*2.2. Measurements and Definitions*

Healthcare institutions for screening were selected in accordance with the Framework Act on Health Examinations and the standard requirements for equipment, manpower and facilities. To lessen the measurement errors, the average values of all test data from laboratory between 2009 and 2011 were used. Values beyond the extreme outlier were considered as missing values. Height, weight and waist circumference were measured, and BMI was calculated with the formula BMI = kg/m2, where kg is a participant's weight in kilograms and m<sup>2</sup> is the square of the participant's height in meters. Blood samples for serum glucose and total cholesterol (TC) level measurement were acquired following an overnight fast [18]. Low-density lipoprotein cholesterol (LDL-C) levels were calculated from TC, high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) levels or measured directly.

Obesity was defined as BMI ≥ 25 kg/m2 and metabolically healthy as metabolic syndrome risk < 2 in the 2009–2011 health-screening program. The participant's level of alcohol consumption, frequency of physical activity, family economic status and smoking status were acquired using a set of questions. Smoking status was grouped as current smoker and not, and alcohol consumption as heavy drinker (i.e., consumption of 14 and 7 units of alcohol per week in men and women, respectively) and not. Regular exercise was interpreted as moderate to vigorous intensity physical activity for more than three days each week.

We categorized the participants into four main groups according to their metabolic status and BMI:

