by indirect calorimetry, adherence to Mediterranean dietary pattern by the MEDscore questionnaire and eating behavior by the Binge Eating Scale (BES). Median and logistic regression with robust confidence intervals were used to compare MONW and non-MONW women taking CEM into account. In the pooled sample, age was between 18 and 62 years. Familiarity for obesity, diabetes, dyslipidemia and cardiovascular disease was similar in the two groups. MONW women had higher waist (median difference = +2.2 cm, p < 0.01), skinfolds sum (+9.4 mm, p < 0.01) and triglycerides (+14 mg/dl, p < 0.01). REE, MEDscore and BES were similar in the two groups. The odds ratio of being engaged in physical activity was 0.56 (p < 0.05) for MONW vs. non-MONW women. In conclusion, we confirm that MONW women have increased central fat despite being normal weight and we suggest that among lifestyle factors the level of physical activity is important in determining this phenotype.