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PubMed2000

The regulation of body fat distribution and the modulation of insulin action.

Body fat distribution may determine insulin resistance and its metabolic syndrome in humans, independent of obesity. Surgical removal of visceral fat (VF) in obese rats was associated with decreased leptin plasma levels and its gene expression in subcutaneous fat (SC). Chronic leptin treatment to rats decreased VF specifically supporting the role of leptin in determining fat distribution. Surgical removal of selected VF provided direct evidence of improved in vivo insulin action on hepatic glucose production (HGP) by over 2-fold vs sham-operated control. The impact of decreased VF on improved in vivo insulin action was further supported by obtaining similar decreases in VF by treating rats with leptin (Lep), beta3-aderenoreceptor agonist, or by severe caloric restriction (CR). All these three interventions improved insulin action on the modulation of HGP and were mostly attributed to preservation of hepatic glycogen stores. Because free fatty acids (FFA) plasma levels were unchanged, this effect may not be mediated portally by substrates. Improved peripheral insulin sensitivity and glycogen synthesis was demonstrated only in Lep. These data suggest that VF is a major determinant of hepatic insulin action. In obese rats, the ability of leptin to prevent visceral adiposity and its own expression is attenuated. Thus, the failure of leptin to regulate fat distribution and its own secretion suggest that 'leptin resistance' may be a pathologic feature in obesity.

Adipose Tissue↗
PubMed1996

Sex differences in measures of body fat and body fat distribution in the elderly.

This study describes sex differences in obesity and body fat distribution using commonly used assessment methods in 140 men and 245 women age 65-96 years from Rancho Bernardo, California. Significant correlations were shown among all obesity measures. The waist/hip ratio was more strongly correlated with the truncal fat/leg fat ratio in women than in men. The waist/hip ratio correlated significantly with the subscapular/ triceps skinfold ration in women only. In both sexes, waist circumference was more strongly correlated with body mass index and the percentage of body fat by bioelectric impedance analysis and dual-energy X-ray absorptiometry than with the waist/hip ratio. In those aged over 80 years, age stratification showed that the waist/hip ration was not correlated with any other measurement of obesity or fat distribution in men and correlated only with subscapular skinfolds in women. Waist circumference, however, correlated significantly with almost all other measures of central obesity in older and younger men and women. Estimates of upper body (central) fat distribution appear to be age specific. After age 80, the waist/hip ratio is a poor method of assessing central or visceral adiposity, and waist circumference is a better measure of body fat distribution.

Absorptiometry, Photon↗
PubMed2005

Rapid automated measurement of body fat distribution from whole-body MRI.

OBJECTIVE: The purpose of this article is to determine the feasibility of using computer-assisted diagnosis (CAD) techniques to automatically identify, localize, and measure body fat tissue from a rapid whole-body MRI examination. CONCLUSION: Whole-body MRI in conjunction with CAD allows a fast, automatic, and accurate approach to body fat measurement and localization and can be a useful alternative to body mass index. Whole-body fat analysis can be achieved in less than 5 min.

Adipose Tissue↗
PubMed1997

New age-adjusted measure of body fat distribution in children and adolescents: standardization of waist-hip ratio using multivariate analysis.

OBJECTIVE: To explore a new anthropometric index of body fat distribution adjusted for ages ranging from 6-15 y in both boys and girls. DESIGN: Sex, age, and 11 anthropometric variables were subjected to principal component analysis. Based on these results, we developed a new anthropometric index, namely an age-adjusted measure of body-fat distribution. This index was evaluated statistically for suitability of use in epidemiological surveys. SUBJECTS: Japanese children, including obese and nonobese subjects, in one elementary and one junior high school in Yamanashi Prefecture, Japan: 508 boys and 549 girls whos ages ranged from 6 y 1 mon-15 y. MEASUREMENTS: Measurements included the height (Ht), body weight, circumference of the waist, hip and thigh. Body mass index, the ratios of the waist, hip or thigh to the Ht, waist-hip ratio (WHR) and waist-thigh ration were calculated. RESULTS: The first principal component (PC 1) accounted for 49.8% of the total variation, and was interpreted as an indicator of the general size on an individual. PC 2 accounted for 25.9%, and was interpreted as a shape measure that indicates body fat distribution. Calculation of WHR/Ht, a parameter that represented PC 2 adjusted by PC 1, gave an highly robust linear regression equation for age by gender. The residuals from the regression line for WHR/Ht deviated from normal distribution only in the boys, whereas the mean residual was nearly zero and distribution of the residuals was similar in three age subgroups by gender, supporting the use of the common standard deviation score in all age groups as an indicator of body fat distribution. CONCLUSION: The common standard deviation score of WHR/Ht can serve as an epidemiological index of body fat distribution adjusted for ages between 6 and 15 y.

Adipose Tissue↗
PubMedDate not supplied

Body fat distribution predicts cardiac risk factors in older female coronary patients.

BACKGROUND: After myocardial infarction, women have higher rates of recurrent coronary events than men. This is caused, at least in part, by a higher prevalence of obesity-related coronary risk factors such as hyperlipidemia, hypertension, sedentary lifestyle, insulin resistance, and diabetes. We studied the relationship between measures of body fat distribution, body composition, aerobic fitness, and dietary intake and several coronary risk factors including lipids, glucose, and insulin levels. METHODS: The study population included 20 women > 60 years of age with recently diagnosed coronary heart disease and a comparison group of 50 healthy women with low-risk coronary risk profiles. Dependent variables included lipid subfractions (fasting, triglycerides, high-density lipoprotein [HDL] cholesterol, and low-density lipoprotein [LDL] cholesterol), glucose levels, and serum insulin levels. RESULTS: Waist-to-hip ratio (WHR) was the best predictor of serum triglyceride levels (r = .65, P = .002), HDL cholesterol level (r = .46, P = .05), and fasting serum insulin levels (r = .76, P < .001) whereas peak oxygen consumption (Peak VO2) was the best predictor of LDL cholesterol (r = .73, P < .001). In a combined population of the 20 coronary patients and 50 healthy age-matched controls, WHR remained the best predictor of serum triglyceride levels (r = .57, P < .001) and insulin levels (r = .63, P < .001) and Peak V02 was the best predictor of HDL (r = .40, P < .001) and LDL cholesterol (r = .57, P = .004). CONCLUSIONS: Body fat distribution and peak aerobic fitness, both modifiable factors, are significant predictors of risk factors for second coronary events in older female coronary patients.

Adipose Tissue↗
PubMed1993

Fat and female fecundity: prospective study of effect of body fat distribution on conception rates.

OBJECTIVES: To study the effect of body fat distribution in women of reproductive age on fecundity. DESIGN: Prospective cohort study of all women who had entered a donor insemination programme. SETTING: One fertility clinic serving a large part of the midwest of the Netherlands. SUBJECTS: Of 542 women attending the clinic for artificial insemination for the first time, 500 women were eligible for study. MAIN OUTCOME MEASURES: Probability of conception per cycle and number of insemination cycles before pregnancy or stopping treatment. RESULTS: A 0.1 unit increase in waist-hip ratio led to a 30% decrease in probability of conception per cycle (hazard ratio 0.706; 95% confidence interval 0.562 to 0.887) after adjustment for age, fatness, reasons for artificial insemination, cycle length and regularity, smoking, and parity. Increasing age was significantly related to lower fecundity (p < 0.05); very lean and obese women were less likely to conceive (p < 0.10) as were women with subfertile partners (p < 0.10). All other exposure variables were not significantly related to fecundity. CONCLUSIONS: Increasing waist-hip ratio is negatively associated with the probability of conception per cycle, before and after adjustment for confounding factors. Body fat distribution in women of reproductive age seems to have more impact on fertility than age or obesity.

Adipose Tissue↗
PubMed1990

Abdominal fat cell lipolysis, body fat distribution, and metabolic variables in premenopausal women.

It is well established that abdominal obesity is related to numerous metabolic abnormalities and that this correlation represents a significant risk factor for coronary heart disease and related mortality. In the present study the relationships among the regional distribution of body fat, selected metabolic variables, and abdominal adipose cell lipolysis were investigated in 30 premenopausal women, 34 +/- 8 yr (mean +/- SD) of age, with body mass indices ranging from 17-45 kg/m2. Basal as well as epinephrine- and isoproterenol-stimulated lipolyses were positively correlated with fasting plasma insulin and triglyceride levels (0.48 less than r less than 0.64; 0.05 greater than P less than 0.0005 and 0.46 less than r less than 0.60; 0.05 greater than P less than 0.005, respectively) and with the insulin area measured during an oral glucose tolerance test (0.49 less than r less than 0.67; 0.005 greater than P less than 0.0005). With the exception of epinephrine-stimulated lipolysis, these correlations remained significant when lipolysis was corrected for cell surface area. Basal and maximal epinephrine- and isoproterenol-induced lipolyses were also negatively related to plasma high density lipoprotein cholesterol (-0.52 less than r less than -0.36; 0.05 greater than P less than 0.005). However, these relationships were no longer significant after control for fat cell surface. The associations between abdominal lipolysis and fat distribution did not remain significant when data were adjusted for total adiposity. Taken together, these results support the notion that variations in abdominal adipocyte lipolysis 1) depend more on total body fatness than on fat distribution, and 2) may be involved in the metabolic complications associated with abdominal obesity, particularly those pertaining to plasma insulin and triglyceride metabolism.

Abdominal Muscles↗
PubMed2006

Changes in body fat distribution in relation to parity in American women: a covert form of maternal depletion.

Using data from the Third National Health and Nutrition Examination Survey (NHANES III), conducted from 1988-1994, we investigated the effect of reproduction on the distribution of body fat in well-nourished American women. While women tend to gain weight and fat with succeeding pregnancies, if age and body mass index are controlled, increasing parity is associated with a decrease in hip and thigh circumferences, suprailiac and thigh skinfolds, and body fat estimated from skinfolds, while waist circumference increases, resulting in a relative decrease in lower-body fat. The mobilization of fat stores in the lower body during late pregnancy and lactation may help to meet the special needs of the developing brain for essential fatty acids and energy during the time of peak growth. When fat is regained after the postpartum period, relatively more is stored in central vs. peripheral depots, resulting in a patterned change in body shape with parity.

Adipose Tissue↗
PubMed1991

Which measure of body fat distribution is best for epidemiologic research?

Multivariate associations were sought between risk factor levels (total cholesterol, high density lipoprotein (HDL) cholesterol, triglycerides, glucose, and systolic and diastolic blood pressures) and two sets of anthropometric variables (four circumferences and six skinfolds) to select a set of anthropometric indicators of body fat distribution that correlate most highly with risk of disease. Subjects were men (n = 285) and women (n = 672) from a study of gallbladder disease in a Mexican American population in Starr County, Texas, 1985-1986. The canonical correlations showed that circumferences (0.49-0.61) and skinfolds (0.42-0.60) were equally well correlated to risk factor levels independently of sex and age. Weights from the canonical analyses suggest that measurements at or above the waist and on the lower limb (thigh) are most heavily loaded toward risk (waist = highest risk; thigh = lowest risk). The simplest and most reliable index of body fat distribution for both sexes is the ratio of waist to thigh circumferences. The more commonly used waist/hip ratio proved more valid in women, but not in men. Simple skinfold indices of body fat distribution were more poorly correlated to risk factor levels than the corresponding circumference ratios. In women, body mass index and waist circumference by themselves did as well as body fat distribution indices in explaining variation in risk factors, suggesting the involvement of visceral fat in the body fat/body fat distribution disease relation.

Adipose Tissue↗
PubMed1990

Body fat distribution and breast cancer in the Framingham Study.

We examined the relation between central body fat distribution and breast cancer in a prospective cohort of women who participated in the Framingham Study. At the baseline examination in 1948, a total of 2,201 women aged 30-62 years were analyzed. An index of central to peripheral body fat (the central adiposity ratio) was calculated from the sum of the trunkal skinfolds (chest, subscapular, and abdominal) divided by the sum of the extremity skinfolds (triceps and thigh). These skinfolds were measured at the fourth examination in 1954. The cohort was followed for up to 28 years and yielded 106 cases of breast cancer. When divided into quartiles based on the central adiposity ratio, only women in the fourth quartile (those with the highest central to peripheral body fat distribution) demonstrated an increased risk for breast cancer. The age- and adiposity-adjusted relative risk estimate for having an increased central adiposity ratio (fourth quartile) compared to lower central adiposity ratios was 1.8 (95% confidence interval, 1.2-2.6). Adjustment for potential confounders of height, parity, and education did not appreciably alter this estimate (1.7, 1.1-2.5). There was no association between degree of adiposity, as measured by the sum of the five skinfolds or by body mass index (weight in kg divided by height in m2), and subsequent breast cancer. The results of this study suggest that increased central to peripheral body fat distribution predicts breast cancer risk independently of the degree of adiposity and may be a more specific marker of a premalignant hormonal pattern than degree of adiposity.

Adult↗
PubMed1999

Body fat distribution predicts the degree of endothelial dysfunction in uncomplicated obesity.

OBJECTIVE: To ascertain in obesity the role of body fat distribution (the strongest predictor of morbility and mortality in obese subjects) in determining the degree of endothelial dysfunction, an early marker of atherosclerotic disease. SUBJECTS: 18 premenopausal women with uncomplicated obesity excluding other cardiovascular risk factors and 12 age-matched slim healthy women. MEASUREMENTS: Endothelium-dependent vasodilation, studied as diameter variation in response to an increase in shear-stress, was evaluated in the right common femoral artery of obese and slim subjects by a non invasive approach and compared to glyceril-trinitrate vasodilation. To characterize better the vascular functional and/or structural properties, we studied the arterial wall distensibility by an echo-tracking system. Adipose tissue regional distribution was determined by computerised axial tomography. RESULTS: The endothelium-dependent vasodilation was significantly impaired in obese subjects (P<0.005 versus non-obese subjects) while glyceril-trinitrate vasodilation and arterial distensibility were similar in the two groups. In our obese subjects endothelial-dependent vasodilation was inversely correlated to body fat distribution (visceral/subcutaneous adipose tissue ratio: r=- 0. 624, P=0.0058). In contrast, metabolic parameters (except C-peptide response during oral glucose tolerance test (OGTT): r=-0.587, P=0. 01), blood pressure values and body weight did not correlate with the endothelial function. CONCLUSION: Uncomplicated obesity per se is characterised by an alteration of the endothelial function; the degree of this vascular damage is predicted by body fat distribution independently of body weight and metabolic and other haemodynamic parameters, and correlates with an index of insulin secretion.

Adipose Tissue↗
PubMed2001

Visceral adipose tissue and metabolic complications of obesity are reduced in Prader-Willi syndrome female adults: evidence for novel influences on body fat distribution.

Visceral obesity is detrimental to health, but the mechanisms controlling body fat distribution are not fully understood. In premenopausal adult females (30 nonobese, 14 obese [body mass index >30 kg/m(2)]), variance in fasting insulin, glucose, insulin/glucose ratio, C-peptide/insulin ratio, triglycerides, and high-density lipoprotein/low-density lipoprotein-cholesterol ratio, were independently influenced by visceral but not total sc or abdominal sc adipose tissue, as measured by whole-body magnetic resonance imaging. Adult females with Prader-Willi syndrome (n = 13) had significantly reduced visceral adiposity, compared with obese controls (visceral/total sc adipose tissue ratio: 0.067 +/- 0.017 vs. 0.108 +/- 0.021), independent of their total adiposity (P < 0.001), or use of exogenous sex steroids. This is in contrast to that expected by their physical inactivity, hypogonadism, adult GH deficiency, and psychiatric problems. Females with Prader-Willi syndrome not receiving sex steroids (n = 8) had significantly reduced fasting insulin, insulin/glucose ratio, and triglycerides and increased C-peptide/insulin ratio, compared with obese controls, adjusting for total (P < 0.05) but not visceral adiposity (P = 0.3-0.6), supporting their association. The cause of the reduced visceral adiposity in Prader-Willi syndrome may reflect novel hormonal, hypothalamic, and/or genetic influences on body fat distribution.

Adipose Tissue↗
PubMed1998

Secretion of major adrenal androgens following ACTH administration in obese women with different body fat distribution.

To investigate whether obese female subjects with abdominal obesity may have adrenal androgen hypersecretion, we examined two groups of women with abdominal (n = 12) and peripheral (n = 13) obesity (defined by body mass index and waist-to-hip ratio) and a group of seven healthy normal-weight women. All subjects underwent the following protocol study that included a) baseline determination of major adrenal androgens, b) an ACTH test, performed by administering two boli of ACTH (Synacthen, 0.2 microg/Kg BW, e.v.), at 90 min intervals, with blood samples taken for cortisol and androgens, c) an oral glucose tolerance test, performed by administering glucose (75 gr), with blood samples taken for glucose and insulin determination. Each woman also underwent a control saline study. We then investigated the relationships between basal and stimulated androgen levels, body weight and fat distribution and fasting and stimulated insulin levels. Although basal cortisol levels were similar, their increase (as AUC) after the ACTH test was higher in women with abdominal obesity than in the other groups. On the contrary, there were no significant differences in basal and stimulated serum levels of dehydroepiandrosterone, androstenedione and 17-hydroxyprogesterone among the three groups. Fasting and stimulated (as AUC) insulin levels were significantly higher (p < 0.05) in women with abdominal obesity than in those with peripheral obesity and controls. No significant correlation was present between basal and stimulated androgen levels and body mass index, the waist-to-hip ratio or basal and stimulated cortisol values. Therefore, our data indicate that adrenal androgen secretion following low-dose ACTH administration in premenopausal women does not seem to be a function of body fat mass, fat distribution and insulin levels, nor does it correlate with the capacity of the adrenal glands to secrete cortisol in both basal and stimulated conditions.

17-alpha-Hydroxyprogesterone↗
PubMed2001

Obesity and body fat distribution in the New Zealand population.

AIMS: To report the prevalence of obesity and body fat distribution in the New Zealand population and to determine if there is a trend to increasing obesity and changes in body fat distribution. METHODS: Body weight, height, two skinfolds (triceps and subscapular), and waist and hip circumferences were measured on 4,420 New Zealanders as part of the 1997 National Nutrition Survey (NNS97). These results are compared with data from the 1977 National Heart Foundation Survey (n=1,800) and the 1989 Life in New Zealand Survey (LINZ89) (n=3,300). RESULTS: 35% of the population (40.4% males, 30.1% females) were classified as overweight and a further 17% as obese (14.7% males, 19.2% females) in NNS97 compared to 32% overweight and 11% obese in LINZ89. Body weight and body mass index have increased in the last two decades. In addition, there has been an increasing trend towards central obesity as estimated by waist to hip ratio and subscapular to triceps ratio. CONCLUSIONS: The increase in body weight, obesity, central obesity, and the proportion of the population likely to exhibit health risk indicators presents an increasing health problem in New Zealand.

Adipose Tissue↗
PubMed1995

A study on indices of body fat distribution for screening for obesity.

In order to screen high risk obesity groups for coronary heart disease, the relationships between certain body fat distribution indices and coronary risk factors (CRFs) were analyzed. Body circumference at various measuring points and skinfold thickness were measured in 938 male clerical workers, and some indices of body fat distribution were calculated. The results are as follows: (1) The body mass index (BMI) showed the highest correlation with systolic blood pressure, and skinfold thickness showed a high correlation with serum total cholesterol (TC) and LDL-cholesterol. (2) In body fat distribution indices, the waist/stature ratio (WSR) showed the highest correlation with CRF measurements, especially with serum triglyceride (TG) and diastolic blood pressure (DBP). (3) WSR showed the highest sensitivity and specificity for screening for abnormal hypertension groups TG and TC. (4) There were significant differences in the mean value for all CRF measurements between the high WSR group (> = 0.49) and the low WSR group (< 0.49), and the rates for high CRF persons in the high WSR group were almost twice those of the low WSR group. These results show that WSR is useful for the screening for obesity to prevent coronary heart disease.

Adipose Tissue↗
PubMed1999

The contribution of menopause to changes in body-fat distribution.

OBJECTIVE: To investigate whether menopause contributes to changes in body-fat distribution, irrespective of aging or obesity. METHODS: The subjects were 545 premenopausal (aged 16-55 years; mean +/- standard deviation, 37.7 +/- 9.1 years) and 219 postmenopausal (aged 45-65 years, 58.0 +/- 5.0 years) women. Baseline characteristics included age, body mass index (BMI), and menopausal status (premenopause or postmenopause). The ratio of trunk fat to leg fat (trunk-leg ratio) was estimated by dual-energy X-ray absorptiometry. The trunk-leg ratio and baseline characteristics were compared between the 2 groups. In all subjects (n = 764), possible correlations between the trunk-leg ratio and the baseline characteristics were determined using univariate and multivariate analysis. In postmenopausal women, the relationship of the trunk-leg ratio to YSM or age after adjusting for BMI was investigated. RESULTS: The trunk-leg ratio and BMI were significantly higher in postmenopausal women than in premenopausal women. In all subjects, age and BMI were positively correlated with the trunk-leg ratio (r = 0.445 and 0.587, respectively, p < 0.0001). Menopause was also positively correlated with the trunk-leg ratio on univariate regression analysis (standardized regression coefficient = 0.369, p < 0.0001). On multiple regression analysis, age, BMI, and menopause were independently correlated with the trunk-leg ratio (p < 0.05). In postmenopausal women, age and YSM were positively correlated with the trunk-leg ratio, independent of the BMI (p < 0.01). CONCLUSIONS: Menopause contributes to a change in body-fat distribution, irrespective of aging or obesity.

Abdomen↗
PubMed2000

Body fat distribution, the menopause transition, and hormone replacement therapy.

Endocrine changes resulting from the menopause transition dramatically modify women's hormonal milieu. The consequences of these changes not only lead to cessation of reproduction and accompanying symptoms in women, but also dramatically impact long-term health. Loss of estrogen has been associated with the development of cardiovascular disease. Central distribution and accumulation of adipose tissue, and the concomitant insulin resistant dyslipidemic state have emerged as important components of a cluster of metabolic abnormalities that are strongly related to coronary heart disease. Thus, estrogen deficiency may affect cardiovascular disease risk by mediating changes in body fat distribution. This article is an update of the literature in the area of menopause, hormone replacement therapy, and body fat distribution. Cross-sectional studies using anthropometric measurements of abdominal fat distribution most often failed to detect an effect of the menopause transition that was independent of advancing age and degree of obesity. The use of radiologic techniques such as DEXA and computed tomography, however, led to the conclusion that the menopause transition accelerates the selective deposition of intra-abdominal fat. Available longitudinal data also support an increase in central body fatness occurring with menopause. Most intervention trials on hormone replacement therapy and body fat distribution showed that the treatment prevented the increase in central adiposity that was noted in postmenopausal women receiving no treatment or placebo. These results are supported by retrospective studies that showed a lower WHR in hormone users vs non-users. Mechanisms potentially explaining the menopause-related acceleration in abdominal fat accumulation include changes in regional adipose tissue metabolism in the face of a positive energy imbalance. As some inconsistencies were found among studies, further investigations using longitudinal and intervention designs, as well as more precise methodologies to measure body fat distribution, are needed to clearly establish the effects of menopause and hormone replacement on abdominal body fat distribution and the concomitant increase in cardiovascular disease risk.

Adipose Tissue↗
PubMed2005

Body fat distribution and long-term risk of stroke mortality.

BACKGROUND AND PURPOSE: Excess weight is an important determinant of cardiovascular disease, but the relationship between excess weight, its distribution, and stroke is yet unclear. We examined in a large prospective cohort study the association between body fat distribution and stroke mortality among middle-aged men. METHODS: A cohort of male civil servants and municipal employees free of cardiovascular disease in Israel (n=9151) were followed up for mortality over 23 years. The subscapular skinfold (SSF) was used as a measure of trunk and overall obesity and the ratio of subscapular to triceps skinfold thickness (SFR) as an indicator of trunk versus peripheral distribution of body fat. RESULTS: During the follow-up period, 316 died of stroke, and 865 died of coronary heart disease. The estimated age-adjusted hazard ratios (HRs) for stroke mortality, associated with 1 SD increment of SSF, was 1.12 (95% CI, 1.01 to 1.25) and for body mass index, 1.17 (1.06 to 1.30), but these associations were markedly weakened when adjusting for blood pressure. SFR was associated with an age-adjusted HR for stroke mortality of 1.14 (1.03 to 1.26). Further adjusting for systolic blood pressure, diabetes mellitus, cigarette smoking, and socioeconomic status (HR, 1.11; 1.01 to 1.23) as well as body mass index (HR, 1.11; 1.00 to 1.23) only mildly attenuated this association. Subjects with SFR in the upper quartile exhibited a approximately 1.5-fold higher adjusted HR (1.53; 1.10 to 2.12) compared with the lowest quartile. CONCLUSIONS: Indices of body fat and body fat distribution predict long-term stroke and coronary heart disease mortality among middle-aged men. SFR, an indicator of trunk versus peripheral distribution of body fat, is associated with stroke mortality, independent of main mediators of the effect of obesity on health and of body mass index.

Adipose Tissue↗