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Relationship between the serum concentrations of C-reactive protein and parameters of adiposity and insulin resistance in patients with type 2 diabetes mellitus.

Serum C-reactive protein (CRP) concentrations have been reported to be associated with body fat, especially visceral fat accumulation, but most studies up to now have been conducted on non-diabetic subjects. In this study, we investigated the association between the serum CRP concentrations and parameters of adiposity and insulin resistance in both Japanese type 2 diabetes patients and non-diabetic subjects. A total of 248 Japanese subjects (140 type 2 diabetes patients and 108 non-diabetic subjects) were enrolled for the study. The degree of insulin resistance was estimated by the homeostasis model assessment (HOMA-R) method. Fat accumulation was evaluated by measuring visceral and subcutaneous fat areas at the level of the umbilicus in abdominal CT scans. To assess hepatic fat content, the ratio of CT attenuation value of the liver to that of the spleen (L/S ratio) was calculated. Serum CRP was found to be significantly correlated with various indices of adiposity, including L/S ratio, visceral fat area (VFA), subcutaneous fat area (SFA), and HOMA-R, in both the diabetic patients and the non-diabetic subjects. After adjustment for five variables (age, gender, serum CRP, HbA1c, and smoking), serum CRP was still significantly correlated with L/S ratio, VFA, SFA, and HOMA-R in the diabetic patients. We also found that changes in serum CRP concentrations were correlated with changes in the VFA and SFA at 1 year after the baseline in 24 diabetic patients. We conclude that serum CRP may be closely related to the degree of liver steatosis and visceral fat accumulation in Japanese type 2 diabetes mellitus patients.

Adiposity↗

What are the physical characteristics associated with a normal metabolic profile despite a high level of obesity in postmenopausal women?

Although obesity is often associated with insulin resistance and a cluster of metabolic disturbances, the existence of a subgroup of healthy but obese individuals has been postulated. It is unclear why some obese individuals fail to show traditional risk factors associated with the insulin resistance syndrome despite having a very high accumulation of body fat. To address this issue, we identified and studied a subgroup of metabolically normal but obese (MNO) postmenopausal women to gain insight into potential physiological factors that may protect them against the development of obesity-related comorbidities. We carefully examined the metabolic characteristics of 43 obese, sedentary postmenopausal women (mean +/- SD, 58.0 +/- 6.0 yr). Subjects were classified as MNO or as metabolically abnormal obese (MAO) based on an accepted cut-point for insulin sensitivity (measured by the hyperinsulinemic/euglycemic clamp technique). Thereafter, we determined 1) body composition (fat mass and lean body mass), 2) body fat distribution (abdominal visceral and sc adipose tissue areas, midthigh sc adipose tissue and muscle attenuation), 3) plasma lipid-lipoprotein levels, 4) plasma glucose and insulin concentrations, 5) resting blood pressure, 6) peak oxygen consumption, 7) physical activity energy expenditure, and 8) age-related onset of obesity with a questionnaire as potential modulators of differences in the risk profile. We identified 17 MNO subjects who displayed high insulin sensitivity (11.2 +/- 2.6 mg/min.kg lean body mass) and 26 MAO subjects with lower insulin sensitivity (5.7 +/- 1.1 mg/min.kg lean body mass). Despite comparable total body fatness between groups (45.2 +/- 5.3% vs. 44.8 +/- 6.6%; P: = NS), MNO individuals had 49% less visceral adipose tissue than MAO subjects (141 +/- 53 vs. 211 +/- 85 cm(2); P: < 0.01). No difference was noted between groups for abdominal sc adipose tissue (453 +/- 126 vs. 442 +/- 144 cm(2); P: = NS), total fat mass (38.1 +/- 10.6 vs. 40.0 +/- 11.8 kg), muscle attenuation (42.2 +/- 2.6 vs. 43.6 +/- 4.8 Houndsfield units), and physical activity energy expenditure (1060 +/- 323 vs. 1045 +/- 331 Cal/day). MNO subjects had lower fasting plasma glucose and insulin concentrations and lower insulin levels during the oral glucose tolerance test (P: values ranging between 0.01-0.001). No difference was observed between groups for 2-h glucose levels and glucose area during the oral glucose tolerance test. MNO subjects showed lower plasma triglycerides and higher high density lipoprotein cholesterol concentrations than MAO individuals (P: < 0.01 in both cases). Results from the questionnaire indicated that 48% of the MNO women presented an early onset of obesity (<20 yr old) compared with 29% of the MAO subjects (P: = 0.09). Stepwise regression analysis showed that visceral adipose tissue and the age-related onset of obesity explained 22% and 13%, respectively, of the variance observed in insulin sensitivity (total r(2) = 0.35; P: < 0.05 in both cases). Our results support the existence of a subgroup of obese but metabolically normal postmenopausal women who display high levels of insulin sensitivity despite having a high accumulation of body fat. This metabolically normal profile is associated with a lower accumulation of visceral adipose tissue and an earlier age-related onset of obesity.

Adipose Tissue↗

Mechanisms in obesity-related hypertension: role of insulin and catecholamines.

Although the association of obesity and hypertension is well recognized, the mechanisms involved in the pathogenesis of increased blood pressure in the obese are poorly understood. Recent studies addressing the impact of 1) body fat distribution on blood pressure and 2) dietary intake on sympathetic nervous system (SNS) activity suggest a plausible hypothesis that relates the hypertension of the obese to hyperinsulinemia and SNS stimulation. Hypertension in the obese is associated with fat accumulation in the upper body segments; this type of obesity is also characterized by hyperinsulinemia and insulin resistance. Insulin, moreover, is an important signal in the relationship between dietary intake and SNS activity: increased insulin levels are associated with SNS stimulation. The hyperinsulinemia of obesity may, therefore, increase blood pressure by 1) direct effects of insulin to stimulate renal sodium reabsorption, and 2) sympathetic stimulation of the heart, blood vessels, and kidney. Conversely, SNS suppression and diminished insulin following caloric restriction may explain the hypotensive effects of caloric restriction in obese hypertensive subjects. The hypothesis presented here emphasizes the important role of diet in the treatment of obese hypertensive subjects. The efficacy of caloric restriction, weight loss, and exercise in reducing blood pressure in the obese is linked to diminished insulin and SNS activity and may be viewed as evidence in favor of this hypothesis.

Blood Pressure↗

Effect of SCP-x gene ablation on branched-chain fatty acid metabolism.

Despite the importance of peroxisomal oxidation in branched-chain lipid (phytol, cholesterol) detoxification, little is known regarding the factors regulating the peroxisomal uptake, targeting, and metabolism of these lipids. Although in vitro data suggest that sterol carrier protein (SCP)-x plays an important role in branched-chain lipid oxidation, the full physiological significance of this peroxisomal enzyme is not completely clear. To begin to resolve this issue, SCP-x-null mice were generated by gene ablation of SCP-x from the SCP-x/SCP-2 gene and fed a phytol-enriched diet to characterize the effects of lipid overload in a system with minimal 2/3-oxoacyl-CoA thiolytic activity. It was shown that SCP-x gene ablation 1) did not result in reduced expression of SCP-2 (previously thought to be derived in considerable part by posttranslational cleavage of SCP-x); 2) increased expression levels of key enzymes involved in alpha- and beta-oxidation; and 3) altered lipid distributions, leading to decreased hepatic fatty acid and triglyceride levels. In response to dietary phytol, lack of SCP-x resulted in 1) accumulation of phytol metabolites despite substantial upregulation of hepatic peroxisomal and mitochondrial enzymes; 2) reduced body weight gain and fat tissue mass; and 3) hepatic enlargement, increased mottling, and necrosis. In summary, the present work with SCP-x gene-ablated mice demonstrates, for the first time, a direct physiological relationship between lack of SCP-x and decreased ability to metabolize branched-chain lipids.

Acetyl-CoA C-Acetyltransferase↗

Waist-to-hip ratio and judgment of attractiveness and healthiness of female figures by male and female physicians.

Sexual dimorphism in body fat distribution as measured by waist-to-hip ratio (WHR) is unique to humans. The WHR has been shown to be an accurate predictor of risk for various diseases, premature mortality, degree of androgenicity/estrogenicity and fecundity of women, independent of overall body weight. This study investigated whether physicians would be influenced by body size or WHR in assessing health, youthfulness, and reproductive capability of a woman. Line drawings of 12 female figures representing three categories of body weight (normal, underweight and overweight) and four sizes of WHR (0.7, 0.8, 0.9 and 1.0) were ranked by male and female physicians for these qualities as well as for attractiveness and intelligence. Both males and females assigned higher ranking for many of these qualities to normal weight figures with low WHRs (0.7 and 0.8). Overweight figures were assigned low rankings for all these qualities except reproductive capability. Underweight figures, regardless of WHR size, were assigned low ranking for reproductive capability and those underweight figures that had high WHRs (0.9 and 1.0) were assigned low ranking for healthiness. While there were minor sex differences in ranking of some attributes for some figures, generally both male and female physicians utilized the WHR in a similar manner to infer healthiness, reproductive capability and attractiveness.

Adult↗

Replacement treatment with biosynthetic human growth hormone in growth hormone-deficient hypopituitary adults.

OBJECTIVES: The physiological role of growth hormone in adult life has recently attracted increased interest. We have studied the clinical effects and the effects on body composition of prolonged replacement with biosynthetic human GH in a large number of hypopituitary adults. DESIGN: A randomized double blind placebo controlled trial for 6 months followed by an open trial of GH treatment for 12 months. GH daily dose was 0.04 (0.02-0.05) IU/kg s.c. PATIENTS: Forty GH deficient hypopituitary patients (19 M, 21 F; aged 19-67 years) on conventional replacement therapy were studied. MEASUREMENTS: Serum insulin like growth factor I (IGF-I), skinfold thickness, total body potassium, total body water (TBW), exercise tolerance and muscle strength, and well-being. RESULTS: During the 6-month double blind phase, two GH treated patients withdrew because of adverse events. Lean body mass (LBM) increased and percentage body fat (%BF) decreased on GH but not on placebo (P) (LBM: (GH: from 48.5 +/- 9.6 to 49.6 +/- 9.5 kg; P: from 50.9 +/- 9.2 to 50.1 +/- 9.0 kg, P < 0.05 GH vs P) and %BF (GH: from 34.7 +/- 11.4 to 34.2 +/- 10.7; P: from 37.4 +/- 7.6 to 38.7 +/- 8.1, P < 0.05 GH vs P)). TBW increased on GH (P < 0.01) but not on P. No change was observed in waist-to-hip ratio or in muscle strength. During longer-term follow-up combining the double blind and open phase components of the study, 34, 27 and 11 patients received GH for 6, 12 and 18 months respectively. Patients dropped out because of adverse events or lack of perceived benefit. Skinfold thicknesses decreased significantly at 6 and 12 months and the waist circumference at 6 months. Waist-to-hip ratio decreased significantly on GH at 12 months. LBM increased on GH treatment from 49.6 +/- 9.1 to 51.6 +/- 9.4 kg (P < 0.0006), 51.9 +/- 8.9 kg (P < 0.07) and 53.1 +/- 10.5 kg (P < 0.0001) at 6, 12 and 18 months respectively. Percentage body fat decreased on GH from 37.2 +/- 10.7 to 34.7 +/- 10.1 (P < 0.005), 35.1 +/- 12.8 (NS) and 34.5 +/- 8.6 (P < 0.04) at 6,12 and 18 months respectively. TBW also increased at 6 and 12 months of GH treatment. Exercise time increased significantly at 6, 12 and 18 months of GH treatment. Muscle strength in selected muscle groups increased significantly at 6, 12 or 18 months of GH treatment. Randomization resulted in the placebo group having a greater GHQ score (higher morbidity) than the GH group before therapy. Over the controlled phase, GHQ scores improved on placebo but not on GH and CPRS score was unchanged in either group. In the open phase, the GHQ score did not change on GH therapy but CPRS score improved at 6 and 12 months. CONCLUSIONS: Growth hormone replacement therapy in adults for 6 months increased lean body mass, total body water and exercise tolerance, and decreased body fat. Growth hormone replacement for longer than 6 months maintains the advantageous effects seen in shorter-term studies and may have additional effects on body fat distribution, muscle strength and psychological well-being.

Adult↗

Anthropometry, lifestyles and fat patterning in Balinese women.

BACKGROUND: In many parts of the developing world, modernization has resulted in an increase in the prevalence of overweight and obesity and a subsequent rise in nutrition-related, non-communicable diseases such as cardiovascular disease and Type 2 diabetes. AIM: The study examined the impact of socio-economic and lifestyle changes associated with modernization on the body size and shape of Balinese women. SUBJECTS AND METHODS: Anthropometric data including weight, height, body mass index (BMI) and seven skinfolds were collected from 564 Balinese women, aged between 15 and 45 years. The relationship between the degree of 'modernization' (using such parameters as household wealth and education level) and body size and shape was analysed using multiple regression analysis, as was the effect of age, family size and breast-feeding. RESULTS: Using the WHO (WHO 1995) categories of BMI, 14% of Balinese women displayed Chronic Energy Deficiency (BMI < 18.5 kg m(-2)), 7% were overweight (BMI = 25.0-29.9 kg m(-2)) and less than 1% were obese (BMI > or = 30.0 kg m(-2)). Household wealth (p < 0.0001) and education level (p < 0.05) were significantly associated with fatness, while breast-feeding (p < 0.05) was significantly associated with leanness. Fat distribution was largely independent of biological and socio-economic variables. CONCLUSIONS: The trend toward increasing fatness associated with greater household wealth and higher education has important health implications for Balinese women as they continue their rapid transition from subsistence agriculture towards a more 'western' lifestyle.

Adipose Tissue↗

Obesity in free-ranging rhesus macaques.

Spontaneous obesity in free-ranging rhesus macaques (Macaca mulatta) was assessed in terms of body size, body fat distribution, endocrinological/metabolic indices, and social and familial factors. Eleven animals (six females, five males), or 7% of the adult population surveyed, were defined as obese on the basis of morphometric indices of adiposity > 2 s.d. above the mean for adults in this colony. The age of the obese animals ranged from 9-16 years; obese males were older than females (average 14 vs. 12 years), but this difference was not significant. Mean body weights for obese males and females were 14.1 +/- 0.5 and 13.5 +/- 0.7 kg, respectively. There were no gender differences in either the incidence of obesity or measures of body fat. Serum concentrations of cholesterol and testosterone were not significantly different between obese and nonobese monkeys. Serum triglyceride levels were somewhat higher in obese animals, but this difference was not significant. Glucose clearance was within normal limits in both obese and age- and sex-matched non-obese monkeys (> 2% per min). Although increased adiposity was significantly correlated with fasting insulin and the insulin response to glucose loading, differences between obese and non-obese animals in these values did not achieve significance. The incidence of obesity ranged from 0-20% among the eleven matrilines studied, and several primary familial relationships were observed within the obese sample. Most obese females were from a high ranking matriline whereas only one of the obese males was high ranking at the time of the survey.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Overweight and mortality in Mexican Americans.

The Geriatric Research Center (GRC) table of desirable weights is based on the mortality experience of holders of 4.2 million policies issued by 25 life insurance companies in the USA and Canada. The GRC table defines optimum weight-for-height as the weight range which is associated with below average mortality for a given age and height group. People who fall outside this range, i.e. overweight or underweight, experience above average mortality for their age and height group. We classified 3176 Mexican Americans and 1841 non-Hispanic whites who participated in the San Antonio Heart Study according to the GRC table and found that Mexican Americans were less likely than non-Hispanic whites to be underweight and more likely to be overweight. The two effects did not offset one another, however, and fewer Mexican Americans were found to be in the 'just right' range. If the mortality experience of the population which generated the GRC table (largely non-Hispanic) applied to Mexican Americans, these results imply that Mexican Americans should have higher mortality rates than non-Hispanic whites. Vital statistics data from the state of Texas for the years 1979-81, however, fail to corroborate this prediction. Beyond age 45 years, an age range in which obesity and obesity-related disorders would be expected to exert an important influence on mortality, age-specific and age-adjusted all cause mortality was at last as good if not better in Mexican Americans than in non-Hispanic whites. These results could not be explained by ethnic differences in body fat distribution, since fat was less favorably distributed in Mexican Americans.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Resting metabolic rate and diet-induced thermogenesis in abdominal and gluteal-femoral obese women before and after weight reduction.

Fifteen premenopausal obese women, seven abdominal obese (AO) and eight gluteal-femoral obese (GFO), followed an energy-reduced diet of 1000 kcal/d (4.2 MJ/d) over 8 wk. Body-fat distribution was assessed using a cutoff point of 0.80 for the waist-to-hips girth ratio. Before and after the dietary treatment resting metabolic rate (RMR) and diet-induced thermogenesis (DIT) (after a normal breakfast) were measured by indirect calorimetry. Body-weight reduction and energy intake during the diet period did not differ significantly between both groups. Before weight loss the AO group had slightly greater RMR than the GFO group. After weight loss mean RMR decreased about 10% in the AO group and about 2.5% in the GFO group. Before weight loss DIT was slightly but not significantly higher in the AO group than in the GFO group. After weight loss DIT increased significantly in the GFO group. Weight loss was generally associated with decreased blood glucose, serum triglycerides, and total serum cholesterol levels in the AO women but not in the GFO women.

Abdomen↗

Evidence for impaired lipolysis in abdominally obese men: postprandial study of apolipoprotein B-48- and B-100-containing lipoproteins.

BACKGROUND: Abdominal obesity has been associated with postprandial hypertriglyceridemia. The contribution of intestinally and hepatically derived lipoproteins to this exaggerated postprandial lipemic response is not known. OBJECTIVE: We examined the associations between body fatness, fat distribution, and postprandial apolipoprotein (apo) B-48 and apo B-100 concentrations measured in triacylglycerol-rich lipoproteins (TRLs). DESIGN: Dietary fat tolerance was investigated in 50 men aged 28-67 y. The subjects were given a test meal containing 60 g fat/m(2) body surface area and providing 64% of energy from fat, 18% from carbohydrates, and 18% from protein. The meal provided 7524-9196 kJ, depending on body surface area. Blood samples were collected every 2 h over an 8-h period. RESULTS: The increase in plasma triacylglycerol after the meal resulted from increases in both apo B-48- and apo B-100-containing lipoproteins. The apo B-100 concentration was the strongest contributor (R(2) = 69.6%, P = 0.0001) to postprandial triacylglycerol in total TRLs; the postprandial increase in triacylglycerol was best predicted by the apo B-48 concentration (R(2) = 32.7%, P = 0.0001). Visceral abdominal fat was significantly associated with high postprandial TRL apo B-48 and apo B-100 concentrations (r = 0.30-0.44, P < 0.05). After the meal, the apo B-100 concentration in small TRLs decreased in 12 subjects. These men showed features of the insulin resistance-dyslipidemic syndrome, including more visceral fat (P = 0.07) and an altered fasting metabolic profile. CONCLUSION: A lower lipolytic capacity may contribute to the exaggerated and prolonged postprandial lipemia among abdominally obese men.

Adult↗

Metabolically active portion of fat-free mass: a cellular body composition level modeling analysis.

The proportion of fat-free mass (FFM) as body cell mass (BCM) is highly related to whole body resting energy expenditure. However, the magnitude of BCM/FFM may have been underestimated in previous studies. This is because Moore's equation [BCM (kg) = 0.00833 x total body potassium (in mmol)], which was used to predict BCM, underestimates BCM by approximately 11%. The aims of the present study were to develop a theoretical BCM/FFM model at the cellular level and to explore the influences of sex, age, and adiposity on the BCM/FFM. Subjects were 112 adults who had the following measurements: total body water by (2)H(2)O or (3)H(2)O dilution; extracellular water by NaBr dilution; total body nitrogen by in vivo neutron activation analysis; and bone mineral by dual-energy X-ray absorptiometry. FFM was calculated using a multicomponent model and BCM as the difference between FFM and the sum of extracellular fluid and solids. The developed theoretical model revealed that the proportion of BCM to FFM is mainly determined by water distribution (i.e., E/I, the ratio of extracellular to intracellular water). A significant correlation (r = 0.90, P < 0.001) was present between measured and model-predicted BCM/FFM for all subjects pooled. Measured BCM/FFM [mean (SD)] was 0.584 +/- 0.041 and 0.529 +/- 0.041 for adult men and women (P < 0.001), respectively. A multiple linear regression model showed that there are independent significant associations of sex, age, and fat mass with BCM/FFM.

Adult↗

Serum adiponectin levels are inversely associated with overall and central fat distribution but are not directly regulated by acute fasting or leptin administration in humans: cross-sectional and interventional studies.

Adiponectin is an adipocyte-secreted protein that circulates in high concentrations in the serum and acts to increase insulin sensitivity. Previous studies have shown that serum adiponectin is inversely associated with fat mass and insulin resistance in humans and that acute fasting decreases adipose tissue adiponectin mRNA expression in rodents. Whether acute energy deprivation, body fat distribution, or serum hormone levels are associated with circulating adiponectin in humans remains largely unknown. To identify predictors of serum adiponectin levels, we evaluated the association of adiponectin with several anthropometric, metabolic, and hormonal variables in a cross-sectional study of 121 women without a known history of diabetes. We also performed interventional studies to assess whether fasting for 48 h and/or leptin administration regulates serum adiponectin in healthy men and women. Our cross-sectional study shows that, in addition to overall obesity, central fat distribution is an independent negative predictor of serum adiponectin and suggests that adiponectin may represent a link between central obesity and insulin resistance. In addition, estradiol is negatively and independently associated with adiponectin, whereas there is no association between serum adiponectin and leptin, cortisol, or free testosterone levels. Our interventional studies demonstrate that neither fasting for 48 h, resulting in a low leptin state, nor leptin administration at physiological or pharmacological doses alters serum adiponectin levels. Further studies are needed to fully elucidate the physiology of adiponectin in humans and its role in the pathogenesis of insulin-resistant states.

Adiponectin↗

Association between serum leptin levels and 24-hour blood pressure in obese women.

OBJECTIVE: To assess the relationship between serum leptin and 24-hour blood pressure (BP) in obese women, according to body fat distribution. RESEARCH METHODS AND PROCEDURES: A cross-sectional study was carried out in a population of 70 nondiabetic, normotensive, obese women (40 with android and 30 with gynoid type of obesity) and 20 nonobese healthy women as a control group. All subjects underwent 24-hour ambulatory BP monitoring. Blood samples were collected for serum leptin and plasma insulin measurements. Total cholesterol and high-density lipoprotein cholesterol were also measured. RESULTS: Serum leptin levels were significantly higher in obese subjects than in controls, and they were more elevated in android obese women than in gynoid ones. Leptin levels were positively related to body mass index (BMI), insulin, and waist and hip circumferences in the android group. Among gynoid subjects, leptin levels showed positive associations with BMI and insulin. In women with android obesity, strong positive correlations (p < 0.001) were found between leptin levels and 24-hour systolic BP (SBP), daytime SBP, nighttime SBP, 24-hour diastolic BP (DBP), and daytime DBP. Multiple regression analyses, including age, insulin and leptin concentrations, BMI, and waist and hip circumferences on 24-hour and daytime SBP and DBP, showed that only leptin levels contributed to the variability of BP. CONCLUSIONS: Our study shows that serum leptin levels are directly related to 24-hour BP levels in normotensive women with android fat distribution, independently of BMI.

Adult↗

Obesity and subcutaneous fat patterning in relation to breast cancer in postmenopausal women participating in the Diagnostic Investigation of Mammary Cancer Project.

Associations of body fat and body fat distribution with breast cancer were studied in 16,355 postmenopausal women with a natural menopause, aged 49 to 68 years, participating in a breast cancer screening project (the Diagnostic Investigation of Mammary Cancer [DOM] project in Utrecht, The Netherlands). One hundred nineteen women had breast cancer detected at first screening. Fat distribution was assessed by contrasting groups of subscapular and triceps skinfold thickness. No relationship between fat distribution and breast cancer was found. After adjustment for age, women in the highest quartile of Quetelet's index (QI) (weight/height2) had an odds ratio of 1.65 (95% confidence interval [CI], 0.97 to 2.81) compared with women in the the lowest quartile (test for trend, P less than 0.05). For subscapular skinfold and triceps skinfold, the odds ratios were 2.23 (95% CI, 1.28 to 3.91) and 2.01 (95% CI, 1.21 to 3.32), respectively, comparing the highest with the lowest quartile. The authors conclude that in postmenopausal women, overall obesity is associated with increased risk of breast cancer, whereas fat distribution, as measured by contrasting groups of subscapular and triceps skinfold thicknesses, is not related to breast cancer.

Adipose Tissue↗

Syndrome X.

Using cross-sectional and longitudinal analysis of data from the San Antonio Heart Study, syndrome X (primary insulin resistance syndrome) has been redefined in terms of hyperinsulinaemia combined with changes in glucose tolerance, lipid pattern, blood pressure and body fat distribution. Syndrome X is itself an atherogenic cardiovascular risk factor, which interacts with environmental and genetic factors to lead to the eventual development of the endpoint of cardiovascular disease.

Adipose Tissue↗

Long-term testosterone administration increases visceral fat in female to male transsexuals.

The amount of intraabdominal (visceral) fat is an important determinant of disturbances in lipid and glucose metabolism. Cross-sectional studies in women have found associations between high androgen levels and visceral fat accumulation. The causal relation between these phenomena is unknown. We, therefore, studied prospectively the effect of testosterone administration on body fat distribution in 10 young, nonobese, female to male transsexuals undergoing sex reassignment. Before, after 1 yr, and after 3 yr of testosterone administration, magnetic resonance images were obtained at the level of the abdomen, hip, and thigh to quantify both sc and visceral fat depots. After 1 yr of testosterone administration, sc fat depots at all levels showed significant reductions compared to baseline measurements. The mean visceral fat area did not change significantly, but subjects who gained weight in the first year after testosterone administration showed an increase in visceral fat. After 3 yr of testosterone administration, sc fat depots were no longer significantly lower compared to pretreatment measurements, but the mean visceral fat depot had increased significantly by 13 cm2 (95% confidence interval, 4-22 cm2), a relative increase of 47% (95% confidence interval, 8-91%) from baseline. The increase in visceral fat was most pronounced in those subjects who had gained weight. We conclude that long term testosterone administration in young, nonobese, female subjects increases the amount of visceral fat. In addition, an increase in weight in this hyperandrogenic state leads to a preferential storage of fat in the visceral depot.

Abdomen↗

[Obesity at different ages and endometrial cancer risk factors in urban Shanghai, China].

OBJECTIVE: To study the relationship between obesity at different ages and the risk of endometrial cancer in urban Shanghai, China. METHODS: In a population-based case-control study conducted in urban Shanghai, in-person interviews and anthropometric measurements were completed for 497 women at age 30 to 69 and an equal number of controls frequency-matched to cases on age distribution. All cases were newly diagnosed with endometrial cancer from January 1, 1997 to June 30, 2000. Unconditional logistic regression model was employed to estimate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of the obesity at different ages. RESULTS: After adjustment for some potential confounding variables, neither adolescent height nor weight was significantly related to endometrial cancer. Obesity in adulthood, except around 20 years old, was associated with elevated risks, with odds ratios for the highest versus lowest quartile of body mass index (BMI) being 1.5 (95% CI: 1.0 - 2.1), 1.7 (95% CI: 1.2 - 2.4), 1.9 (95% CI: 1.3 - 2.8) and 1.7 (95% CI: 1.0 - 2.7) at ages 30, 40, 50 and 60, respectively. Weight gain of more than 7.5 kg at different 10-year intervals in adulthood were associated with increased risk of endometrial cancer, whereas only weight gain more than 15% of initial weight from 40 to 50 years old significantly related to the risk. Only weight loss from ages 20 to 30 was inversely associated with endometrial cancer risk (OR = 0.4, 95% CI: 0.2 - 0.8). Current body weight, BMI and waist-to-hip ratio (WHR) were independent risk factors to endometrial cancer while standing height and sitting-to-standing height ratio were unrelated to the risk of endometrial cancer. CONCLUSION: Results indicated that adolescent obesity was unrelated to endometrial cancer. General obesity in adulthood, as well as body fat distribution, were associated with the risk of endometrial cancer independently. Weight changes before and after age 30 had different effects on the risk of endometrial cancer.

Adult↗