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Exogenous androgens influence body composition and regional body fat distribution in obese postmenopausal women--a clinical research center study.

Abdominal fat distribution is influenced by androgen levels in both men and women. The purpose of this study was to assess the effects on fat distribution of administering nandrolone decanoate (ND; an anabolic steroid with weak androgenic activity) or spironolactone (SP; an antiandrogen) in obese postmenopausal women. The design was a randomized, placebo-controlled, 9-month trial with simultaneous calorie restriction for weight loss. Women in all three groups lost comparable amounts of weight, but the ND-treated women gained lean mass relative to the other two groups (P < 0.0005) and lost more body fat than women in the SP group (P < 0.01). The resting metabolic rate also increased slightly in the ND group. ND treatment produced a gain in visceral fat, as determined by computed tomography scan, and a relatively greater loss of sc abdominal fat. SP-treated women lost significantly less sc fat than the other two groups. Serum cholesterol decreased in the placebo group, but increased slightly in the other two groups (significant for SP vs. placebo, P < 0.05). High density lipoprotein cholesterol decreased significantly in the ND-treated women. There were no significant changes in fasting glucose or insulin sensitivity. We conclude that administration of exogenous androgens modulates body composition in obese postmenopausal women and independently affects visceral and sc abdominal fat.

Adipose Tissue↗

The effect of metformin on the metabolic abnormalities associated with upper-body fat distribution. BIGPRO Study Group.

OBJECTIVE: The constellation of anomalies associated with insulin resistance is a plausible additional cause of ischemic cardiovascular disease and of NIDDM. To test this hypothesis in a primary prevention trial, the effects of metformin as a potential candidate for intervention in the insulin resistance syndrome (IRS) were evaluated in 324 middle-aged subjects with upper-body obesity. RESEARCH DESIGN AND METHODS: Trial patients were selected on the basis of a high waist-to-hip ratio. They were randomly allocated to receive either metformin or placebo, following a double-blind procedure. After 1 year of treatment, the main clinical and biological parameters of the IRS were assessed and their evolution compared between treatment groups. RESULTS: Compared with placebo, metformin induced a significant weight loss, a better maintenance of fasting blood glucose, total and LDL cholesterol levels, and a greater decrease of fasting plasma insulin concentration. Moreover, tissue-type plasminogen activator antigen, a marker of fibrinolytic impairment, showed a significant decrease under metformin. By contrast, metformin treatment had no significant effect on blood pressure or serum triglyceride and HDL cholesterol concentrations. The main side effect of metformin was diarrhea. CONCLUSIONS: The BIGuanides and Prevention of Risks in Obesity (BIGPRO1) results suggest that metformin would be a suitable candidate for long-term intervention for the prevention of diabetes but that its use in a trial of primary prevention of cardiovascular diseases requires either a reevaluation of its properties toward the most potentially atherogenic anomalies of the IRS or a better definition of the target population.

Adipose Tissue↗

Effects of obesity and body fat distribution on lipids and lipoproteins in nondiabetic American Indians: The Strong Heart Study.

OBJECTIVES: To examine the relationship between obesity and lipoprotein profiles and compare the effects of total obesity and central adiposity on lipids/lipoproteins in American Indians. RESEARCH METHODS AND PROCEDURES: Participants were 773 nondiabetic American Indian women and 739 men aged 45 to 74 years participating in the Strong Heart Study. Total obesity was estimated using body mass index (BMI). Central obesity was measured as waist circumference. Lipoprotein measures included triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, apolipoprotein AI (apoAI), and apolipoprotein B (apoB). Partial and canonical correlation analyses were used to examine the associations between obesity and lipids/ lipoproteins. RESULTS: Women were more obese than men in Arizona (median BMI 32.1 vs. 29.2 kg/m2) and South Dakota and North Dakota (28.3 vs. 28.0 kg/m2), but there was no sex difference in waist circumference. Men had higher apoB and lower apoAI levels than did women. In women, when adjusted for center, gender, and age, BMI was significantly related to HDL cholesterol (r = -0.24, p < 0.001). There was a significant but weak relation with apoAI (r = -0.14, p < 0.001). Waist circumference was positively related to triglycerides (r = 0.14, p < 0.001) and negatively related to HDL cholesterol (r = -0.23, p < 0.001) and apoAI (r = -0.13, p < 0.001). In men, BMI was positively correlated with triglycerides (r = 0.30, p < 0.001) and negatively correlated with HDL cholesterol (r = -0.35, p < 0.001) and apoAI (r = -0.23, p < 0.001). Triglycerides increased with waist circumference (r = 0.30, p < 0.001) and HDL cholesterol decreased with waist circumference (r = -0.36, p < 0.001). In both women and men there was an inverted U-shaped relationship between obesity and waist with LDL cholesterol and apoB. In canonical correlation analysis, waist circumference received a greater weight (0.86) than did BMI (0.17) in women. However, the canonical weights were similar for waist (0.46) and BMI (0.56) in men. Only HDL cholesterol (-1.02) carried greater weight in women, whereas in men, triglycerides (0.50), and HDL cholesterol (-0.64) carried a large amount of weight. All the correlation coefficients between BMI, waist circumference, and the first canonical variable of lipids/lipoproteins or between the individual lipid/lipoprotein variables and the first canonical variable of obesity were smaller in women than in men. Triglycerides and HDL cholesterol showed clinically meaningful changes with BMI and waist circumference in men. All lipid/lipoprotein changes in women in relation to BMI and waist circumference were minimal. DISCUSSION: The main lipoprotein abnormality related to obesity in American Indians was decreased HDL cholesterol, especially in men. Central adiposity was more associated with abnormal lipid/lipoprotein profiles than general obesity in women; both were equally important in men.

Adipose Tissue↗

Androgenicity in relation to body fat distribution and metabolism in 38-year-old women--the European Fat Distribution Study.

We studied fat distribution and metabolic risk factors in 434 38-year old women selected from population registrars in 5 cities in different parts of Europe. In the present study we focussed on the geographical variation in serum concentrations of free testosterone and its relation to measures of obesity, fat distribution and indicators of cardiovascular risk (serum lipids, insulin, and blood pressure). There were significant differences in free testosterone levels (F = 5.4, p less than 0.001) with lowest levels in Polish women (mean +/- SEM: 1.56 +/- 0.08 pg/ml) and highest in women from Italy (2.07 +/- 0.12 pg/ml). In the pooled data, free testosterone levels were correlated with several anthropometric variables (strongest with subscapular/triceps ratio r = 0.27, with subscapular skinfold and waist/thigh circumference ratio r = 0.25 p-values less than 0.001). In addition, free testosterone was positively correlated with serum total cholesterol (r = 0.11), HDL/total cholesterol fraction (r = 0.12), serum insulin (r = 0.20) and diastolic blood pressure (r = 0.15). These associations remained significant after adjustment for body mass index and waist/thigh ratio (not for diastolic blood pressure) but were no longer significant after further adjustment for insulin levels. There were considerable differences in strength of the associations mentioned between the 5 centers. We conclude that degree of obesity, fat distribution and serum levels of free testosterone all, to a limited degree, contribute to the metabolic profile of randomly selected 38-year old women but that adjustment for such variables increases the differences in metabolic profiles between women from different centers of Europe.

Adipose Tissue↗

Body fat distribution and the risk of non-insulin-dependent diabetes mellitus in the Omani population.

Anthropometric measures of overall and central obesity as predictors of non-insulin-dependent diabetes mellitus (NIDDM) risk were studied. Data for 4728 Omanis were taken from the 1991 National Diabetes Survey. Diabetes mellitus was assessed using a 2-hour post glucose load. After adjusting for age, sex, family history of diabetes, physical activity and blood pressure, body mass index (BMI) was positively associated with increased risk of diabetes mellitus. Controlling for BMI and other potential confounders, waist-to-hip ratio and waist circumference were positively associated with increased risk of diabetes mellitus. Waist measurement (alone or with hip circumference) is a simple and independent tool for assessing the risk of NIDDM.

Adolescent↗

Precursors of essential hypertension. The role of body fat distribution pattern.

Progression from normotension between 1964 and 1972 to essential hypertension by age 55 years was documented in 1,031 adult members of the Kaiser Permanente Medical Care Program (Northern California region) from computerized multiphasic health checkup records and medical record review. Each case was matched to a persistently normotensive control on age, sex, race, number, and dates of multiphasics. In 609 pairs with baseline measurements of subscapular and triceps skinfolds, mean interval from baseline to the case's first hypertensive multiphasic was 5.7 years, and mean age at onset of hypertension was 47 years. Baseline measures of body mass index, subscapular skinfold, and triceps skinfold were each predictive of development of hypertension (odds ratios 3.85, 3.75, and 2.29 respectively, comparing highest with lowest quintiles, p less than 0.0001 for each). When both skinfolds were included in the same model, subscapular skinfold was highly predictive and triceps skinfold was no longer related to risk. When the authors controlled for overall obesity (body mass index), subscapular skinfold remained highly predictive (p less than 0.0001). In 330 pairs who also had skinfold measurements at the hypertensive multiphasic, weight gain was a strong predictor of hypertension. Increase in subscapular skinfold conferred a small increase in risk in women only. The authors conclude that centrally deposited body fat increases risk for developing essential hypertension independent of the overall level of obesity, while peripherally deposited fat does not.

Adipose Tissue↗

Relation of body fat distribution to ischemic heart disease. The National Health and Nutrition Examination Survey I (NHANES I) Epidemiologic Follow-up Study.

Although an excess of adipose tissue in the abdominal and truncal regions is associated with various metabolic alterations, relatively few cohort studies have examined its importance in the development of ischemic heart disease, and little information is available from black populations. The authors examined the relation of central obesity, as characterized by a thick subscapular skinfold relative to the triceps skinfold, to the incidence of ischemic heart disease among 9,822 persons in the Epidemiologic Follow-up Study of the National Health and Nutrition Examination Survey I; baseline data were collected in 1971-1975 and follow-up was through 1987. We found that, independently of relative weight, cigarette smoking, and other covariates, the hazard rate ratios for ischemic heart disease incidence contrasting the upper and lower quintiles of central obesity were 1.75 (95% confidence interval 1.3-2.3) among women and 1.65 (95% confidence interval 1.3-2.2) among men. Although central obesity was related similarly to disease among white and black men, the association among women differed between whites (rate ratio = 1.94) and blacks (rate ratio = 0.73); p = 0.002 for race x the central obesity product term. Additional research is needed to clarify the relation of various anthropometric measurements to ischemic heart disease, particularly among blacks, but the assessment of fat distribution may help identify high-risk persons for whom weight loss might be most beneficial.

Adipose Tissue↗

A validation study of body fat distribution as determined by self-measurement of waist and hip circumference.

The accuracy of self-measured waist and hip circumferences is investigated in 200 men and women 30-85 years old. Systematic bias is not found in circumferences measured by the men. Female subjects tend to underestimate waist circumference. This error is greatest in women with central fat distribution (characterized by waist:hip ratio). Misclassification of fat distribution pattern may result from this error, which may in turn lead to underestimation of associations between fat pattern and disease risk.

Adipose Tissue↗

Relationship of upper body fat distribution to serum glucose and lipids in a Costa Rican population.

Present models of the relation between subcutaneous fat distribution and serum biochemistries have been based largely on U.S. White populations. To determine interpopulational differences in that relation, we measured 68 clinically normal adult Costa Ricans aged 17-32. Data collected included six skinfolds: triceps, subscapular, suprailiac, umbilical, anterior mid-thigh, and medial calf; height, weight, and four fasting serum parameters: glucose, triglyceride, cholesterol, and high-density lipoprotein (HDL). Correlations between standardized skinfold ratios and biochemistries were highest--on the order of 0.40-0.50--for upper-lower body contrasts to triglyceride and cholesterol in males and to glucose and HDL in females. Canonical correlation analysis, with body mass index partialed out, found significant correlations for the first male variate and the first two female variates. The first male variate was positively weighted on subscapular fatness and on triglyceride and cholesterol, respectively. The two female skinfold variates were positively weighted on subscapular and on outer limbs, respectively, while their corresponding biochemical variates were weighted on glucose and triglyceride and on cholesterol and HDL, respectively. These findings are generally consistent with those based on U.S. populations but suggest that in non-Anglo populations, upper trunk fatness may be more relevant than anterior waist fatness to biochemical dysfunction.

Adipose Tissue↗

Body fat distribution in females: metabolic consequences and implications for weight loss.

The main function of adipose tissue is to store triglyceride during relative affluence and to break down this fat and release fatty acids and glycerol when needed. Both the deposition and degradation of lipid are under precise hormonal and neural control. Recently, it has become evident that adipose tissue is not homogeneous and that the regional distribution of fat may be important with respect to metabolism and hormonal responsiveness and, thus, of interest from a number of viewpoints. This review will focus on the physiological significance of differences in adipose tissue distribution and implications for the female. Included will be the hormonal and metabolic consequences of child bearing and the metabolic outcome for chronic disease risk. Furthermore, the influence of the distribution of adiposity on weight loss by diet and exercise, as well as changes in fat and lean tissue, will be examined. Possible directions for future research in this area will be discussed.

Adipose Tissue↗

Lean body mass and body fat distribution in participants with chronic low back pain.

BACKGROUND: Loss of muscle mass and central obesity progress with aging, but the effect of muscle loss on chronic low back pain has not been precisely evaluated. METHODS: Three hundred thirty Japanese persons aged 45 to 69 years, with a complaint of low back pain for longer than 3 months (n = 203) and age- and sex-matched healthy control subjects (n = 127), were enrolled in this study. Participants with chronic low back pain were classified into the following groups: (1) women with a positive straight leg raise test result, (2) women with a negative straight leg raise test result, (3) men with a positive straight leg raise test result, and (4) men with a negative straight leg raise test result. Controls were classified by sex into a female and a male group. Anthropometric data, consisting of body mass index, percentage body fat, waist-hip ratio, and lean body mass of the upper extremities, trunk, and lower extremities divided by body weight, were measured in participants with low back pain, and the results were compared with those of controls. RESULTS: The waist-hip ratio in women with a negative straight leg raise test result was significantly higher than those in the female control group (P<.001) and in the women with a positive straight leg raise test result (P =.04). The lean body mass of the trunk and lower extremities divided by body weight of women with a negative straight leg raise test result was significantly lower than that of female controls (P =.03 for the trunk and P<.001 for the lower extremities). However, no significant differences were detected between the female negative straight leg raise test result group and the female control group for lean body mass of the upper extremities divided by body weight or body mass index. There were no significant differences in anthropometric data between the male test and control groups or between the female positive straight leg raise test result group and the female control group. CONCLUSION: Trunk and lower extremity loss of muscle mass and central obesity may be risk factors for chronic low back pain without a positive straight leg raise test result in women aged 45 to 69 years. Arch Intern Med. 2000;160:3265-3269.

Adipose Tissue↗

Body fat distribution's impact on physiologic outcomes during cardiac rehabilitation.

BACKGROUND: High waist-to-hip ratios (WHRs) predispose individuals to metabolic syndromes that may affect outcome responses to cardiac rehabilitation programs. METHODS: A total of 101 male patients who had undergone coronary artery revascularization surgery and completed 12 weeks of cardiac rehabilitation were divided into lower (LOWHR, n = 51) and higher (HIWHR, n = 50) waist-to-hip groups. Outcomes were measured at week 1 and week 12 of cardiac rehabilitation. RESULTS: Waist-to-hip ratio and body weight were greatest for HIWHR (P < 0.001) with no between-group differences in the amount of change from week 1 to 12. Triceps and subscapular skin-folds were greater for HIWHR (P < 0.001) with no difference in the amount of change between groups. Caloric expenditure during exercise class was higher for LOWHR (P = 0.022). Daily caloric expenditure was greater for LOWHR (P = 0.034) as was daily caloric intake (P < 0.001). There were no group differences for VO2peak and ventilatory anaerobic threshold (VAT) with nonsignificant trends for greater increases in LOWHR. CONCLUSIONS: Cardiac rehabilitation patients with greater WHRs expend less calories during exercise classes. To enhance overall caloric expenditure and obtain positive outcomes, cardiac rehabilitation professionals must emphasize greater activity with less sedentary time throughout the patients normal daily routine. The validity of using self-reported caloric intake and expenditure values in the cardiac rehabilitation population is questionable.

Adipose Tissue↗

Micro-albuminuria in obese subjects: relationship among body fat distribution, blood pressure and left ventricular structure and function.

OBJECTIVE: To evaluate the relationships among micro-albuminuria, blood pressure and measurements of left ventricular structure and function in centrally and peripherally obese subjects compared with members of a lean control group. METHODS: Centrally obese subjects were subdivided according to whether they had levels of micro-albuminuria higher than 30 mg/24 h (micro-albuminuric group) or lower than or equal to 30 mg/24 h (normo-albuminuric group). For all the subjects we measured heart rate, casual mean blood pressure (MBP), 24 h MBP, total cholesterol level, high-density lipoprotein cholesterol, lipoprotein (a) level, fasting immunoreactive insulin level, plasma renin activity, plasma aldosterone level and micro-albminuria (UAE) by current methods. Left ventricular mass indexed for body height, left ventricular diastolic and systolic diameters, interventricular septal thickness and left ventricular ejection fraction were measured by echocardiography. Peak filling rate was also calculated by radionuclide study. Family history of cardiovascular disease was evaluated for all the obese subjects.RESULTS: Lipoprotein (a) level, total cholesterol level, 24 h MBP and interventricular septal thickness were significantly (P < 0.05) greater for micro-albuminuric than they were for normo-albuminuric centrally obese subjects, whereas high-density lipoprotein cholesterol level and left ventricular ejection fraction were significantly (P < 0.05 lower. In addition, UAE levels of centrally obese subjects were significantly (P < 0.05) higher than those of peripherally obese subjects. UAE of all the centrally obese subjects was correlated directly to lipoprotein (a) level (r = 0.33, P < 0.009), 24 h MBP (r = 0.41, P < 0.002), interventricular septal thickness (= 0.36, P < 0.005) and family history of cardiovascular disease (r = 0.33, P < 0.007). Multiple regression analysis indicated that UAE was independently related to 24 h MBP and family history of cardiovascular disease. CONCLUSION: Our data indicated that measurement of micro-albuminuria is useful for evaluating cardiovascular risk profiles of obese subjects with a central fat distribution.

Journal Article↗

Body fat distribution, plasma lipoproteins and the risk of coronary heart disease of male subjects.

Recent studies have related waist to hip ratio (WHR) to the incidence of coronary heart disease (CHD), but the causes underlying this relation are not fully known. The purpose of this study was to determine if waist to hip ratio is associated with the concentration of plasma lipids and apolipoproteins (apoproteins) that predispose individuals to a higher CHD risk. Plasma lipids and apoprotein concentrations were determined in 100 male volunteers, ranging in age from 19-68 yr, and WHR ranging from 0.89-1.09. Significant positive associations were found between WHR, plasma glucose (r = 0.25, P = 0.01), cholesterol (r = 0.21, P = 0.04), LDL cholesterol (r = 0.22, P = 0.03), triglycerides (r = 0.25, P = 0.01) and the ratio of total cholesterol to HDL-cholesterol (r = 0.30, P = 0.002). Negative associations were found between WHR and HDL-cholesterol (r = -0.19, P = 0.05), plasma apoprotein A-I (4 = -0.28, P = 0.005) and the ratio of plasma apoprotein A-I to apoprotein B (r = -0.26, P = 0.01). To determine the extent to which these correlations were independent of age and body fat content, a subsample of 15 pairs matched on age and percent body fat, but differing in WHR was selected from the larger sample. In the group with high WHR (1.06) HDL-cholesterol and apo A-I levels were lower and apo B higher than in the group with low WHR (0.96). Total cholesterol, triglycerides and LDL cholesterol levels in the group with high WHR were also higher but marginally significant statistically. These results show that WHR is associated with plasma lipid and apolipoprotein concentrations that are more predisposing to CHD and that males with male type obesity may be at a higher risk of CHD development than those with female type, regardless of age or degree of obesity.

Adipose Tissue↗

Body fat distribution, obesity, overweight and stroke incidence in women and men--the NHANES I Epidemiologic Follow-up Study.

OBJECTIVE: To test the hypothesis that an elevated ratio of subscapular to triceps skinfold thickness (SFR), a measure of truncal obesity, is associated with increased incidence of stroke independent of overweight. DESIGN: Data from the NHANES I Epidemiologic Follow-up Study were analyzed. SUBJECTS: A cohort of 3652 women and 3284 men with complete data who had no history of stroke at baseline in 1971-1975. MEASUREMENTS: Incidence of stroke diagnosed at hospital discharge or death during the follow-up period through 1992; triceps and subscapular skinfold thickness (SSF) and body mass index (BMI) at baseline. RESULTS: In a complex relationship, higher SFR was associated with a mildly but significantly increased incidence of stroke only in white male former smokers. In white men, SSF showed a U-shaped association with stroke risk. In white men, stroke risk was elevated in the top quartile of BMI only in never smokers. In black women, stroke risk was significantly elevated in the bottom compared to the top quartile of BMI. No significant associations were seen in white women or black men. CONCLUSIONS: In white men, SSF showed a U-shaped association with stroke risk, which was elevated in the top quartile of BMI only in never smokers. Surprisingly, stroke risk was elevated in black women with the lowest BMI. More studies of these associations are needed, especially in black women.

Adipose Tissue↗

Body fat distribution and risk of non-insulin-dependent diabetes mellitus in women. The Nurses' Health Study.

Obesity is an established risk factor for non-insulin-dependent diabetes mellitus (NIDDM). Anthropometric measures of overall and central obesity as predictors of NIDDM risk have not been as well studied, especially in women. Among 43,581 women enrolled in the Nurses' Health Study who in 1986 provided waist, hip, and weight information and who were initially free from diabetes and other major chronic diseases, NIDDM incidence was followed from 1986 to 1994. After adjustment for age, family history of diabetes, smoking, exercise, and several dietary factors, the relative risk of NIDDM for the 90th percentile of body mass index (BMI) (weight (kg)/height (m)2) (BMI = 29.9) versus the 10th percentile (BMI = 20.1) was 11.2 (95% confidence interval (CI) 7.9-15.9). Controlling for BMI and other potentially confounding factors, the relative risk for the 90th percentile of waist: hip ratio (WHR) (WHR = 0.86) versus the 10th percentile (WHR = 0.70) was 3.1 (95% CI 2.3-4.1), and the relative risk for the 90th percentile of waist circumference (36.2 inches or 92 cm) versus the 10th percentile (26.2 inches or 67 cm) was 5.1 (95% CI 2.9-8.9). BMI, WHR, and waist circumference are powerful independent predictors of NIDDM in US women. Measurement of BMI and waist circumference (with or without hip circumference) are potentially useful tools for clinicians in counseling patients regarding NIDDM risk and risk reduction.

Adult↗

[Body fat distribution: anthropometric indicators].

There are two types of fat distribution in obese subjects. The abdominal, superior, android or apple shaped and the gluteo-femoral, gynecoid, inferior or pear shaped. In the former, fat is accumulated in the abdomen and in the latter, in the gluteal region. The superior distribution is associated with a higher risk of cardiovascular diseases. Among anthropometric measurements of fat distribution, the ratio between waist circumference measured at the level of the navel and hip circumference, measured at the level of greater trochanters, is the best indicator. Using the cutoff points of 0.8 for women and 1 for men, it has a good correlation with visceral fat.

Adipose Tissue↗