Abstract
BackgroundCross-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.MethodsWe 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.ResultsAt 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).ConclusionsRelative 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.
Highlights
The rapid world-wide increase in obesity levels has led to a rise in the prevalence of non-communicable diseases such as type 2 diabetes (T2D) and cardiovascular diseases, in particular, in low- and middle-income countries such as South Africa (SA)[1,2]
It is the accumulation of central body fat, in particular, visceral adipose tissue (VAT), which mainly determines the risk for Insulin resistance (IR) and T2D10–12
Measures of central obesity increased to a greater extent than lower-body fat mass (FM), with trunk FM increasing on average by 25%, whereas leg FM increased by 12.3%
Summary
The rapid world-wide increase in obesity levels has led to a rise in the prevalence of non-communicable diseases such as type 2 diabetes (T2D) and cardiovascular diseases, in particular, in low- and middle-income countries such as South Africa (SA)[1,2]. Insulin resistance (IR), a major risk factor for T2D, is more pronounced in black SA women compared with their white counterparts even when matched for body fat and waist circumference, and is linked to a greater insulin response to maintain normoglycaemia[5,7,8,9] It is the accumulation of central body fat, in particular, visceral adipose tissue (VAT), which mainly determines the risk for IR and T2D10–12. Studies of middle-aged or older black SA women, who are at high risk of developing T2D, are of main interest in this aspect[14] This period coincides with menopausal transition in women, and is often characterised by relative redistribution of fat from the peripheral to the central region, and a significant increase in VAT15–17. 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
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