British Journal of Nutrition

Full Papers

Metabolism and Metabolic Studies

Synergistic associations of physical activity and diet quality on cardiometabolic risk factors in overweight and obese postmenopausal women

Marie-Eve Lavoiea1a2, May Faraja1a2a3, Irene Strychara1a3a4, Éric Douceta5, Martin Brochua6a7, Jean-Marc Lavoiea8 and Rémi Rabasa-Lhoreta1a2a3 c1

a1 Département de Nutrition, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada H3T 1A8

a2 Institut de Recherches Cliniques de Montréal (IRCM), 110 Avenue des Pins Ouest, Montreal, QC, Canada H2W 1R7

a3 Montreal Diabetes Research Center (MDRC), Montreal, QC, Canada

a4 Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada

a5 Behavioural and Metabolic Research Unit, Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada

a6 Faculté d'éducation Physique et Sportive, Université de Sherbrooke, Sherbrooke, QC, Canada

a7 Centre de Santé et de Services Sociaux, Institut Universitaire de Gériatrie de Sherbrooke, Sherbrooke, QC, Canada

a8 Département de Kinésiologie, Université de Montréal, QC, Canada


Healthy diet and physical activity are associated with a lower cardiometabolic risk (CMR). Little is known about whether they interact to improve CMR. The purpose of the present study was to determine the synergistic associations of diet quality and physical activity energy expenditure (PAEE) on CMR factors. The present study was an a posteriori analysis of two cross-sectional studies on 124 inactive non-diabetic postmenopausal women with a BMI ≥ 27 kg/m2. The following factors were measured: diet quality (assessed by the Canadian Healthy Eating Index (C-HEI) from a 3 d food record); PAEE (doubly labelled water); body composition (dual-energy X-ray absorptiometry, computed tomography scan); lipoprotein profile (total, HDL- and LDL-cholesterol (HDL-C and LDL-C), non-HDL-C, total cholesterol:HDL-C, TAG, apoA1, apoB, apoA1:apoB and LDL-C:apoB); insulin sensitivity (homeostasis model assessment of insulin resistance and hyperinsulinaemic–euglycaemic clamp); inflammatory markers (high-sensitivity C-reactive protein (hs-CRP), haptoglobin, orosomucoid, IL-6 and leucocyte count). The association of the interaction PAEE × C-HEI and CMR factors was evaluated by hierarchical regressions. Fat mass-adjusted ANCOVA determined the interaction between PAEE and the C-HEI. In hierarchical regressions, the interaction PAEE × C-HEI was a correlate of more favourable values of HDL-C, apoB, apoA1:apoB and LDL-C:apoB ratios, and hs-CRP, while only PAEE was a negative correlate of haptoglobin. Compared with those in the low-PAEE/low-C-HEI group, women in the high-PAEE/high-C-HEI group had 10 % higher HDL-C, 13 % lower apoB, 11 % larger LDL particles and 28 % lower hs-CRP concentrations (P< 0·05). PAEE and the C-HEI have a synergistic association with the CMR profile. These results support the integration of both diet quality and physical activity in the management of CMR.

(Received July 09 2011)

(Revised March 12 2012)

(Accepted March 12 2012)

(Online publication May 09 2012)

Key Words:

  • Inflammation;
  • Physical activity energy expenditure;
  • Healthy Eating Index;
  • Diet quality;
  • Obesity;
  • Women


c1 Corresponding author: Dr R. Rabasa-Lhoret, fax +1 514 987 5670, E-mail:


  Abbreviations: BP, blood pressure; C-HEI, Canadian Healthy Eating Index; CAO, Complications Associated with Obesity; CMR, cardiometabolic risk; CRP, C-reactive protein; EI, energy intake; hs-CRP, high-sensitivity C-reactive protein; HDL-C, HDL-cholesterol; HEI, Healthy Eating Index; HOMA-IR, homeostasis model assessment of insulin resistance; LDL-C, LDL-cholesterol; MONET, Montreal-Ottawa New Emerging Team; NHANES III, Third National Health and Nutrition Examination Survey; PAEE, physical activity energy expenditure; T2D, type 2 diabetes; TEE, total energy expenditure