[Factors associated with the accumulation of abdominal fat estimated with anthropometric indexes]

Total and regional relationship between lean and fat mass with increasing adiposity--impact for the diagnosis of sarcopenic obesity

BACKGROUND/OBJECTIVE

Besides the effect of age used to define sarcopenia, there is need to understand the impact of adiposity on the relationship between lean (fat-free mass, FFM) and fat mass (FM) in order to diagnose sarcopenic obese phenotypes. More importantly, the regional distribution of skeletal muscle (SM) to adipose tissue (AT) or the composition of FFM (that is, SM proportion of lean mass) may also depend on adiposity.

SUBJECTS/METHODS

In a large database (n=1737) of healthy males and females (age 11-84 years, BMI 13.5-52.5 kg/m(2)) we investigated changes in the relationship between FFM and FM (normalized by height as fat-free mass index and fat mass index: FFMI and FMI, kg/m(2) assessed by densitometry) with increasing adiposity and age. In a subgroup (n=263) we analyzed the relationship between regional SM and (i) AT (by magnetic resonance imaging) or (ii) lean soft tissue (by dual X-ray absorptiometry) with increasing adiposity.

RESULTS

The relationship between lean and FM was influenced by adiposity, age and gender. With increasing adiposity, SM/AT declined faster at the trunk in men and at the extremities in women. The contribution of appendicular SM to lean soft tissue of arms and legs tended to decrease at a higher adiposity in both genders (FMI >6.97 kg/m(2) in women; FMI>7.77 kg/m(2) in men).

CONCLUSION

Besides age and gender, adiposity and body region should be considered when evaluating the normal relationship between lean and FM, SM/FFM and SM/AT.

Alcohol and macronutrient intake patterns are related to general and central adiposity

BACKGROUND/OBJECTIVES

Alcohol and dietary fat have high energy densities and may therefore be related to body weight and fat deposition. We studied associations between alcohol and macronutrient intake patterns and general and central adiposity.

SUBJECTS/METHODS

A population-based cross-sectional study of 524 men and 611 women. The participants answered a dietary questionnaire describing habitual food consumption including intake of alcoholic beverages. Macronutrient intake was analysed in relation to anthropometric measures and dual energy X-ray absorptiometry determined body fat.

RESULTS

In women, total alcohol intake was negatively associated with body fat percentage (β:-0.67, P<0.01). In men, total alcohol intake was positively associated with sagittal abdominal diameter (SAD) (β: 0.28, P=0.01). In addition, positive associations were found between intake of alcohol from spirits and body fat percentage (β: 1.17, P<0.05), SAD (β: 0.52, P<0.05) and waist circumference (β: 2.29, P=0.01). In men, protein intake was positively associated with body mass index (BMI) (β: 0.03, P=0.001), body fat percentage (β: 0.04, P<0.05), SAD (β: 0.02, P=0.01) and waist circumference (β: 0.09, P<0.01). Also in men only, negative associations between fat intake and BMI (β: -0.03, P<0.01), SAD (β: -0.02, P<0.05) and waist circumference (β: -0.05, P<0.05) were found.

CONCLUSIONS

Alcohol intake was inversely associated to relative body fat in women whereas spirits consumption was positively related to central and general obesity in men. Macronutrient intakes, particularly protein and fat, were differently associated with obesity indicators in men versus women. This may reflect a differential effect by gender, or differential obesity related reporting errors in men and women.

Relationship of abdominal obesity with alcohol consumption at population scale

BACKGROUND

The high energy content of alcohol makes its consumption a potential contributor to the obesity epidemic.

AIM OF THE STUDY

To determine whether alcohol consumption is a risk factor for abdominal obesity, taking into account energy underreporting.

METHODS

The subjects were Spanish men (n = 1491) and women (n = 1563) aged 25-74 years who were examined in 1999-2000, in a population-based cross-sectional survey in northeastern Spain (Girona). Dietary intake, including alcohol consumption, was assessed using a food frequency questionnaire. Anthropometric variables were measured.

RESULTS

The mean consumption of alcohol was 18.1 +/- 20.7 g/d in men and 5.3 +/- 10.4 g/d in women. 19.3% of men and 2.3% of women reported alcohol consumption of more than 3 drinks per day. The consumption of alcohol was directly associated with total energy intake in men (P < 0.001) and women (P = 0.001). The proportion of energy underreporting significantly (P < 0.001) decreased with higher amounts of alcohol drinking in both genders. Multiple logistic regression analysis, controlled for energy underreporting, smoking, educational level, leisure-time physical activity, energy, and diet quality, revealed that consuming more than 3 drinks of alcohol (>30 g ethanol) was significantly associated with the risk of abdominal obesity (Odds ratio 1.80; 1.05, 3.09) and exceeding recommended energy consumption (Odds ratio 1.97; 1.32, 2.93) in men. A very small number (2.13%) of women in this population reported high levels of alcohol consumption.

CONCLUSIONS

Alcohol consumption in elevated amounts was associated with risk of abdominal obesity in men, independent of energy underreporting.

Is alcohol consumption a risk factor for weight gain and obesity?

Alcohol represents an important source of energy. Despite its comparatively high energy content of 7.1 g/kcal, it is still controversial whether moderate amounts of alcohol represent a risk factor for weight gain and obesity. Epidemiologic data showed a positive, negative, or no relationship between alcohol intake and body weight. Despite the difficulty in assessing alcohol intake as well as controlling for different confounders of the energy-balance equation, the conflicting epidemiologic data can be explained in most instances. Every component of the energy-balance equation is affected by the ingestion of alcohol. Moderate amounts of alcohol enhance energy intake due to the caloric content of the alcohol as well as its appetite-enhancing effects. Alcohol-induced thermogenesis is approximately 20% in healthy nonalcoholic subjects, i.e., moderate alcohol consumers, which is higher than for other energy substrates but considerably lower than in heavy alcohol consumers. This would suggest that a major fraction of the alcohol energy represents a navailable energy source for ATP synthesis in moderate non-daily alcohol consumers. Experimental evidence from several metabolic studies showed a suppression of lipid oxidation by alcohol and thus the enhancement of a positive fat balance. The nonoxidized fat is preferentially deposited in the abdominal area. The experimental metabolic evidence suggests that the consumption of moderate amounts of alcohol has to be accounted for in the energy-balance equation and may represent a risk factor for the development of a positive energy balance and thus weight gain. In the heavy alcohol consumer and eventually also in daily moderate alcohol consumers, a larger fraction of the alcohol energy might not be an available source of energy due to the induction of the microsomal ethanol-oxidizing system (MEOS). Experimental data in combination with epidemiologic findings suggest that alcohol energy counts more in moderate nondaily alcohol consumers than in some moderate daily and all heavy consumers. Accordingly the question is not "Whether alcohol calories do count" but "How much do alcohol calories count?". There seems to be a large individual variability according to the absolute amount of alcohol consumed, the drinking frequency as well as genetic factors. Presently it can be said that alcohol calories count more in moderate nondaily consumers than in daily (heavy) consumers. Further, they count more in combination with a high-fat diet and in overweight and obese subjects.

Obesity and socioeconomic position measured at three stages of the life course in the elderly

OBJECTIVE

To investigate the association between socioeconomic position, measured at three stages of the life course, and obesity in the elderly.

DESIGN

Cross-sectional study carried out in 2000-2001.

SUBJECTS

In total, 4009 subjects aged 60 y and older, representative of the Spanish noninstitutionalised population.

RESEARCH METHODS AND PROCEDURES

We estimated body mass index (BMI) and waist circumference (WC) by social class in childhood, by educational level and by adult social class, as well as the association between these two obesity measures and each socioeconomic characteristic after adjusting for the other two.

RESULTS

In men, no relation was found between the two measures of obesity studied and socioeconomic circumstances throughout the life course. Nor was any relation found in women between social class in childhood and the two measures of obesity after adjusting for the other two socioeconomic variables. In contrast, BMI and WC in women showed a statistically significant inverse gradient with educational level and with adult social class after adjusting for age and the rest of the socioeconomic variables.

CONCLUSIONS

In general, these results support the small amount of existing evidence on the association between obesity and abdominal obesity and socioeconomic position by educational level and adult social class. The results for social class in childhood do not support the existing evidence, and suggest that this association may depend on specific historic and cultural circumstances.

Work-related physical activity is not associated with body mass index and obesity

OBJECTIVE

To analyze the association of work-related physical activity (WRPA) and leisure-time physical activity (LTPA) with body mass index (BMI) and obesity in the Spanish adult population aged 20 to 60 years.

RESEARCH METHODS AND PROCEDURES

The data were taken from the 1993 Spanish National Health Survey. We analyzed a sample of 12,044 men and women representative of the Spanish population aged 20 to 60 years. BMI and frequency of obesity (BMI > or = 30 kg/m(2)) were obtained from self-reported weight and height. Multiple linear regression and logistic regression models were constructed, adjusting for the main confounding factors. WRPA and LTPA were measured by two questions to classify subjects into four categories of physical activity.

RESULTS

Neither mean BMI nor percentage of obesity varied significantly (p > 0.05) by WRPA. Mean BMI was significantly higher (p < 0.01) in those who were inactive in their leisure time (25.90 kg/m(2) in men and 24.43 kg/m(2) in women) than in those who reported vigorous activity (24.42 kg/m(2) and 22.97 kg/m(2) in men and women, respectively). The odds ration (OR) for obesity decreased with increasing level of LTPA in both men (OR of 0.64 for vigorous activity) and women (OR = 0.68), showing a statistically significant dose-response relation in both men (for linear trend, p = 0.0021) and women (p = 0.0245).

DISCUSSION

These results raise questions about the association between WRPA and obesity and suggest the need to reexamine models of the obesity epidemic that point to automation of the workplace as one of the major explanatory factors.

[Abdominal fat assessment by magnetic resonance: comparison with biometric profiles and cardiovascular risk markers]

BACKGROUND

Obesity is associated with numerous metabolic complications and cardiovascular disease. Magnetic Resonance (MR) imaging provides fair resolution of fat distribution, its quantification by semiautomatic methods being feasible. Our purpose was to analyze abdominal fat deposition by MR imaging and quantify its relative distribution in 50 obese patients. RESULTS were then related to anthropometric measures and cardiovascular risk markers.

PATIENTS AND METHOD

Six axial T1-weighted abdominal images were obtained from each patient and transferred to a PC. A software (ASYMED 3.0; Valencia) was used to analyze the images and quantify relative fat deposition. Comparison of MR results with several cardiovascular risk markers was performed using unpaired data Student t-test. Significance level was defined as a P < 0.05.

RESULTS

12% of patients showed predominant intra-abdominal fat deposition.Significant differences were found with regard to age, waist-hip ratio and average serum levels of total cholesterol, LDL, VLDL,triglycerides and apoprotein B between intra-abdominal deposition versus subcutaneous fat deposition.

CONCLUSION

MR imaging allows estimation of abdominal fat deposition and its relative distribution. There is a significant relationship between a predominant intra-abdominal fat deposition and an atherogeniclipid profile.

[Prevalence of obesity in the population assisted at primary health care services in Girona, 1995-1999]

OBJECTIVES

To estimate the prevalence of obesity and overweight in the population of Girona (Spain) between 1995 and 1999 and to divide the prevalences in geographical areas according to age and sex.

METHODS

Height and weight were directly measures in 24,554 health care consumers older than 14 years (10,595 men and 13,959 women) treated in four primary health care areas: Girona 1, Girona 4, Salt and Camprodon and in one primary health care center in the province of Girona. Body mas index (BMI) was calcuted by dividing weight in kilograms bye height in meters squared. Obesity was defined as grades II and III of Garrow's index (BMI >= 30 kg/m2) and overweight as degree I (25 kg/m2 >= BMI < 30 kg/m2). Because the sample was not randomized, the prevalences were adequately weighted. The comparison between prevalences in two different primary health care areas for each sex (in the same Garrow's index and age group) was carried out using a parametric test of differences in proportions (Student's t-test). A hierarchical logistic regression was used to compare prevalences in the same grade Garrow's index, controlling for age and sex.

RESULTS

The prevalence of obesity was estimated as 15.6% in men aged from 20-74 years (from 14.0% in Girona 1 to 22.4% in Camprodon) and 17.5% for women (15.6% in Girona 1, 22.7% in Camprodon). The weighted mean was 16.7%. The prevalence of overweight was 44% in men and 33% in women and the weighted mean was 37.8%. The prevalence of obesity was graduated with statistically significant differences between Girona 1, Salt, Girona 4, Camprodon and Sils.

CONCLUSIONS

The estimates of the prevalences of obesity and overweight obtained in this study were closer to those of other studies in similar populations than previously believed. Indeed, the prevalences may be similar to those of the European Union and, in some age groups, to those of the United States.