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Measurement of body fat and fat distribution.

Overweight and obesity are increasing in prevalent and thus an important area for intervention and investigation. Researchers and clinicians have a variety of measurement techniques to assess body fatness and regional fat. These techniques are chosen for their accuracy and precision in light of their cost, convenience, and safety. This article introduces techniques for the measurement of body fatness and regional fat, their advantages and disadvantages and accuracy. Recommended measurement techniques for investigators and clinicians are provided.

Absorptiometry, Photon↗

Do postmenopausal women with NIDDM have a reduced capacity to deposit and conserve lower-body fat?

OBJECTIVE: To compare regional body fat distribution and sex hormone status of postmenopausal women with NIDDM with those of age- and BMI-matched normoglycemic women. RESEARCH DESIGN AND METHODS: The regional body fat distribution and sex hormone status of 42 postmenopausal women with NIDDM were compared with those of 42 normoglycemic women matched for age and BMI, who served as control subjects. Body composition was measured by dual-energy X-ray absorptiometry, and sex hormone-binding globulin (SHBG) and testosterone were measured in serum. RESULTS: Although the levels of total body fat were similar between the two groups, the women with NIDDM had significantly less lower-body fat (LBF) (P < 0.01) than the control subjects matched for age and BMI. This pattern of fat deposition in women with NIDDM was accompanied by an androgenic hormone profile, with decreased SHBG concentration and an increased free androgen index (P < 0.05 and P < 0.01, respectively). CONCLUSIONS: A reduced capacity to deposit and/or conserve LBF may be an independent factor associated with (or may be a marker of) the metabolic manifestations of the insulin resistance syndrome in women with NIDDM. The possibility that the smaller relative accumulation of LBF is a consequence of the androgenic hormonal profile should be investigated in future studies.

Adipose Tissue↗

Hormonal changes during puberty and their relationship to fat distribution.

In adults, abdominal visceral adiposity is related to an increased risk of cardiovascular diseases, Type 2 diabetes mellitus, and stroke. The antecedents of these conditions likely begin with the alterations in body fat distribution during childhood and adolescence. The sexually dimorphic alterations in fat distribution are influenced by sex differences in hormone concentrations, anatomical differences in the number and density of specific hormone receptors, capillary blood flow, and the activity of enzymes promoting lipid synthesis or degradation. Hormones influencing the amount and regional distribution of adipose tissue during puberty include cortisol, insulin, growth hormone, and the sex steroids. Cortisol and insulin promote fat deposition while the sex steroids and GH stimulate lipolysis. An overly sensitive hypothalamic-pituitary-adrenal axis may exist in obesity and disrupt the balance between the lipogenic effects of cortisol and insulin and the lipolytic effects of sex steroids and growth hormone. Leptin is released from the adipocytes and may act as a metabolic signal to the hypothalamic areas controlling satiety, energy expenditure, and the regulation of cortisol, insulin, sex steroid and growth hormone release. The complex issues of the hormonal control of alterations in body fat distribution during puberty are developed and a working model is proposed. Am. J. Hum. Biol. 11:209-224, 1999. Copyright 1999 Wiley-Liss, Inc.

Journal Article↗

Validity of self-reported fat distribution in young adults: the CARDIA Study. Coronary Artery Risk Development in Young Adults.

To determine the validity of self-reported information on body fat distribution, relationships between reported location of weight gain and measured waist-to-hip ratio (WHR), high density lipoprotein cholesterol (HDL-C), and fasting insulin were analyzed in 5115 black and white men and women aged 18-30 years. In black men, WHR adjusted for age and body mass index (BMI) ranged from 0.833 among those reporting upper and central weight gain to 0.812 among those reporting lower body weight gain (trend across five reported fat distribution categories, P = 0.0004). Corresponding values were, for white men, 0.852 to 0.831; for black women, 0.777 to 0.721; and for white women, 0.772 to 0.701 (each P < 0.0001). Reported fat distribution was associated with HDL-C in women, but not in men, and with fasting insulin in all groups. While these associations were somewhat weaker than with measured WHR, self-reported fat distribution does provide valid information about body fat distribution in young adults, particularly women.

Adult↗

Waist circumference and cardiovascular risk factors in prepubertal children.

OBJECTIVE: Intra-abdominal fat has been identified as being the most clinically relevant type of fat in humans. Therefore, an assessment of body-fat distribution could possibly identify subjects with the highest risk of adverse lipid profile and hypertension. Few data on the relationship between body-fat distribution and cardiovascular risk factors are available in children, especially before puberty. RESEARCH METHODS AND PROCEDURES: This cross-sectional study was undertaken to explore the relationship between anthropometric variables, lipid concentrations, and blood pressure (BP) in a sample of 818 prepubertal children (ages 3 to 11 years) and to assess the clinical relevance of waist circumference in identifying prepubertal children with higher cardiovascular risk. Height, weight, triceps and subscapular skinfolds, waist circumference, and BP were measured. Plasma levels for triacylglycerol, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, apolipoprotein A1 (ApoA1), and apolipoprotein B (ApoB) were determined. RESULTS: Females were fatter than males (5.8 [3.5] vs. 4.8 [3.3] kg of fat mass; p < 0.01). Males had higher HDL cholesterol and ApoA1/ApoB plasma concentrations than females (p < 0.001 and p < 0.01, respectively). Waist circumference had a higher correlation with systolic and diastolic BP (r = 0.40 and 0.29, respectively; p < 0.001) than triceps (r = 0.35 and 0.21, respectively; p < 0.001) and subscapular (r = 0.28 and 0.16, respectively; p < 0.001) skinfolds and relative body weight (0.33 and 0.23, respectively; p < 0.001). Multivariate linear model analysis showed that ApoA1/ApoB, HDL cholesterol, total cholesterol/HDL cholesterol, and systolic as well as diastolic BP were significantly associated with waist circumference and triceps and subscapular skinfolds, independently of age, gender, and body mass index. DISCUSSION: Waist circumference as well as subscapular and triceps skinfolds may be helpful parameters in identifying prepubertal children with an adverse blood-lipids profile and hypertension. However, waist circumference, which is easy to measure and more easily reproducible than skinfolds, may be considered in clinical practice. Children with a waist circumference greater than the 90th percentile are more likely to have multiple risk factors than children with a waist circumference that is less than or equal to the 90th percentile.

Abdomen↗

C-reactive protein is independently associated with total body fat, central fat, and insulin resistance in adult women.

OBJECTIVE: To investigate whether C-reactive protein (CRP) concentrations are influenced by body composition, insulin resistance, and body fat distribution in healthy women. DESIGN: Cross-sectional study of CRP plasma levels in adult women. SUBJECTS: A total of 201 apparently healthy normal weight, overweight, and obese women, aged 18-60 y. MEASUREMENTS: CRP plasma levels, several fatness and body fat distribution parameters (by bioimpedance analysis and anthropometry), and insulin resistance (HOMA(IR)), as calculated by homeostatic model assessment. RESULTS: CRP was positively correlated with age, body mass index (BMI), waist, fasting glucose and insulin, HOMA(IR), fat-free mass (FFM) and fat mass (FM). After multivariate analyses, age, HOMA(IR), waist and FM maintained their independent association with CRP. CONCLUSION: Our study has shown an independent relationship of central fat accumulation and insulin resistance with CRP plasma levels, thus suggesting that mild, chronic inflammation may be a further component of the metabolic syndrome and a mediator of the atherogenic profile of this syndrome.

Abdomen↗

Altered body composition and fuel metabolism in stable kidney transplant patients on immuno-suppressive monotherapy with cyclosporine A.

Glucocorticoid associated altered body fat distribution and muscle wasting are well known following kidney grafting. Whether an immunosuppressive regimen after glucocorticoid withdrawal (i.e. monotherapy with cyclosporine A (CsA)) is associated with normalization of altered body fat distribution and muscle mass remains to be determined. Therefore 18 renal transplant patients (nine males and nine females, 64 +/- 5 (mean +/- SEM) months since transplantation; CsA-monotherapy: 38 +/- 7 months) and 18 age, sex and body mass index matched healthy volunteers were investigated using indirect calorimetry and dual energy X-ray absorptiometry. Lean body mass (LBM) was decreased in patients mostly due to loss of striated muscle in the legs (P < 0.01). Compared to healthy controls, fat mass was increased in head and trunk (P < 0.01) and similar in extremities. Resting energy expenditure expressed per kg LBM was increased by more than 10% (P < 0.05) in patients vs. controls. Plasma insulin and glucose concentrations, total serum cholesterol (C), triglyceride levels and the ratio of LDL-C to HDL-C were all elevated (P < 0.01) in patients as compared with controls. In summary, renal transplant patients on immunosuppressive monotherapy with CsA demonstrate decreased muscle mass despite discontinuation of prednisone therapy. The increased upper body fat might account, at least in part, for peripheral hyperinsulinaemia and dyslipidaemia observed in kidney transplant patients even years after successful transplantation.

Blood Proteins↗

[Changes in body weight and the distribution of adipose tissue in hysterectomized postmenopausal patients on estrogen replacement therapy].

The purpose was to look how the weight and body fat distribution is modified after estrogen replacement therapy (ERT). 52 patients older 40 years age, hysterectomized and with bilateral salpingo-oophorectomy were studied. They were divided in two groups: I) received ERT with conjugated equine estrogens 0.625 mg daily (n = 35) and II) with no ERT (n = 27) (control). Every three months corporal weight, body mass index (BMI) and waist-hip ratio was measured for a 12-month period. With the exception of the control group, which was only studied for three months. In the ERT group the corporal weight and the BMI significantly increased at six months (p < 0.01 y p < 0.006, respectively), without changes in the other parameters. The control group had no significant changes in the analyzed parameters during the study time. When the group with ERT was compared with the control group at third month, there was a significant increase in weight (p < 0.05) in the control group. Without any differences in the other analyzed variables between the groups. It was not possible to demonstrate that corporal weight and body fat distribution were permanently modified in those patients with ERT. These data agree with recent reports in which no changes have been detected with hormone replacement therapy usage.

Adipose Tissue↗

Central adiposity and gallbladder disease in Mexican Americans.

Obesity is widely recognized as a risk factor for gallstones. However, to the authors' knowledge, only one study has examined the effect of body fat distribution on the prevalence of gallbladder disease. Mexican Americans are a population characterized by both a high prevalence of gallbladder disease and an unfavorable body fat distribution. The authors examined whether central adiposity (as measured by the ratio of subscapular-to-triceps skinfold) was related to clinically evident gallbladder disease in 1,202 Mexican Americans and 908 non-Hispanic whites in the San Antonio Heart Study from 1979 to 1982. After adjustment for overall adiposity (as measured by body mass index) and the ratio of subscapular-to-triceps skinfold, an increased prevalence of gallbladder disease was still observed in Mexican-American women. Both body mass index and the ratio of subscapular-to-triceps skinfold were positively and independently associated with gallbladder disease in women, while in men, body mass index, but not the subscapular-to-triceps skinfold ratio, was associated with gallbladder disease. Central adiposity is also related to the adverse pattern of cardiovascular risk factors observed in women with gallbladder disease.

Adult↗

Fat distribution and HIV protease inhibitors.

(1) Disturbing changes in body fat distribution started to be described in 1997 in HIV-infected patients treated with antiretroviral drugs, with fat accumulation at various levels of the trunk, and thinning of the limbs, buttocks and face. (2) The vast majority of cases occurred in patients on HIV protease inhibitors. (3) The long-term clinical consequences are unknown.

Adipose Tissue↗

Androgyny in fat patterning is associated with obesity in adolescents and young adults.

Recent work suggests that android or male-type obesity is characterized by fat cell enlargement on the trunk and upper body. This implies adult differences in patterns of body fat distribution may have developmental origins connected with differences in maturation or age of onset of obesity. To investigate this, we studied adolescent females (N = 455, 12 years), males (N = 527, 14 years) and young adults (N = 393 females and N = 413 males, 17 years) of the US Health Examination Survey. Five skinfolds and five maturity indicators were available. Individuals were classed as normal weight, overweight or obese on the basis of the body mass index (WT/HT2). Fat patterning was studied by principal components analysis of the log residual skinfold thickness at the five sites, which revealed trunk/extremity and upper/lower trunk fat distribution components in all sex/age groups studied. The means of both components were significantly (P less than 0.05) greater in obese than in normal weight individuals indicating that obesity in adolescence and young adulthood consists of fat concentrated on the upper aspect of the trunk. The effect was independent of maturity, which was a significant correlate of the trunk/extremity patterning component only and in males only. Advanced physiological maturity is probably not a determinant of adult patterns of body fat distribution, but obesity which occurs in adolescence may be.

Adipose Tissue↗

[Relationship between leptin and insulin blood levels in obese and lean Chilean women].

BACKGROUND: Leptin, a product of ob gene and insulin blood levels, are proportional to the amount of adipose tissue. Insulin could have an independent regulatory effect on leptin secretion. AIM: To assess the relationship between serum leptin and plasma insulin levels in obese and lean Chilean women. MATERIAL AND METHODS: One hundred forty five women, aged 20 to 60 years old, were studied. Weight, height, waist and hip circumference, fasting blood glucose, insulin and leptin levels were measured. Insulin resistance was assessed using the homeostasis model assessment. The relationship between different variables was determined using multiple linear regression, variance analysis and non parametric correlation. RESULTS: Leptin serum concentrations were positively correlated with body mass index, insulin plasma levels and degree of insulin resistance. The association of leptin with insulin was independent of body mass index and persisted after adjustments by body fat distribution and age. CONCLUSIONS: Insulin and insulin resistance are associated to high blood leptin levels and this association is independent of the degree of adiposity and body fat distribution.

Adult↗

Associations of body mass and fat distribution with sex hormone concentrations in postmenopausal women.

The associations of body mass and body fat distribution, as measured by waist-to-hip circumference ratio, with serum concentrations of sex hormones and sex hormone binding globulin were examined in 88 postmenopausal women. Body mass index (BMI) was significantly and negatively associated with sex hormone binding globulin (SHBG) (r = -0.41), luteinizing hormone (LH) (r = -0.40) and follicle stimulating hormone (FSH) (r = -0.38) and was also significantly positively associated with both total and free oestradiol (r = 0.40 and 0.45, respectively). Waist-to-hip circumference ratio was significantly negatively correlated with SHBG (r = -0.53), LH (r = -0.35), and FSH (r = -0.35). After adjustment for BMI and other related factors, waist-to-hip circumference ratio was significantly and negatively associated with SHBG, LH, and FSH, and demonstrated a significant curvilinear relationship with free testosterone. These results suggest that in postmenopausal women, abdominal adiposity is associated with a relatively more androgenic sex hormone profile.

Adipose Tissue↗

Body composition and fat distribution pattern of urban elderly females, Delhi, India.

The present study was conducted on females (n = 279) in the age range of 51-89 year, living in the urban dwellings of Delhi, India. Another group of 21-25 years old young adult females was taken as a control group. A total of 14 anthropometric measurements were taken: stature, sitting height, weight, skinfold thickness at nine different sites over the body and body girths such as upper arm, waist and hip circumference. Indices like body mass index, grand mean thickness, waist-hip ratio were computed to assess the body composition. Fat profile and responsiveness of different skinfold sites towards fat accumulation were studied to find out the regional fat distribution with advancing age. Redistribution of body fat was found to take place with increasing age. A relative preponderance of upper body fat was visible among elderly subjects. However, a clear reverse trend was observed in the young control group females. Significant differences were observed with regards to the body composition and fat profile between young adult females and test group females. Abdomen and the sub-scapular area were reported to be the most sensitive sites for fat deposition as the age advanced. The stature and sitting height showed significant decline with age. All the indices of adiposity i.e. grand mean thickness, waist-hip ratio and body mass index revealed significant changes in elderly females when compared with young adult control group females.

Age Distribution↗

[Influence of weight and distribution of adipose tissue in functional hyperandrogenism].

Approximately half the women with the polycystic ovary syndrome (PCOS) are obese or overweight. Obesity and body fat distribution have independent roles in the development of hyperandrogenism in PCOS. Most obese and normal weight PCOS are insulin resistant and hyperinsulinemic. Moreover, a significant positive correlation exists between the degree of hyperandrogenism and that of hyperinsulinism. The pathogenetic role of obesity may involve different mechanisms, the major one being the hyperinsulemic state, since insulin is capable of stimulating ovarian androgen secretion and controlling androgen metabolism and transport in peripheral tissues. Abdominal body fat distribution in obese women with PCOS amplifies the degree of hyperandrogenism and related clinical symptoms and signs. Both loss of body weight and/or the reduction of the degree of hyperinsuliemia, induced by diet or insulin-sensitizing drugs, have important effects, since they reduce blood androgen levels and can improve ovulation and clinical signs of hyperandrogenism.

Adipose Tissue↗

Body size, body composition, and fat distribution: a comparison of young New Zealand men of European, Pacific Island, and Asian Indian ethnicities.

AIMS: To investigate body size and body fat relationships and fat distribution in young healthy men drawn from New Zealand European, Pacific Island, and Asian Indian populations. METHOD: A total of 114 healthy men (64 European, 31 Pacific Island, 19 Asian Indian) aged 17-30 years underwent measurements of height, weight, and body composition by total body dual-energy X-ray absorptiometry (DXA). Body mass index (BMI) was then calculated. Percent body fat (%BF), fat-free mass, bone mineral content, bone mineral density, abdominal fat, thigh fat, and appendicular skeletal muscle mass (ASMM) were obtained from the DXA scans. RESULTS: For the same BMI, %BF for Pacific Island men was 4% points lower and for Asian Indian men was 7-8% points higher compared to Europeans. Compared to European men for the same %BF, BMI was 2-3 units higher for Pacific Island, and 3-6 units lower for Asian Indian. The ratio of abdominal fat to thigh fat, adjusted for height, weight, and %BF, was significantly higher for Asian Indian men than European (p=0.022) and Pacific Island (p=0.002) men. ASMM, adjusted for height and weight, was highest in Pacific Island and lowest in Asian Indian men. CONCLUSIONS: The relationship between %BF and BMI is different for European, Pacific Island, and Asian Indian men which may, at least in part, be due to differences in muscularity. Asian Indians have more abdominal fat deposition than their European and Pacific Island counterparts. Use of universal BMI cut-off points are not appropriate for comparison of obesity prevalence between these ethnic groups.

Adolescent↗

Influence of physiological factors on the age-related increase in blood pressure in healthy men.

The independent and collective influences of several physiological factors on the age-related increase in blood pressure in healthy men were examined. Twenty-seven younger and 25 older, mostly normotensive, healthy men were studied. Blood pressure, body fat, body fat distribution, maximal oxygen consumption (VO2max), plasma norepinephrine, dietary Na, and erythrocyte Na-K pump activity were measured. Older men showed 57% higher percent body fat, 40% higher plasma norepinephrine concentration, 14% greater mean arterial blood pressure (MAP), and 5% higher plasma K concentration than younger men (all p < 0.01). Older men showed a 38% (p < 0.01) lower VO2max, 19% (p < 0.05) lower energy intake, 18% (p < 0.05) lower Na-K pump rate constant, and a 17% (p < 0.05) lower Na-K pump rate. Group means for MAP were adjusted for combinations of plasma norepinephrine, waist:thigh ratio, VO2max, and the Na-K pump rate constant, to determine if any one variable or combination could account for the age related increase in MAP. Statistical adjustment for plasma norepinephrine, waist:thigh ratio, and Na-K pump rate constant eliminated the significant difference between MAPs for the two groups. Thus, alterations in sympathetic nervous system activity, body fat distribution, and the membrane Na-K pump activity independently contribute to the age-related increase in MAP in healthy men.

Adolescent↗

Increased plasma cholesteryl ester transfer protein in obese subjects. A possible mechanism for the reduction of serum HDL cholesterol levels in obesity.

It is well known that obesity is frequently associated with low levels of serum high-density lipoprotein (HDL) cholesterol. However, the mechanism for this reduction has not been fully clarified. Cholesteryl ester transfer protein (CETP) transfers cholesteryl ester from HDL to apolipoprotein B-containing lipoproteins and plays an important role in regulating the concentration and composition of HDL. To elucidate the mechanism for the reduction of serum HDL cholesterol in obesity, we analyzed serum lipoproteins, CETP, and postheparin lipoprotein lipase (LPL) and hepatic triglyceride lipase (HTGL) activities in 30 obese subjects (17 women and 13 men, age 44 +/- 14 years, mean +/- SD). We also investigated the relationship between these variables, total adiposity, and indices of body fat distribution. The average body mass index of the obese subjects was 33.1 +/- 4.8 kg/m2 (range, 26.4 to 43.8 kg/m2). The obese subjects showed significantly lower serum HDL cholesterol levels than control subjects (1.04 +/- 0.28 versus 1.50 +/- 0.34 mmol/L, P < .01). In the obese subjects, both activities and protein mass of CETP and postheparin HTGL activities were significantly increased, whereas postheparin LPL activities were significantly decreased. CETP activities, independent of postheparin HTGL and LPL activities, were correlated negatively with HDL cholesterol (r = -.39, P < .05) and the cholesteryl ester to triglyceride ratio of HDL2 and HDL3 (r = -.36, P < .05; r = -.46, P < .05, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗