Abstract
Body fat distribution seems to have different effects in cardiovascular diseases (CVD). We aimed to estimate the associations between lower limbs and trunk fat ratio and the 10-year CVD risk, and isolated risk factors in men and women. A total of 10,917 participants from ELSA-Brasil were eligible for this cross-sectional study. Associations between lower limb/trunk fat ratio with the percentage of 10-year CVD risk - according to the Framingham Risk Score - and its risk factors (systolic blood pressure, total cholesterol and HDL-cholesterol, diabetes, and use of antihypertensive medication) were performed using generalized linear models, linear and logistic regressions. All analyses were stratified by gender and adjustments were made by age, self-reported skin color, educational attainment, alcohol consumption, leisure physical activity, hypolipidemic drug use and, for women, menopausal status. In this study, 55.91% were women, with a mean age of 52.68 (SD = 6.57) years. A higher lower limb/trunk fat ratio was related to lower 10-year CVD risk, as well as a reduction in systolic blood pressure, total cholesterol, and antihypertensive drug use, also an increasing HDL-cholesterol in both genders, but this relationship was stronger in women. Besides, a protective relationship to diabetes was observed in women. Higher fat accumulation in the lower body, when compared to the trunk, seems to have a lower risk of CVD and associated risk factors - even in the presence of fat in the abdominal region - with women presenting lower risks than men.
Highlights
Cardiovascular diseases (CVD) are the leading cause of death worldwide, corresponding to 32% (17.8 million) of deaths in 2017 1, and in all Brazilian regions 2
This study aims to investigate whether the higher fat ratio between lower limbs and trunk is associated with a lower risk for CVD in 10 years by the Framingham Risk Score (FRS) and its risk factors in adults and whether this relationship is stronger in women compared to men
Among 10,047 participants, men represented 44.09% of the total population. These men were younger, lower educated, mostly self-reported skin their color as brown-skinned or pardo; they presented excessive alcohol use, diabetes and intense leisure physical activity, higher levels of systolic blood pressure, total cholesterol, percentage of risk for CVD and lower levels of high-density level (HDL)-cholesterol compared to women (Table 1)
Summary
Cardiovascular diseases (CVD) are the leading cause of death worldwide, corresponding to 32% (17.8 million) of deaths in 2017 1, and in all Brazilian regions 2. The body composition and body fat location are strongly related to many risk factors for CVD 3,4,5,6,7,8,9. The adipose tissue located in the abdominal area has been shown to be pathogenic and leading to metabolic disorders [10,11]. Lower body fat – including glutes, legs and hips – is considered a “metabolic sink” due to its low rate of lipolysis, fatty acid absorption, and blood flow 12. Lower body fat is the most insulin sensitive adipose tissue 13. It is inversely associated with metabolic risk factors, including hyperinsulinemia, dyslipidemia, and hypertension, as well as directly associated with the reduction in the incidence of type 2 diabetes mellitus and the occurrence of CVD 14,15
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