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Bennett JP, Prado CM, Heymsfield SB, Shepherd JA. Evaluation of visceral adipose tissue thresholds for elevated metabolic syndrome risk across diverse populations: A systematic review. Obes Rev 2024:e13767. [PMID: 38761009 DOI: 10.1111/obr.13767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 05/20/2024]
Abstract
Beyond obesity, excess levels of visceral adipose tissue (VAT) significantly contribute to the risk of developing metabolic syndrome (MetS), although thresholds for increased risk vary based on population, regions of interest, and units of measure employed. We sought to determine whether a common threshold exists that is indicative of heightened MetS risk across all populations, accounting for sex, age, BMI, and race/ethnicity. A systematic literature review was conducted in September 2023, presenting threshold values for elevated MetS risk. Standardization equations harmonized the results from DXA, CT, and MRI systems to facilitate a comparison of threshold variations across studies. A total of 52 papers were identified. No single threshold could accurately indicate elevated risk for both males and females across varying BMI, race/ethnicity, and age groups. Thresholds fluctuated from 70 to 165.9 cm2, with reported values consistently lower in females. Generally, premenopausal females and younger adults manifested elevated risks at lower VAT compared to their older counterparts. Notably, Asian populations exhibited elevated risks at lower VAT areas (70-136 cm2) compared to Caucasian populations (85.6-165.9 cm2). All considered studies reported associations of VAT without accommodating covariates. No single VAT area threshold for elevated MetS risk was discernible post-harmonization by technology, units of measure, and region of interest. This review summarizes available evidence for MetS risk assessment in clinical practice. Further exploration of demographic-specific interactions between VAT area and other risk factors is imperative to comprehensively delineate overarching MetS risk.
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Affiliation(s)
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
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2
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Brimienė I, Šiaudinytė M, Burokas A, Grikšienė R. Exploration of the association between menopausal symptoms, gastrointestinal symptoms, and perceived stress: survey-based analysis. Menopause 2023; 30:1124-1131. [PMID: 37788428 DOI: 10.1097/gme.0000000000002259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVE The study aimed to evaluate the relationship between menopausal symptoms, gastrointestinal symptoms, and experienced stress in women from premenopause to postmenopause. METHODS We conducted a cross-sectional study using an anonymous survey that included questions on demographics, health (gynecological, gastrointestinal), and lifestyle (physical activity, sleep, etc) factors, the Perceived Stress Scale (PSS), and the Menopause-Specific Quality of Life Questionnaire (MENQOL). RESULTS Data of 693 participants aged 50.1 ± 3.2 years were analyzed. We found that the MENQOL total score increased depending on the stages of reproductive aging ( P < 0.001) and positively correlated with PSS scores ( r = 0.47, P < 0.001). Age, reproductive stage, body mass index (BMI), PSS score, diagnosis of depression or anxiety disorder, physical activity, and frequency of defecation appeared to have significant association with the total MENQOL score ( P < 0.05). The analysis within separate MENQOL domains revealed that PSS score and diagnosis of depression or anxiety disorder were associated with higher scores in all MENQOL domains ( P < 0.05) except sexual. Physical activity and the values of the Bristol stool form scale were related to the vasomotor items ( P < 0.05). The frequency of defecation was an independent contributor to the psychosocial and sexual domains ( P < 0.05). BMI, physical activity, and frequency of defecation were associated with physical symptoms ( P < 0.05). CONCLUSIONS Perceived stress and some gastrointestinal symptoms in women were associated with menopausal symptoms. Reproductive stages, physical activity, BMI, and previously diagnosed depression or anxiety disorder were related to the intensity of menopausal symptoms. However, further research is needed to confirm the relationship between stress, gastrointestinal, and menopausal symptoms.
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Affiliation(s)
| | | | - Aurelijus Burokas
- Department of Biological Models, Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Ramunė Grikšienė
- From the Department of Neurobiology and Biophysics, Institute of Biosciences, Life Sciences Center, Vilnius University, Vilnius, Lithuania
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3
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Jarrar F, Tennankore K, Vinson A. Recipient race modifies the association between obesity and long-term graft outcomes after kidney transplantation. Am J Transplant 2023; 23:1159-1170. [PMID: 37119856 DOI: 10.1016/j.ajt.2023.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/01/2023]
Abstract
Donor and recipient obesity (defined using body mass index [BMI]) are associated with worse outcomes after kidney transplant (KT). In adult KT recipients identified using the Scientific Registry of Transplant Recipients (2000-2017), we examined the modifying effect of recipient race on recipient obesity (BMI > 30 kg/m2) and combined donor and recipient (DR) obesity pairing, with death-censored graft loss (DCGL), all-cause graft loss (ACGL), and short-term graft outcomes using multivariable Cox proportional hazards models and logistic regression. Obesity was associated with a higher risk of DCGL in White (adjusted hazard ratio [aHR], 1.29; 95% CI, 1.25-1.35) than Black (aHR, 1.13; 95% CI, 1.08-1.19) recipients. White, but not Black, recipients with obesity were at higher risk for ACGL (aHR, 1.08; 95% CI, 1.05-1.11, for White recipients; aHR, 0.99; 95% CI, 0.95-1.02, for Black recipients). Relative to nonobese DR, White recipients with combined DR obesity experienced more DCGL (aHR, 1.38; 95% CI, 1.29-1.47 for White; aHR, 1.19; 95% CI, 1.10-1.29 for Black) and ACGL (aHR, 1.12; 95% CI, 1.07-1.17 for White; aHR, 1.00; 95% CI, 0.94-1.07 for Black) than Black recipients. Short-term obesity risk was similar irrespective of race. An elevated BMI differentially affects long-term outcomes in Black and White KT recipients; uniform BMI thresholds to define transplant eligibility are likely inappropriate.
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Affiliation(s)
- Faisal Jarrar
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Karthik Tennankore
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Division of Nephrology, Department of Medicine, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Amanda Vinson
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Division of Nephrology, Department of Medicine, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
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4
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Agrawal S, Klarqvist MDR, Diamant N, Stanley TL, Ellinor PT, Mehta NN, Philippakis A, Ng K, Claussnitzer M, Grinspoon SK, Batra P, Khera AV. BMI-adjusted adipose tissue volumes exhibit depot-specific and divergent associations with cardiometabolic diseases. Nat Commun 2023; 14:266. [PMID: 36650173 PMCID: PMC9844175 DOI: 10.1038/s41467-022-35704-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/20/2022] [Indexed: 01/18/2023] Open
Abstract
For any given body mass index (BMI), individuals vary substantially in fat distribution, and this variation may have important implications for cardiometabolic risk. Here, we study disease associations with BMI-independent variation in visceral (VAT), abdominal subcutaneous (ASAT), and gluteofemoral (GFAT) fat depots in 40,032 individuals of the UK Biobank with body MRI. We apply deep learning models based on two-dimensional body MRI projections to enable near-perfect estimation of fat depot volumes (R2 in heldout dataset = 0.978-0.991 for VAT, ASAT, and GFAT). Next, we derive BMI-adjusted metrics for each fat depot (e.g. VAT adjusted for BMI, VATadjBMI) to quantify local adiposity burden. VATadjBMI is associated with increased risk of type 2 diabetes and coronary artery disease, ASATadjBMI is largely neutral, and GFATadjBMI is associated with reduced risk. These results - describing three metabolically distinct fat depots at scale - clarify the cardiometabolic impact of BMI-independent differences in body fat distribution.
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Affiliation(s)
- Saaket Agrawal
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Nathaniel Diamant
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Takara L Stanley
- Metabolism Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick T Ellinor
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anthony Philippakis
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Eric and Wendy Schmidt Center, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Kenney Ng
- Center for Computational Health, IBM Research, Cambridge, MA, USA
| | - Melina Claussnitzer
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Steven K Grinspoon
- Metabolism Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Puneet Batra
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Amit V Khera
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
- Verve Therapeutics, Cambridge, MA, USA.
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5
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Xu F, Earp JE, Adami A, Lofgren IE, Delmonico MJ, Greene GW, Riebe D. The Sex and Race/Ethnicity-Specific Relationships of Abdominal Fat Distribution and Anthropometric Indices in US Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15521. [PMID: 36497594 PMCID: PMC9736224 DOI: 10.3390/ijerph192315521] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/18/2022] [Accepted: 11/19/2022] [Indexed: 06/17/2023]
Abstract
The purpose of this study was to examine demographic-specific relationships between direct abdominal fat measures and anthropometric indices. A cross-sectional study was conducted utilizing abdominal fat measures (visceral fat area, VFA; visceral to subcutaneous adipose area ratio, VSR) and anthropometrics (body mass index, BMI; waist circumference, WC) data from the 2011-2018 National Health and Nutrition Examination Survey. Linear or polynomial linear regression models were used to examine the relationships of abdominal fat measures to anthropometrics with adjustment for demographics. The results revealed that while VFA was linearly related to BMI and WC across all demographics (p < 0.001), the relationships between VSR and both BMI and WC were concave in men and convex in women. The relationships between VFA, VSR, and BMI, WC varied by sex and race/ethnicity. In conclusion, increasing BMI and WC were linearly associated with increased VFA, but their relationships with VSR were nonlinear and differed by sex.
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Affiliation(s)
- Furong Xu
- School of Education, University of Rhode Island, 142 Flagg Road, Kingston, RI 02881, USA
| | - Jacob E. Earp
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | - Alessandra Adami
- Department of Kinesiology, University of Rhode Island, Independence Square, Kingston, RI 02881, USA
| | - Ingrid E. Lofgren
- Department of Nutrition and Food Sciences, University of Rhode Island, Fogarty Hall, Kingston, RI 02881, USA
| | - Matthew J. Delmonico
- Department of Kinesiology, University of Rhode Island, Independence Square, Kingston, RI 02881, USA
| | - Geoffrey W. Greene
- Department of Nutrition and Food Sciences, University of Rhode Island, Fogarty Hall, Kingston, RI 02881, USA
| | - Deborah Riebe
- Department of Kinesiology, University of Rhode Island, Independence Square, Kingston, RI 02881, USA
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Silhouette images enable estimation of body fat distribution and associated cardiometabolic risk. NPJ Digit Med 2022; 5:105. [PMID: 35896726 PMCID: PMC9329470 DOI: 10.1038/s41746-022-00654-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 07/06/2022] [Indexed: 11/09/2022] Open
Abstract
Inter-individual variation in fat distribution is increasingly recognized as clinically important but is not routinely assessed in clinical practice, in part because medical imaging has not been practical to deploy at scale for this task. Here, we report a deep learning model trained on an individual’s body shape outline—or “silhouette” —that enables accurate estimation of specific fat depots of interest, including visceral (VAT), abdominal subcutaneous (ASAT), and gluteofemoral (GFAT) adipose tissue volumes, and VAT/ASAT ratio. Two-dimensional coronal and sagittal silhouettes are constructed from whole-body magnetic resonance images in 40,032 participants of the UK Biobank and used as inputs for a convolutional neural network to predict each of these quantities. Mean age of the study participants is 65 years and 51% are female. A cross-validated deep learning model trained on silhouettes enables accurate estimation of VAT, ASAT, and GFAT volumes (R2: 0.88, 0.93, and 0.93, respectively), outperforming a comparator model combining anthropometric and bioimpedance measures (ΔR2 = 0.05–0.13). Next, we study VAT/ASAT ratio, a nearly body-mass index (BMI)—and waist circumference-independent marker of metabolically unhealthy fat distribution. While the comparator model poorly predicts VAT/ASAT ratio (R2: 0.17–0.26), a silhouette-based model enables significant improvement (R2: 0.50–0.55). Increased silhouette-predicted VAT/ASAT ratio is associated with increased risk of prevalent and incident type 2 diabetes and coronary artery disease independent of BMI and waist circumference. These results demonstrate that body silhouette images can estimate important measures of fat distribution, laying the scientific foundation for scalable population-based assessment.
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Stein MJ, Matarasso A. High-Definition Liposuction in Men. Clin Plast Surg 2022; 49:307-312. [DOI: 10.1016/j.cps.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Caffo O, Ralston PA, Lemacks JL, Young-Clark I, Wickrama KKAS, Ilich JZ. Sex and Body Circumferences Associated with Serum Leptin in African American Adults. J Womens Health (Larchmt) 2021; 30:1769-1777. [PMID: 33661054 DOI: 10.1089/jwh.2020.8820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objective: Cardiovascular disease (CVD) continues to be a leading cause of death for U.S. adults, especially African Americans (AA). Yet, few studies have examined a comprehensive set of metabolic health and health behavior factors related to CVD risk in this population. This study investigated the relationship between serum leptin and anthropometries (body mass index [BMI], circumferences [waist-WC, hip-HC, and waist/hip ratio W/H]), metabolic health (systolic and diastolic blood pressure [BP], serum lipids, glucose, and C-reactive protein [CRP]), and health behaviors (hours of sleep, physical activity) in midlife and older AAs. Materials and Methods: Participants (n = 89, ≥45 years of age) were AAs in six churches in North Florida enrolled in a broader church-based longitudinal study. Anthropometric measurements, serum analyses, and self-reported items. Results: Serum leptin was positively correlated with gender (being female) (r = 0.623, p < 0.001), BMI log transformed (r = 0.469, p < 0.001), WC (r = 0.440, p < 0.001), HC (r = 0.658, p < 0.001), use of BP medication (r = 0.216, p < 0.05), and serum CRP (r = 0.277, p < 0.01). Correlations by sex showed significant relationships for both men and women between leptin and BMI log transformed, WC, and HC. The final multiple regression model [R2 = 0.758, F(4, 66) = 55.871, p < 0.001] showed that 75.8% of the variance in leptin was explained by being female (β = 0.65, p < 0.001), WC (β = 0.26, p < 0.02), and HC (β = 0.28, p < 0.01). Conclusions: Findings more specifically delineate the variables associated with serum leptin in AAs, particularly WC and HC, and suggest greater attention to possible risk for leptin resistance in AA females. Clinical Trial Registration: This study is registered at www.clinicaltrials.gov NCT03339050.
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Affiliation(s)
- Olenka Caffo
- College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Penny A Ralston
- Center on Better Health and Life for Underserved Populations, Florida State University, Tallahassee, Florida, USA
| | - Jennifer L Lemacks
- School of Kinesiology and Nutrition, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Iris Young-Clark
- Center on Better Health and Life for Underserved Populations, Florida State University, Tallahassee, Florida, USA
| | | | - Jasminka Z Ilich
- Institute for Successful Longevity, Consulting Faculty, Center on Better Health and Life for Underserved Populations, Florida State University, Tallahassee, Florida, USA
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Cameron NA, Petito LC, McCabe M, Allen NB, O'Brien MJ, Carnethon MR, Khan SS. Quantifying the Sex-Race/Ethnicity-Specific Burden of Obesity on Incident Diabetes Mellitus in the United States, 2001 to 2016: MESA and NHANES. J Am Heart Assoc 2021; 10:e018799. [PMID: 33563002 PMCID: PMC7955335 DOI: 10.1161/jaha.120.018799] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Given the increasing prevalence of diabetes mellitus (DM) in the United States, estimating the effects of population‐level increases in obesity on incident DM has substantial implications for public health policy. Therefore, we determined the population attributable fraction, which accounts for the prevalence and excess risk of DM associated with obesity. Methods and Results We included non‐Hispanic White, non‐Hispanic Black, and Mexican American participants without DM at baseline from MESA (Multi‐Ethnic Study of Atherosclerosis) with available data on body mass index and key covariates from 2000 to 2017 to calculate unadjusted and adjusted (age, study site, physical activity, diet, income, and education level) hazard ratios (HR) for obesity‐attributable DM. We calculated national age‐adjusted prevalence estimates for obesity using data from NHANES (National Health and Nutrition Examination Survey) in 4 pooled cycles (2001–2016) among adults with similar characteristics to MESA participants. Last, we calculated unadjusted and adjusted population attributable fractions from the race/ethnic and sex‐specific HR and prevalence estimates. Of 4200 MESA participants, the median age was 61 years, 46.8% were men, 53.9% were non‐Hispanic White, 32.9% were non‐Hispanic Black, and 13.3% were Mexican. Among MESA participants, incident DM occurred in 11.6% over a median follow‐up of 9.2 years. The adjusted HR for obesity‐related DM was 2.7 (95% CI, 2.2–3.3). Adjusted population attributable fractions were 0.35 (95% CI, 0.29–0.40) in 2001 to 2004 and 0.41 (95% CI, 0.36–0.46) in 2013 to 2016, and greatest among non‐Hispanic White women. Conclusions The contribution of obesity towards DM in the population remains substantial and varies significantly by race/ethnicity and sex, highlighting the need for tailored public health interventions to reduce obesity. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NC00005487, NCT00005154.
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Affiliation(s)
- Natalie A Cameron
- Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Lucia C Petito
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Megan McCabe
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Norrina B Allen
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Matthew J O'Brien
- Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL.,Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Mercedes R Carnethon
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Sadiya S Khan
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL.,Division of Cardiology Northwestern University Feinberg School of Medicine Chicago IL
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Sheean P, Gonzalez MC, Prado CM, McKeever L, Hall AM, Braunschweig CA. American Society for Parenteral and Enteral Nutrition Clinical Guidelines: The Validity of Body Composition Assessment in Clinical Populations. JPEN J Parenter Enteral Nutr 2019; 44:12-43. [DOI: 10.1002/jpen.1669] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Patricia Sheean
- Marcella Niehoff School of Nursing Department of Health Promotion Loyola University Chicago Maywood Illinois USA
| | - M. Cristina Gonzalez
- Postgraduate Program in Health and Behavior Catholic University of Pelotas Pelotas Rio Grande do Sul Brazil
| | - Carla M. Prado
- Human Nutrition Research Unit Department of Agricultural Food and Nutritional Science Division of Human Nutrition, University of Alberta Edmonton Alberta Canada
| | - Liam McKeever
- Department of Kinesiology and Nutrition University of Illinois Chicago Illinois USA
| | - Amber M. Hall
- University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Carol A. Braunschweig
- Department of Kinesiology and Nutrition and Division of Epidemiology and Biostatistics University of Illinois at Chicago Chicago Illinois USA
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Mtintsilana A, Micklesfield LK, Chorell E, Olsson T, Goedecke JH. Fat redistribution and accumulation of visceral adipose tissue predicts type 2 diabetes risk in middle-aged black South African women: a 13-year longitudinal study. Nutr Diabetes 2019; 9:12. [PMID: 30918247 PMCID: PMC6437211 DOI: 10.1038/s41387-019-0079-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 03/08/2019] [Accepted: 03/12/2019] [Indexed: 01/30/2023] Open
Abstract
Background Cross-sectional studies in South Africa (SA) have shown that black SA women, despite being more insulin resistant, have less visceral adipose tissue (VAT) and more subcutaneous adipose tissue (SAT) than white women. This study aimed to investigate whether baseline and/or change in body fat and its distribution predict type 2 diabetes (T2D) risk in middle-aged black SA women, 13 years later. Methods We studied 142 black SA women who are the caregivers of the Birth-to-Twenty plus cohort, and who had normal glucose tolerance (NGT) at baseline. At baseline and follow-up, fasting blood samples, basic anthropometry and dual-energy X-ray absorptiometry-derived body composition were measured. At follow-up, an oral glucose tolerance test was completed. The WHO diabetes diagnostic criteria were used to define NGT, impaired fasting glucose (IFG)/impaired glucose tolerance (IGT), impaired glucose metabolism (IGM) and T2D. Results At follow-up, 64% of participants remained NGT, whereas 25% developed IGM, and 11% developed T2D. The IGM and the T2D groups were combined for statistical analyses. At baseline, trunk fat mass (FM), VAT but not SAT (measures of central FM) were higher in the IGM/T2D group than the NGT group (p < 0.0001). In contrast, the IGM/T2D group had lower leg %FM at baseline than the NGT group (p < 0.0001). Baseline trunk FM (Odds ratio per 1 kg increase (95% confidence interval, 1.95 (1.43–2.67))), and VAT (OR per 10 cm2 increase, 1.25 (1.10–1.42)), and the change in VAT (1.12 (1.03–1.23)) were associated with greater odds of developing IGM/T2D, whereas baseline leg FM (OR per 1 kg increase, 0.55 (0.41–0.73)) were associated with reduced IGM/T2D risk at follow-up (p < 0.05). Conclusions Relative fat redistribution, with VAT accumulation, predicted the development of IGM/T2D 13 years before its onset. Prevention of central obesity is a key factor to reduce the risk of developing T2D among middle-aged urban black SA women.
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Affiliation(s)
- Asanda Mtintsilana
- South African Medical Research Council/University of the Witwatersrand Developmental Pathways for Health Research Unit, Department of Paediatrics, University of Witwatersrand, Johannesburg, South Africa
| | - Lisa K Micklesfield
- South African Medical Research Council/University of the Witwatersrand Developmental Pathways for Health Research Unit, Department of Paediatrics, University of Witwatersrand, Johannesburg, South Africa
| | - Elin Chorell
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Tommy Olsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Julia H Goedecke
- South African Medical Research Council/University of the Witwatersrand Developmental Pathways for Health Research Unit, Department of Paediatrics, University of Witwatersrand, Johannesburg, South Africa. .,Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa.
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12
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Harrison RF, Mcnamara JE, Beaumont CB, Sadowski EA, Chappell RJ, Shahzad MM, Spencer RJ, Al-Niaimi AN, Barroilhet LM, Rose SL, Kushner DM. Using simple radiologic measurements to anticipate surgical challenge in endometrial cancer: a prospective study. Int J Gynecol Cancer 2019; 29:102-107. [DOI: 10.1136/ijgc-2018-000037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/27/2018] [Accepted: 09/13/2018] [Indexed: 11/04/2022] Open
Abstract
ObjectivesTo determine if linear measurements of adiposity from pre-operative imaging can improve anticipation of surgical difficulty among endometrial cancer patients.MethodsEighty patients with newly diagnosed endometrial cancer were enrolled. Routine pre-operative imaging (MRI or CT) was performed. Radiologic linear measurements of the following were obtained: anterior-to-posterior skin distance; anterior skin to anterior edge of L5 distance (total anterior); anterior peritoneum to anterior edge of L5 distance (visceral obesity); and posterior edge of L5 to posterior skin distance (total posterior). Surgeons completed questionnaires quantifying preoperative anticipated operative difficulty and postoperative reported operative difficulty. The primary objective was to assess for a correlation between linear measurements of visceral fat and reported operative difficulty.ResultsSeventy-nine patients had questionnaires completed, preoperative imaging obtained, and surgery performed. Univariate analysis showed all four linear measurements, body mass index, weight, and anticipated operative difficulty were associated with increased reported operative difficulty (P< 0.05). Multivariate analysis demonstrated that body mass index and linear measurements visceral obesity and total posterior were independently associated with increased reported operative difficulty (P< 0.05). Compared with body mass index, the visceral obesity measurement was more sensitive and specific for predicting increased reported operative difficulty (visceral obesity; sensitivity 54%, specificity 91 %; body mass index; sensitivity 38%, specificity 89%). A difficulty risk model combining body mass index, visceral obesity, and total posterior demonstrated better predictive performance than any individual preoperative variable.ConclusionsSimple linear measurements of visceral fat obtained from preoperative imaging are more predictive than body mass index alone in anticipating surgeon-reported operative difficulty. These easily obtained measurements may assist in preoperative decision making in this challenging patient population.
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13
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Zaidi M, Lizneva D, Kim SM, Sun L, Iqbal J, New MI, Rosen CJ, Yuen T. FSH, Bone Mass, Body Fat, and Biological Aging. Endocrinology 2018; 159:3503-3514. [PMID: 30085049 PMCID: PMC6134257 DOI: 10.1210/en.2018-00601] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/24/2018] [Indexed: 12/11/2022]
Abstract
The Study of Women's Health Across the Nation has taught us that impending ovarian failure during late perimenopause is associated with a sharp rise in serum FSH, which coincides with the most rapid rate of bone loss and the onset of visceral adiposity. At this time in a woman's life, serum estrogen levels are largely unaltered, so the hypothesis that hypoestrogenemia is the sole cause of bone loss and visceral obesity does not offer a full explanation. An alternative explanation, arising from animal models and human data, is that both physiologic aberrations, obesity and osteoporosis, arise at least in part from rising FSH levels. Here, we discuss recent findings on the mechanism through which FSH exerts biological actions on bone and fat and review clinical data that support a role for FSH in causing osteoporosis and obesity. We will also provide a conceptual framework for using a single anti-FSH agent to prevent and treat both osteoporosis and obesity in women across the menopausal transition.
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Affiliation(s)
- Mone Zaidi
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Correspondence: Mone Zaidi, MD, PhD, Mount Sinai Bone Program, Endocrinology, Box 1055, One Gustave L. Levy Place, New York, New York 10029. E-mail:
| | - Daria Lizneva
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Reproductive Health Protection, Scientific Center of Family Health and Human Reproduction, Irkutsk, Russian Federation
| | - Se-Min Kim
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Li Sun
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jameel Iqbal
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maria I New
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Tony Yuen
- The Mount Sinai Bone Program, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Cardiovascular fat in women at midlife: effects of race, overall adiposity, and central adiposity. The SWAN Cardiovascular Fat Study. Menopause 2018; 25:38-45. [PMID: 28763398 DOI: 10.1097/gme.0000000000000945] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Cardiovascular fat (CF) is associated with greater coronary heart disease (CHD) risk. Postmenopausal women have greater CF volumes than premenopausal women, and the association between specific CF depot volumes and CHD risk is more pronounced after menopause. Race, central adiposity, and visceral adiposity are important factors that could impact CF volumes. Whether racial differences in CF volumes and in their associations with central (visceral fat [VAT]) and general adiposity (body mass index [BMI]) exist in midlife women have not been addressed before. METHODS In all, 524 participants from the Study of Women's Health Across the Nation (mean age: 50.9 ± 2.9 years; 62% White and 38% Black) who had data on CF volumes (epicardial fat [EAT], paracardial fat [PAT], total heart fat, and aortic perivascular fat), VAT, and BMI were studied. RESULTS In models adjusted for age, study site, menopausal status, comorbid conditions, alcohol consumption, and physical activity, Black women had 19.8% less EAT, 24.5% less PAT, 20.4% less total heart fat, and 13.2% less perivascular fat than White women (all P < 0.001). These racial differences remained significant after additional adjustment for BMI or VAT. Race significantly modified associations between adiposity measures and CF volumes. Every 1-SD higher BMI was associated with 66.7% greater PAT volume in White compared with 42.4% greater PAT volume in Black women (P = 0.004), whereas every 1-SD higher VAT was associated with 32.3% greater EAT volume in Black compared with 25.3% greater EAT volume in White women (P = 0.039). CONCLUSIONS Racial differences were found in CF volumes and in their associations with adiposity measures among midlife women. Future research should determine how race-specific changes in CF volumes impact CHD risk in women.
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Monteleone P, Mascagni G, Giannini A, Genazzani AR, Simoncini T. Symptoms of menopause - global prevalence, physiology and implications. Nat Rev Endocrinol 2018; 14:199-215. [PMID: 29393299 DOI: 10.1038/nrendo.2017.180] [Citation(s) in RCA: 285] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The symptoms of menopause can be distressing, particularly as they occur at a time when women have important roles in society, within the family and at the workplace. Hormonal changes that begin during the menopausal transition affect many biological systems. Accordingly, the signs and symptoms of menopause include central nervous system-related disorders; metabolic, weight, cardiovascular and musculoskeletal changes; urogenital and skin atrophy; and sexual dysfunction. The physiological basis of these manifestations is emerging as complex and related, but not limited to, oestrogen deprivation. Findings generated mainly from longitudinal population studies have shown that ethnic, geographical and individual factors affect symptom prevalence and severity. Moreover, and of great importance to clinical practice, the latest research has highlighted how certain menopausal symptoms can be associated with the onset of other disorders and might therefore serve as predictors of future health risks in postmenopausal women. The goal of this Review is to describe in a timely manner new research findings on the global prevalence and physiology of menopausal symptoms and their impact on future health.
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Affiliation(s)
- Patrizia Monteleone
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, Pisa 56126, Italy
| | - Giulia Mascagni
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, Pisa 56126, Italy
| | - Andrea Giannini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, Pisa 56126, Italy
| | - Andrea R Genazzani
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, Pisa 56126, Italy
| | - Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, Pisa 56126, Italy
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Prevalence and Predictors of Low Serum 25-Hydroxyvitamin D among Female African-American Breast Cancer Survivors. J Acad Nutr Diet 2018; 118:568-577. [PMID: 29305131 DOI: 10.1016/j.jand.2017.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 10/13/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND African-American breast cancer survivors commonly demonstrate low serum 25-hydroxyvitamin D (25(OH)D). Decreased cutaneous conversion, high levels of adiposity, and even breast cancer treatment may influence vitamin D status. Previous investigations have analyzed African-American women in aggregate with other breast cancer survivors and have not comprehensively addressed these influential factors. OBJECTIVES To determine the prevalence of low serum 25(OH)D in an exclusively African-American cohort of female breast cancer survivors with overweight/obesity and to evaluate the role of ultraviolet (UV) light exposure, body composition, and dietary sources of vitamin D on serum 25(OH)D levels. DESIGN Cross-sectional. PARTICIPANTS Pre- and postmenopausal African-American breast cancer survivors (n=244) were recruited from various neighborhoods in the city of Chicago, IL, between September 2011 and September 2014 for a larger weight loss trial. MAIN OUTCOME MEASURES Demographic, clinical, anthropometric (body mass index [calculated as kg/m2], waist circumference, and hip circumference), blood specimen, dietary intake (food frequency questionnaire), and sun behavior data were collected by trained study personnel before trial participation. Dual-energy x-ray absorptiometry was used to quantify adiposity (total, percentage, regional, visceral) and lean mass. Serum 25(OH)D was used as the biomarker reflective of vitamin D status. STATISTICAL ANALYSES Mean (±standard deviation), frequencies, and multivariate linear regression modeling. RESULTS The average participant was 57.4 years old (±10.0), 6.9 years (±5.2) from initial breast cancer diagnosis with a body mass index of 36.2 (±6.2). The majority of participants (60%) reported habitual oral vitamin D supplementation with mean intake of 327 IU (±169). Vitamin D deficiency was prevalent in 81% and 43%, when the cut points of the Endocrine Society (<30 ng/mL or <75 nmol/L) and the Institute of Medicine (<20 ng/mL or <50 nmol/L) were applied, respectively. A multivariate model adjusting for age, seasonality of blood draw, total energy intake, use of supplemental vitamin D, darker skin pigmentation, breast cancer stage, and waist-to-hip ratio was able to explain 28.8% of the observed variance in serum 25(OH)D concentrations. No significant associations were detected for body mass index or any dual-energy x-ray absorptiometry measures of body composition. CONCLUSIONS Considering the number of women who endorsed use of vitamin D supplementation, the prevalence of vitamin D deficiency among these African-American breast cancer survivors was high. Vitamin D supplementation, sun behavior, and waist-to-hip ratio may serve as future points of intervention to improve the vitamin D status of this minority survivor population.
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Yildirim M, Ipek A, Dauletkazin G, Cendek BD, Gezegen S, Desdicioglu R, Yavuz AFA. Sonographic measurement of the fetal thymus: Relationship with maternal obesity. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:277-281. [PMID: 28271526 DOI: 10.1002/jcu.22470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 12/30/2016] [Accepted: 12/30/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the influence of maternal obesity on the size of the fetal thymus. METHODS The study population consisted of 138 pregnant women who were divided into two groups based on their body mass index (BMI): Normal-weight group (n = 97; BMI: 18-25 kg/m2 ) and obese group (n = 41; BMI: ≥ 30 kg/m2 ). All participants underwent routine second-trimester prenatal ultrasound (US) screening at 20-25 weeks of gestation. Differences in US measurement of fetal thymus, fetal anthropometric measurements, subcutaneous adipose tissue thickness, fetal weight, gestational age, white blood cell count, and C-reactive protein (CRP) values between groups were compared. RESULTS The mean thymus size was 18.7 ± 2.9 mm for normal-weight group, and 21.6 ± 3.7 mm for the obese group (p < 0.001). CRP values were also significantly different between groups (6.8 ± 4.4 mg/dl for normal-weight group, 14.8 ± 1.8 mg/dl for obese group, p < 0.001). CONCLUSIONS Fetal thymus size was increased in obese women, and this increase may indicate immunologic abnormalities in fetuses. However, future large-scale studies are necessary to support this association. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:277-281, 2017.
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Affiliation(s)
- Melahat Yildirim
- Yildirim Beyazit University, Department of Obstetrics and Gynecology, Bilkent, Ankara, Turkey
| | - Ali Ipek
- Ataturk Training and Research Hospital, Department of Radiology, Bilkent, Ankara, Turkey
| | - Gulcan Dauletkazin
- Ataturk Training and Research Hospital, Department of Obstetrics and Gynecology, Bilkent, Ankara, Turkey
| | - Busra Demir Cendek
- Etlik Zübeyde Han[inodot]m Women's Health Education and Research Hospital, Ankara, Turkey
| | - Saniye Gezegen
- Ataturk Training and Research Hospital, Department of Obstetrics and Gynecology, Bilkent, Ankara, Turkey
| | - Raziye Desdicioglu
- Yildirim Beyazit University, Department of Obstetrics and Gynecology, Bilkent, Ankara, Turkey
| | - Ayse Filiz Avsar Yavuz
- Yildirim Beyazit University, Department of Obstetrics and Gynecology, Bilkent, Ankara, Turkey
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Ibeneme S, Ezeigwe C, Ibeneme GC, Ezuma A, Okoye I, Nwankwo JM. Response of Gait Output and Handgrip Strength to Changes in Body Fat Mass in Pre- and Postmenopausal Women. CURRENT THERAPEUTIC RESEARCH 2017; 90:92-98. [PMID: 31388361 PMCID: PMC6677777 DOI: 10.1016/j.curtheres.2017.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 03/28/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Available preliminary data on menopause does not relate changes in body fat mass (BFM) and handgrip strength (HGS) (an indicator of body/muscle strength) to gait parameters. OBJECTIVE To determine the relationship between BFM, HGS and gait parameters, namely, stride length (SL) (an indicator of walking balance/postural stability), stride frequency (SF), and velocity (V) (gait output), to guide gait training. METHODS Ninety consenting (45 postmenopausal and 45 premenopausal) female staff of the University of Nigeria Teaching Hospital, Enugu, were randomly selected and assessed for BFM and HGS with a hydration monitor and dynamometer, respectively, in an observational study. The mean of 2 trials of the number of steps and time taken to cover a 10-m distance at normal speed was used to calculate SF, SL, and V. Data were analyzed using an independent t test and a Pearson correlation coefficient at P < 0.05. RESULTS Premenopausal (BFM = 42.93% [12.61%], HGS = 27.89 [7.52] kg, stride ratio = 1.43, and velocity = 1.04 [0.01] m/sec) and postmenopausal (BFM = 41.55% [12.71%], HGS = 30.91 [7.07] kg, stride ratio = 1.44, and velocity = 1.06 [0.01] m/sec) women showed no significant differences in gait output/velocity (t = 0.138; P = 0.89; d = 0.029). At postmenopause, BFM was significantly and negatively (r = -0.369; r 2 = 0.1362; P = 0.013) correlated with SL, whereas HGS was positively and significantly (r = 0.323; r 2 = 0.104; P = 0.030) correlated with gait output at premenopause. CONCLUSIONS BFM may adversely influence walking balance at postmenopause, whereas HGS may enhance gait output at premenopause but not postmenopause. Therefore, muscle strengthening alone may not enhance gait output in postmenopausal women without balance training.
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Affiliation(s)
- Sam Ibeneme
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Clinical Trial Consortium, University of Nigeria, Nsukka, Nigeria
- UNIRED Research Group, Hochschule Hannover-University of Applied Sciences and Arts, Hannover, Germany
| | - Chinenye Ezeigwe
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Georgian C. Ibeneme
- Department of Nursing Sciences, Faculty of Health Sciences & Technology, College of Medicine, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | - Amarachi Ezuma
- Clinical Trial Consortium, University of Nigeria, Nsukka, Nigeria
- Department of Physiotherapy, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Ifeoma Okoye
- Clinical Trial Consortium, University of Nigeria, Nsukka, Nigeria
- Department of Radiation Medicine, Faculty of Medical sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Joseph M. Nwankwo
- Department of Medical Rehabilitation, Faculty of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
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Karvonen-Gutierrez C, Kim C. Association of Mid-Life Changes in Body Size, Body Composition and Obesity Status with the Menopausal Transition. Healthcare (Basel) 2016; 4:healthcare4030042. [PMID: 27417630 PMCID: PMC5041043 DOI: 10.3390/healthcare4030042] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 06/29/2016] [Accepted: 07/08/2016] [Indexed: 12/16/2022] Open
Abstract
The mid-life period is a critical window for increases in body weight and changes in body composition. In this review, we summarize the clinical experience of the menopausal transition by obesity status, and examine the evidence regarding the menopausal transition and reproductive hormones effects on body weight, body composition, or fat distribution. Mid-life obesity is associated with a different menopausal experience including associations with menstrual cycle length prior to the final menstrual period (FMP), age at the FMP, and higher prevalence of vasomotor symptoms. The menopausal transition is associated with weight gain and increased central body fat distribution; the majority of evidence suggests that changes in weight are due to chronological aging whereas changes in body composition and fat distribution are primarily due to ovarian aging. Continuous and regular physical activity during mid-life may be an efficacious strategy to counteract the age-related and menopause-related changes in resting energy expenditure and to prevent weight gain and abdominal adiposity deposition.
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Affiliation(s)
- Carrie Karvonen-Gutierrez
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Catherine Kim
- Departments of Medicine and Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI 48109, USA.
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Sex differences in the rate of abdominal adipose accrual during adulthood: the Fels Longitudinal Study. Int J Obes (Lond) 2016; 40:1278-85. [PMID: 27005404 PMCID: PMC4970892 DOI: 10.1038/ijo.2016.48] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 02/16/2016] [Accepted: 03/08/2016] [Indexed: 02/07/2023]
Abstract
Objectives The purpose of this analysis was to evaluate sex differences in the rate of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) accrual in adults. Secondary analyses examined differences in the rate of VAT and SAT accrual in pre-, peri-, and post-menopausal women. Subjects/Methods Participants were 472 (60% female) non-Hispanic whites, aged 18-84 years at baseline in whom abdominal VAT and SAT were assessed using multiple-image magnetic resonance imaging at two time points, with an average follow-up of 7.3 ± 2.6 years. Linear regression models were used to examine the effects of sex, baseline age and their interaction on rate of change per year in body composition measures (ΔBMI, ΔVAT, and ΔVAT/SAT ratio (ΔVSR)) independent of baseline body composition measures, visit year, income, marital status, physical activity, smoking and alcohol intake. Secondary analyses examined differences in rate of fat change by menopausal status (pre, peri, post). Results Levels of BMI, VAT, and VSR all increased over the 7 year period on average (p<.001); however, the change in BMI (mean ΔBMI = +0.5%) was far smaller than for VAT (mean ΔVAT= +6.8%), SAT (mean ΔSAT = +2.4%), and VSR (mean ΔVSR = +3.6%). ΔBMI, ΔVAT, and ΔSAT decreased linearly with age in both sexes (p<0.01), such that older individuals had lower rates of BMI, VAT, and SAT gain, and this deceleration in BMI, VAT, and SAT accrual was greater in men than women (p for interaction <0.05). ΔVSR did not vary with age in either sex, but remained higher in men than women throughout adulthood. There were no differences in rate of weight or fat gain by menopausal status after adjustment for age. Conclusions Men and women continue to accrue abdominal adiposity with age, but the rate of weight and fat gain decreases over time, particularly in men.
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Abstract
In the USA, compared to whites, African-Americans are disproportionately impacted by the diabetes epidemic. Traditional diabetes risk factors, such as obesity, are more common among African-Americans, but these traditional risk factors do not explain all of the disparity in diabetes risk. Recent research has identified novel environmental, lifestyle, physiologic, and genetic risk factors for diabetes, some of which appear to impact African-Americans more than whites. This manuscript reviews the recent literature to highlight some of these novel risk factors that may be contributing to the racial disparity in diabetes risk. Further study is needed of the modifiable risk factors for development of interventions to reduce the risk of diabetes in African-Americans, as well as other high-risk populations.
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Affiliation(s)
- Ranee Chatterjee
- Division of General Internal Medicine, Duke University, 411 West Chapel Hill Street, Suite 500, Durham, NC, 27701, USA.
| | - Nisa M Maruthur
- Division of General Internal Medicine, Johns Hopkins University, 2024 E Monument St., Baltimore, MD, 21287, USA.
| | - David Edelman
- Division of General Internal Medicine, Duke University, 411 West Chapel Hill Street, Suite 500, Durham, NC, 27701, USA.
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Ethnic Differences in Cardiovascular Disease Risk Factors: A Systematic Review of North American Evidence. Can J Cardiol 2015; 31:1169-79. [DOI: 10.1016/j.cjca.2015.06.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 06/17/2015] [Accepted: 06/17/2015] [Indexed: 02/06/2023] Open
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Abstract
The obesity epidemic in the USA affects disproportionately women and the ethnic minorities. On the other hand, female sex is traditionally associated with a favorable fat distribution preferentially in the subcutaneous depots of the lower body and with improved endocrine and metabolic function of the adipose tissue. However, these data are derived from predominantly non-Hispanic white populations. This review discusses fat distribution patterns in women of diverse ethnic backgrounds, together with data on the release of adipokines from adipose tissue in these populations. Very little information is available on how the metabolic function of the adipocyte differs depending on ethnicity. Thus, it becomes clear that future clinical and translational research should explicitly discuss and take into account the sex and ethnic background of the populations studied.
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Affiliation(s)
- Kalypso Karastergiou
- Section of Endocrinology, Diabetes & Nutrition, School of Medicine, Boston University, 650 Albany St. EBRC-810, Boston, MA, 02118, USA.
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Janssen I, Powell LH, Jasielec MS, Kazlauskaite R. Covariation of change in bioavailable testosterone and adiposity in midlife women. Obesity (Silver Spring) 2015; 23:488-494. [PMID: 25557490 PMCID: PMC4310763 DOI: 10.1002/oby.20974] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 10/25/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine whether menopause-related changes in reproductive hormones were associated with change in adiposity and whether these relationships were independent of important covariates. METHODS Annual assessments of adiposity measures [computed tomography-assessed visceral adipose tissue (VAT) and subcutaneous abdominal adipose tissue (SAT) and dual-energy X-ray absorptiometry-assessed total body fat (TBF)] over 4 years from an ancillary study at the Chicago site of the Study of Women's Health Across the Nation (SWAN) were paired with reproductive hormones collected by SWAN. Included were 243 women (44% African American, 56% Caucasian) who were eligible participants in a population-based cohort with a 72% participation rate. RESULTS VAT increased by 3.8% annually, and SAT increased by 1.8% per year. Change in bioavailable testosterone was significantly positively associated with changes both in VAT and in SAT but was not related to change in total body fat. The associations were independent of age, race, physical activity, smoking, baseline TBF, baseline bioavailable testosterone, and change in TBF. Change in estradiol was unrelated to changes in any adiposity measure. CONCLUSIONS Bioavailable testosterone may play an important role in menopause-related redistribution of visceral and subcutaneous fat in the central abdominal region.
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Affiliation(s)
- Imke Janssen
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL 60612
| | - Lynda H. Powell
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL 60612
- Department of Medicine, Rush University Medical Center, Chicago, IL 60612
- Behavioral Sciences, and Pharmacology, Rush University Medical Center, Chicago, IL 60612
| | - Mateusz S. Jasielec
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL 60612
| | - Rasa Kazlauskaite
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL 60612
- Department of Medicine, Rush University Medical Center, Chicago, IL 60612
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Abrahams Z, Dave JA, Maartens G, Lesosky M, Levitt NS. The development of simple anthropometric measures to diagnose antiretroviral therapy-associated lipodystrophy in resource limited settings. AIDS Res Ther 2014; 11:26. [PMID: 25143778 PMCID: PMC4138415 DOI: 10.1186/1742-6405-11-26] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 07/21/2014] [Indexed: 11/10/2022] Open
Abstract
Background Lipohypertrophy does not appear to be an adverse ART reaction while lipoatrophy is clearly associated with the use of stavudine (d4T) and zidovudine (AZT). In low and middle income countries d4T has only recently been phased out and AZT is still widely being used. Several case definitions have been developed to diagnose lipodystrophy, but none of them are generalizable to sub-Saharan Africa where black women have less visceral adipose tissue and more subcutaneous adipose tissue than white women. We aimed to develop a simple, objective measure to define lipoatrophy and lipohypertrophy by comparing patient report to anthropometric and dual-energy X-ray absorptiometry (DXA) -derived variables. Methods DXA and anthropometric measures were obtained in a cross sectional sample of black HIV-infected South African men (n = 116) and women (n = 434) on ART. Self-reported information on fat gain or fat loss was collected using a standard questionnaire. Receiver operating characteristic (ROC) curves were used to describe the performance of anthropometric and DXA-derived variables using patient reported lipoatrophy and lipohypertrophy as the reference standard. Results Lipoatrophy and lipohypertrophy were more common in women (25% and 33% respectively) than in men (10% and 13% respectively). There were insufficient numbers of men with DXA scans for meaningful analysis. The best predictors of lipoatrophy in women were the anthropometric variables tricep (AUC = 0.725) and thigh skinfold (AUC =0.720) thicknesses; and the DXA-derived variables percentage lower limb fat (AUC = 0.705) and percentage lower limb fat/height (AUC = 0.713). The best predictors of lipohypertrophy in women were the anthropometric variable waist/hip ratio (AUC = 0.645) and the DXA-derived variable percentage trunk fat/percentage limb fat (AUC = 0.647). Conclusions We were able to develop simple, anthropometric measures for defining lipoatrophy and lipohypertrophy, using a sample of black HIV-infected South African women with DXA scans. This is of particular relevance in resource limited settings, where health professionals need simple and inexpensive methods of diagnosing patients with lipoatrophy and lipohypertrophy.
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de Jonge PJF, van Blankenstein M, Grady WM, Kuipers EJ. Barrett's oesophagus: epidemiology, cancer risk and implications for management. Gut 2014; 63:191-202. [PMID: 24092861 PMCID: PMC6597262 DOI: 10.1136/gutjnl-2013-305490] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Although endoscopic surveillance of patients with Barrett's oesophagus has been widely implemented, its effectiveness is debateable. The recently reported low annual oesophageal adenocarcinoma risk in population studies, the failure to identify most Barrett's patients at risk of disease progression, the poor adherence to surveillance and biopsy protocols, and the significant risk of misclassification of dysplasia all tend to undermine the effectiveness of current management, in particular, endoscopic surveillance programmes, to prevent or improve the outcomes of patients with oesophageal adenocarcinoma. The ongoing increase in incidence of Barrett's oesophagus and consequent growth of the surveillance population, together with the associated discomfort and costs of endoscopic surveillance, demand improved techniques for accurately determining individual risk of oesophageal adenocarcinoma. More accurate techniques are needed to run efficient surveillance programmes in the coming decades. In this review, we will discuss the current knowledge on the epidemiology of Barrett's oesophagus, and the challenging epidemiological dilemmas that need to be addressed when assessing the current screening and surveillance strategies.
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Affiliation(s)
- Pieter Jan F de Jonge
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, , Rotterdam, The Netherlands
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Nazare JA, Smith JD, Borel AL, Haffner SM, Balkau B, Ross R, Massien C, Alméras N, Després JP. Ethnic influences on the relations between abdominal subcutaneous and visceral adiposity, liver fat, and cardiometabolic risk profile: the International Study of Prediction of Intra-Abdominal Adiposity and Its Relationship With Cardiometabolic Risk/Intra-Abdominal Adiposity. Am J Clin Nutr 2012; 96:714-26. [PMID: 22932278 DOI: 10.3945/ajcn.112.035758] [Citation(s) in RCA: 286] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Ethnic differences in cardiometabolic risk (CMR) may be related to patterns of ethnic-specific body fat distribution. OBJECTIVE We aimed to identify differences across ethnic groups in interrelations between BMI, abdominal adiposity, liver fat, and CMR profile. DESIGN In the International Study of Prediction of Intra-Abdominal Adiposity and Its Relationship With Cardiometabolic Risk/Intra-Abdominal Adiposity, 297 physicians recruited 4504 patients (from 29 countries). In the current cross-sectional analyses, 2011 whites, 166 African Caribbean blacks, 381 Hispanics, 1192 East Asians, and 347 Southeast Asians were included. Computed tomography was used to assess abdominal fat distribution and to estimate liver fat content. Anthropometric variables and CMR profile were measured. RESULTS Higher ranges of BMI were associated with higher levels of visceral [visceral adipose tissue (VAT)] and deep subcutaneous [deep subcutaneous adipose tissue (DSAT)] adiposity, with significant ethnic differences regarding the slope of these relations. Despite lower absolute BMI values, East Asians presented the largest accumulation of VAT but the lowest accumulation of DSAT with increasing adiposity. The association of BMI with liver fat did not differ between ethnic groups. Liver fat and DSAT were positively correlated with VAT with no ethnic variation. All ethnic groups had a similar association between a 1-SD increase in VAT, DSAT, or liver fat with hypertension, type 2 diabetes, hypertriglyceridemia, low HDL-cholesterol concentration, or high C-reactive protein concentration. CONCLUSIONS Ethnicity significantly affects abdominal adiposity and liver fat partitioning, and East Asians have the most deleterious abdominal fat distribution. Irrespective of ethnicity, abdominal and hepatic fat depots are strongly interrelated and increased with obesity. Higher amounts of VAT or liver fat are associated with a more deteriorated CMR profile in all ethnic groups.
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Affiliation(s)
- Julie-Anne Nazare
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
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Khan UI, Wang D, Sowers MR, Mancuso P, Everson-Rose SA, Scherer PE, Wildman RP. Race-ethnic differences in adipokine levels: the Study of Women's Health Across the Nation (SWAN). Metabolism 2012; 61:1261-9. [PMID: 22444780 PMCID: PMC3404256 DOI: 10.1016/j.metabol.2012.02.005] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 02/07/2012] [Accepted: 02/08/2012] [Indexed: 12/15/2022]
Abstract
Differences in adipose tissue secretory profile, as measured by adipokine levels, may play a role in race-ethnic disparities in cardiovascular disease (CVD). We examined race-ethnic differences in adipokine levels in a group of mid-life Caucasian, African American (AA), Chinese and Japanese women, after accounting for adiposity. Data on 1876 women from the Study of Women's Health Across the Nation were analyzed. In multivariable adjustment, including total fat mass, differences in total and high molecular weight (HMW) adiponectin, leptin and soluble leptin receptor (sOB-R) levels were examined. Despite intermediate levels of adiposity, Caucasian women had higher levels of both total and HMW adiponectin, when compared to both AA and Chinese and Japanese women. After multivariable adjustment, compared to Caucasian women, AA women had significantly lower total (β: -3.40; 95% CI: -4.29, -2.52; P<.001) and HMW adiponectin (β: -0.53; 95% CI: -0.64, -0.43; P<.001) levels, higher leptin levels (β: 3.26; 95% CI: 1.36, 5.16; P<.001) and lower sOB-R levels (β: -0.07; 95% CI: -0.11, -0.03; P<.001). Compared to Caucasian women, both Chinese and Japanese women had lower total (Chinese: β: -5.50; 95% CI: -7.07, -3.93; P<.001; Japanese: β: -5.48; 95% CI: -6.95, -4.02; P<.001) and HMW adiponectin (Chinese: β: -0.57; 95% CI: -0.75, -0.38; P<.001; Japanese: β: -0.61; 95% CI: -0.78, -0.44; P<.001) levels and lower sOB-R levels (Chinese: β: -0.13; 95% CI: -0.20, -0.06; P<.001; Japanese: β: -0.09; 95% CI: -0.15, -0.02; P=.008). Significant race-ethnic differences exist in circulating adipokines, even after accounting for adiposity. Further research is needed to explicitly determine if such differences contribute to known racial differences in CVD risk.
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Affiliation(s)
- Unab I Khan
- Department of Pediatrics, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E. 210th Street, Bronx, NY 10467, USA.
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Cohen SS, Fowke JH, Cai Q, Buchowski MS, Signorello LB, Hargreaves MK, Zheng W, Blot WJ, Matthews CE. Differences in the association between serum leptin levels and body mass index in black and white women: a report from the Southern Community Cohort Study. ANNALS OF NUTRITION & METABOLISM 2012; 60:90-7. [PMID: 22353927 PMCID: PMC3710998 DOI: 10.1159/000336180] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 01/01/2012] [Indexed: 01/26/2023]
Abstract
BACKGROUND/AIMS Leptin may be an important link between obesity and many high-burden diseases, including cancer and cardiovascular disease, but leptin levels and correlates in individuals of diverse racial backgrounds have not been well characterized despite racial differences in incidence and mortality patterns for many obesity-related diseases. METHODS In a cross-sectional study of 915 white and 892 black women enrolled in the Southern Community Cohort Study (age 40-79 years, half postmenopausal), serum leptin levels were compared between the race groups and across categories of body mass index (BMI). Potential correlates of leptin were assessed via race-stratified linear regression models. RESULTS Blacks had higher unadjusted leptin levels than whites (geometric mean 22.4 vs. 19.0 ng/ml; p < 0.0001). Leptin increased with increasing BMI, and racial differences in leptin were most pronounced in women with BMI ≥25. Significant correlates of leptin included BMI, age, alcohol consumption, cigarette smoking, diabetes (both races) and fat consumption (black women only). Leptin remained higher in black women (22.7 vs. 18.8 ng/ml) after adjustment for these factors. CONCLUSIONS Persistent racial differences in leptin concentrations exist after adjustment for BMI and other factors. Leptin assessment may be informative in future studies that investigate racial differences in the development of obesity-related diseases.
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Affiliation(s)
- Sarah S Cohen
- International Epidemiology Institute, Rockville, MD, USA.
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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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De Lucia Rolfe E, Norris SA, Sleigh A, Brage S, Dunger DB, Stolk RP, Ong KK. Validation of ultrasound estimates of visceral fat in black South African adolescents. Obesity (Silver Spring) 2011; 19:1892-7. [PMID: 21738240 DOI: 10.1038/oby.2011.213] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Accurate quantification of visceral adipose tissue (VAT) is needed to understand ethnic variations and their implications for metabolic disease risk. The use of reference methods such as computed tomography (CT) and magnetic resonance imaging (MRI) is limited in large epidemiological studies. Surrogate measures such as anthropometry and dual-energy X-ray absorptiometry (DXA) do not differentiate between VAT and subcutaneous abdominal adipose tissue (SCAT). Ultrasound provides a validated estimate of VAT and SCAT in white populations. This study aimed to validate the use of ultrasound-based assessment of VAT in black South African adolescents. One hundred healthy adolescents (boys = 48, girls = 52) aged 18-19 years participating in the birth to twenty cohort study had VAT and SCAT measured by single slice MRI at L4. These MRI "criterion measures" were related to ultrasound VAT and SCAT thickness, anthropometry (BMI, waist and hip circumferences), and DXA android region fat. Ultrasound VAT thickness showed the strongest correlations with MRI VAT (Spearman's correlation coefficients: r = 0.72 and r = 0.64; in boys and girls, respectively), and substantially improved the estimation of MRI VAT compared to anthropometry and DXA alone; in regression models the addition of ultrasound VAT thickness to models containing BMI, waist, and DXA android fat improved the explained variance in VAT from 39% to 60% in boys, and from 31% to 52% in girls. In conclusion, ultrasound substantially increased the precision of estimating VAT beyond anthropometry and DXA alone. Black South African adolescents have relatively little VAT compared to elderly whites, and we therefore provide new ultrasound-based prediction equations for VAT specific to this group.
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Albert MA, Williams DR. Invited commentary: Discrimination--an emerging target for reducing risk of cardiovascular disease? Am J Epidemiol 2011; 173:1240-3. [PMID: 21354989 DOI: 10.1093/aje/kwq514] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
A growing body of research suggests that perceived discrimination, in multiple societies, is a neglected but important predictor of increased risk of disease for a broad range of health status indicators. Several prior studies propose that discrimination is adversely related to increased cardiovascular disease risk. The studies by Hunte (Am J Epidemiol. 2011;173(11):1223-1231) and Lewis et al. (Am J Epidemiol. 2011;173(11):1232-1239) find that self-reported discrimination is associated with increased risk of adiposity for men and women. These studies highlight the potentially important role of discrimination as a risk factor for excess fat but also raise important research questions regarding the role of fat in cardiovascular disease and racial differences in these processes. More generally, they also provide an important reminder to epidemiologists and medical professionals that discrimination and other aspects of racism persist in contemporary society and that increased efforts are needed to document the extent to which they may have pathogenic consequences and to identify the most promising initiatives to reduce any observed negative effects. Equally important, these studies remind us that, although social stressors are difficult to measure accurately and comprehensively, understanding how multiple stressors combine over the life course to affect the risk of morbidity and mortality remains an important priority for concerted research attention.
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Affiliation(s)
- Michelle A Albert
- Division of Cardiovascular Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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33
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Wildman RP, Janssen I, Khan UI, Thurston R, Barinas-Mitchell E, El Khoudary SR, Everson-Rose SA, Kazlauskaite R, Matthews KA, Sutton-Tyrrell K. Subcutaneous adipose tissue in relation to subclinical atherosclerosis and cardiometabolic risk factors in midlife women. Am J Clin Nutr 2011; 93:719-26. [PMID: 21346089 PMCID: PMC3057544 DOI: 10.3945/ajcn.110.007153] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Limited data suggest that the effects of abdominal subcutaneous adipose tissue (SAT) on cardiovascular disease risk may depend on accompanying amounts of abdominal visceral adipose tissue (VAT). OBJECTIVE The objective was to examine whether abdominal VAT area modifies the effects of abdominal SAT area on subclinical atherosclerosis and cardiometabolic risk factors in both whites and African Americans. DESIGN Computed tomographic measures of abdominal SAT and VAT were examined in relation to carotid intima-media thickness (cIMT) and cardiometabolic risk factor levels in 500 African American and white women in midlife. A VAT × SAT interaction term was evaluated. RESULTS The mean (±SD) age of the sample was 51.0 ± 2.9 y, and 37% were African American. Higher amounts of SAT and VAT were associated with higher cIMT, blood pressure, homeostasis model assessment insulin resistance index (HOMA-IR), and concentrations of glucose, triglycerides, and insulin and with lower concentrations of HDL cholesterol. However, in African Americans, but not in whites, higher amounts of VAT significantly attenuated associations between higher amounts of SAT and higher insulin concentrations (P for interaction = 0.032) and HOMA-IR (P for interaction = 0.011) and reversed associations with cIMT (P for interaction = 0.005) and glucose (P for interaction = 0.044). CONCLUSIONS These results suggest that in midlife African American but not white women, adverse associations between abdominal SAT and cardiometabolic risk factors are attenuated and, in the case of subclinical atherosclerosis, are reversed as VAT amounts increase. Given that African American women suffer disproportionately from obesity and cardiovascular disease, further research into the role of this effect modification on obesity-associated vascular disease in African American women is warranted.
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Affiliation(s)
- Rachel P Wildman
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
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Simpson NS, Banks S, Arroyo S, Dinges DF. Effects of sleep restriction on adiponectin levels in healthy men and women. Physiol Behav 2010; 101:693-8. [PMID: 20723551 PMCID: PMC2975754 DOI: 10.1016/j.physbeh.2010.08.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 08/10/2010] [Accepted: 08/12/2010] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Population studies have consistently found that shorter sleep durations are associated with obesity and cardiovascular disease, particularly among women. Adiponectin is an adipocyte-derived, anti-inflammatory hormone that is related to cardiovascular disease risk. We hypothesized that sleep restriction would reduce adiponectin levels in healthy young adults. METHODS 74 healthy adults (57% men, 63% African American, mean age 29.9years) completed 2 nights of baseline sleep at 10h time in bed (TIB) per night followed by 5 nights of sleep restricted to 4h TIB per night. An additional 8 participants were randomized to a control group that received 10h TIB per night throughout the study. Plasma adiponectin levels were measured following the second night of baseline sleep and the fifth night of sleep restriction or control sleep. RESULTS Sleep restriction resulted in a decrease in plasma adiponectin levels among Caucasian women (Z=-2.19, p=0.028), but an increase among African American women (Z=-2.73, p=0.006). No significant effects of sleep restriction on adiponectin levels were found among men. A 2×2 between-group analysis of covariance on adiponectin change scores controlling for BMI confirmed significant interactions between sleep restriction and race/ethnicity [F(1,66)=13.73, p<0.001], as well as among sleep restriction, race/ethnicity and sex [F(1,66)=4.27, p=0.043)]. CONCLUSIONS Inflammatory responses to sleep loss appear to be moderated by sex and race/ethnicity; observed decreases in adiponectin following sleep restriction may be one avenue by which reduced sleep duration promotes cardiovascular risk in Caucasian women.
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Affiliation(s)
- Norah S Simpson
- Department of Neurology, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Ave/DA-779, Boston, MA 02215, United States.
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Dugan SA, Everson-Rose SA, Karavolos K, Avery EF, Wesley DE, Powell LH. Physical activity and reduced intra-abdominal fat in midlife African-American and white women. Obesity (Silver Spring) 2010; 18:1260-5. [PMID: 19876007 PMCID: PMC3139333 DOI: 10.1038/oby.2009.396] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The purpose of our study was to determine whether self-reported physical activity (PA), including recreational, household, and exercise activities, is associated with intra-abdominal fat (IAF) in community-dwelling white and black midlife women. We performed a cross-sectional study of 369 women from the Chicago site of the Study of Women's Health Across the Nation (SWAN) ancillary study, the SWAN Fat Patterning Study. PA level was the independent variable, and IAF, assessed by computerized tomography (CT) scan, was the dependent variable. Measures were obtained at SWAN Fat Patterning Baseline visit between August 2002 and December 2005. Linear regression models explored the association between PA and IAF. The first model included IAF as the outcome and total score PA as the main predictor, adjusting for total percent fat mass, age, and ethnicity. The second model included education, parity, sex hormone-binding globulin (SHBG) level, and depressive symptoms, measured by Center for Epidemiological Studies-Depression (CES-D) scale. Each 1-point higher total PA score was associated with a 4.0 cm(2) lower amount of IAF (P = 0.004), independent of total percent fat mass, age, ethnicity, SHBG level, educational level, CES-D, and parity. Associations did not differ between white and black women. This study demonstrates a significant negative association between PA and IAF independent of multiple covariates in midlife women. Our findings suggest that motivating white and black women to increase PA during midlife may lessen IAF, which may have a positive impact on subsequent development of diabetes and cardiovascular disease.
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Affiliation(s)
- Sheila A Dugan
- Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois, USA.
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36
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Griffith ML, Younk LM, Davis SN. Visceral Adiposity, Insulin Resistance, and Type 2 Diabetes. Am J Lifestyle Med 2010. [DOI: 10.1177/1559827609360959] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The worldwide prevalence of obesity and obesity-related diseases continues to rise. Insulin resistance, the metabolic syndrome, and type 2 diabetes are all associated with obesity. Visceral fat is now recognized to have metabolic, endocrine, and immune functions; increased visceral adiposity enhances the risk of metabolic and cardiovascular disorders. Potential mechanisms of this increased risk may include increased free fatty acid release and alterations in adipokines. Lifestyle interventions resulting in weight loss and loss of visceral fat can have a significant impact on cardiometabolic risk. Bariatric surgery has also been shown to improve insulin resistance, type 2 diabetes, and other comorbidities of obesity. Several medical therapies for type 2 diabetes or obesity also show promise for an impact on visceral adiposity-related comorbidities.
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Affiliation(s)
- Michelle L. Griffith
- Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Lisa M. Younk
- Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Stephen N. Davis
- Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University School of Medicine, Nashville, Tennessee,
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Cheng CY, Reich D, Coresh J, Boerwinkle E, Patterson N, Li M, North KE, Tandon A, Bailey-Wilson JE, Wilson JG, Linda Kao WH. Admixture mapping of obesity-related traits in African Americans: the Atherosclerosis Risk in Communities (ARIC) Study. Obesity (Silver Spring) 2010; 18:563-72. [PMID: 19696751 PMCID: PMC2866099 DOI: 10.1038/oby.2009.282] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Obesity is an important cause of morbidity and mortality worldwide. In the United States, the prevalence of obesity is higher in African Americans than whites, even after adjustment for socioeconomic status (SES). This leads to the hypothesis that differences in genetic background may contribute to racial/ethnic differences in obesity-related traits. We tested this hypothesis by conducting a genome-wide admixture mapping scan using 1,350 ancestry-informative single-nucleotide polymorphisms (SNPs) in 3,531 self-identified blacks from the Atherosclerosis Risk in Communities (ARIC) study. We used these markers to estimate the overall proportions of European ancestry (PEAs) for each individual and then scanned for the association between PEA and obesity-related traits (both continuous and dichotomous) at each locus. The median (interquartile range) PEA was 0.151 (0.115). PEA was inversely correlated with continuous BMI, weight, and subscapular skinfold thickness, even after adjusting for socioeconomic factors. In contrast, PEA was positively correlated with BMI-adjusted waist circumference. Using admixture mapping on dichotomized traits, we identified a locus on 2p23.3 to be suggestively associated with BMI (locus-specific lod = 4.11) and weight (locus-specific lod = 4.07). After adjusting for global PEA, each additional copy of a European ancestral allele at the 2p23.3 peak was associated with a BMI decrease of approximately 0.92 kg/m(2) (P = 2.9 x 10(-5)). Further mapping in this region on chromosome 2 may be able to uncover causative variants underlying obesity, which may offer insights into the control of energy homeostasis.
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Affiliation(s)
- Ching-Yu Cheng
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Inherited Disease Research Branch, National Human Genome Research Institute, Baltimore, Maryland, United States of America
- National Yang Ming University School of Medicine and Taipei Veterans General Hospital, Taipei, Taiwan
| | - David Reich
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, United States of America
- Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Boston, Massachusetts, United States of America
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Eric Boerwinkle
- Human Genetics Center, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Nick Patterson
- Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Boston, Massachusetts, United States of America
| | - Man Li
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kari E. North
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Arti Tandon
- Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Boston, Massachusetts, United States of America
| | - Joan E. Bailey-Wilson
- Inherited Disease Research Branch, National Human Genome Research Institute, Baltimore, Maryland, United States of America
| | - James G. Wilson
- The V.A. Medical Center and the University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - W. H. Linda Kao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Janssen I, Powell LH, Kazlauskaite R, Dugan SA. Testosterone and visceral fat in midlife women: the Study of Women's Health Across the Nation (SWAN) fat patterning study. Obesity (Silver Spring) 2010; 18:604-10. [PMID: 19696765 PMCID: PMC2866448 DOI: 10.1038/oby.2009.251] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Visceral fat (VF) increases with the menopause and is an independent predictor of the metabolic syndrome, diabetes, and cardiovascular disease (CVD) in women. Little is known about how hormonal changes during the menopausal transition are related to the increase in VF. We aimed to determine the relationship between bioavailable testosterone and VF in middle-aged women at various stages of the menopausal transition and whether this relationship is independent of age and other CVD risk factors. The Study of Women's Health Across the Nation (SWAN) is a longitudinal, community-based study. This report uses baseline data from a population-based longitudinal ancillary study at the Chicago site to examine the cross-sectional relationship between testosterone and computed tomography (CT)-assessed VF in women at different stages of the menopausal transition. Included are 359 women (47.2% black), aged 42-60 years, who were randomly selected from a complete community census in which a 72% participation rate was achieved. In multivariate models, bioavailable testosterone was associated with VF independent of age, race, percent total body fat, and other cardiovascular risk factors. Bioavailable testosterone was a stronger predictor than estradiol and was interchangeable in its strength of association with sex hormone-binding globulin (SHBG). As bioavailable testosterone was associated with VF even after adjusting for insulin resistance, this suggests that it plays an important role in regional fat distribution. Our findings may have direct implications in explaining the effect of menopause-related testosterone predominance on VF accumulation and subsequent cardiovascular risk.
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Affiliation(s)
- Imke Janssen
- Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois, USA.
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Fujimoto VY, Luke B, Brown MB, Jain T, Armstrong A, Grainger DA, Hornstein MD. Racial and ethnic disparities in assisted reproductive technology outcomes in the United States. Fertil Steril 2010; 93:382-90. [PMID: 19081561 PMCID: PMC4786183 DOI: 10.1016/j.fertnstert.2008.10.061] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Revised: 10/20/2008] [Accepted: 10/29/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate ethnic differences in assisted reproductive technology (ART) outcomes in the United States. DESIGN Historical cohort study. SETTING Clinic-based data. PATIENT(S) A total of 139,027 ART cycles from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System online database for 2004-2006, limited to white, Asian, black, and Hispanic women. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Logistic regression was used to model the odds of pregnancy and live birth; among singletons and twins, the odds of preterm birth and fetal growth restriction. Results are presented as adjusted odds ratios, with white women as the reference group. RESULT(S) The odds of pregnancy were reduced for Asians (0.86), and the odds of live birth were reduced for all groups: Asian (0.90), black (0.62), and Hispanic (0.87) women. Among singletons, moderate and severe growth restriction were increased for all infants in all three minority groups (Asians [1.78, 2.05]; blacks [1.81, 2.17]; Hispanics [1.36, 1.64]), and preterm birth was increased among black (1.79) and Hispanic women (1.22). Among twins, the odds for moderate growth restriction were increased for infants of Asian (1.30) and black women (1.97), and severe growth restriction was increased among black women (3.21). The odds of preterm birth were increased for blacks (1.64) and decreased for Asians (0.70). CONCLUSION(S) There are significant disparities in ART outcomes according to ethnicity.
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Affiliation(s)
- Victor Y Fujimoto
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco, 2356 Sutter Street, 7th Floor, San Francisco, CA 94115-0916, USA.
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Katzmarzyk PT, Bray GA, Greenway FL, Johnson WD, Newton RL, Ravussin E, Ryan DH, Smith SR, Bouchard C. Racial differences in abdominal depot-specific adiposity in white and African American adults. Am J Clin Nutr 2010; 91:7-15. [PMID: 19828714 PMCID: PMC6443262 DOI: 10.3945/ajcn.2009.28136] [Citation(s) in RCA: 180] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Accepted: 09/03/2009] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There is increasing interest in understanding racial differences in adiposity in specific body depots as a way to explain differential health risks associated with obesity. OBJECTIVE Our aim was to examine the differences in abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) between white and African American adults. DESIGN The sample included 1967 adults aged 18-84 y, including 790 white women, 435 African American women, 606 white men, and 136 African American men. Total body fat was measured by using dual-energy X-ray absorptiometry, whereas abdominal VAT and SAT cross-sectional areas (L4-L5 level) were measured by using computed tomography. Sex-specific differences in SAT and VAT between racial groups were analyzed by the use of general linear models, which controlled for age and total body fat. Additional models tested for racial differences in VAT and SAT and controlled for age, total body fat, smoking, and menopausal status. Statistical significance was accepted at P < 0.05. RESULTS Abdominal VAT was significantly higher in white than in African American men and women, even after adjustment for covariates. White women had significantly lower SAT than did African American women, both before and after adjustment for covariates. White men had significantly higher SAT than did African American men, but after adjustment for covariates, their SAT was lower than that of African American men. CONCLUSIONS Abdominal visceral adiposity is significantly greater in white men and women. After adjustment for covariates, white men and women had significantly lower SAT than did African American men and women. The results of this study highlight the heterogeneity of human body fat distribution across racial groups.This trial was registered at clinicaltrials.gov as NCT00959270.
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Affiliation(s)
- Peter T Katzmarzyk
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA 70808-4124, USA.
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Hernandez BY, Park SY, Wilkens LR, Henderson BE, Kolonel LN. Relationship of body mass, height, and weight gain to prostate cancer risk in the multiethnic cohort. Cancer Epidemiol Biomarkers Prev 2009; 18:2413-21. [PMID: 19723920 DOI: 10.1158/1055-9965.epi-09-0293] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We investigated the relationship of body size and prostate cancer risk in the Multiethnic Cohort, a longitudinal study of individuals ages 45 to 75 in Hawaii and in California. Self-reported measures of height and weight were obtained at baseline. Of 83,879 men enrolled from 1993 to 1996, a total of 5,554 were diagnosed with prostate cancer during an average of 9.6 years of follow-up. The influence of baseline weight and weight change since age 21 varied by ethnic group. Whites gaining more than 10 lbs had a nonlinear, increased risk of advanced and high-grade prostate cancer [relative risks (RR), 2.12; 95% confidence intervals (CI), 1.19-3.78 for 25-39.9 lbs; P trend 0.43; and RR, 1.49; 95% CI, 1.04-2.14, for >or=40 lbs; P trend 0.20, respectively]. African American men gaining 40 lbs or more (relative to <10 lbs) had a nonmonotonic, increased risk of localized prostate cancers (RR, 1.26; 95% CI, 1.02-1.54; P trend 0.09) and those who gained 25 lbs or more were at increased risk of low-grade disease (RR, 1.28; 95% CI, 1.03-1.58, for >or=40 versus 10 lbs, respectively; P trend 0.07). Japanese men had a statistically significant, inverse association of weight gain and localized disease (RR, 0.80; 95% CI, 0.65-0.99 for >or=40 versus 10 lbs; P trend 0.05). Our findings provide evidence that adiposity and changes in adiposity between younger and older adulthood influence the development of prostate cancer. Ethnic differences in risk may be explained by variation in the distribution of accumulated body fat that could differentially affect prostate carcinogenesis.
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Affiliation(s)
- Brenda Y Hernandez
- Epidemiology Department, Cancer Research Center of Hawaii, University of Hawaii, Honolulu, Hawaii, USA.
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Rahman M, Temple JR, Breitkopf CR, Berenson AB. Racial differences in body fat distribution among reproductive-aged women. Metabolism 2009; 58:1329-37. [PMID: 19501860 PMCID: PMC2728780 DOI: 10.1016/j.metabol.2009.04.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Revised: 04/02/2009] [Accepted: 04/27/2009] [Indexed: 02/06/2023]
Abstract
We examined the influence of race/ethnicity on body fat distribution for a given body mass index (BMI) among reproductive-aged women. Body weight, height, and body fat distribution were measured with a digital scale, wall-mounted stadiometer, and dual-energy x-ray absorptiometry, respectively, on 708 healthy black, white, and Hispanic women 16 to 33 years of age. Multiple linear regression was used to model the relationship between race/ethnicity and different body fat distribution variables after adjusting for BMI, age at menarche, and demographic and lifestyle variables. For a given BMI, white women had the highest total fat mass (FM(total)), trunk fat mass (FM(trunk)), and leg fat mass (FM(leg)), whereas Hispanic women had the highest percentage of FM(trunk) (%FM(trunk)) and trunk-to-limb fat mass ratio (FMR(trunk-to-limb)). Conversely, black women had the lowest FM(total), FM(trunk), percentage body fat mass (%FM), %FM(trunk), and FMR(trunk-to-limb), and the highest percentage of FM(leg). The %FM was similar in whites and Hispanics and lower in blacks. The race x BMI interactions were significant for almost all of the body fat distribution variables. Increasing in differences with increasing BMI were apparent between blacks and whites in FM(trunk), %FM(trunk), FMR(trunk-to-limb), %FM(leg), and %FM, and between blacks and Hispanics in FM(trunk), %FM(trunk), FMR(trunk-to-limb), and FM(leg). In summary, the distribution of body fat for a given BMI differs by race among reproductive-aged women. These findings raise questions regarding universally applied BMI-based guidelines for obesity and have implications for patient education regarding individual risk factors for cardiovascular disease and metabolic complications.
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Affiliation(s)
- Mahbubur Rahman
- Department of Obstetrics and Gynecology, Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston TX 77555-0587, USA.
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Carroll JF, Fulda KG, Chiapa AL, Rodriquez M, Phelps DR, Cardarelli KM, Vishwanatha JK, Cardarelli R. Impact of race/ethnicity on the relationship between visceral fat and inflammatory biomarkers. Obesity (Silver Spring) 2009; 17:1420-7. [PMID: 19197255 DOI: 10.1038/oby.2008.657] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The purpose of this study was to determine whether racial/ethnic differences exist in the relationship between visceral adipose tissue (VAT) and selected inflammatory biomarkers. Subjects included 136 African-American, 133 Hispanic, and 100 white men and women, aged > or =45. Waist circumference and BMI were measured using standard methods. Total VAT, and VAT and subcutaneous adipose tissue (SAT) at the L4L5 spinal level were measured using computed tomography. Interleukin-6 (IL-6), C-reactive protein (CRP), and fibrinogen were measured from fasting blood samples. Results revealed that waist circumference and BMI were similar among groups but African Americans had significantly lower L4L5 VAT compared with Hispanics and whites. Despite lower VAT, African-American men had similar concentrations of inflammatory biomarkers. On the other hand, African-American women had higher CRP and IL-6 than white women, and higher fibrinogen than both Hispanic and white women. After controlling for L4L5 VAT, L4L5 SAT, and age, African-American women had higher concentrations of IL-6 and fibrinogen. Stratified analyses for CRP indicated that L4L5 SAT was associated with CRP in African-American and white women after controlling for L4L5 VAT and age, but that the reverse was not true. These data indicate that African Americans had lower VAT but similar or higher concentrations of inflammatory biomarkers. African-American women consistently displayed greater inflammation compared with whites, even after controlling for VAT or SAT.
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Affiliation(s)
- Joan F Carroll
- Department of Integrative Physiology, University of North Texas Health Science Center, Fort Worth, Texas, USA.
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Abstract
OBJECTIVE Two competing hypotheses suggest how adiposity may affect menopausal hot flashes. The "thin hypothesis" asserts that aromatization of androgens to estrogens in body fat should be associated with decreased hot flashes. Conversely, thermoregulatory models argue that body fat should be associated with increased hot flashes. The study objective was to examine associations between abdominal adiposity and hot flashes, including the role of reproductive hormones in these associations. DESIGN The Study of Women's Health Across the Nation Heart Study (2001-2003) is an ancillary study to the Study of Women's Health Across the Nation, a community-based cohort study. Participants were 461 women (35% African American, 65% white) ages 45 to 58 years with an intact uterus and at least one ovary. Measures included a computed tomography scan to assess abdominal adiposity; reported hot flashes over the previous 2 weeks; and a blood sample for measurement of follicle-stimulating hormone, estradiol, and sex hormone-binding globulin-adjusted estradiol (free estradiol index). Associations were evaluated within multivariable logistic and linear regression models. RESULTS Every 1-SD increase in total (odds ratio [OR]=1.28; 95% CI: 1.06-1.55) and subcutaneous (OR=1.30; 95% CI: 1.07-1.58) abdominal adiposity was associated with increased odds of hot flashes in age- and site-adjusted models. Visceral adiposity was not associated with hot flashes. Associations were not reduced when models included reproductive hormone concentrations. CONCLUSION Increased abdominal adiposity, particularly subcutaneous adiposity, is associated with increased odds of hot flashes, favoring thermoregulatory models of hot flashes. Body fat may not protect women from hot flashes as once thought.
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Baynard T, Carhart RL, Ploutz-Snyder LL, Weinstock RS, Kanaley JA. Short-term training effects on diastolic function in obese persons with the metabolic syndrome. Obesity (Silver Spring) 2008; 16:1277-83. [PMID: 18388897 DOI: 10.1038/oby.2008.212] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this study was to determine the effects of a short-term high-intensity exercise program on diastolic function and glucose tolerance in obese individuals with and without metabolic syndrome (MetSyn). Obese men and women (BMI > 30 kg/m(2); 39-60 years) with and without the MetSyn (MetSyn 13; non-MetSyn 18) underwent exercise training consisting of 10 consecutive days of treadmill walking for 1 h/day at 70-75% of peak aerobic capacity. Subjects performed pre- and post-training testing for aerobic capacity, glucose tolerance (2-h meal test), and standard echocardiography. Aerobic capacity improved for both groups (non-MetSyn 24.0 +/- 1.6 ml/kg/min vs. 25.1 +/- 1.5 ml/kg/min; MetSyn 25.2 +/- 1.8 ml/kg/min vs. 26.2 +/- 1.7 ml/kg/min, P < 0.05). Glucose area under the curve (AUC) improved in the MetSyn group (1,017 +/- 58 pmol/l/min vs. 883 +/- 75 pmol/l/min, P < 0.05) with no change for the non-MetSyn group (685 +/- 54 pmol/l/min vs. 695 +/- 70 pmol/l/min). Isovolumic relaxation time (IVRT) improved in the MetSyn group (97 +/- 6 ms vs. 80 +/- 5 ms, P < 0.05), and remained normal in the non-MetSyn group (82 +/- 6 ms vs. 86 +/- 5 ms). No changes in other diastolic parameters were observed. The overall reduction in IVRT was correlated with a decrease in diastolic blood pressure (DBP) (r = 0.45, P < 0.05), but not with changes in glucose tolerance. Body weight did not change with training in either group. A 10-day high-intensity exercise program improved diastolic function and glucose tolerance in the group with MetSyn. The reduction in IVRT in MetSyn was associated with a fall in blood pressure. These data suggest that it may be possible to reverse early parameters of diastolic dysfunction in MetSyn with a high-intensity exercise program.
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Affiliation(s)
- Tracy Baynard
- Department of Exercise Science, Syracuse University, Syracuse, New York, USA.
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Lee S, Kuk JL, Hannon TS, Arslanian SA. Race and gender differences in the relationships between anthropometrics and abdominal fat in youth. Obesity (Silver Spring) 2008; 16:1066-71. [PMID: 18356853 DOI: 10.1038/oby.2008.13] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We examined the influence of race and gender on abdominal adipose tissue (AT) distribution for a given anthropometric measure including waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height (W/Ht) in youth. METHODS AND PROCEDURES Subjects included healthy 62 black and 98 white youth. A single transverse image of the abdomen (L4-L5) was obtained using computed tomography. RESULTS For a given BMI, there was a significant (P<0.05) main effect of race and sex on the relationship between BMI and WC, such that boys and whites had a higher WC than girls and blacks. There was a significant (P<0.05) main effect and interaction effect of gender on the relationship between WC and visceral AT, such that boys had a higher visceral AT than girls, and the difference was magnified with increasing WC. For a given WC, black boys and girls had higher abdominal subcutaneous AT (SAT) than white peers, wherein the magnitude of the difference is increased with increasing WC. For a given W/Ht, black boys had significantly (P<0.05) lower visceral AT than white boys, but with no difference in girls. Black boys and girls had higher SAT than white peers, wherein the magnitude of the difference is increased with increasing W/Ht. DISCUSSION Our findings demonstrate a significant race and gender differential in the abdominal AT distribution for a given BMI, WC, WHR, and W/Ht. Future studies should take these differences into consideration when developing race- and gender-specific anthropometric cut-offs for obesity and obesity-related health risks in youth.
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Affiliation(s)
- SoJung Lee
- Children's Hospital of Pittsburgh, Division of Weight Management & Wellness, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Blaudeau TE, Hunter GR, St-Onge MP, Gower BA, Roy JLP, Bryan DR, Zuckerman PA, Darnell BE. IAAT, catecholamines, and parity in African-American and European-American women. Obesity (Silver Spring) 2008; 16:797-803. [PMID: 18239569 DOI: 10.1038/oby.2007.137] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We have recently reported that parous European-American (EA) women have disproportionately more intra-abdominal adipose tissue (IAAT) than their nulliparous counterparts. Mediating mechanisms for IAAT accumulation remain unknown; however, some evidence suggests a possible catecholamine link. The objective of this study was to determine whether the IAAT-parity relationship found in EA women exists in African-American (AA) women and to determine whether catecholamines play a mediating role. METHODS AND PROCEDURES Subjects included 44 EA and 47 AA premenopausal women. Free-living physical activity by doubly labeled water (activity-related time equivalent (ARTE)), body composition (air plethysmography, computed tomography), and 24-h fractionated urinary catecholamines were measured. RESULTS Repeated measures ANOVA revealed parous EA and AA women had significantly higher IAAT than their nulliparous counterparts (100.1 +/- 28.5 and 76.2 +/- 34.8 cm(2) vs. 75.9 +/- 29.1 and 59.6 +/- 15.0 cm(2)). In AA women and nulliparous women, 24-h urinary dopamine was significantly higher (AA parous 260.8 +/- 88; EA parous 197.2 +/- 78.8; AA nulliparous 376.5 +/- 81; EA nulliparous 289.6 +/- 62). Multiple regression analysis for modeling IAAT indicated that race, parity, dopamine, ARTE, and VO(2max) were all significant and independent contributors to the model (Unstandardized betas: race -32.6 +/- 7.4; parity (number of births) 10.0 +/- 3.4; 24-h urinary dopamine 0.08 +/- 0.04; ARTE (min/day) -0.09 +/- 0.04; VO(2max) (ml/kg/min) -2.8 +/- 1.0). DISCUSSION Independent of the potential confounders: age, race, percent body fat, IAAT, 24-h fractionated urinary catecholamines, physical activity, and VO(2max), parous EA and AA women had more IAAT than their nulliparous counterparts. Of the catecholamines, dopamine was found to be significantly lower in parous women and higher in AA's. Dopamine, however, did not explain racial or parity differences in IAAT.
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Affiliation(s)
- Tamilane E Blaudeau
- Department of Human Studies, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Carroll JF, Chiapa AL, Rodriquez M, Phelps DR, Cardarelli KM, Vishwanatha JK, Bae S, Cardarelli R. Visceral fat, waist circumference, and BMI: impact of race/ethnicity. Obesity (Silver Spring) 2008; 16:600-7. [PMID: 18239557 DOI: 10.1038/oby.2007.92] [Citation(s) in RCA: 239] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE BMI and waist circumference are used to define risk from excess body fat. Limited data in women suggest that there may be racial/ethnic differences in visceral adipose tissue (VAT) at a given BMI or waist circumference. This study tested the hypothesis that racial/ethnic differences exist in both men and women in the relationship of anthropometric measures of body composition and computed tomography (CT)-determined VAT or subcutaneous adipose tissue (SAT). METHODS AND PROCEDURES Subjects included 66 African American, 72 Hispanic, and 47 white men and women, aged > or =45. Waist circumference and BMI were measured using standard methods. Total abdominal and L4L5 VAT and SAT were measured using CT. RESULTS Among both men and women, groups did not differ in waist circumference or BMI. White men had greater L4L5 VAT than African-American men, and both white and Hispanic men had greater total VAT than African-American men. Among women, Hispanics and whites had greater L4L5 VAT than African Americans, and Hispanics had greater total VAT than African Americans. The slope of the linear relationship between BMI or waist circumference and VAT was lower in African Americans than in Hispanics and/or whites. DISCUSSION Middle-aged and older African-American men and women had lower VAT despite similar BMI and waist circumference measurements. Altered relationships between anthropometric measures and VAT may have implications for defining metabolic risk in different populations. Different waist circumference or BMI cutoff points may be necessary to adequately reflect risk in different racial/ethnic groups.
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Affiliation(s)
- Joan F Carroll
- Department of Integrative Physiology, University of North Texas Health Science Center, Fort Worth, TX, USA.
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Considine RV, Premkumar A, Reynolds JC, Sebring NG, Ricks M, Sumner AE. Adiponectin and leptin in African Americans. Obesity (Silver Spring) 2008; 16:428-34. [PMID: 18239655 DOI: 10.1038/oby.2007.80] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE African Americans (AAs) have less visceral and more subcutaneous fat than whites, thus the relationship of adiponectin and leptin to body fat and insulin sensitivity in AA may be different from that in whites. METHODS AND PROCEDURES Sixty-nine non-diabetic AA (37 men and 32 women), aged 33 +/- 1 year participated. The percent fat was determined by dual-energy X-ray absorptiometry, abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) volume by computerized tomography (CT), and insulin sensitivity by homeostasis model assessment (HOMA). RESULTS VAT was greater in men (1,619 +/- 177 cm(3) vs. 1,022 +/- 149 cm(3); P = 0.01); women had a higher percentage of body fat (34.1 +/- 1.4 vs. 24.0 +/- 1.2; P < 0.0001), adiponectin (15.8 +/- 1.2 microg/ml vs. 10.4 +/- 0.8 microg/ml; P = 0.0004) and leptin (23.2 +/- 15.8 ng/ml vs. 9.2 +/- 7.2 ng/ml; P < 0.0001). SAT and HOMA did not differ because of the sex. Adiponectin negatively correlated with VAT (r = -0.41, P < 0.05) in men, and with VAT (r = -0.55, P < 0.01), and SAT (r = -0.35, P < 0.05) in women. Adiponectin negatively correlated with HOMA in men (r = -0.38, P < 0.05) and women (r = -0.44, P < 0.05). In multiple regression, sex (P = 0.02), HOMA (P = 0.03) and VAT (P = 0.003) were significant predictors of adiponectin (adj R (2) = 0.38, P < 0.0001). Leptin positively correlated with VAT, SAT, percent fat and HOMA in men (r = 0.79, r = 0.86, r = 0.89, and r = 0.53; P < 0.001) and women (r = 0.62, r = 0.75, r = 0.83, and r = 0.55; P < 0.01). In multiple regression VAT (P = 0.04), percent body fat (P < 0.0001) and sex (P = 0.01), but not HOMA were significant predictors of serum leptin (adj R (2)= 0.82, P < 0.0001). DISCUSSION The relationship of adiponectin and leptin to body fat content and distribution in AA is dependent on sex. Although VAT and insulin sensitivity are significant determinants of adiponectin, VAT and percent body fat determine leptin.
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Affiliation(s)
- Robert V Considine
- Division of Endocrinology and Metabolism, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
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