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PubMed2004

Body fat distribution and risk of diabetes among Chinese women.

OBJECTIVE: To assess the relationship between measures of central and overall obesity and risk of diabetes. DESIGN: Nested case-control study. SETTING: Shanghai, China. PARTICIPANTS: A total of 57 130 women were screened for diabetes at enrollment for the Shanghai Women's Health Study (SWHS), a population-based cohort study of Chinese women aged 40-70 y. In this study, 345 women diagnosed with diabetes and 2760 age-matched controls (eight controls per case), randomly selected from women who tested negative for urine glucose, were included. RESULTS: Risk of diabetes increased significantly with increasing levels of obesity, particularly with measures of central obesity. Compared to those in the lowest quartile, women in the highest quartile of body mass index (BMI) (>/=26.57) and waist to hip ratio (WHR) (>/=0.855) had a 2.57-fold (95% CI 1.75-3.77) and a 6.05-fold (95% CI 4.05-9.04) increased risk of diabetes, respectively. The risk of diabetes was elevated with increasing WHR at all levels of BMI, while the positive association between BMI and diabetes was observed primarily among women with a low WHR. However, test for multiplicative interaction was not statistically significant. CONCLUSIONS: Our data indicated that central obesity is a stronger risk factor for diabetes than overall obesity, suggesting that WHR may be a better indicator of risk of diabetes than BMI among Chinese women.

Adult↗
PubMed1989

Body fat distribution measured with CT: correlations in healthy subjects, patients with anorexia nervosa, and patients with Cushing syndrome.

Computed tomography (CT) was used to study fat distribution in three groups of women of comparable age: 39 healthy volunteers, 15 patients with anorexia nervosa, and seven with Cushing syndrome. Patients with anorexia nervosa had a fivefold decrease in subcutaneous fat and only a twofold decrease in intraabdominal fat compared with the values for the volunteers. Patients with Cushing syndrome had less than a twofold increase in subcutaneous fat and greater than a fivefold increase in intraabdominal fat compared with values for the healthy subjects. These findings suggest that fat in different body compartments responds differently to disease processes and that CT can be used to measure these changes.

Adipose Tissue↗
PubMed1998

Breast-cancer incidence in relation to height, weight and body-fat distribution in the Dutch "DOM" cohort.

In a cohort of 11,663 participants in a breast-cancer screening program, height, weight, waist circumference and hip circumference were measured, and information about menstrual and reproductive history was obtained by questionnaire. After exclusion of 83 women with unclear menopausal status, the subjects were divided into 3 sub-cohorts: 5,891 women who were pre-menopausal at the time of data collection, 3,521 women who had entered the study after natural menopause, and 2068 women who had been hysterectomized and/or ovariectomized. After a median follow-up of 10.6 years, 147, 76 and 52 incident cases of breast cancer were detected in the 3 respective sub-cohorts. No statistically significant association was found in any of the sub-cohorts between breast-cancer risk and height, weight, body-mass index (BMI) or hip circumference. In the sub-cohort of women with natural menopause, however, risk of breast cancer was positively and significantly associated with the ratio of waist-to-hip circumferences (WHR) (RR = 2.63 for upper vs. lower quartile), and this association did not change after adjustment for variations in disease risk related to body height and weight. Although similar to observations in other cohort studies showing positive associations between obesity and breast-cancer risk in post-menopausal women, our results are different, in that WHR and not BMI appears to be the more specific indicator of breast-cancer risk.

Adipose Tissue↗
PubMed1998

Body fat distribution and hypertension 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), one measure of truncal obesity, is associated with increased incidence of essential hypertension. DESIGN: Data from the NHANES I Epidemiologic Follow-up Study (NHEFS) were analyzed. SUBJECTS: A cohort of 4303 women and 2579 men with complete data who were normotensive at baseline in 1971-1975. MEASUREMENTS: Incidence of hypertension, blood pressure 160/95 mm Hg or greater or on blood pressure medication at follow-up in 1982-1984. RESULTS: There was a statistically significant increase in risk of hypertension over approximately 10 y follow-up in white women aged 25-74 y with SFR in the fifth compared to the first quintile independent of age and body mass index (BMI) (relative risk = 1.52, 95% confidence interval 1.13-2.06, P = 0.006). The association was somewhat diminished after controlling for baseline blood pressure, change in BMI and other risk variables. An even stronger association was seen for subscapular skinfold and hypertension incidence. In white men aged 25-74 y, a significant association of high SFR with age-, BMI-adjusted risk of hypertension was seen (RR = 1.41, 95% CI 1.01-1.96, P = 0.04). Data for black women or black men failed to reveal significant variation in hypertension risk among quintiles of SFR or subscapular skinfold except in black women with low baseline BMI. CONCLUSIONS: Data from NHEFS confirm the association of higher truncal obesity with increased incidence of hypertension in white women. Further studies are needed, especially in larger samples of black women.

Adult↗
PubMed1996

Development of a rapid and efficient magnetic resonance imaging technique for analysis of body fat distribution.

Fast scan magnetic resonance imaging techniques for adipose tissue (AT) quantification were compared to a conventional T1-weighted spin-echo (SE) sequence (TR = 500 ms, TE = 20 ms), imaging a mid-abdominal slice. A rapid T1-weighted SE sequence (TR = 36 ms, TE = 14 ms) was optimal, with minimal distortion (field, motion, flow artefact). Tissue contrast was higher and visceral AT was clearly differentiated. Quantification of all AT compartments (total, subcutaneous, internal, visceral) showed close agreement with the T1-weighted SE sequence and reproducibility was high (coefficient of variation < 4.7%). For AT quantification in a whole subject, this fast technique allows each image to be acquired serially at the magnet isocenter, as the subject is moved through the scanner (serial isocenter scanning, SIS). This method provides minimal image distortion and allows rapid coverage of the whole body.

Abdomen↗
PubMed1999

Psychological and behavioral predictors of body fat distribution: age and gender effects.

OBJECTIVE: Abdominal fat has been shown to be associated with several adverse outcomes including diabetes, cardiovascular disease, and hypertension. Risk factors for abdominal fatness include genetic effects, age, and gender. Most recently, it has been hypothesized that psychological factors, as well as behavioral factors, may play a part in where fat is distributed. The purpose of this study was to assess the longitudinal predictive power of psychological variables (cynicism, anger, anxiety, and depression) measured in 1987 on waist-hip ratio (WHR) measured from 1992 to 1994 among different age and gender groups, as well as to test if alcohol consumption or smoking (measured in 1990) would mediate any of the relationships found. RESEARCH METHODS AND PROCEDURES: Data from the Swedish Adoption/Twin Study of Aging (n = 1392; average age: 58 years for middle-aged group and 74 years for older group; 58% female) were analyzed using a maximum-likelihood regression model where age, gender, and age by gender effects were assessed. RESULTS: Cynicism and anxiety predicted WHR in middle-aged subjects regardless of gender. Cynicism explained 2.5% of the variance in WHR and anxiety explained 1.7% of the variance in WHR. Anger predicted WHR in males regardless of age, explaining 4.0% of the variance; depression predicted WHR only in middle-aged females, explaining 2.0% of the variance. All analyses adjusted for body mass index, and neither alcohol consumption or smoking status mediated the relationships. DISCUSSION: These findings are suggestive with regard to the hypotheses that certain psychological states and behaviors may be associated with increased abdominal fatness.

Adipose Tissue↗
PubMed2000

Body fat distribution and cardiovascular risk in normal weight women. Associations with insulin resistance, lipids and plasma leptin.

OBJECTIVE: To systematically examine the correlations between insulin resistance, plasma leptin concentration, obesity and the distribution of fat assessed by anthropometry and magnetic resonance imaging in Asian women. DESIGN: A cross sectional study of non-diabetic, normal weight women. SUBJECTS: Twenty-one healthy women aged 38.8 y (s.d. 11.7) and BMI 22.6 kg/m2 (s.d. 2.3). MEASUREMENTS: Intraperitoneal, retroperitoneal and subcutaneous abdominal fat volume was assessed by magnetic resonance imaging. Anthropometric data were collected. Total fat mass was assessed by bioelectric impedance analysis. Fasting serum lipids, insulin and plasma leptin were assayed. RESULTS: Generalized obesity correlated with subcutaneous abdominal fat mass (r=0.83, P<0.001), but not with intra-abdominal fat mass. Both intraperitoneal fat mass and retroperitoneal fat mass increased with age (r=0.58, P=0.005 and r=0. 612, P=0.003, respectively). Abdominal subcutaneous fat mass was the most important determinant of insulin resistance and plasma leptin. Of the serum lipids, only fasting triglyceride correlated significantly with the waist-to-hip ratio. CONCLUSIONS: It is possible that the large size of the subcutaneous depot compared to the intra-abdominal depot overwhelms any metabolic differences between adipose tissue from these two sites, resulting in the stronger correlation between insulin resistance and subcutaneous abdominal fat mass rather than intra-abdominal fat mass. On the other hand, the distribution of fat between subcutaneous fat depots may be important in the metabolic syndrome given the correlation of fasting triglyceride with waist to hip ratio but not with abdominal fat. However, the study population was small, younger and leaner compared to previous studies and we may not be able to generalize these results to all segments of the population. We confirm that subcutaneous fat mass is the major determinant of plasma leptin.

Abdomen↗
PubMed2001

Relationships between tamoxifen use, liver fat and body fat distribution in women with breast cancer.

Tamoxifen is a nonsteroidal anti-estrogenic drug used for adjuvant treatment of breast cancer and recently as a chemopreventative agent for breast cancer and, on an investigational basis, for other cancers. To date there are case reports of hypertriglyceridemia and fatty liver disease in tamoxifen users. Fatty liver is associated with visceral obesity and other components of the metabolic syndrome. Here we evaluated steatosis and adipose tissue distribution by CT scan in a cross-sectional study of 32 women on tamoxifen and 39 control women. Tamoxifen users had more visceral adipose tissue (VAT) and more liver fat than controls. This is the first study to demonstrate that fatty liver and intra-abdominal fat accumulation are common in breast cancer patients receiving tamoxifen. Prospective studies of tamoxifen should monitor metabolic changes in obese women with or without breast cancer.

Adipose Tissue↗
PubMed1997

Body fat distribution and race differences in apolipoprotein A1.

OBJECTIVE: This is the first study to assess the role of waist-to-hip ratio in explaining race differences in levels of serum apolipoprotein A1, a protective risk factor for atherosclerosis. METHODS: Linear regression analyses were used in a community-based survey of 3,043 adults (23.5% African-American) to assess associations of race, age, anthropometric measures, education, diabetes, blood pressure medication use, cigarette smoking, and leisure-time physical activity with apolipoprotein A1 levels. RESULTS: Higher apolipoprotein A1 levels were observed among African-American than among white adults (African-American men: +15.6 mg/dl than white men, African-American women: +3.1 mg/dl more than white women; p < 0.05). Waist-to-hip ratio and other variables did not account for race differences among men. African-American women had +8.6 mg/dl higher levels than white women after adjustment for differing distributions of waist-to-hip ratio, age, body mass index and education. Cigarette smoking, physical activity, and medical history accounted for no further differences among women. CONCLUSIONS: Higher levels of obesity indicators and lower educational attainment among African-American women reduced a potentially greater beneficial race difference in apolipoprotein A1. These findings also suggest that other environmental and biochemical factors may play roles in explaining the higher protective levels of apolipoprotein A1 observed among African-American children and adults.

Adipose Tissue↗
PubMed1996

Serum levels of sex hormones, thyroid hormones, growth hormone, IGF I, and cortisol and their relations to body fat distribution in healthy women dependent on their menopausal status.

The relations between 10 anthropometric variables describing the amount of adipose tissue and the serum levels of thyroxine, triiodothyronin, thyroid stimulating hormone, estradiol, progesterone, 17-hydroxyprogesterone, prolactin, luteinizing hormone, follicle stimulating hormone, DHEA-S, androstendion, testosterone, sex hormone binding globulin, growth hormone, IGF I as well as cortisol were investigated in 39 premenopausal and 38 postmenopausal women. Several statistically significant correlations between hormonal parameters and the amount and the distribution of subcutaneous fat tissue were found for the premenopausal group. The postmenopausal probands, however, showed fewer statistically significant connections between the two trait systems. The correlation patterns in both proband groups resembled each other. Only with regard to the gonadotropines (LH and FSH) a difference in the algebraic sign of the correlation coefficients can be observed for pre- and postmenopausal probands. The multiple regression analysis corroborated the hypothesis that hormonal parameters are responsible for somatic changes after menopause.

Adipose Tissue↗
PubMed1997

Gender differences in serum leptin in obese people: relationships with testosterone, body fat distribution and insulin sensitivity.

Testosterone levels are decreased in obese men but increased in obese women. The interplay between gonadal steroids and leptin is, at present, far from being elucidated. This study was carried out to investigate the relationship between serum leptin, plasma insulin, insulin sensitivity and free testosterone in 46 men (29 obese and 17 lean) and 65 premenopausal women (42 obese and 23 lean). In all subjects, anthropometric parameters and serum levels of insulin, leptin, free testosterone (T), dehydroepiandrosterone sulphate and sex hormone-binding globulin were measured. An oral glucose tolerance test (OGTT) and an insulin tolerance test were also performed to determine the insulin sensitivity index. Our results show a significant difference in serum leptin between lean and obese men (3.19 +/- 0.71 vs. 20.28 +/- 0.26 ng mL-1; P < 0.0005) as well as between lean and obese women (10.78 +/- 2.14 vs. 34.79 +/- 2.26 ng mL-1; P < 0.00001). Basal T concentration in the obese men was significantly lower than in the control group (18.6 +/- 1.3 vs. 23.3 +/- 1.4 ng L-1; P < 0.01), whereas in the obese women it was significantly higher than in the control group (2.0 +/- 0.2 vs. 1.3 +/- 0.1 ng L-1; P < 0.05). When multiple linear regression was performed without body mass index (BMI) in the statistical model, leptin was correlated with basal insulin (P < 0.0001), insulin sensitivity (P < 0.0001) and T (P < 0.0001) in both men and women. When BMI was included in the model as an independent variable, leptin was significantly correlated only with BMI (P < 0.0001), the degree of insulin resistance (P < 0.05) and T (only in men, P < 0.05). This study confirms that serum leptin is strongly correlated with the degree of obesity and female sex. The negative correlation between leptin and T in men, independent of BMI, is consistent with the hypothesis that T may possess an inhibitory effect on adipocyte ob gene transcription.

Adipose Tissue↗
PubMed1988

Is body fat distribution changed by dieting?

Studies of fat distribution have generally relied on the ratio of circumference measurements, such as waist/hip, or waist/thigh. However, these circumferences do not increase at a uniform rate with increasing obesity, and fat is deposited relatively more in the antero-posterior axis of the trunk and limbs than laterally. With weight loss the waist/hip ratio does not change, but the waist/thigh ratio decreases. This is to be expected since in obesity there is a relatively greater deposition of fat at the waist than on the thighs. Serial studies of a small number of subjects with unusually large or small fat depots at particular sites suggest that these characteristics persist after weight loss. It is probable on theoretical grounds that (except in special cases, such as lactation) a similar proportion of fat is gained and lost in all fat depots, although the relative size of these depots differs between individuals.

Adipose Tissue↗
PubMedDate not supplied

Obesity, body fat distribution, and coronary artery disease.

Obesity is an independent risk factor for the development of coronary artery disease (CAD). Obesity also increases risk for CAD indirectly through its association with insulin resistance, hyperlipidemia, and hypertension. An increased accumulation of fat in the intraabdominal cavity, termed visceral adiposity, is highly correlated with an adverse coronary risk profile. In patients at risk for coronary artery disease, the treatment of obesity results in an improved coronary risk profile. The prevalence of obesity is extremely high in coronary populations, yet the effect of weight loss on cardiovascular outcomes in CAD patients has received relatively little attention. Observational studies in the cardiac rehabilitation setting showed that patients who lose weight and exercise show an improvement in coronary risk profile. Further research is needed to better define the clinical effectiveness of weight loss programs and their benefits in coronary patients.

Adipose Tissue↗
PubMed2000

Genetic evidence for obesity loci involved in the regulation of body fat distribution in obese type 2 diabetes rat, OLETF.

The Otsuka Long-Evans Tokushima Fatty (OLETF) rat is an animal model for obese type 2 diabetes in human. Obesity is essential for the onset of type 2 diabetes in this rat. Our present investigation was designed to identify quantitative trait loci (QTLs) contributing to obesity by performing a whole-genome search using 214 F(2) intercross progeny between OLETF and F344 rats. We have identified six QTLs responsible for adiposity indices of fat pads on rat chromosomes 2 (Obs1 for mesenteric fat), 4 (Obs2 for retroperitoneal fat), 8 (Obs3 for mesenteric fat), 9 (Obs4 for retroperitoneal fat), and 14 (Obs5 and Obs6 for retroperitoneal fat), demonstrating that the adiposity indices of individual fat pads were under the control of different genes. As expected, the OLETF allele corresponds to increased adiposity indices for all QTLs, except for Obs3, in which the F344 allele leads to an increase in the index.

Adipose Tissue↗
PubMed1995

Body weight versus body fat distribution, adiposity, and frame size as predictors of bone density.

Weight is strongly associated with bone mineral density (BMD), but the mechanism of this effect is not well understood. Weight, height, hip-waist ratio, elbow breadth, adiposity, and BMD were measured in 6705 older women participating in the Study of Osteoporotic Fractures. Adiposity was measured by bioelectric impedance and BMD by single-photon (proximal and distal radius and calcaneus) and dual-energy x-ray absorptiometry (lumbar spine and proximal femur). Age-adjusted associations between weight and BMD were robust at all sites (R2 = 5.9-20.4%), but the addition of other anthropometric variables to the model only marginally improved the association. Adiposity explained a substantial fraction of the effect of weight on BMD, particularly at weight-bearing sites (36-62%). On the other hand, weight explained virtually all the variability of adiposity on BMD at weight-bearing sites (81-100%). At the radial measurement sites, adiposity had more substantial independent contributions. Weight did not seem to influence the relationship between BMD and age. In sum, at weight bearing-sites, the preponderance of the effect of weight on BMD is a direct result of mass effects rather than adiposity, whereas at non-weight-bearing sites, adiposity exerts more important effects, potentially mediated by metabolic factors.

Adipose Tissue↗
PubMed1995

Hyperuricaemia: relationships to body fat distribution and other components of the insulin resistance syndrome in 38-year-old healthy men and women.

The aim of this work was to evaluate whether hyperuricaemia correlates with the cluster of metabolic and haemodynamic disorders closely associated with insulin resistance syndrome (IRS) in young apparently healthy individuals also, and, if so, whether hyperinsulinaemia itself or some other component of this syndrome, are independently associated with hyperuricaemia. The subjects were a random population sample of 181 (M = 94/F = 87) 38-year-old apparently healthy subjects, non-diabetic, without a history of gout. Obesity (overall and regional), serum lipid profile, uric acid, fasting glucose and insulin, 2 h insulin after glucose-load (only in men), blood pressure and main behavioural variables were measured. As expected, most parameters were statistically different between men and women. In particular, serum uric acid levels were significantly higher in the male group than in female group (348 +/- 59 mumol l-1 vs 277 +/- 59 mumol l-1, P < 0.0001). After adjustment for sex, in pooled individuals, serum uric acid concentration showed positive associations with BMI (r = 0.21; P < 0.001), waist/hip girth (WHR; r = 0.45; P < 0.0001), waist/thigh girth (WTR; r = 0.35; P < 0.0001) and subscapula/triceps skinfold ratios (STR; r = 0.30; P < 0.001). Furthermore, serum uric acid was also positively correlated with fasting insulin (r = 0.23; P < 0.001), serum triglycerides (r = 0.34; P < 0.0001), LDL cholesterol (r = 0.16; P = < 0.01), diastolic blood pressure (r = 0.26; P < 0.001), and negatively with HDL/total cholesterol ratio (r = 0.28; P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗
PubMed2004

Insulin sensitivity, body fat distribution, and family diabetes history: the IRAS Family Study.

OBJECTIVE: Markers of insulin resistance are often apparent in nondiabetic relatives of subjects with type 2 diabetes. Whether diabetes family history (FH) also predicts visceral fat accumulation and, if so, whether the increased insulin resistance in relatives of diabetic subjects occurs independently of visceral fat accumulation are not known. RESEARCH METHODS AND PROCEDURES: To examine this issue, we studied the relationship of diabetes FH with insulin sensitivity and fat measures, measured by minimal model analysis and computed tomography, respectively, in families participating in the Insulin Resistance Atherosclerosis (IRAS) Family Study. FH scores were based on the diabetes status of the participants' parents and older siblings. RESULTS: FH scores were significantly correlated with reduced insulin sensitivity (p < 0.05) and increased subcutaneous (p < 0.05) and visceral (p < 0.05, San Antonio only) fat in families from San Antonio and Los Angeles but not in the leaner Hispanic families from San Luis Valley. There was no evidence for a stronger association of FH score with visceral fat accumulation than with subcutaneous fat or insulin resistance. DISCUSSION: The absence of an association between FH score and insulin resistance/fat accumulation in San Luis Valley is consistent with the idea that the expression of transmitted diabetes genes may be suppressed in leaner, more physically active populations.

Adipose Tissue↗
PubMed1994

Does body fat distribution promote familial aggregation of adult onset diabetes mellitus and postmenopausal breast cancer?

Noninsulin-dependent diabetes mellitus and postmenopausal breast cancer share a number of risk factors, including obesity, increased waist-to-hip ratio, and a positive family history. If risk for these diseases is mediated through a familial tendency for abdominal obesity, then one might expect to see familial clustering of both diseases. We analyzed data from a prospective cohort study of 41,837 Iowa women age 55-69 years. Diabetes was not associated with incidence of breast cancer [relative risk (RR) = 0.97]. The association between family history of breast cancer and breast cancer incidence, however, was slightly modified by individual history of diabetes: a positive family history of breast cancer in the absence of baseline diabetes was associated with a relative risk of 1.36 [95% confidence interval (CI) = 1.08-1.70], whereas the presence of both factors was associated with a RR of 1.87 (95% CI = 0.93-3.76). Adjustment for waist-to-hip ratio greatly diminished this difference. Conversely, a family history of breast cancer was associated with a RR of 5-year diabetes mortality of 1.94 (95% CI = 1.17-3.24) that persisted after stratification by tertile of waist-to-hip ratio. No clear association of family history of breast cancer and waist-to-hip ratio for self-reported diabetes incidence was evident. These data are indicative of a complex interrelation between waist-to-hip ratio, familial predisposition, diabetes, and breast cancer.

Adipose Tissue↗