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Nazare JA, Smith J, Borel AL, Aschner P, Barter P, Van Gaal L, Tan CE, Wittchen HU, Matsuzawa Y, Kadowaki T, Ross R, Brulle-Wohlhueter C, Alméras N, Haffner SM, Balkau B, Després JP. Usefulness of measuring both body mass index and waist circumference for the estimation of visceral adiposity and related cardiometabolic risk profile (from the INSPIRE ME IAA study). Am J Cardiol 2015; 115:307-15. [PMID: 25499404 DOI: 10.1016/j.amjcard.2014.10.039] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 10/28/2014] [Accepted: 10/28/2014] [Indexed: 02/06/2023]
Abstract
Despite its well-documented relation with visceral adiposity (VAT) and cardiometabolic risk (CMR), whether waist circumference (WC) should be measured in addition to body mass index (BMI) remains debated. This study tested the relevance of adding WC to BMI for the estimation of VAT and CMR. In the International Study of Prediction of Intra-abdominal Adiposity and Its Relationship with Cardiometabolic Risk/Intra-abdominal Adiposity, 297 physicians recruited 4,504 patients (29 countries). Both BMI and WC were measured, whereas VAT and liver fat were assessed by computed tomography. A composite CMR score was calculated. From the 4,109 patients included in the present analyses (20 ≤ BMI < 40 kg/m(2), 47% women), about 30% displayed discordant values for WC and BMI quintiles, despite a strong correlation between the 2 anthropometric variables (r = 0.87 and r = 0.84 for men and women, respectively, p <0.001). Within each single BMI unit, VAT and WC showed substantial variability between subjects (mean difference between 90th and 10th percentiles: 175 cm(2)/16 cm and 137 cm(2)/18 cm for VAT/WC in men and women, respectively). Within each BMI category, increasing gender-specific WC tertiles were associated with significantly higher VAT, liver fat, and with a more adverse CMR profile. In conclusion, this large international cardiometabolic study highlights the frequent discordance between BMI and WC, driven by the substantial variability in VAT for a given BMI. Within each BMI category, WC was cross-sectionally associated with VAT, liver fat, and CMR factors. Thus, WC allows a further refinement of the CMR related to any given BMI.
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Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation 2014; 131:e29-322. [PMID: 25520374 DOI: 10.1161/cir.0000000000000152] [Citation(s) in RCA: 4464] [Impact Index Per Article: 446.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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De Schutter A, Lavie CJ, Kachur S, Patel DA, Milani RV. Body composition and mortality in a large cohort with preserved ejection fraction: untangling the obesity paradox. Mayo Clin Proc 2014; 89:1072-9. [PMID: 25039037 DOI: 10.1016/j.mayocp.2014.04.025] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 03/11/2014] [Accepted: 04/16/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the effects of body composition as a function of lean mass index (LMI) and body fat (BF) on the correlation between increasing body mass index (BMI; calculated as the weight in kilograms divided by the height in meters squared) and decreasing mortality, which is known as the obesity paradox. PATIENTS AND METHODS We retrospectively assessed 47,866 patients with preserved left ventricular ejection fraction (≥50%). We calculated BF by using the Jackson-Pollock equation and LMI using (1 - BF) × BMI. The population was divided according to the sex-adjusted BMI classification, sex-adjusted LMI classification, and sex-adjusted BF tertiles. The population was analyzed by using multivariate analysis for total mortality over a mean follow-up duration of 3.1 years by using the National Death Index, adjusting for left ventricular ejection fraction, left ventricular mass index, age, sex, and relative wall thickness. RESULTS In the entire population, higher BMI was narrowly associated (hazard ratio [HR], 0.99; P<.001) with lower mortality. The higher LMI group was clearly protective (HR, 0.71; P<.001), whereas BF tertile was associated with lower mortality only if no adjustment was made for LMI (HR, 0.87; P<.001 without LMI; HR, 0.97; P=.23 with LMI). In the lean patients, low BMI was clearly associated with higher mortality (HR, 0.92; P<.001) and lower BF tertile was associated with lower mortality only if no adjustment was made for LMI (HR, 0.80; P<.001 without LMI; HR, 1.01; P=.83 with LMI). The underweight patients stratified by BF seemed to have an increased mortality (HR, 1.91; 95% CI, 1.56-2.34) that was independent of LMI. However, in obese patients, both BMI (HR, 1.03; P<.001) and BF (HR, 1.18; P=.003) were associated with higher mortality, even after adjusting for LMI, which remained protective (HR, 0.57; P<.001) independently of BF. CONCLUSION Body composition could explain the inverse J shape of the mortality curve noted with increasing BMI. Body fat seems to be protective in this cohort only if no adjustment was made for LMI, although being underweight stratified by BF seems to be an independent risk factor. Lean mass index seems to remain protective in obese patients even when BMI is not.
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Affiliation(s)
- Alban De Schutter
- John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA; Department of Medicine, Cleveland Clinic Florida, Weston
| | - Carl J Lavie
- John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA; Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge.
| | - Sergey Kachur
- Department of Medicine, Cleveland Clinic Florida, Weston
| | - Dharmendrakumar A Patel
- John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Richard V Milani
- John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
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Azzout-Marniche D, Chaumontet C, Nadkarni NA, Piedcoq J, Fromentin G, Tomé D, Even PC. Food intake and energy expenditure are increased in high-fat-sensitive but not in high-carbohydrate-sensitive obesity-prone rats. Am J Physiol Regul Integr Comp Physiol 2014; 307:R299-309. [DOI: 10.1152/ajpregu.00065.2014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Obesity-prone (OP) rodents are used as models of human obesity predisposition. The goal of the present study was to identify preexisting defects in energy expenditure components in OP rats. Two studies were performed. In the first one, male Wistar rats ( n = 48) were fed a high-carbohydrate diet (HCD) for 3 wk and then a high-fat diet (HFD) for the next 3 wk. This study showed that adiposity gain under HCD was 2.9-fold larger in carbohydrate-sensitive (CS) than in carbohydrate-resistant (CR) rats, confirming the concept of “carbohydrate-sensitive” rats. Energy expenditure (EE), respiratory quotient (RQ), caloric intake (CI), and locomotor activity measured during HFD identified no differences in EE and RQ between fat-resistant (FR) and fat-sensitive (FS) rats, and indicated that obesity developed in FS rats only as the result of a larger CI not fully compensated by a parallel increase in EE. A specific pattern of spontaneous activity, characterized by reduced activity burst intensity, was identified in FS rats but not in CS ones. This mirrors a previous observation that under HCD, CS but not FS rats, exhibited bursts of activity of reduced intensity. In a second study, rats were fed a HFD for 3 wk, and the components of energy expenditure were examined by indirect calorimetry in 10 FR and 10 FS rats. This study confirmed that a low basal EE, reduced thermic effect of feeding, defective postprandial energy partitioning, or a defective substrate utilization by the working muscle are not involved in the FS phenotype.
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Affiliation(s)
- Dalila Azzout-Marniche
- Institut National de la Recherche Agronomique, Centre de Recherche en Nutrition Humaine d'Ile-de-France (CRNH-IdF), UMR 914 Nutrition Physiology and Ingestive Behavior, Paris, France; and
- AgroParisTech, CRNH-IdF, UMR 914 Nutrition Physiology and Ingestive Behavior, Paris, France
| | - Catherine Chaumontet
- Institut National de la Recherche Agronomique, Centre de Recherche en Nutrition Humaine d'Ile-de-France (CRNH-IdF), UMR 914 Nutrition Physiology and Ingestive Behavior, Paris, France; and
- AgroParisTech, CRNH-IdF, UMR 914 Nutrition Physiology and Ingestive Behavior, Paris, France
| | - Nachiket A. Nadkarni
- Institut National de la Recherche Agronomique, Centre de Recherche en Nutrition Humaine d'Ile-de-France (CRNH-IdF), UMR 914 Nutrition Physiology and Ingestive Behavior, Paris, France; and
- AgroParisTech, CRNH-IdF, UMR 914 Nutrition Physiology and Ingestive Behavior, Paris, France
| | - Julien Piedcoq
- Institut National de la Recherche Agronomique, Centre de Recherche en Nutrition Humaine d'Ile-de-France (CRNH-IdF), UMR 914 Nutrition Physiology and Ingestive Behavior, Paris, France; and
- AgroParisTech, CRNH-IdF, UMR 914 Nutrition Physiology and Ingestive Behavior, Paris, France
| | - Gilles Fromentin
- Institut National de la Recherche Agronomique, Centre de Recherche en Nutrition Humaine d'Ile-de-France (CRNH-IdF), UMR 914 Nutrition Physiology and Ingestive Behavior, Paris, France; and
- AgroParisTech, CRNH-IdF, UMR 914 Nutrition Physiology and Ingestive Behavior, Paris, France
| | - Daniel Tomé
- Institut National de la Recherche Agronomique, Centre de Recherche en Nutrition Humaine d'Ile-de-France (CRNH-IdF), UMR 914 Nutrition Physiology and Ingestive Behavior, Paris, France; and
- AgroParisTech, CRNH-IdF, UMR 914 Nutrition Physiology and Ingestive Behavior, Paris, France
| | - Patrick C. Even
- Institut National de la Recherche Agronomique, Centre de Recherche en Nutrition Humaine d'Ile-de-France (CRNH-IdF), UMR 914 Nutrition Physiology and Ingestive Behavior, Paris, France; and
- AgroParisTech, CRNH-IdF, UMR 914 Nutrition Physiology and Ingestive Behavior, Paris, France
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Després JP. Waist circumference as a vital sign in cardiology 20 years after its initial publication in the American Journal of Cardiology. Am J Cardiol 2014; 114:320-3. [PMID: 24878123 DOI: 10.1016/j.amjcard.2014.04.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 04/23/2014] [Accepted: 04/23/2014] [Indexed: 12/18/2022]
Abstract
In 1994, we reported in The American Journal of Cardiology that a simple anthropometric measurement, waist circumference, was related to the amount of abdominal visceral adipose tissue measured by computed tomography. An elevated waist circumference was also found to be associated with several features of the cardiometabolic risk profile such as glucose intolerance, hyperinsulinemia, and an atherogenic dyslipidemic profile that included hypertriglyceridemia and reduced high-density lipoprotein cholesterol levels. Although a linear relation was found between waist circumference and these metabolic alterations, we reported that a waist circumference value of about 100 cm was associated with a high probability of finding diabetogenic and atherogenic abnormalities. The present short report provides a brief update of issues that have been raised regarding the measurement of waist circumference and its clinical use over a period of 20 years since the original publication.
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Affiliation(s)
- Jean-Pierre Després
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada; Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Québec, Canada
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56
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Ngueta G, Laouan-Sidi EA, Lucas M. Does waist circumference uncorrelated with BMI add valuable information? J Epidemiol Community Health 2014; 68:849-55. [PMID: 24915975 DOI: 10.1136/jech-2014-204005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Estimation of relative contribution of Body Mass Index (BMI) and waist circumference (WC) on health outcomes requires a regression model that includes both obesity metrics. But, multicollinearity could yield biased estimates. METHODS To address the multicollinearity issue between BMI and WC, we used the residual model approach. The standard WC (Y-axis) was regressed on the BMI (X-axis) to obtain residual WC. Data from two adult population surveys (Nunavik Inuit and James Bay Cree) were analysed to evaluate relative effect of BMI and WC on four cardiometabolic risk factors: insulin, triglycerides, systolic blood pressure and high-density lipoprotein levels. RESULTS In multivariate models, standard WC and BMI were significantly associated with cardiometabolic outcomes. Residual WC was not linked with any outcomes. The BMI effect was weakened by including standard WC in the model, but its effect remained unchanged if residual WC was considered. CONCLUSIONS The strong correlation between standard WC and BMI does not allow assessment of their relative contributions to health in the same model without a risk of making erroneous estimations. By contrast with BMI, fat distribution (residual WC) does not add valuable information to a model that already contains overall adiposity (BMI) in Inuit and Cree.
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Affiliation(s)
- Gerard Ngueta
- Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Québec, Québec, Canada
| | - Elhadji A Laouan-Sidi
- Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Québec, Québec, Canada
| | - Michel Lucas
- Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Québec, Québec, Canada Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Québec, Québec, Canada
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Gonzalez-Campoy JM, Richardson B, Richardson C, Gonzalez-Cameron D, Ebrahim A, Strobel P, Martinez T, Blaha B, Ransom M, Quinonez-Weislow J, Pierson A, Gonzalez Ahumada M. Bariatric endocrinology: principles of medical practice. Int J Endocrinol 2014; 2014:917813. [PMID: 24899894 PMCID: PMC4036612 DOI: 10.1155/2014/917813] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 03/19/2014] [Accepted: 04/11/2014] [Indexed: 12/11/2022] Open
Abstract
Obesity, is a chronic, biological, preventable, and treatable disease. The accumulation of fat mass causes physical changes (adiposity), metabolic and hormonal changes due to adipose tissue dysfunction (adiposopathy), and psychological changes. Bariatric endocrinology was conceived from the need to address the neuro-endocrinological derangements that are associated with adiposopathy, and from the need to broaden the scope of the management of its complications. In addition to the well-established metabolic complications of overweight and obesity, adiposopathy leads to hyperinsulinemia, hyperleptinemia, hypoadiponectinemia, dysregulation of gut peptides including GLP-1 and ghrelin, the development of an inflammatory milieu, and the strong risk of vascular disease. Therapy for adiposopathy hinges on effectively lowering the ratio of orexigenic to anorexigenic signals reaching the the hypothalamus and other relevant brain regions, favoring a lower caloric intake. Adiposopathy, overweight and obesity should be treated indefinitely with the specific aims to reduce fat mass for the adiposity complications, and to normalize adipose tissue function for the adiposopathic complications. This paper defines the principles of medical practice in bariatric endocrinology-the treatment of overweight and obesity as means to treat adiposopathy and its accompanying metabolic and hormonal derangements.
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Affiliation(s)
- J. Michael Gonzalez-Campoy
- Minnesota Center for Obesity, Metabolism and Endocrinology (MNCOME), 1185 Town Centre Drive, Suite 220, Eagan, MN 55123, USA
| | - Bruce Richardson
- Minnesota Center for Obesity, Metabolism and Endocrinology (MNCOME), 1185 Town Centre Drive, Suite 220, Eagan, MN 55123, USA
| | - Conor Richardson
- Minnesota Center for Obesity, Metabolism and Endocrinology (MNCOME), 1185 Town Centre Drive, Suite 220, Eagan, MN 55123, USA
| | - David Gonzalez-Cameron
- Minnesota Center for Obesity, Metabolism and Endocrinology (MNCOME), 1185 Town Centre Drive, Suite 220, Eagan, MN 55123, USA
| | - Ayesha Ebrahim
- Minnesota Center for Obesity, Metabolism and Endocrinology (MNCOME), 1185 Town Centre Drive, Suite 220, Eagan, MN 55123, USA
| | - Pamela Strobel
- Minnesota Center for Obesity, Metabolism and Endocrinology (MNCOME), 1185 Town Centre Drive, Suite 220, Eagan, MN 55123, USA
| | - Tiphani Martinez
- Minnesota Center for Obesity, Metabolism and Endocrinology (MNCOME), 1185 Town Centre Drive, Suite 220, Eagan, MN 55123, USA
| | - Beth Blaha
- Minnesota Center for Obesity, Metabolism and Endocrinology (MNCOME), 1185 Town Centre Drive, Suite 220, Eagan, MN 55123, USA
| | - Maria Ransom
- Minnesota Center for Obesity, Metabolism and Endocrinology (MNCOME), 1185 Town Centre Drive, Suite 220, Eagan, MN 55123, USA
| | - Jessica Quinonez-Weislow
- Minnesota Center for Obesity, Metabolism and Endocrinology (MNCOME), 1185 Town Centre Drive, Suite 220, Eagan, MN 55123, USA
| | - Andrea Pierson
- Minnesota Center for Obesity, Metabolism and Endocrinology (MNCOME), 1185 Town Centre Drive, Suite 220, Eagan, MN 55123, USA
| | - Miguel Gonzalez Ahumada
- Minnesota Center for Obesity, Metabolism and Endocrinology (MNCOME), 1185 Town Centre Drive, Suite 220, Eagan, MN 55123, USA
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Madsbad S, Dirksen C, Holst JJ. Mechanisms of changes in glucose metabolism and bodyweight after bariatric surgery. Lancet Diabetes Endocrinol 2014; 2:152-64. [PMID: 24622719 DOI: 10.1016/s2213-8587(13)70218-3] [Citation(s) in RCA: 197] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Bariatric surgery is the most effective treatment for obesity and also greatly improves glycaemic control, often within days after surgery, independently of weight loss. Laparoscopic adjustable gastric banding (LAGB) was designed as a purely restrictive procedure, whereas vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB) induce changes in appetite through regulation of gut hormones, resulting in decreased hunger and increased satiation. Thus, VSG and RYBG more frequently result in remission of type 2 diabetes than does LAGB. With all three of these procedures, remission of diabetes is associated with early increases in insulin sensitivity in the liver and later in peripheral tissues; VSG and RYBG are also associated with improved insulin secretion and an exaggerated postprandial rise in glucagon-like peptide 1. The vagal pathway could have a role in the neurohumoral regulatory pathways that control appetite and glucose metabolism after bariatric surgery. Recent research suggests that changes in bile acid concentrations in the blood and altered intestinal microbiota might contribute to metabolic changes after surgery, but the mechanisms are unclear. In this Series paper, we explore the possible mechanisms underlying the effects on glucose metabolism and bodyweight of LAGB, VSG, and RYGB surgery. Elucidation of these mechanisms is providing knowledge about bodyweight regulation and the pathophysiology of type 2 diabetes, and could help to identify new drug targets and improved surgical techniques.
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Affiliation(s)
- Sten Madsbad
- Department of Endocrinology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.
| | - Carsten Dirksen
- Department of Endocrinology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark; NNF Centre for Basic Metabolic Research, Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - Jens J Holst
- NNF Centre for Basic Metabolic Research, Panum Institute, University of Copenhagen, Copenhagen, Denmark; Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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59
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Graziani F, Leone AM, Basile E, Cialdella P, Tritarelli A, Bona RD, Liuzzo G, Nanni G, Iaconelli A, Iaconelli A, Mingrone G, Biasucci LM, Crea F. Endothelial Progenitor Cells in Morbid Obesity. Circ J 2014; 78:977-85. [DOI: 10.1253/circj.cj-13-0976] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Francesca Graziani
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
| | - Antonio Maria Leone
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
| | - Eloisa Basile
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
| | - Pio Cialdella
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
| | | | - Roberta Della Bona
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
| | - Giovanna Liuzzo
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
| | - Giuseppe Nanni
- Department of Surgery, Catholic University of the Sacred Heart
| | - Amerigo Iaconelli
- Department of Internal Medicine, Catholic University of the Sacred Heart
| | - Antonio Iaconelli
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
| | - Geltrude Mingrone
- Department of Internal Medicine, Catholic University of the Sacred Heart
| | | | - Filippo Crea
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
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Scafoglieri A, Clarys JP, Cattrysse E, Bautmans I. Use of anthropometry for the prediction of regional body tissue distribution in adults: benefits and limitations in clinical practice. Aging Dis 2013; 5:373-93. [PMID: 25489489 DOI: 10.14366/ad.2014.0500373] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/06/2013] [Accepted: 12/07/2013] [Indexed: 12/25/2022] Open
Abstract
Regional body composition changes with aging. Some of the changes in composition are considered major risk factors for developing obesity related chronic diseases which in turn may lead to increased mortality in adults. The role of anthropometry is well recognized in the screening, diagnosis and follow-up of adults for risk classification, regardless of age. Regional body composition is influenced by a number of intrinsic and extrinsic factors. Therapeutic measures recommended to lower cardiovascular disease risk include lifestyle changes. The aim of this review is to systematically summarize studies that assessed the relationships between anthropometry and regional body composition. The potential benefits and limitations of anthropometry for use in clinical practice are presented and suggestions for future research given.
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Affiliation(s)
- Aldo Scafoglieri
- Department of Human Anatomy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels ; Department of Experimental Anatomy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels
| | - Jan Pieter Clarys
- Department of Experimental Anatomy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels
| | - Erik Cattrysse
- Department of Experimental Anatomy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels
| | - Ivan Bautmans
- Frailty in Ageing research department, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels
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Abstract
The prevalence of overweight, obesity and insulin resistance in patients with coronary heart disease (CHD) exceeds that of the general population. Obesity is associated with a constellation of coronary risk factors that predispose to the development and progression of CHD. Intentional weight loss, accomplished through behavioral weight loss and exercise, improves insulin sensitivity and associated cardio-metabolic risk factors such as lipid measures, blood pressure, measures of inflammation and vascular function both in healthy individuals and patients with CHD. Additionally, physical fitness, physical function and quality of life all improve. There is evidence that intentional weight loss prevents the onset of CHD in high risk overweight individuals. While weight loss associated improvements in insulin resistance, fitness and related risk factors strongly supports favorable prognostic effects in individuals with established CHD, further study is needed to determine if long-term clinical outcomes are improved.
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Affiliation(s)
- Philip A Ades
- Division of Cardiology, University of Vermont College of Medicine, Burlington,VT05403.
| | - Patrick D Savage
- Division of Cardiology, University of Vermont College of Medicine, Burlington,VT05403
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62
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De Schutter A, Lavie CJ, Milani RV. The impact of obesity on risk factors and prevalence and prognosis of coronary heart disease-the obesity paradox. Prog Cardiovasc Dis 2013; 56:401-8. [PMID: 24438731 DOI: 10.1016/j.pcad.2013.08.003] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Obesity is associated with a host of cardiovascular risk factors and its prevalence is rising rapidly. Despite strong evidence that obesity predisposes to the development and progression of coronary heart disease (CHD), numerous studies have shown an inverse relationship between various measures of obesity (most commonly body mass index) and outcomes in established CHD. In this article we review the evidence surrounding the ≪obesity paradox≫ in the secondary care of CHD patients and the CHD presentations where a paradox has been found. Finally we discuss the impact of cardiorespiratory fitness and a number of mechanisms which may offer potential explanations for this puzzling phenomenon.
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Affiliation(s)
- Alban De Schutter
- Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA
| | - Carl J Lavie
- Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA; The Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA.
| | - Richard V Milani
- Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA
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63
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Katakami N, Kaneto H, Funahashi T, Shimomura I. Type 2 diabetes and atherosclerosis: focusing on metabolic syndrome. Diabetol Int 2013. [DOI: 10.1007/s13340-013-0131-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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64
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Nadkarni NA, Chaumontet C, Azzout-Marniche D, Piedcoq J, Fromentin G, Tomé D, Even PC. The carbohydrate sensitive rat as a model of obesity. PLoS One 2013; 8:e68436. [PMID: 23935869 PMCID: PMC3728328 DOI: 10.1371/journal.pone.0068436] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 05/30/2013] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Sensitivity to obesity is highly variable in humans, and rats fed a high fat diet (HFD) are used as a model of this inhomogeneity. Energy expenditure components (basal metabolism, thermic effect of feeding, activity) and variations in substrate partitioning are possible factors underlying the variability. Unfortunately, in rats as in humans, results have often been inconclusive and measurements usually made after obesity onset, obscuring if metabolism was a cause or consequence. Additionally, the role of high carbohydrate diet (HCD) has seldom been studied. METHODOLOGY/FINDINGS Rats (n=24) were fed for 3 weeks on HCD and then 3 weeks on HFD. Body composition was tracked by MRI and compared to energy expenditure components measured prior to obesity. RESULTS 1) under HFD, as expected, by adiposity rats were variable enough to be separable into relatively fat resistant (FR) and sensitive (FS) groups, 2) under HCD, and again by adiposity, rats were also variable enough to be separable into carbohydrate resistant (CR) and sensitive (CS) groups, the normal body weight of CS rats hiding viscerally-biased fat accumulation, 3) HCD adiposity sensitivity was not related to that under HFD, and both HCD and HFD adiposity sensitivities were not related to energy expenditure components (BMR, TEF, activity cost), and 4) only carbohydrate to fat partitioning in response to an HCD test meal was related to HCD-induced adiposity. CONCLUSIONS/SIGNIFICANCE The rat model of human obesity is based on substantial variance in adiposity gains under HFD (FR/FS model). Here, since we also found this phenomenon under HCD, where it was also linked to an identifiable metabolic difference, we should consider the existence of another model: the carbohydrate resistant (CR) or sensitive (CS) rat. This new model is potentially complementary to the FR/FS model due to relatively greater visceral fat accumulation on a low fat high carbohydrate diet.
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Affiliation(s)
- Nachiket A. Nadkarni
- Chaire Aliment, Nutrition, Comportement Alimentaire, AgroParisTech, Paris, France
| | - Catherine Chaumontet
- Unité Mixte Recherche 914, Nutrition Physiology and Ingestive Behavior, AgroParisTech, Institut Nationale de Recherche, Agronomique, Paris, France
| | - Dalila Azzout-Marniche
- Unité Mixte Recherche 914, Nutrition Physiology and Ingestive Behavior, AgroParisTech, Institut Nationale de Recherche, Agronomique, Paris, France
| | - Julien Piedcoq
- Unité Mixte Recherche 914, Nutrition Physiology and Ingestive Behavior, AgroParisTech, Institut Nationale de Recherche, Agronomique, Paris, France
| | - Gilles Fromentin
- Unité Mixte Recherche 914, Nutrition Physiology and Ingestive Behavior, AgroParisTech, Institut Nationale de Recherche, Agronomique, Paris, France
| | - Daniel Tomé
- Unité Mixte Recherche 914, Nutrition Physiology and Ingestive Behavior, AgroParisTech, Institut Nationale de Recherche, Agronomique, Paris, France
| | - Patrick C. Even
- Unité Mixte Recherche 914, Nutrition Physiology and Ingestive Behavior, AgroParisTech, Institut Nationale de Recherche, Agronomique, Paris, France
- * E-mail:
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Morelli M, Gaggini M, Daniele G, Marraccini P, Sicari R, Gastaldelli A. Ectopic fat: the true culprit linking obesity and cardiovascular disease? Thromb Haemost 2013; 110:651-60. [PMID: 23884194 DOI: 10.1160/th13-04-0285] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 06/22/2013] [Indexed: 01/14/2023]
Abstract
Obesity is a major risk factor for cardiovascular disease and its complications. However, not all fat depots share the same characteristics. Recent studies have found that ectopic rather than subcutaneous fat accumulation is associated with increased cardiometabolic risk. However, ectopic fat accumulation can be seen initially as a protective mechanism against lipotoxicity. Subsequently the adipose tissue becomes dysfunctional, thus inducing systemic metabolic alterations (through release of cytokines) or specific organ dysfunctions. The purpose of this review is to summarise the current available data on the impact of excess adiposity vs ectopic fat in the development of cardio-metabolic diseases.
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Affiliation(s)
- Mariangela Morelli
- Amalia Gastaldelli, PhD, Head of Cardiometabolic Risk Unit, Institute of Clinical Physiology, via Moruzzi 1, 56100 Pisa, Italy, Tel.: +39 050 3152680/79, Fax: +39 050 3152166, E-mail:
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Abstract
Excess intra-abdominal adipose tissue accumulation, often termed visceral obesity, is part of a phenotype including dysfunctional subcutaneous adipose tissue expansion and ectopic triglyceride storage closely related to clustering cardiometabolic risk factors. Hypertriglyceridemia; increased free fatty acid availability; adipose tissue release of proinflammatory cytokines; liver insulin resistance and inflammation; increased liver VLDL synthesis and secretion; reduced clearance of triglyceride-rich lipoproteins; presence of small, dense LDL particles; and reduced HDL cholesterol levels are among the many metabolic alterations closely related to this condition. Age, gender, genetics, and ethnicity are broad etiological factors contributing to variation in visceral adipose tissue accumulation. Specific mechanisms responsible for proportionally increased visceral fat storage when facing positive energy balance and weight gain may involve sex hormones, local cortisol production in abdominal adipose tissues, endocannabinoids, growth hormone, and dietary fructose. Physiological characteristics of abdominal adipose tissues such as adipocyte size and number, lipolytic responsiveness, lipid storage capacity, and inflammatory cytokine production are significant correlates and even possible determinants of the increased cardiometabolic risk associated with visceral obesity. Thiazolidinediones, estrogen replacement in postmenopausal women, and testosterone replacement in androgen-deficient men have been shown to favorably modulate body fat distribution and cardiometabolic risk to various degrees. However, some of these therapies must now be considered in the context of their serious side effects. Lifestyle interventions leading to weight loss generally induce preferential mobilization of visceral fat. In clinical practice, measuring waist circumference in addition to the body mass index could be helpful for the identification and management of a subgroup of overweight or obese patients at high cardiometabolic risk.
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Affiliation(s)
- André Tchernof
- Endocrinology and Genomics Axis, Centre Hospitalier Universitaire de Québec, Québec, Canada
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Affiliation(s)
- Jean-Pierre Després
- FAHA, FIAS, Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Pavilion Marguerite-D'Youville, 4th Floor, 2725 Chemin Ste-Foy, Québec QC G1V 4G5, Canada.
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Kazlauskaite R, Karavolos K, Janssen I, Carlson K, Shipp KJ, Dugan SA, Powell LH. The Association between Self-Reported Energy Intake and Intra-Abdominal Adipose Tissue in Perimenopausal Women. J Obes 2012; 2012:567320. [PMID: 22997569 PMCID: PMC3391902 DOI: 10.1155/2012/567320] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 04/19/2012] [Indexed: 11/17/2022] Open
Abstract
We have previously shown that physical activity predicts intra-abdominal adipose tissue (IAT), but it is unknown whether energy intake predicts IAT independently of physical activity in a community-based, naturalistic environment. The association of energy intake with IAT was explored cross-sectionally in women, recruited between 2002 and 2005 for a study of fat patterning in midlife. IAT at L(4)-L(5) vertebral interspace was assessed by computed tomography, energy intake by the Block Food Frequency Questionnaire, and physical activity by the Kaiser Physical Activity Survey. Linear regression models were used for the principal analyses. Among the 257 women, 48% were African American and 52% were Caucasian. Women were 52 ± 3 years old, and 49% were postmenopausal. Every 500 kcal increase in energy intake was associated with a 6% higher IAT (P = 0.02), independent of physical activity (P = 0.02), after adjustment for ethnicity, menopausal status, age, smoking, income, and DXA-assessed percent body fat. Energy intake had a significant interaction with ethnicity (P = 0.02), but not with physical activity. Models using the IAT to subcutaneous abdominal adipose tissue ratio as an outcome had similar associations. In conclusion, self-reported EI was associated with preferential IAT accumulation in midlife women, independent of physical activity. This association was significantly stronger in Caucasian than African American women. Future longitudinal studies are needed to explore lifestyle predictors of IAT accumulation during the menopausal transition.
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Affiliation(s)
- Rasa Kazlauskaite
- Rush Center for Urban Health Equity, Department of Preventive Medicine, Rush University Medical Center, 1700 W Van Buren Street, Suite 470, Chicago, IL 60612, USA
- *Rasa Kazlauskaite:
| | - Kelly Karavolos
- Rush Center for Urban Health Equity, Department of Preventive Medicine, Rush University Medical Center, 1700 W Van Buren Street, Suite 470, Chicago, IL 60612, USA
| | - Imke Janssen
- Rush Center for Urban Health Equity, Department of Preventive Medicine, Rush University Medical Center, 1700 W Van Buren Street, Suite 470, Chicago, IL 60612, USA
| | - Kimberly Carlson
- Rush Center for Urban Health Equity, Department of Preventive Medicine, Rush University Medical Center, 1700 W Van Buren Street, Suite 470, Chicago, IL 60612, USA
| | - Karla J. Shipp
- Rush Center for Urban Health Equity, Department of Preventive Medicine, Rush University Medical Center, 1700 W Van Buren Street, Suite 470, Chicago, IL 60612, USA
| | - Sheila A. Dugan
- Rush Center for Urban Health Equity, Department of Preventive Medicine, Rush University Medical Center, 1700 W Van Buren Street, Suite 470, Chicago, IL 60612, USA
| | - Lynda H. Powell
- Rush Center for Urban Health Equity, Department of Preventive Medicine, Rush University Medical Center, 1700 W Van Buren Street, Suite 470, Chicago, IL 60612, USA
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Long-term risk of incident type 2 diabetes and measures of overall and regional obesity: the EPIC-InterAct case-cohort study. PLoS Med 2012; 9:e1001230. [PMID: 22679397 PMCID: PMC3367997 DOI: 10.1371/journal.pmed.1001230] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Accepted: 04/24/2012] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Waist circumference (WC) is a simple and reliable measure of fat distribution that may add to the prediction of type 2 diabetes (T2D), but previous studies have been too small to reliably quantify the relative and absolute risk of future diabetes by WC at different levels of body mass index (BMI). METHODS AND FINDINGS The prospective InterAct case-cohort study was conducted in 26 centres in eight European countries and consists of 12,403 incident T2D cases and a stratified subcohort of 16,154 individuals from a total cohort of 340,234 participants with 3.99 million person-years of follow-up. We used Prentice-weighted Cox regression and random effects meta-analysis methods to estimate hazard ratios for T2D. Kaplan-Meier estimates of the cumulative incidence of T2D were calculated. BMI and WC were each independently associated with T2D, with WC being a stronger risk factor in women than in men. Risk increased across groups defined by BMI and WC; compared to low normal weight individuals (BMI 18.5-22.4 kg/m(2)) with a low WC (<94/80 cm in men/women), the hazard ratio of T2D was 22.0 (95% confidence interval 14.3; 33.8) in men and 31.8 (25.2; 40.2) in women with grade 2 obesity (BMI≥35 kg/m(2)) and a high WC (>102/88 cm). Among the large group of overweight individuals, WC measurement was highly informative and facilitated the identification of a subgroup of overweight people with high WC whose 10-y T2D cumulative incidence (men, 70 per 1,000 person-years; women, 44 per 1,000 person-years) was comparable to that of the obese group (50-103 per 1,000 person-years in men and 28-74 per 1,000 person-years in women). CONCLUSIONS WC is independently and strongly associated with T2D, particularly in women, and should be more widely measured for risk stratification. If targeted measurement is necessary for reasons of resource scarcity, measuring WC in overweight individuals may be an effective strategy, since it identifies a high-risk subgroup of individuals who could benefit from individualised preventive action.
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Cardiovascular Effects of Weight Loss. CURRENT CARDIOVASCULAR RISK REPORTS 2011. [DOI: 10.1007/s12170-011-0211-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Kang SM, Yoon JW, Ahn HY, Kim SY, Lee KH, Shin H, Choi SH, Park KS, Jang HC, Lim S. Android fat depot is more closely associated with metabolic syndrome than abdominal visceral fat in elderly people. PLoS One 2011; 6:e27694. [PMID: 22096613 PMCID: PMC3214067 DOI: 10.1371/journal.pone.0027694] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 10/22/2011] [Indexed: 12/31/2022] Open
Abstract
Background Fat accumulation in android compartments may confer increased metabolic risk. The incremental utility of measuring regional fat deposition in association with metabolic syndrome (MS) has not been well described particularly in an elderly population. Methods and Findings As part of the Korean Longitudinal Study on Health and Aging, which is a community-based cohort study of people aged more than 65 years, subjects (287 male, 75.9±8.6 years and 278 female, 76.0±8.8 years) with regional body composition data using Dual energy X-ray absorptiometry for android/gynoid area, computed tomography for visceral/subcutaneous adipose tissue (VAT/SAT), and cardiometabolic markers including adiponectin and high-sensitivity CRP were enrolled. We investigated the relationship between regional body composition and MS in multivariate regression models. Mean VAT and SAT area was 131.4±65.5 cm2 and 126.9±55.2 cm2 in men (P = 0.045) and 120.0±46.7 cm2 and 211.8±65.9 cm2 in women (P<0.01). Mean android and gynoid fat amount was 1.8±0.8 kg and 2.5±0.8 kg in men and 2.0±0.6 kg and 3.3±0.8 kg in women, respectively (both P<0.01). VAT area and android fat amount was strongly correlated with most metabolic risk factors compared to SAT or gynoid fat. Furthermore, android fat amount was significantly associated with clustering of MS components after adjustment for multiple parameters including age, gender, adiponectin, hsCRP, a surrogate marker of insulin resistance, whole body fat mass and VAT area. Conclusions Our findings are consistent with the hypothesized role of android fat as a pathogenic fat depot in the MS. Measurement of android fat may provide a more complete understanding of metabolic risk associated with variations in fat distribution.
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Affiliation(s)
- Seon Mee Kang
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Won Yoon
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hwa Young Ahn
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea
| | - So Yeon Kim
- Department of Radiology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyoung Ho Lee
- Department of Radiology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hayley Shin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Sung Hee Choi
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyong Soo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail:
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Botero's Fat Figures and the Risk of Heart Failure. J Am Coll Cardiol 2011; 58:1351-2. [DOI: 10.1016/j.jacc.2011.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 06/21/2011] [Indexed: 11/23/2022]
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Shibata R, Ouchi N, Kikuchi R, Takahashi R, Takeshita K, Kataoka Y, Ohashi K, Ikeda N, Kihara S, Murohara T. Circulating omentin is associated with coronary artery disease in men. Atherosclerosis 2011; 219:811-4. [PMID: 21925659 DOI: 10.1016/j.atherosclerosis.2011.08.017] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 07/27/2011] [Accepted: 08/08/2011] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Obesity is closely associated with an increased risk for cardiovascular morbidity and mortality. Omentin is a fat-derived secreted factor that is downregulated in obesity. We investigated whether circulating omentin associates with the prevalence of coronary artery disease (CAD). METHODS The consecutive 78 male subjects were enrolled from patients who underwent coronary angiography. Sixty one age-matched male subjects served as controls. Plasma omentin concentration was measured by enzyme-linked immunosorbent assay. RESULTS Plasma levels of omentin correlated negatively with body mass index (BMI), systolic blood pressure, hemoglobin A1c and total cholesterol levels, and positively with HDL cholesterol and adiponectin levels. Circulating omentin was independently associated with hemoglobin A1c and HDL cholesterol in a multiple regression analysis. Plasma levels of omentin were markedly lower in CAD patients than in control subjects (CAD: 102.8 ± 69.0 ng/ml, control: 454.7 ± 128.6 ng/ml, P < 0.001). Multiple logistic regression analysis with BMI, systolic blood pressure, glucose, hemoglobin A1c, HDL cholesterol, adiponectin and omentin revealed that plasma omentin levels were independently correlated with CAD. CONCLUSION These data indicate that low levels of omentin are closely linked with the presence of CAD and that omentin serves as a novel biomarker for CAD.
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Affiliation(s)
- Rei Shibata
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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