Central obesity, glucose intolerance and other cardiovascular disease risk factors: An old syndrome rediscovered

Abstract

Over 30 years ago, Vague suggested that cardiovascular disease (CVD) risk factors were more prevalent in central or android obesity (excess fat in the upper part of the body) than in gynoid obesity (excess fat in the gluteal-femoral regions) [ 11. A decade later, Prior highlighted the coexistence of high rates of obesity, hypertension, diabetes mellitus and hyperuricaemia, associated with high risk of coronary heart disease (CHD) in New Zealand Maoris [2]. Subsequently, we were able to demonstrate similar findings in a number of other Pacific populations [3] and O’Dea et al. noted the same situation in Australian Aborigines [4]. The association of android obesity with atherosclerosis and diabetes was confirmed in 1982 [5]. However, no clear, independent association between CVD and obesity (measured as the thickness of the triceps skinfold, percentage of desirable weight or body mass index (BMI)) has been found in earlier studies [6]. Swedish studies have shown a clear association between android obesity and CVD in both men and women [7]. The risk of stroke increased more than IO-fold between men with the lowest waist-to-hip circumference ratio and men with the highest ratio. Abdominal obesity has also been associated with the development of diabetes in Sweden [7]. More recently, Bergstrom et al. have demonstrated that increased cross-sectional intra-abdominal fat area (determined by computerised tomography) is associated with subsequent development of NIDDM in second generation, Japanese-American men 183. These findings suggest that subjects with abdominal obesity may be the ‘subgroup’ that carries the increased risk of CVD, stroke and premature death. This form of obesity is often associated with other major risk factors for CVD such as hypertriglyceridaemia, hypertension, hyperuricaemia, hyperinsulinaemia and diabetes [ 1,5-81. Nalcajima and co-workers have also reported a correlation between intra-abdominal fat accumulation and abnormality of left ventricular function in obesity [9]. These subjects would be a subgroup at whom a ‘high risk’ preventive strategy should be directed [6].