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PubMed2001

Relationship between hormone replacement therapy use with body fat distribution and insulin sensitivity in obese postmenopausal women.

The aim of this study was to compare the effect of hormone replacement therapy (HRT) on insulin resistance and central adiposity in obese postmenopausal women. Forty-five obese postmenopausal women (16 HRT users and 29 nonusers), with a mean age of 56.6 +/- 5.3 years and duration of current, continuous HRT use of 4.7 +/- 2.9 years, were included in the study. Subjects were studied using oral glucose tolerance tests, euglycemic clamping, dual photon x-ray absorptiometry, computed tomography, doubly labeled water, and treadmill testing. Insulin sensitivity, total fat, visceral fat, subcutaneous abdominal fat, thigh muscle attenuation, daily physical activity energy expenditure, peak oxygen consumption (Vo(2)) were measured. HRT users had lower body weight (88.0 +/- 11.0 v 98.2 +/- 15.0 kg, P =.05), lower body mass index (33.1 +/- 3.5 v 36.8 +/- 5.2 kg/m(2), P =.05), lower fat mass (38.3 +/- 7.3 v 44.1 +/- 10 kg, P =.05), less visceral adipose tissue (157 +/- 47 v 211 +/- 81 cm(2); P =.05), and higher peak Vo(2) (21.1 +/- 4.6 v 17.6 +/- 2.2 mL/kg/min, P =.001) than nonusers. After adjustment for total fat, we noted a trend for decreased visceral adipose tissue in HRT users (P =.09). After adjustment for peak Vo(2), the decreased visceral adipose tissue persisted in HRT users (P <.01). Insulin sensitivity per kilogram of lean body mass did not differ between HRT users (0.51 +/- 0.22 mmol/kg/min) and nonusers (0.49 +/- 0.22 mmol/kg/min). It was concluded that obese postmenopausal women using HRT have a more favorable body composition and fat distribution pattern than nonusers. Although visceral adipose tissue is decreased in HRT users, insulin sensitivity does not differ between HRT users and nonusers.

Adipose Tissue↗
PubMed1999

Role of exercise intervention in improving body fat distribution and risk profile in children.

The influence of 4 months of physical training (PT) and detraining on body composition, and risk factors for coronary artery disease (CAD) and noninsulin-dependent diabetes mellitus (NIDDM) was examined. The subjects were 81 obese 7-11-year-olds. At baseline, visceral adipose tissue (VAT) was the main adiposity variable cross-sectionally associated with unfavorable levels of the lipid-lipoprotein risk factors, while fat mass was more highly correlated with insulin, systolic blood pressure, and leptin. Adiposity measures were associated with unfavorable concentrations of clotting-fibrinolysis factors. Subjects were randomly assigned to engage in PT for the first or second 4-month period of the study; for most variables, tests were done at 0, 4, and 8-month time points. The PT program was offered 5 days a week for 40 min/session. For the 73 children who completed 4 months of PT, attendance was 80% and heart rate during the sessions was 157 bpm. PT had a favorable influence on percent fat, VAT, subcutaneous abdominal adipose tissue, insulin, triacylglycerol, and cardiac parasympathetic activity. Detraining generally led to unfavorable changes in percent fat and associated risk factors. Leptin decreased during periods of PT and increased following cessation of PT. No significant changes due to PT were found for diet, hemodynamic, left ventricular, or most lipid parameters. Thus, 4 months of controlled PT, without dietary intervention, had a favorable impact on body composition and some obesity-associated CAD/NIDDM risk factors. Am. J. Hum. Biol. 11:237-247, 1999. Copyright 1999 Wiley-Liss, Inc.

Journal Article↗
PubMed2005

Body fat distribution, liver enzymes, and risk of hypertension: evidence from the Western New York Study.

Gamma-glutamyltransferase (GGT) has been associated with hypertension (HTN); however, the nature of this association remains unclear. GGT is a marker of alcohol consumption, but it is also related to the infiltration of fat in the liver (fatty liver). The association between GGT and HTN was examined in a 6-year longitudinal investigation among 1455 men and women who returned for the follow-up visit. Baseline variables included serum GGT, blood pressure, and anthropometric measures. Incident HTN was defined as blood pressure > or =140/90 or on antihypertensive medication at the follow-up visit. To eliminate individuals with potential liver pathology, analyses focused only on individuals with GGT within its normal range (n=897). Participants were divided in quintiles (Q) based on their baseline GGT levels. Multiple logistic regression analyses [odds ratio (95% confidence intervals)] revealed a significant association of GGT with incident hypertension [2.1 (1.1 to 4.0) Q5 versus Q1]. In subgroup analyses, GGT and HTN were significantly associated among both noncurrent and current drinkers, but only for participants above the median of anthropometric measures [eg, body mass index >26.4, 2.3 (0.9 to 5.7), waist circumference >86.1 cm, 3.7 (1.4 to 9.9), and abdominal height >19.8 cm, 3.1 (1.2 to 8.5), for Q5 versus Q1, in fully adjusted models]. These findings suggest that the association between GGT and hypertension is not caused solely by alcohol consumption and indicate that serum GGT, within its normal range, may predict hypertension among individuals with increased central fat distribution, suggesting that fatty liver may represent an important underlying mechanism for this association.

Adult↗
PubMed2000

Relations of body fat distribution and height with cataract in men.

BACKGROUND: Cataract is the leading cause of blindness worldwide. Body mass index (BMI; in kg/m(2)) is a risk factor for cataract, but other anthropometric measurements may also be important. OBJECTIVE: We tested relations of alternative measures of body size, including height and waist-to-hip ratio (WHR), as well as BMI, with cataract. DESIGN: This was a prospective follow-up study. We analyzed data from 20271 participants in the Physicians' Health Study who did not have cataract at baseline and for whom there was complete information on weight, height, and other risk factors. For analyses concerning WHR, we excluded 3121 additional men for whom we did not have these measurements, assessed at the ninth year of follow-up. The main outcome measures were incident cataract and cataract surgery. RESULTS: Among the 17150 men for whom there were complete data, we confirmed an incident cataract in 1727 during an average of 14 y of follow-up. In proportional hazards regression models that adjusted for many known or suspected risk factors, higher BMI [rate ratio (RR) = 1.25 for >/=27.8 compared with <22, P: for trend = 0. 03], height (RR = 1.23 for >/=184 cm compared with </=170 cm, P: for trend = 0.02), and WHR (RR = 1.31 for top compared with bottom quintile, P: for trend = 0.003) were each independently associated with incident cataract. CONCLUSIONS: In addition to BMI, both height and abdominal adiposity are independent risk factors for cataract. These relations are biologically plausible and, if causal, suggest that prevention of obesity and beneficial lifestyle changes resulting in weight loss and reduction of central obesity would lessen the incidence and costs of cataract.

Adipose Tissue↗
PubMed1990

Incidence of type II diabetes in Mexican Americans predicted by fasting insulin and glucose levels, obesity, and body-fat distribution.

Few data exist on predictors of non-insulin-dependent (type II) diabetes mellitus. We examined body mass index (BMI), ratio of subscapular-to-triceps skin fold (centrality index), and fasting glucose and insulin concentrations as predictors of decompensation to type II diabetes in Mexican Americans, a population at high risk for this disorder. Twenty-eight of 474 initially nondiabetic Mexican Americans developed type II diabetes after 8 yr of follow-up. Converters to diabetes were older and had higher BMIs, centrality indices, and fasting glucose and insulin concentrations than nonconverters. Subjects in the highest quartile of the insulin distribution had 6.6 times the risk of developing type II diabetes as subjects in the remaining three quartiles combined (95% confidence interval [CI] = 3.14-13.7). In multivariate analysis, fasting glucose (odds ratio [OR] = 5.80, 95% CI = 2.57-13.1) and insulin (OR = 3.12, 95% CI = 1.36-7.14) remained significantly related to conversion to diabetes. However, BMI and centrality index, which were significantly related to conversion in the univariate analysis, were no longer significant in the multivariate analysis once glucose and insulin concentrations were taken into consideration, suggesting that the effect of these variables may be mediated by insulin resistance. Nearly half of the incident cases developed in a subset of the population who were simultaneously in the highest quartile of both fasting insulin and glucose concentrations (population-attributable risk 44.2%). Our results support the insulin resistance/pancreatic exhaustion theory of type II diabetes.

Adipose Tissue↗
PubMed1993

Body fat distribution and 5-year risk of death in older women.

OBJECTIVE: To test the hypothesis that both body mass index (expressed as the ratio of weight in kilograms per height in meters squared) and the ratio of waist circumference to hip circumference are positively associated with mortality risk in older women. DESIGN: Prospective cohort study with a 5-year follow-up period. SETTING: General community. PARTICIPANTS: Random sample of 41,837 Iowa women aged 55 to 69 years. MAIN OUTCOME MEASURE: Total mortality (1504 deaths). MAIN RESULTS: Body mass index, an index of relative weight, was associated with mortality in a J-shaped fashion: rates were elevated in the leanest as well as in the most obese women. In contrast, waist/hip circumference ratio was strongly and positively associated with mortality in a dose-response manner. Adjusted for age, body mass index, smoking, education level, marital status, estrogen use, and alcohol use, a 0.15-unit increase in waist/hip circumference ratio (eg, a 15-cm [6-in] increase in waist measurement in a woman with 100-cm [40-in] hips) was associated with a 60% greater relative risk of death. The observed associations were not explained to any great degree by bias from weight loss prior to baseline or higher early deaths among lean participants. CONCLUSIONS: Waist/hip circumference ratio is a better marker than body mass index of risk of death in older women. Waist/hip circumference ratio should be measured as part of routine surveillance and risk monitoring in medical practice.

Adipose Tissue↗
PubMed1992

Relation of central hemodynamics to obesity and body fat distribution.

Central obesity increases the risk for cardiovascular disease, but little is known about its hemodynamic effects. The aims were to investigate the influence of obesity (as defined by body mass index) and abdominal fat accumulation (as defined by the waist/hip ratio) on hemodynamics at rest and during mental stress. Invasive hemodynamic studies were performed in 20 healthy, normotensive young men (aged 18-22 years) recruited from an unbiased population sample. Their body mass index and waist/hip ratio ranged between 18.5 and 30.2 (mean 24.1) and 0.77 and 0.98 (mean 0.87), respectively. Hemodynamics were related to the two anthropometric indexes by bivariate regression analyses. Cardiac output and stroke volume were positively correlated to body mass index (p = 0.05 and p = 0.005), but inversely to waist/hip ratio (p = 0.01 and p = 0.01). Mental stress augmented the hemodynamic patterns. Total peripheral resistance during stress correlated inversely to body mass index (p = 0.02), whereas high waist/hip ratio was associated with higher systemic vascular resistance p = 0.002). The delta CO/delta MAP ratio, i.e., relative contribution of cardiac output for the stress-induced increase in mean arterial pressure, showed a strong positive association with body mass index (p = 0.004), but was inversely related to the waist/hip ratio (p = 0.002). Serum insulin correlated significantly to the stress-induced change in total peripheral resistance (r = 0.54; p = 0.02), whereas the increase in cardiac output was inversely related to insulin (r = -0.59; p = 0.007). Thus, central obesity is associated with a specific hemodynamic pattern characterized by higher total peripheral resistance, lower cardiac output, and a vasoconstrictor response to psychosocial stress.

Adipose Tissue↗
PubMed1994

24-hour energy expenditure and substrate oxidation rates are unaffected by body fat distribution in obese women.

Twenty-four-hour energy expenditure (EE) and nonprotein respiratory quotient (RQnp) were measured by indirect calorimetry in 19 upper-body-obese (UBO) and 15 lower-body-obese (LBO) women with similar body mass index (BMI) and body fat percent. The measurements were performed in a respiration chamber on a predetermined physical activity program and a controlled diet. No differences between the UBO and LBO groups were found in 24-hour, daytime, and sleeping EE after adjustment for differences in fat-free mass (FFM). Furthermore, no group effect was observed in RQnp, but a positive correlation was found between RQnp and age. Despite the fact that an increased free fatty acid (FFA) turnover has been found in UBO subjects, the present study does not support the contention that upper-body obesity is accompanied by an increased lipid oxidation.

Adipose Tissue↗
PubMed2005

Regional body fat distribution in HIV-infected patients with lipodystrophy.

BACKGROUND: Objective criteria for the assessment of patients with lipodystrophy syndrome in human immunodeficiency virus infection (LDHIV) have not emerged. METHODS: We compared regional body fat changes in 13 men with severe LDHIV on protease inhibitor-inclusive antiretroviral therapy with 13 control HIV-infected men using anthropometry, dual-energy X-ray absorptiometry (DEXA), and whole-body magnetic resonance imaging (MRI). RESULTS: LDHIV patients, compared with control subjects, had thinner gluteal, suprailiac, and triceps skinfolds (p < .01) and increased waist circumference (98 +/- 5 cm vs 86 +/- 9 cm, respectively; p = .0008). DEXA studies revealed reduced lower extremity fat (12 +/- 5% vs 22 +/- 9%; p = .0006), increased head and neck fat (18 +/- 3% vs 16 +/- 1%; p = .01), and increased proportion of total body fat in the trunk (65 +/- 7% vs 53 +/- 8%; p = .0005). MRI analysis revealed reduced thigh fat (12 +/- 5% vs 22 +/- 12%; p = .01), increased dorsocervical fat depth (47 +/- 24 mm vs 19 +/- 7 mm; p = .0009), and nearly significant increase in intra-abdominal fat (218 +/- 90 cm2 vs 157 +/- 70 cm2; p = .057). Interestingly, control subjects showed a positive relationship between intra-abdominal and dorsocervical fat (r= .57, p = .04), but the LDHIV patients showed a negative relationship (r= -.55, p = .05), suggesting a novel split phenotype among LDHIV patients of either dorsocervical or intra-abdominal fat accumulation. CONCLUSIONS: We conclude that MRI provides the best tools for definition of LDHIV syndrome and reveals variable phenotypes among LDHIV patients.

Absorptiometry, Photon↗
PubMed1996

Inhibition of cortisol secretion by dexamethasone in relation to body fat distribution: a dose-response study.

There is now evidence of a hypersensitive hypothalamo-pituitary-adrenal (HPA) axis in subjects with an elevated waist/hip circumference ratio (WHR), an indicator of the centralization of body fat stores. The activity of the HPA axis is regulated by central glucocorticoid receptors, whose activity can be tested by the administration of exogenous glucocorticoids, which normally inhibit cortisol secretion. In this study, dexamethasone (dex) was administered in random order in doses of 0.05, 0.125, 0.25 and 0.5 mg at 10 p.m. with measurements of serum cortisol in the morning (8 a.m.) of this and the following day. The test was performed on 22 apparently healthy men, 40 to 60 years of age, recruited from laboratory personnel, outpatient clinics or advertisements in a newspaper. Eight had a body mass index (BMI) (kg/m2) of < 25 and 14 of > 25. Twelve men had a waist hip ratio (WHR) of < 1.0 and 10 men had a WHR of > 1.0. Cortisol values at baseline were correlated inversely with WHR and were usually lower in men with a high (> 1.0) rather than a low than low (< 1.0) WHR after dex inhibition. There was apparently no inhibition by dex at 0.05 and 0.125 mg on average in men with a WHR of > 1.0. In addition, the inhibition at 0.5 mg dex correlated negatively with the WHR and was significantly lower (p < 0.05) in men with a WHR of > 1.0 than in men with a WHR of < 1.0. None of these differences or relationships was found to be dependent on BMI. It is concluded that men with an elevated WHR experience a decrease in the inhibition of cortisol secretion by dex. It is suggested that this could explain or contribute to the elevated sensitivity of their HPA axis. Furthermore, lower morning cortisol concentrations suggest a change in diurnal secretion patterns.

Adult↗
PubMed2000

Associations of leptin with body fat distribution and metabolic parameters in non-insulin-dependent diabetic patients: no effect of apolipoprotein E polymorphism.

Leptin levels have been shown previously to be associated with anthropometric parameters such as the body mass index (BMI), total body fat, and subcutaneous fat. Since apolipoprotein E (apoE) polymorphism is known to be a genetic marker affecting the relationship between certain anthropometric and metabolic parameters, we evaluated whether the leptin level and/or associations between the leptin level and body composition in non-insulin-dependent diabetic patients could be determined by apoE polymorphism. In 171 type 2 diabetic patients (105 male and 66 female), body composition (BMI, waist to hip ratio [WHR], fat mass, and visceral fat) was measured and fasting blood samples were obtained to determine the apoE genotype, leptin, glucose, and insulin levels, and the lipid profile. The mean leptin level for the whole group was 11.7 +/- 9.3 ng/mL, with a significant difference (P < .001) between men (7.1 +/- 4.9 ng/mL) and women (19.0 +/- 10.1 ng/mL). No difference was found for leptin levels or anthropometric variables between the 3 different apoE genotypes (E3/E3 homozygotes, E2 carriers, and E4 carriers). Only low-density lipoprotein (LDL) cholesterol was significantly different between the 3 apoE subgroups. The correlations of leptin with anthropometric variables, especially visceral fat, tended to be different between the 3 apoE groups, but this was not independent and no effect was found after controlling for the other parameters in the model. A multiple regression model containing gender, subcutaneous fat, fasting glucose, triglycerides, and high-density lipoprotein (HDL) cholesterol explained 81% of the variance in leptin levels. We conclude that apoE polymorphism has no effect on the leptin level or its associations with other anthropometric and metabolic parameters.

Apolipoproteins E↗
PubMed1994

Obesity and regional body-fat distribution in men: separate and joint relationships to glucose tolerance and plasma lipoproteins.

Relationships between obesity and fat distribution as evaluated by computed tomography and metabolic variables were studied in 35 men. Significant correlations emerged between body mass index and sum of glucose during oral glucose load and HDL3 triglycerides and also between visceral abdominal fat and triglycerides, apolipoprotein B, sum of insulin during oral glucose load, very-low-density-lipoprotein (VLDL) cholesterol, and VLDL and low-density-lipoprotein (LDL) triglycerides. Visceral abdominal fat correlated negatively with the ratio of HDL to LDL cholesterol. When the subjects were subdivided into four groups according to body mass index (< or = 26.7, > 26.7) and median visceral abdominal fat, no significant differences were found in body mass index, whereas significant differences were found for triglycerides, cholesterol, apolipoprotein B, VLDL cholesterol, HDL:LDL cholesterol, and VLDL triglycerides. Our study shows that the amount of visceral abdominal fat is the most relevant factor for metabolic abnormalities. Our data also suggest that the effect of visceral fat is independent of body mass index.

Adipose Tissue↗
PubMed1992

Smoking initiation and cessation in relation to body fat distribution based on data from a study of Swedish women.

In a representative sample of Swedish women, smokers were significantly less obese than nonsmokers. However, a smoker was likely to have significantly more upper-body fat than a nonsmoker of similar body mass index. Women who quit smoking experienced less upper-body fat deposition than would be expected by their accompanying weight gain, suggesting that weight gained as a consequence of smoking cessation is not preferentially deposited in the region associated with increased cardiovascular risk.

Age Factors↗
PubMed2006

Increased dietary protein and combined high intensity aerobic and resistance exercise improves body fat distribution and cardiovascular risk factors.

We investigated the effectiveness of two lifestyle modification programs of exercise training and nutritional intake (ad libitum) on improving body composition and disease risk in overweight/obese men and women. Sixty-three subjects were weight matched and assigned to one of three groups for a 12 wk intervention: (1) high-intensity resistance and cardiovascular training and a balanced diet (RC+BD, 40% CHO: 40% PRO; n=27, 16 female/11 male, age = 42 +/- 9 y); (2) moderate-intensity cardiovascular training and a traditional food guide pyramid diet (C+TD, CHO 50 to 55%; PRO 15 to 20%; FAT < 30%; n=19, 10 female/9 male, age = 43 +/- 10 y); and (3) an inactive control group (C, n=17, 5 female/12 male, age 43 +/- 11 y). RC+BD resulted in more favorable changes (P < 0.01) in percent body fat (-15.8% vs. -6.9%) and abdominal fat (-15.6% vs. -7.5%) compared to C+TD and C. Total cholesterol (-13.8%), LDL-cholesterol (-20.8%), and systolic blood pressure (-5.7%) declined (P > 0.05) in RC+BD, whereas C+TD and C remained unchanged. Our results suggest that RC+BD may be more effective than C+TD and C in enhancing body composition and lowering cardiovascular risk in obese individuals.

Adipose Tissue↗
PubMed1998

Circadian rhythm of plasma leptin levels in upper and lower body obese women: influence of body fat distribution and weight loss.

Plasma leptin concentrations were measured every 20 min for 24 h in eight normal weight women and in eight upper body and eight lower body obese women matched for body mass index. The circadian rhythm of leptin, which could mathematically be described by a cosine, was characterized by an acrophase just after midnight in all subjects. The amplitude of a cosine fit as well as the average 24-h leptin concentration were increased by 280% and 420%, respectively, in obese compared to normal weight women. All characteristics of leptin concentration profiles were similar in upper body and lower body obese women, except for a significantly higher amplitude in the lower body obese group. Visceral and sc body fat depots were measured using magnetic resonance imaging in all three groups. Average 24-h leptin concentrations were strongly correlated with sc fat (r = 0.84), whereas visceral fat was not an independent predictor of the plasma leptin level. A loss of 50% of the overweight was associated with a 55% decrease in the average 24-h leptin concentrations in obese women (95% confidence interval, 12.3, 26.6), whereas the characteristics of the circadian rhythm of leptin remained unchanged. Finally, it was observed that a fasting plasma leptin concentration is not an acceptable indicator of the average leptin concentration over 24 h.

Adipose Tissue↗