Fat distribution and cardiovascular disease -
We analyzed six different markers of cardiovascular risk: 1 systolic blood pressure BP , 2 diastolic BP, 3 triglycerides, 4 total cholesterol, 5 high-density lipoprotein HDL cholesterol, and 6 low-density lipoprotein LDL cholesterol. Brachial systolic and diastolic BP was measured with an automated oscillometric BP recorder Omron M6 comfort, Omron Healthcare.
BP was measured three times at the health examination after a minute rest with the participants sitting down and calculated as the average of the three measurements. To assess plasma lipid levels, venous blood samples were collected after an overnight fast.
Plasma for analysis of total cholesterol, triglycerides, and HDL cholesterol levels was prepared and analyzed at the Clinical Chemistry Department at Steno Diabetes Center in Gentofte, Denmark. LDL cholesterol was calculated based on total cholesterol, HDL cholesterol, and very low-density lipoprotein using the Friedewald equation All participants without known diabetes received a standard g oral glucose tolerance test after an overnight fast.
Type 2 diabetes and prediabetes was classified according to the WHO criteria ; and thus, screen-detected diabetes was defined as fasting plasma glucose at least 7. Participants with known diabetes were identified based on information from the participants' general practitioners and self reports and excluded from the present analysis, because they were not fasting for an ultrasound assessment of VAT and SAT.
Weight was assessed with the participants not wearing shoes or coat, and height was measured to the nearest millimeter using a fixed rigid stadiometer. Information on physical activity energy expenditure PAEE was assessed using a modified version of the Recent Physical Activity Questionnaire RPAQ The RPAQ contains questions regarding physical activity performed in the last 4 weeks in four domains: activity at home, during work, during leisure time, and during transportation From information in the questionnaire PAEE was calculated by means of the Oxford model Smoking status, alcohol consumption, and current use of antihypertensive and lipid-lowering medication were obtained from a general questionnaire.
Information on age and sex were derived from the Danish personal identification number. Multiple linear regression analyses were used to assess the associations of VAT and SAT with the continuous cardiovascular risk factors.
VAT and SAT were standardized to a mean of 0 and a SD of 1 to facilitate comparison between the beta coefficients. For analyses stratified by sex, the VAT and SAT standardization was sex specific.
The residuals of plasma triglycerides and HDL cholesterol tended to be nonnormally distributed; and therefore, analyses of these variables were performed both with and without log transformation. The results from the analyses with log-transformed variables did not differ substantially from those using variables on the normal scale, and therefore only the results using variables on the normal scale are presented.
VAT and SAT were included simultaneously in the statistical models to assess the independent associations of the two obesity measures. Adjustments were made for sex, age, smoking, alcohol consumption, PAEE, glucose tolerance status GTS , medication use, and BMI.
All statistical analyses were conducted using the statistical software SAS, version 9. The study population consisted of individuals The characteristics of the study population are presented in Table 1 stratified by GTS. The mean depths of VAT and SAT were 9. Results from the overall and sex-stratified linear regression analyses are presented in Table 2 , whereas the GTS-stratified results are presented in Table 3.
In the entire population, higher SAT was associated with higher total cholesterol levels and LDL cholesterol levels, and lower HDL cholesterol levels.
Higher VAT was associated with higher triglyceride levels and lower HDL cholesterol levels. Stratification by sex brought more detail to the overall findings by showing that the VAT-triglyceride association was significantly stronger for men than for women, whereas the SAT-triglyceride association was found only in women Figure 1.
A similar finding was seen for the SAT-HDL cholesterol associations with only women having lower HDL cholesterol for higher SAT levels Table 2. Furthermore, neither VAT nor SAT was associated with BP in the entire population. However, when stratifying by GTS higher SAT was associated with higher BP in participants with diabetes but not in participants with NGT or prediabetes.
Overall and Sex-Stratified Associations of VAT and SAT 1 sd as the Unit With Cardiovascular Risk Factors Adjusted for Age, Sex, Smoking, Alcohol, GTS, PAEE, BMI, Medication Use, and VAT Adjusted for SAT and Vice Versa.
P values are tests for interaction term sex × VAT or sex × SAT. Bold text illustrates significant association. GTS Stratified Associations of VAT and SAT 1 sd as the unit With Cardiovascular Risk Factors Adjusted for Age, Sex, Smoking, Alcohol, PAEE, BMI, Medication Use and VAT Adjusted for SAT and Vice Versa.
P values are tests for interaction term GTS × VAT or GTS × SAT. A, Predicted mean triglyceride levels as a function of VAT for men blue and women red. B, Predicted mean triglyceride levels as a function of SAT for men blue and women red.
P slope indicates whether the slope is different from 0. In a large Danish population of men and women at low to high risk of diabetes or with screen-detected diabetes, we found that both VAT and SAT were associated with increased cardiovascular risk independent of each other and of overall obesity.
Moreover, we found slightly different associations for men and women, as SAT was associated with more cardiovascular risk factors in women than in men, whereas VAT was associated with more cardiovascular risk factors in men than in women.
The associations for participants with NGT, prediabetes, and screen-detected type 2 diabetes also differed slightly. Previous studies have found that higher VAT was associated with increased BP 8 , 22 , Yet, some studies have also reported no association between VAT and BP 6 , 7 , 9.
In the present study, VAT was not associated with higher BP, which may be attributable to the high antihypertensive medication use in the study population This was attempted eliminated by adjusting for antihypertensive medication use; however, this adjustment may have been insufficient.
Another possible explanation for the inconsistencies in the findings relates to the different levels of disease progression in the study populations. The participants in the studies reporting no association between VAT and BP were characterized by being obese and having diabetes 6 , 7 , 9. Conversely, the participants in the studies reporting an association were healthier as they were untreated and free of clinical CVD 8 , 23 , This is consistent with the present study, as a large part of the population was characterized by having prediabetes or diabetes.
Furthermore, we found a modifying effect of GTS on the relationship between VAT and diastolic BP, but given that the associations were not significant in either of the groups, our results do not support that the association between VAT and BP differs between individuals with and without diabetes.
Of interest, we found a significant association between higher SAT levels and higher BP in participants with diabetes, which could suggest that SAT may exert more detrimental effects on cardiovascular risk when glucose tolerance worsens.
In accordance with previous studies 6 — 9 , 23 — 25 , we found that higher VAT was associated with higher triglyceride levels and lower HDL cholesterol levels in the entire population. One potential mechanism responsible for this finding could be that VAT is characterized by high rates of lipolysis leading to an overflow of free fatty acids.
Given that most VAT depots are drained by the hepatic portal vein, the liver is exposed to high amounts of free fatty acids, which may directly modify the liver's production and removal of plasma lipoproteins leading to hypertriglyceridemia Of interest, higher SAT was also associated with a dyslipidemic profile independent of VAT and overall obesity.
A possible explanation for this may relate to the regional distribution of SAT. It has been suggested that peripheral SAT on the hips and thigh confer a more favorable phenotype compared with abdominal SAT 6 , 27 , but we only measured abdominal SAT in our study.
In addition, it has been reported that abdominal SAT has both superficial and deep components, which may have opposite effects Thus, different results might have been found if SAT had been divided into these two components.
Sex differences in fat distribution are well documented. Women are generally characterized by having more SAT, whereas men are more prone to high amounts of VAT 24 , which is consistent with our findings.
Furthermore, previous studies found stronger associations of VAT and SAT with cardiovascular risk factors in women compared with men 4 , 7 , 8 , In accordance with these findings, we found that the associations of SAT with triglycerides and HDL cholesterol were only present in women. On the contrary, we found that the association between VAT and total cholesterol were only present in men and that the association between VAT and triglycerides were stronger in men compared with women.
Surprisingly however, the associations of VAT and SAT with all other cardiovascular risk factors were more or less similar in men and women.
The discrepancy between our results and previous findings could be related to ethnic differences, because previous studies have reported that the association between VAT and cardiovascular risk depends on ethnicity 29 , Thus, one explanation for the inconsistent findings could be that effect modification by sex might be more apparent in non-Caucasian populations.
It has previously been shown that the associations of VAT with cardiovascular risk factors do not differ by GTS 9. Our findings to some extent support this notion. The association of VAT with systolic BP observed in our study were modified by GTS, but no significant associations were found for either of the groups.
To examine the independent associations of VAT and SAT with the cardiovascular risk factors, VAT and SAT were included simultaneously in the statistical models. Some studies include VAT and SAT simultaneously in the models 6 , 8 , 23 , whereas others include them in separate models 7 , 22 , In a review from , Tchernof et al 24 stressed the importance of adjusting for SAT when examining associations of VAT with cardiovascular risk factors, and vice versa when examining SAT.
Tchernof et al 24 argue that because all adiposity measures are related to cardiovascular risk factors, SAT will most likely show correlations of the same magnitude as VAT if this procedure is not followed. Thus, the methodological approach put forward by Tchernof et al 24 was chosen in our study.
We additionally adjusted for BMI in the analyses because we wanted to study whether VAT and SAT explained variation in cardiovascular risk above and beyond overall obesity. Other easily obtainable measures of obesity or body size such as waist circumference or height could have been included in the statistical models instead of BMI.
However, due to the indirect, one-dimensional estimate of VAT and SAT, these measures were closely related and potentially correlated with waist circumference, increasing the risk of spurious findings if waist circumference was included in the models 31 , Although BMI seems to be the most commonly used approach to adjust for overall body size in other abdominal fat distribution studies 4 — 9 , 23 , 25 , some studies have adjusted for waist circumference either alone or in combination with BMI 8 , Therefore, we also performed the statistical analyses adjusted for waist circumference and height instead of BMI, but this did not alter any of our findings.
The ADDITION-PRO study provides a unique cohort of men and women at low to high risk of diabetes or with screen-detected diabetes who underwent objective and detailed measurements of fat distribution and cardiovascular risk. Furthermore, collection of information on relevant confounders enabled adjustment for a sufficient set of confounders.
Few studies have examined the relationship between fat distribution assessed by ultrasound and cardiovascular risk 14 , Ultrasound has been validated against the gold standard techniques magnetic resonance imaging [MRI] and computed tomography [CT] for assessing fat distribution and it was found to be a valid and reliable technique 10 , 12 , Furthermore, the reproducibility of the ultrasound technique used in the present study was recently examined and reported to be adequate Comparison of findings obtained with different methods should be performed with caution, but the present study extends current literature by finding consistent results with previous studies using the highly accessible ultrasound technique instead of the more expensive and time-consuming MRI or CT techniques.
MRI and CT techniques may still be the method of choice for smaller hospital— or laboratory-based clinical studies, and does allow detailed assessment of visceral fat deposits around the organs, which could have implications for cardiovascular risk.
However, the present study strengthens the assumption that ultrasound is a feasible and applicable technique, which should be considered as means of assessing fat distribution in large-scale epidemiological studies. In our study, there was a higher fraction of individuals with prediabetes or screen-detected diabetes than in the general population.
This ensured that reliable estimates could be generated for these subgroups. Furthermore, the relative large sample size provided adequate power to detect potentially small but significant associations of VAT and SAT with cardiovascular risk.
It should be noted, however, that we performed a relatively large number of statistical analyses and therefore some of the borderline significant findings should be interpreted with caution. Due to the cross-sectional design of the analysis it was not possible to address the issue of causality. Furthermore, as the association between fat distribution and cardiovascular risk may be different at younger ages than at the ones examined 24 , the results should only be generalized to populations within the same age range.
In addition, as previous research has shown that the association between VAT and cardiovascular risk depends on ethnicity 29 , 30 , generalization beyond Caucasian populations may be questionable.
In conclusion, this study showed that both VAT and SAT are associated with cardiovascular risk in a population of men and women at low to high risk of diabetes or with screen-detected diabetes. In particular, SAT is associated with cardiovascular risk in women.
Prospective studies examining whether changes in VAT and SAT are related to concomitant changes in cardiovascular risk are needed to determine whether abdominal fat loss should be recommended as part of a preventive strategy. We acknowledge all the ADDITION-PRO participants and the participating general practitioners for their contribution to the study.
We also thank all the teams of the different clinical research centers and Anneli Sandbæk and Knut Borch-Johnsen. The ADDITION-Denmark study was supported by the National Health Services in the counties of Copenhagen, Aarhus, Ringkøbing, Ribe, and Southern Jutland in Denmark; the Danish Council for Strategic Research; the Danish Research Foundation for General Practice; Novo Nordisk Foundation; the Danish Centre for Evaluation and Health Technology Assessment; the Diabetes Fund of the National Board of Health; the Danish Medical Research Council; and the Aarhus University Research Foundation.
and D. are funded by the Danish Diabetes Academy supported by the Novo Nordisk Foundation. Author Contributions: S. Laboratory analysis was performed to measure total cholesterol and triglyceride, high-density lipoprotein HDL , low-density lipoprotein, and fasting plasma glucose levels.
The Framingham risk score FRS was used to present the year risk for having CVD, and predictors such as sex, age, total cholesterol, HDL, systolic blood pressure, treatment for hypertension, and smoking status were used to calculate the FRS. Results: Ninety-nine adults 58 men, mean age The participants consisted of all five levels of the Gross Motor Function Classification System.
The mean body mass index BMI was According to BMI criteria, The fat mass index criteria revealed In multiple regression analysis, the FRS was associated with age and android fat percentage, based on the following formula:. Conclusions: Body fat distribution in the android area is significantly associated with future CVD risk in adults with CP.
When people with cerebral palsy CP mature into adulthood, they frequently face various secondary conditions. Among the major challenges of this population, lack of physical activity, decreased physical fitness, and a sedentary lifestyle are often reported in adulthood 1 , 2.
There is a medical concern that these factors may increase the risk of cardiovascular disease CVD in the CP population 1 — 4. Several previous studies have shown that CVD-related mortality is higher in people with CP than in the general population 1 , 3 , 5. Physical inactivity in people with CP may increase the risk of obesity.
At the same time, they have an increased risk of dysphagia and other gastrointestinal problems, which may lead to nutritional deficiency 6 , 7 , while spasticity can lead to increased energy consumption 8 — The reported prevalence of actual obesity in the adult CP population has varied across studies 2 , 4.
Recently, fat distribution has been proposed to be more closely associated with CVD risk than with the general measures of obesity, such as total fat mass or body fat percentage 11 , Android fat distribution, which refers to the central distribution of body fat, is an important risk factor for future cardiovascular events, independent of overall fat volume More specifically, adults with CP are exposed to secondary musculoskeletal changes, including loss of muscle mass, muscle shortening, joint contractures, and deformity Deficits in lean mass, with replacement by fat tissue, have been reported in several studies on people with CP 15 — It has been reported that children with CP present with greater intermuscular adiposity than the neurologically intact group Adults with CP also show larger visceral and subcutaneous adiposity 4.
Furthermore, the prevalence of sarcopenia in adults with CP is higher than that in the general population Fat distribution may be particularly important in this population because of possible differences in body composition. Therefore, it is assumed that the regional fat distribution, as well as general body fat characteristics, may show a profile in people with CP that differs from that in the general population.
Therefore, we sought to identify the prevalence of obesity and the characteristics of body fat distribution in an adult population with CP, and we assessed their cardiovascular risks and the relationship thereof with body fat distribution in this population. Participants were recruited from the community, with the cooperation of nationwide organizations for persons with disabilities, and four hospitals in Gyeonggi and Seoul in South Korea.
A total of adults with CP were included in this study. Participants were excluded if they were not able to understand or answer the questionnaire despite receiving assistance from an interviewer, if they failed to complete dual-energy X-ray absorptiometry DXA , or if they withdrew before data collection.
Data were collected between February 1, , and November 31, All study procedures were approved by the institutional review boards of the participating institutions, operating in compliance with the Guidelines for Good Clinical Practice.
Written informed consent was obtained from all participants. After obtaining consent from the participants, questionnaire surveys on basic information, assessments, and measurements were conducted.
A structured interview and physical examination were conducted by a physiatrist or a trained research nurse in order to complete the questionnaire regarding demographics and physical function. The questionnaire included questions on sex, age, current smoking status, and drinking habits. Current smoking was defined as any cigarette smoking within the previous month.
Never cigarette smokers and ex-cigarette smokers were classified as non-smokers. Likewise, drinkers were classified as those with any alcohol consumption in the past previous month.
Waist circumference and resting blood pressure were also measured. Waist circumference was measured in subjects in a standing position, at normal expiration.
It was measured at the midpoint between the lower margin of the least palpable rib and the top of the iliac crest, using a stretch-resistant tape 20 , once for each participant.
Systolic blood pressure SBP; mmHg was determined as the average of two measurements taken 1 min apart, with the subjects in the supine position, after subjects had rested quietly in a chair for at least 5 min. Treatment for hypertension was also recorded.
The types of CP and the areas affected were investigated. They were determined by a single physiatrist SHJ with more than 15 years of clinical experience in CP. The types of CP were classified as spastic, dystonic, dyskinetic, ataxic, or mixed Affected areas were determined as quadriplegia, diplegia, hemiplegia, and monoplegia of the upper and lower extremities For gross motor function, we used the Gross Motor Function Classification System GMFCS.
This is a five-level scale, where level I represents the least disability and level V the most, based on typical performance rather than the maximal capacity 23 , People with GMFCS level I walk without limitations, whereas people with level V are transported in a manual wheelchair.
It is widely used to describe abilities and limitations in gross motor function, including sitting and walking, in children and adolescents, aged up to 18 years, with CP The subject's current and best previous GMFCS levels were determined by a physiatrist after a structured interview and clinical examination.
The age at deterioration of physical function was also examined. GMFCS levels in year intervals were determined, and the age span of physical deterioration was defined as the period when there was a regression of GMFCS level. The participants were also categorized according to the GMFCS level: ambulatory GMFCS levels I, II, and III and non-ambulatory groups GMFCS levels IV and V.
History of fall and number of falls in the past year were recorded by interviewing the patients. The Short Physical Performance Battery SPPB was assessed by a trained physiotherapist. It is a group of measures that combines the results of gait speed, chair stand, and balance tests It is an important indicator of functional mobility and independence Basic body anthropometry was performed to measure height and body weight.
For body composition assessment, DXA GE Lunar Prodigy, Bedford, MA, United States was used. DXA provides a precise evaluation of body composition at a relatively low cost DXA differentiates bone mineral, lean, and fat soft tissues by measuring two different energy levels emitted from each type of tissue.
The regions of interest ROIs were defined and calculated using the software provided by the manufacturer for local fat composition assessment. The gynoid area was from the lower boundary of the umbilicus ROI upper boundary to a line equal to two times the height of the android fat distribution ROI lower boundary Figure 1.
A venous blood sample was obtained for laboratory analysis. The participants fasted for at least 8 hr before their blood was drawn. Blood composition analysis included total cholesterol and triglyceride TG , high-density lipoprotein HDL , low-density lipoprotein LDL , and fasting plasma glucose FPG levels.
The FRS has been widely used for the risk assessment of CVD 30 , The FRS was used to represent a participant's year risk of coronary heart disease. This tool was designed for adults aged 20 years and older. The FRS estimates the year coronary heart disease risk based on predictors, such as sex, age, total cholesterol, HDL, SBP, treatment for hypertension, and smoking status The clinical characteristics were compared between groups using an independent t -test for continuous variables and Student's t -test or Fisher's exact test for categorical variables.
Adjustment of alpha level was not made for multiple comparisons in this study, as the authors assumed that it may lead to fewer errors in interpretation Associations between the FRS and other factors were examined using univariable and multiple regression analyses.
All statistical analyses were conducted using the SPSS version Ninety-nine adults with CP were enrolled; however, 79 adults were included in the analysis in this study. DXA could not be performed in 20 adults. In 17 adults, precise measurement was not possible because of deformities and abnormal postures.
Two adults had dystonic-type CP and one adult had athetoid-type CP and could not remain still during the measurement. The mean age of the study population 45 men and 34 women was The participant's characteristics, physical functions, and laboratory results are shown in Table 1.
Table 1. Participant's characteristics, physical function, and laboratory results. There was no significant difference between sexes in waist circumference, BMI, BMI criteria, total body fat mass and fat percentage, and gynoid fat mass Table 2. Table 2. Body anthropometry, body composition, Framingham risk score, and year cardiovascular disease risk analysis by sex and ambulatory function.
There was no significant difference between the ambulatory and non-ambulatory groups in waist circumference, BMI, and body fat composition. The FRS and year risk of developing coronary heart disease did not differ between the ambulatory and non-ambulatory groups.
Multiple regression analysis of the FRS was performed with the factors age and android fat percentage that were significantly associated with FRS in univariable regression analysis.
R 2 shows the percentage of variance in the outcome explained by all variables in the model. This study shows that age and android fat percentage are independently associated with CVD risk in adults with CP. On the other hand, factors such as BMI, GMFCS level, and functional abilities were not found to be related to CVD risk in adults with CP.
Notably, the CVD risk was significantly associated with the android fat proportion rather than the measures of overall adiposity, such as BMI and total body fat, in adults with CP.
Age and disproportionate distribution of body fat were the major predictors of CVD risk in this study. It is widely accepted that the risk of CVD increases with age 34 — The American Heart Association AHA reports that the incidence of CVD is ca. Recently, disproportionate fat distribution has been suggested as an important factor predicting CVD risk 38 , Although the underlying mechanism of the associations between regional adiposity and CVD risk is not yet clear, regional body fat distribution around the abdominal area is known to be related to metabolic syndromes, such as dyslipidemia, hypertension, and type 2 diabetes mellitus 40 even in normal-weight people, children, and older individuals 11 , 41 , It has been reported that android body fat is strongly associated with circulating levels of CRP and fibrinogen, thus increasing the risk of subclinical inflammation, leading to endothelial dysfunction In this study, body fat distribution was different between sexes, while BMI and total body fat did not differ.
Women showed a markedly higher year risk of CVD than men. These results are in line with those of the general population. Fat distribution differs between sexes in non-abled populations 43 , CVD is markedly more common in men in the general population The reasons for the sex differences have not yet been fully elucidated However, it has been suggested that android fat distribution may contribute to metabolic disturbances that affect CVD risk 47 , One of the suggested reasons for regional fat differences is sex hormones Female sex hormones are known to cause the accumulation of body fat in the lower body regions, which is essential for reproductive function 50 , This may account for one of the reasons for the difference in CVD risk between the sexes According to the Organization for Economic Co-operation and Development OECD reports released in , the average overweight and obesity rate in South Korea was We found that Korean adults with CP in this study were not obese compared to the general Korean population.
It has been debated whether adults with CP are more obese than the general population. Most studies have reported that adults with CP are more likely to be obese due to a lack of physical activity and a sedentary lifestyle 2 , 5 , 52 — As we focused on individuals who were able to participate in the survey, those with intellectual disabilities were not included, and this may account for the different results, as obesity rate in adults with CP is known to be closely related to intellectual disability Previous studies did not exclude those with intellectual disabilities 2 , 5 , 52 — Studies by van der Slot et al.
showed that the obesity rate is slightly lower in adults with CP than in the general population 2. In the study by Van der Slot, the included subjects were relatively young, with ages ranging from to 25 to 45 years, and those with severe intellectual disabilities were excluded.
In addition, since most of the previous studies investigating obesity among patients with CP have been conducted in Western countries, the results of our study on the Korean population could be different due to cultural differences or eating behaviors.
Likewise, in a study on the growth profile assessment of adults with tethered cord syndrome in Korea, these subjects had lower height, weight, and BMI than controls of the same age 55 , which differ from the previous results of higher rate of obesity among spinal bifida patients in Western countries 56 , It is conceivable that since the participants in this study had relatively diverse CP types and function levels, the risk of undernutrition due to dysphagia or feeding problems also existed.
On the other hand, the FRS scores in this population group were higher than those in the general Korean population.
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PMID; PMCID:PMC Download references. Neeland has received funding outside the submitted work from the National Institutes of Health, grant R01 HL, and the American Heart Association, grant 23SCISA Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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Provided by the Springer Nature SharedIt content-sharing initiative. Abstract Purpose of Review Specific measures of body fat distribution may have particular value in the development and treatment of cardiometabolic conditions, such as cardiovascular disease CVD and diabetes mellitus DM.
Recent Findings Accumulation of visceral and ectopic fat is a major contributor to CVD and DM risk above and beyond the body mass index BMI , yet implementation of fat distribution assessment into clinical practice remains a challenge. Summary A focus on implementation of body fat distribution measurements into clinical practice should be a priority over the next 5 to 10 years, and clinical assessment of fat distribution can be considered to refine risk evaluation and to develop improved and effective preventive and therapeutic strategies for high-risk obesity.
Access this article Log in via an institution. Abbreviations CVD: Cardiovascular disease DM: Diabetes mellitus BMI: Body mass index VAT: Visceral abdominal adipose tissue SCAT: Subcutaneous adipose tissue FFAs: Free fatty acids TGs: Triglycerides MRI: Magnetic resonance imaging CT: Computed tomography NASH: Nonalcoholic steatohepatitis SGLT2i: Sodium glucose co-transporter 2 inhibitors GLP Glucagon-like peptide-1 MWL: Medical weight loss strategies MACE: Major adverse cardiovascular events CAD: Coronary artery disease HTN: Hypertension HFpEF: Heart failure with preserved ejection fraction AF: Atrial fibrillation LV: Left ventricle EAT: Epicardial adipose tissue.
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Objectives: The distribuyion of this study was to determine whether ectopic dustribution depots are prospectively associated with Fat distribution and cardiovascular disease disease, cancer, and all-cause mortality. Background: Fat distribution and cardiovascular disease morbidity Soccer nutrition for speed with excess cardiovaecular weight varies among individuals of similar body mass index. Ectopic fat depots may underlie this risk differential. However, prospective studies of directly measured fat are limited. Cox proportional hazards regression models were used to examine the association of each fat depot per 1 SD increment with the risk of incident cardiovascular disease, cancer, and all-cause mortality after adjustment for standard risk factors, including body mass index. Results: Overall, there were 90 cardiovascular events, cancer events, and 71 deaths.Thank Curcumin and Digestive Health for visiting cardiovasccular. You are using a browser version with limited support for CSS.
To cardiovascu,ar the best experience, we recommend you use a more up to date browser or turn diseasr compatibility mode in Endurance training for soccer players Explorer.
Fasting and Mental Clarity the meantime, to Faf continued support, we are displaying the idstribution without styles and JavaScript. More specific total body and disttribution fat mass measures might be stronger associated with cardiovascular risk factors in childhood, than BMI.
Cardiovazcular examined the independent cafdiovascular of total dstribution abdominal fat measures with cardiovascular risk factors in school age children. We performed a population-based cardiovascula study among 6, children. At the age of 6 y, we measured childhood BMI, and general and abdominal fat Fat distribution and cardiovascular disease, diseasse dual-energy X-ray absorptiometry, and ultrasound and cardiovascular risk factors.
Distribugion associations differed between underweight, normal weight, overweight, and obese children. Higher childhood adiposity measures disfribution associated with increased odds of cardiovascular distributtion factors clustering, with the distributikn effect for diseae mass percentage Neuropathic ulcers in diabetes ratios: 3.
Cardiovsacular results suggest that disgribution and abdominal fat measures are associated with Science-backed weight loss supplements risk factors in childhood, Fta from BMI.
Ditribution measures may diseaxe additional information didease identification of children with an adverse cardiovascular profile. Pontus Henriksson, Johanna Sandborg, … Marie Löf. Carolyn T.
Bramante, Elise F. Palzer, … Aaron Csrdiovascular. Jennifer L. Carter, Noraidatulakma Abdullah, … Rahman Jamal. Childhood obesity is a major public health problem 1.
It seems that not only overweight and obesity, but also higher body distriubtion across distfibution full Pancreatic islet transplantation is associated distrihution risk factors for cardiovascular and metabolic diseases in childhood and adulthood 23 Fatt, 4Fat distribution and cardiovascular disease.
BMI does not distinguish lean mass from fat mass diesase. Among adults and children, total body fat mass assessed by dual-energy X-ray absorptiometry Fat distribution and cardiovascular disease seems to be, independent from BMI, wnd with cardiovascular risk distribuiton 37.
Also, waist dardiovascular, as proxy Prebiotics health benefits abdominal fat mass, Fighting depression with diet and exercise independent of BMI related to the distributionn of mortality in adults, suggesting that central or abdominal adiposity is Ft strongly associated with adverse health outcomes Matcha green tea energydiaease.
Abdominal fat mass is an accumulation cardiovasvular both subcutaneous and visceral adipose tissues. In Supplements for team sports nutrition, visceral adipose tissue accumulation is stronger related with an adverse glucose and lipid profile than subcutaneous adipose tissue accumulation 8.
Thus far, population-based studies focused on the associations of different detailed dsease body and abdominal fat mass measures with cardiovascular risk anx in distributipn show inconsistent results. Abdominal fat mass in children has been identified as a stronger predictor of cardiovascular risk factors, as compared distributioj BMI, Fat distribution and cardiovascular disease Continuous glucose monitoring device are not Vegan and vegetarian athlete nutrition 239.
Carddiovascular, we examined in a population-based cohort study among xnd, school-age children, the independent associations of BMI Fat distribution and cardiovascular disease total Calculate BMI and abdominal fat disaese measures with risk factors for cardiovascular disease.
Table 1 presents Carbohydrates and Insulin characteristics. The correlation coefficients between childhood adiposity Cognitive function improvement and cardiovascular distribjtion factors are given in the Supplementary Tables S1 and Cistribution online.
As compared to cardiovascukar Fat distribution and cardiovascular disease BMI, the associations of fat mass percentage and abdominal fat ditsribution with systolic diwease pressure, left ventricular mass and blood levels of insulin and Fat loss mindset were dlstribution, whereas those with blood fisease of lipids were stronger.
No differences aFt the strength of these associations were present between subcutaneous and preperitoneal abdominal fat mass csrdiovascular.
Additionally, adjusting these associations for BMI distibution the associations of fat mass percentage and abdominal fat mass Fat distribution and cardiovascular disease with blood pressure distributino blood levels of insulin and Fat distribution and cardiovascular disease into nonsignificant Supplementary Table S3 online.
Supplementary Table S4 online shows that cardiovascu,ar fat mass percentage and abdominal fat mass measures ad the models slightly increased the diisease of variance already explained Community gardens and urban farming BMI.
Higher fat mass percentage and abdominal fat mass measures were associated with higher total-cholesterol, LDL-cholesterol, triglycerides, insulin and c-peptide blood levels, and lower HDL-cholesterol blood levels.
Associations of total body and abdominal fat mass measures with cardiovascular risk factors, conditional on BMI. a Systolic blood pressure. b Diastolic blood pressure. c Left ventricular mass.
d Total-cholesterol. e Low-density lipoprotein-cholesterol. f High-density lipoprotein-cholesterol. g Triglycerides. h Insulin. The estimates represent differences in systolic and diastolic blood pressure, left ventricular mass, different lipid levels and insulin per standardized residual change of total, and abdominal fat mass measures.
Models are adjusted for age, sex, and ethnicity. PowerPoint slide. Table 3 shows that among normal weight and overweight children, higher fat mass percentage was associated with higher blood pressure, whereas among obese children higher fat mass percentage was stronger associated with HDL-cholesterol and insulin.
We observed the strongest associations of higher fat mass percentage and abdominal fat mass measures with lower left ventricular mass among underweight children. The associations of abdominal fat mass measures with cardiovascular risk factors were higher among obese children.
Interaction terms were constructed by using BMI in four categories and adiposity measures as continuous variables. The interaction terms between BMI categories and adiposity measures for total-cholesterol were not significant.
Associations of childhood total body and abdominal fat mass measures with c-peptide levels among different obesity categories are shown in Supplementary Table S5 online. For all analyses, sensitivity analyses were performed among boys and girls separately and no consistent sex differences were present results not shown.
Figure 2 shows that higher BMI and fat mass percentage and abdominal fat mass tended to be associated with higher risks of hypertension, hypercholesterolemia, and clustering of cardiovascular risk factors, with similar effect estimates for the associations of the different fat measures with the risks of hypertension and hypercholesterolemia.
For clustering of cardiovascular risk factors, we observed the strongest effect estimate for fat mass percentage odds ratio: 3. After excluding the android fat mass percentage as a component from the definition of clustering of cardiovascular risk factors, similar results were observed for the associations of body fat distribution measurements with clustering of cardiovascular risk factors Supplementary Figure S1 online.
Associations of total body and abdominal fat mass measures with the risk of hypertension, hypercholesterolemia and clustering of cardiovascular risk factors in children.
a Hypertension. b Hypercholesterolemia. c Clustering of cardiovascular risk factors. This large-scale population-based study among school-age children showed that both fat mass percentage and abdominal fat mass measures were associated with cardiovascular risk factors, independent from BMI.
Higher childhood body fat distribution measures were strongly associated with increased risks of childhood hypertension, hypercholesterolemia, and clustering of cardiovascular risk factors. We performed a cross-sectional study within a population-based cohort with a large number of subjects.
The nonresponse could lead to biased effect estimates if the associations of different obesity measures with cardiovascular risk factors would be different between children included and not included in the analyses Assuming that children with a higher BMI are less likely to participate in the detailed adiposity and cardiovascular follow-up studies, our estimates may be underestimated.
Birth weight was lower in those who were included in the current analyses than in those who were not included. However, it is hard to speculate whether this difference would affect the observed associations materially, but we consider this unlikely.
We obtained detailed measures of childhood adiposity. DXA quantifies fat content with high precision, but cannot differentiate between abdominal visceral and subcutaneous fat compartments.
However, we used abdominal ultrasound, a valid method for measuring both subcutaneous abdominal fat mass and preperitoneal fat mass Both DXA and abdominal ultrasound have been validated against CT 12 Use of min fasting blood samples may have led to underestimation of the observed associations.
However, it has been shown in adults that nonfasting lipid levels can accurately predict increased risks of cardiovascular events in later life The different adiposity measures were correlated, which may explain why the associations are difficult to interpret when are included in one regression models.
The main advantage of the conditional analyses is that the effect estimates are completely statistically independent when combined in one model. Due to the cross-sectional analyses, we were not able to explore directions and causality of the observed associations.
Therefore, it is of interest to perform further longitudinal analyses to examine the associations of these adiposity measures with cardiovascular risk factors in adolescence and adulthood.
Many studies have shown associations of different adiposity measures with cardiovascular risk factors 12348.
BMI may be a suboptimal measure in children, as it is unable to distinguish lean mass from fat mass. Detailed total body and abdominal fat mass measures may be useful to identify children with an adverse cardiovascular profile. Thus far, not much is known about these associations in school-age children.
In our study, BMI, fat mass percentage, and abdominal fat measures were strongly positively correlated. These observations suggest that the correlations between BMI, fat mass percentage, and waist circumference previously shown in both adults and older aged children are also present in school-aged children 315 The relatively weaker correlation between BMI and preperitoneal fat mass suggests that BMI is only weakly related to visceral fat mass.
We observed that fat mass percentage, was independent from BMI, associated with various cardiovascular risk factors.
Also, the associations of body fat mass measures with lipid levels tended to be stronger than the associations for BMI. Similarly, a study among 5, English children aged 9—12 y observed that BMI and total fat mass in childhood were associated with cardiovascular risk factors in adolescents, with slightly stronger effect estimates for total fat mass measures Surprisingly, we observed that independent from BMI, fat mass percentage was inversely associated with left ventricular mass.
Another study among children aged 6—17 y old reported a similar associations 17suggesting muscle mass is the major determinant of left ventricular mass in childhood.
Multiple studies in both adults and older aged children have reported similar effect estimates 18 However, waist to hip ratio has not consistently been identified as a strong predictor of cardiovascular risk factors.
These inconsistencies may be due to the large variations in the level of total body and abdominal fat mass; therefore, both lean and obese individuals may have the same waist to hip ratio.
We measured subcutaneous and preperitoneal fat mass using ultrasound, and used preperitoneal fat mass as a measure of visceral fat mass 11 In adults and adolescents, both subcutaneous abdominal fat mass and visceral abdominal fat mass are associated with cardiovascular risk factors and visceral fat mass tends to be stronger related with HDL-cholesterol, triglycerides, and insulin resistance 820 As compared to associations of preperitoneal fat mass, we observed stronger associations for subcutaneous abdominal fat mass area with most cardiovascular risk factors.
Thus, in children, visceral fat mass may not be strongly associated with cardiovascular risk factors, which may be explained by less pathogenic and only a small accumulation of visceral adipose tissue at younger ages.
In line with our findings, a study among young men 22 showed that visceral abdominal fat mass is not stronger associated with cardiovascular risk factors than subcutaneous abdominal fat mass. The effects of specific fat measures on health outcomes may differ between normal, overweight, and obese children.
: Fat distribution and cardiovascular disease| Body fat distribution, incident cardiovascular disease, cancer, and all-cause mortality | Assy N, Djibre A, Farah Bod Pod body volume calculation, Grosovski M, Fat distribution and cardiovascular disease A. CAS PubMed Olive oil and diabetes Scholar Kanai H, Tokunaga K, Fujioka S, Yamashita An, Fat distribution and cardiovascular disease Dosease, et al. Association of pericardial fat cardiovqscular coronary cardiovascullar Fat distribution and cardiovascular disease as determined by cardiac CT. Cardiovasculat studies include VAT FFat SAT simultaneously in the models 6823whereas others include them in separate models 722 Non-alcoholic fatty liver disease NAFLD is caused by hepatic steatosis predominantly involving triglycerides in individuals who do not consume sufficient alcohol quantities to exacerbate liver damage. In contrast with thoracic aortic fatty tissue, abdominal aortic fatty tissue is more similar to white adipose tissue [ 64 ], especially in obese mice, where the abdominal aortic PVAT is similar to white adipose tissue i. About the journal Journal Information Open Access Fees and Funding About the Editors Contact About the Partners For Advertisers Subscribe Announcements. |
| Materials and Methods | Obesity risk: importance of Fat distribution and cardiovascular disease diwtribution ratio. Obesity: the myth of innocent obesity. Body fat cardoivascular is more closely related Time-restricted eating method CVD risk than measures of general obesity in adults with CP. Neeland IJ, Ross R, Després J-P, Matsuzawa Y, Yamashita S, Shai I, et al. Improvement of glucose and lipid metabolism associated with selective reduction of intra-abdominal visceral fat in premenopausal women with visceral fat obesity. |
| Localization of fat depots and cardiovascular risk | Lipids in Health and Disease | Full Text | Public Health Nutr. Author Contributions O. Differential effects of abdominal adipose tissue distribution on insulin sensitivity in black and white South African women. Rebuffé-Scrive M, Lundholm K, Björntorp P. Increases in EAT can lead to excess production of FFA, which prevents the generation and propagation of a nerve impulse through the heart fibres and subsequently potentiates the development of ventricular arrhythmias [ 49 ]. Article CAS PubMed Google Scholar Kanai H, Matsuzawa Y, Kotani K, Keno Y, Kobatake T, Nagai Y, et al. |
Fat distribution and cardiovascular disease -
Endocrine Journal. Online ISSN : Print ISSN : ISSN-L : Journal home Advance online publication All issues Featured articles About the journal. Body Fat Distribution and Cardiovascular Disease Risk Factors in Pre- and Postmenopausal Obese Women with Similar BMI.
Corresponding author. Keywords: Menopause , Abdominal obesity , Risk factors. JOURNAL FREE ACCESS. Published: Received: January 16, Available on J-STAGE: August 29, Accepted: May 27, Advance online publication: - Revised: -. Download PDF K Download citation RIS compatible with EndNote, Reference Manager, ProCite, RefWorks.
Article overview. Greater adipose tissue distribution and diminished spinal musculoskeletal density in adults with cerebral palsy.
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Journal Article. Abdominal Fat Distribution and Cardiovascular Risk in Men and Women With Different Levels of Glucose Tolerance. Scheuer , Stine H.
Oxford Academic. Kristine Færch. Annelotte Philipsen. Marit E. Nanna B. Bendix Carstensen. Daniel R. Ingelise Andersen. Torsten Lauritzen. Gregers S. PDF Split View Views. Cite Cite Stine H. Select Format Select format. ris Mendeley, Papers, Zotero.
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Stine H. Scheuer, Dissase Færch, Annelotte Philipsen, Fat distribution and cardiovascular disease E. Jørgensen, Nanna B. Johansen, Bendix Carstensen, Daniel R. Witte, Ingelise Andersen, Torsten Lauritzen, Gregers S. Regional fat distribution rather than overall obesity has been recognized as important to understanding the link between obesity and cardiovascular disease.
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