Normal Weight Obesity Is Associated with Metabolic Syndrome and Insulin Resistance in Young Adults from a Middle-Income Country

Objective: This population-based birth cohort study examined whether normal weight obesity is associated with metabolic disorders in young adults in a middle-income country undergoing rapid nutrition transition. Design and Methods: The sample involved 1,222 males and females from the 1978/79 Ribeirao Preto birth cohort, Brazil, aged 23-25 years. NWO was defined as body mass index (BMI) within the normal range (18.5-24.9 kg/m(2)) and the sum of subscapular and triceps skinfolds above the sex-specific 90th percentiles of the study sample. It was also defined as normal BMI and % BF (body fat) >23% in men and >30% in women. Insulin resistance (IR), insulin sensitivity and secretion were based on the Homeostasis Model Assessment (HOMA) model. Results: In logistic models, after adjusting for age, sex and skin colour, NWO was significantly associated with Metabolic Syndrome (MS) according to the Joint Interim Statement (JIS) definition (Odds Ratio OR = 6.83; 95% Confidence Interval CI 2.84-16.47). NWO was also associated with HOMA2-IR (OR = 3.81; 95% CI 1.57-9.28), low insulin sensitivity (OR = 3.89; 95% CI 2.39-6.33), and high insulin secretion (OR = 2.17; 95% CI 1.24-3.80). Significant associations between NWO and some components of the MS were also detected: high waist circumference (OR = 8.46; 95% CI 5.09-14.04), low High Density Lipoprotein cholesterol (OR = 1.65; 95% CI 1.11-2.47) and high triglyceride levels (OR = 1.93; 95% CI 1.02-3.64). Most estimates changed little after further adjustment for early and adult life variables. Conclusions: NWO was associated with MS and IR, suggesting that clinical assessment of excess body fat in normal-BMI individuals should begin early in life even in middle-income countries.