Peripheral Fat Distribution Research Articles

The effect of hyperlipidemia and body fat distribution on subclinical left ventricular function in obesity: a cardiovascular magnetic resonance study

BackgroundObesity is often associated with multiple comorbidities. However, whether obese subjects with hyperlipidemia in the absence of other complications have worse cardiac indices than metabolically healthy obese subjects is unclear. Therefore, we aimed to determine the effect of hyperlipidemia on subclinical left ventricular (LV) function in obesity and to evaluate the association of cardiac parameters with body fat distribution.Materials and methodsNinety-two adults were recruited and divided into 3 groups: obesity with hyperlipidemia (n = 24, 14 males), obesity without hyperlipidemia (n = 25, 13 males), and c ntrols (n = 43, 25 males). LV strain parameters (peak strain (PS), peak diastolic strain rate (PDSR), peak systolic strain rate) derived from cardiovascular magnetic resonance tissue tracking were measured and compared. Dual-energy X-ray absorptiometer was used to measure body fat distribution. Correlations of hyperlipidemia and body fat distribution with LV strain were assessed by multivariable linear regression.ResultsObese individuals with preserved LV ejection fraction showed lower global LV longitudinal, circumferential, and radial PS and longitudinal and circumferential PDSR than controls (all P < 0.05). Among obese patients, those with hyperlipidemia had lower longitudinal PS and PDSR and circumferential PDSR than those without hyperlipidemia (− 12.8 ± 2.9% vs. − 14.2 ± 2.7%, 0.8 ± 0.1 s−1 vs. 0.9 ± 0.3 s−1, 1.2 ± 0.2 s−1 vs. 1.4 ± 0.2 s−1; all P < 0.05). Multivariable linear regression demonstrated that hyperlipidemia was independently associated with circumferential PDSR (β = − 0.477, P < 0.05) in obesity after controlling for growth differences, other cardiovascular risk factors, and central fat distribution. In addition, android fat had an independently negative relationship with longitudinal and radial PS (β = − 0.486 and β = − 0.408, respectively; all P < 0.05); and visceral fat was negatively associated with longitudinal PDSR (β = − 0.563, P < 0.05). Differently, gynoid fat was positively correlated with circumferential PS and PDSR and radial PDSR (β = 0.490, β = 0.481, and β = 0.413, respectively; all P < 0.05).ConclusionHyperlipidemia is independently associated with subclinical LV diastolic dysfunction in obesity. Central fat distribution (android and visceral fat) has a negative association, while peripheral fat distribution (gynoid fat) has a positive association on subclinical LV function. These results suggest that appropriate management of hyperlipidemia may be beneficial for obese patients, and that the differentiation of fat distribution in different regions may facilitate the precise management of obese patients.Clinical trials registration Effect of lifestyle intervention on metabolism of obese patients based on smart phone software (ChiCTR1900026476).

The NADPH oxidase NOX4 and the transcription factor STAT6 as two key regulators of peripheral fat distribution in diet-induced obesity

The NADPH oxidase NOX4 and the transcription factor STAT6 as two key regulators of peripheral fat distribution in diet-induced obesity

Central body fat deposits are associated with poor vitamin D status in Chinese children and adolescents

ObjectivesTo examine the association between regional fat deposits and vitamin D levels in Chinese children. Whether regional fat distribution contributes to vitamin D deficiency remains uncertain. MethodsA population-based, nationwide and multicenter cross-sectional study involving 6,589 pediatric participants (49.9% boys) ages 6 to 18 y. The regional fat mass index (FMI) variables were calculated as regional fat mass (kg) divided by the square of height (m2), and plasma 25-hydroxyvitamin D (25[OH]D) levels were measured. ResultsAmong boys, after adjustment for multiple variables (including opposite regional fat), higher values for trunk FMI and android FMI were associated with a greater likelihood of vitamin D inadequacy (odds ratios [ORs], 2.14 and 1.87, respectively), whereas the extremity FMI and gynoid FMI were associated with protection from vitamin D inadequacy (ORs, 0.63 and 0.71, respectively). Consistently, increased central fat distribution (e.g., trunk or android to total fat ratio) and decreased peripheral fat distribution (e.g., extremity or gynoid to total fat ratio) were associated with greater odds of vitamin D inadequacy. Among girls, the associations of regional fat with vitamin D were weaker than those in boys, and most analyses did not reach statistical significance. ConclusionsRegional fat deposits were associated with vitamin D status in Chinese school-aged children and more pronounced among boys.

Electroconvulsive therapy and adiposity-related parameters in treatment-resistant depressed patients

Obesity is often accompanied by major depressive disorder (MDD), and vice versa. Latest research findings suggest the body mass index (BMI) to play a role in antidepressant treatment response in general. Our study aims to examine whether adiposity-related parameters such as BMI, glucose homeostasis, or serum lipids are associated with remission to electroconvulsive therapy (ECT). A pilot study (PS, n = 9) and a glucose study (GS, n = 29) were conducted. Blood was withdrawn directly before and 15 min (GS) as well as 1 h (PS) after the first ECT and directly before the last one (usually an ECT series comprised up to twelve sessions). BMI was associated with remission in the PS (remitters: M = 28, SD = 2.5; non-remitters: M = 22, SD = 2.08; t(7) = 3.325, p < 0.001, d = 0.24) but not in the GS or when pooled together. Glucose and insulin levels increased significantly after a single ECT session (GS: glucose: F (2,25.66) = 39.04, p < 0.001; insulin: PS: F (2,83) = 25.8, p < 0.001; GS: F (2,25.87) = 3.97, p < 0.05) but no chronic effect was detectable. Serum lipids were neither significantly altered after a single ECT session nor during a whole course of ECT. There was no difference between remitters and non-remitters in insulin, glucose, or serum lipid levels. Our study is lacking the differentiation between abdominal and peripheral fat distribution, and the sample size is small. Unexpectedly, BMI, glucose homeostasis, and lipid serum levels did not differ in patients remitting during ECT. In contrast to recently published studies, we cannot confirm the hypothesis that BMI may have an impact on ECT response.

Race affects the association of obesity measures with insulin sensitivity

Race differences in body composition and fat distribution may in part explain the differences in insulin sensitivity and the disproportionate burden of type 2 diabetes in African Americans. To determine if differences in body composition and fat distribution explain race differences in insulin sensitivity and identify obesity measures that were independently associated with insulin sensitivity. Participants were 113 lean, overweight, and obese African-American and Caucasian-American adults without diabetes. Skeletal muscle insulin sensitivity was determined using a hyperinsulinemic-euglycemic clamp (SIClamp, insulin rate:120 mU/m2/min). Subcutaneous abdominal adipose tissue (SAAT), intra-abdominal adipose tissue (IAAT), and liver fat were measured by MRI; leg fat, total fat, and lean mass were measured by DXA. Race-by-adiposity interactions were significant in cross-sectional analyses utilizing multiple linear regression models for SIClamp (P<0.05); higher BMI, fat mass, SAAT, leg fat, and liver fat were associated with lower SIClamp in Caucasian Americans but not African Americans. Race-by-IAAT interaction was not significant (P=0.65). A central fat distribution (SAAT adjusted for leg fat) was associated with lower SIClamp in African Americans (β = -0.45, SE=0.11, P<0.001) but not Caucasian Americans (β = -0.42, SE=0.30, P=0.17). A peripheral fat distribution (leg fat adjusted for IAAT/SAAT) was associated with a higher SIClamp in African Americans (β = 0.11, SE=0.05, P=0.02) but lower SIClamp in Caucasian Americans (β = -0.28, SE=0.14, P=0.049). Lean mass was inversely associated with SIClamp in African Americans (β = -0.05, SE=0.03, P=0.04) but not Caucasian Americans (β = 0.08, SE=0.05, P=0.10) in the model for leg fat. Measures of overall adiposity were more strongly associated with SIClamp in Caucasian Americans, whereas body fat distribution and lean mass showed stronger correlations with SIClamp in African Americans. Insulin sensitivity may have a genetic basis in African Americans that is reflected in the pattern of body fat distribution. These findings suggest a race-specific pathophysiology of insulin resistance, which has implications for the prevention of diabetes and related cardiometabolic diseases.

In women, central obesity predicts higher inflammation, higher serum hepcidin, lower absorption and hypoferremia

Obesity is characterized by chronic low-grade inflammation. Visceral adipose tissue (VAT) is heavily infiltrated by macrophages producing pro-inflammatory cytokines (IL-6), therefore VAT predicts greater systemic inflammation compared to peripheral fat. Thus, central adiposity may cause increased serum hepcidin (SHep) and may affect iron metabolism more than peripheral adiposity. Although increased total body fat (BF) is linked to disordered iron homeostasis, the potential effects of body fat distribution on iron metabolism have not been studied. Therefore, the aim of this study was to assess the effect of BF distribution on iron and inflammation parameters, SHep and iron metabolism.We enrolled 37 normal-weight women and 81 overweight/obese women in this cross-sectional study. Body composition was assessed using DXA and iron- and inflammation parameters and SHep were measured. The overweight/obese women were assigned to a peripheral (n = 54) and a central (n = 27) fat deposit group, according to their android fat percentage. All women received 100 mg oral iron as ferrous citrate and the change in serum iron was assessed after 2 h to determine iron absorption.The three groups differed significantly in body weight, BMI, waist circumference, android fat, gynoid fat, total fat, android/gynoid ratio and VAT (for all p &lt; 0.001). Hemoglobin, serum ferritin, body iron stores (BIS), serum iron and transferrin saturation (TSAT) were lowest and transferrin receptor was highest in central obesity. CRP was higher in central obesity compared to both, peripheral obesity (p &lt; 0.05) and normal-weight (p &lt; 0.001). SHep was higher in central and peripheral obesity compared to normal-weight (both p &lt; 0.01), with no difference between the two overweight/obese groups. Δserum iron was ≈30% and ≈20% lower in central obesity compared to normal-weight and peripheral obesity. We performed linear regression analysis on SHep, CRP, TSAT and Δserum iron: Android fat and BIS were positive predictors of SHep (p &lt; 0.05, p &lt; 0.001), android fat was a positive predictor of CRP (p &lt; 0.001), BIS was a positive, android fat was a negative predictor of TSAT (p &lt; 0.001, p &lt; 0.05) and TSAT and android fat were both negative predictors of Δserum iron (p &lt; 0.001, p &lt; 0.05).Controlling for iron status, inflammation and SHep are increased in women with central obesity and predict lower iron absorption and hypoferremia compared to women with more peripheral fat distribution. Thus, women with central fat distribution may be at increased risk for iron deficiency and anemia.

Central and peripheral body fat distribution: Different associations with low-grade inflammation in young adults?

Background and aimsEvidence regarding the impact of regional body fat distribution on low-grade inflammation is limited. The current study examined the association of central and peripheral body fat distribution and low-grade inflammation levels in young adults, considering collinearity between variables. Methods and resultsA cross-sectional analysis of 809 adults (aged 27 years) was conducted as part of the EPITeen cohort, Porto, Portugal. Regional body fat was measured by dual-energy X-ray absorptiometry scan (DXA) and serum high-sensitivity C-reactive protein (hsCRP) was measured in a fasting blood sample. OLS (ordinary least squares) and LASSO (least absolute shrinkage and selection operator) regression models were fitted to estimate the association of trunk and peripheral fat with hsCRP, stratified by sex. Using OLS regression, trunk fat in females was positively associated with ln(hsCRP) (β1 = 0.064, 95% CI 0.018; 0.109). The effect of peripheral fat on ln(hsCRP) was shown not to be significantly different from trunk fat (β2 = −0.011, 95% CI −0.110; 0.089), but no statistically significant association was observed (β3 = 0.053, 95% CI −0.004; 0.110) between peripheral fat and ln(hsCRP). In males, trunk fat also showed a positive association with ln(hsCRP) (β1 = 0.104, 95% CI 0.055; 0.154), and the effect of peripheral fat on ln(hsCRP) was shown to be significantly different from trunk fat (β2 = −0.124, 95% CI −0.237;−0.011). However, the association between peripheral fat and ln(hsCRP) did not reach statistical significance (β3 = −0.020, 95% CI −0.086; 0.046). The results of OLS were confirmed by LASSO regression. ConclusionA higher fat deposited in the trunk was positively associated with hsCRP, whereas no statistically significant effect was observed for peripheral fat.

Associations of nicotine dependence and fat distribution in Chinese male adults: a cross-sectional study in Lanxi, China

IntroductionPrevious studies have showed association between smoking and central fat distribution. However, the impact of smoking on whole body fat distribution, particularly peripheral fat distribution remains unclear.MethodsNicotine dependence was assessed...

Peripheral fat distribution versus waist circumference for predicting mortality in metabolic syndrome.

To elucidate whether the peripheral fat (PF)-combined definition of metabolic syndrome (MetS) would show a better predictive ability for cause-specific mortality than the common MetS. Data were derived from the National Health and Nutrition Examination Survey from 1999 through 2002. We investigated three types of MetS including waist circumference MetS (WCMetS), PFMetS, and PF-combined definition of MetS. The main outcome was to evaluate the predictive ability of the newly defined MetS for time to cause-specific mortality. The secondary outcomes were the relationships between the PF percentage and C-reactive protein (CRP) and homeostasis model assessment of insulin resistance (HOMA-IR) to clarify the gender discrepancy. For cardiovascular mortality, the adjusted hazard ratios for WCMetS, PFMetS, and PF-combined definition MetS were 1.867, 1.742, and 2.117, respectively (all P<0.001). A positive association between PF percentage and CRP in men and a negative correlation between PF percentage and HOMA-IR in women after adjustment for all variates were found. The PF-combined definition of MetS had a stronger predictive ability for all-cause and cardiovascular mortality than general MetS. Notably, the PF might have differential gender-specific health effects on cardiovascular events.

Central and Peripheral Body Fat Distribution on Insulin Resistance of Young Obese Women

Studies have shown that excess of fat in central region is the main substrate for pathophysiological alterations that leads obesity‐associated insulin resistance. Lately, in the medical practice the use of the waist circumference (WC) instead waist‐to‐hip ratio (WHR) is more usual. We hypothesized that WHR is a better tool to infer insulin resistance in young obese women. The aim of this study was to evaluate the insulin‐sensitive/insulin‐resistant in young obese women within central and peripheral body fat distribution. We studied 61 young obese women (BMI 30 to 40 kg/m2) with WC ≥ 88 cm and without comorbidities. They were divided into: with central fat distribution (CF), defined as waist‐to‐hip ratio (WHR) ≥ 0.85 cm (n=30, 33±7 y), and with peripheral fat distribution (PF) with WHR &lt; 0.85 cm (n=31, 33±6 y). All volunteers were submitted to anthropometric, glycemic and insulin measurements and indexes: fasting, HOMA‐IR, QUICKI and area under the curve (AUC) during the Oral Glucose Tolerance Test (OGTT) to assess the insulin sensitivity. Despite the fat distribution, CF and PF shown similar anthropometric measures (weight= 86.8±8.5 vs.87.6±8.3 kg, WC= 109±6 vs.106±8 cm, BMI= 33.2±2.7 vs. 33.7±2.4 kg/m2; respectively, p&gt;0.05). Also, both obese groups, CF and PF, showed normal fasting glucose (84±10 vs. 82±10 mg/dL, p=0.420), based in the IDF criteria (&lt;100mg/dL). However, the group CF compared with PF presented elevated fasting insulin (17.8±8.2 vs. 12.6±6.8 uUI/mL, p=0.008), HOMA‐IR (3.7±1.9 vs. 2.6±1.6 uUI/mL, p=0.011), reduced QUICKI (0.322±0.025 vs. 0.340±0.025, p=0.007). Furthermore, the group CF compared with PF had lower insulin sensitivity as AUCglucose/AUCinsulin ratio from OGTT (1.42±0.67 vs. 2.12±0.86, p=0.001). In conclusion, our data demonstrated that in young obese women with similar WC and fasting glucose, the central body fat distribution increase insulin‐resistant, emphasizing the importance in used the waist‐to‐hip ratio as important tool for identify the additional risk factor in obesity young women.Support or Funding Information#Universidade Nove de Julho (UNINOVE), SP ‐ Brazil.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Changes in blood pressure, glucose levels, insulin secretion and anthropometry after long term exposure to antiretroviral therapy in South African women.

BackgroundA number of metabolic abnormalities, such as dysglycaemia, insulin resistance, lipodystrophy and dyslipidaemia, are associated with the use of antiretroviral drugs. We aimed to assess the effects of long-term antiretroviral exposure on blood pressure, glycaemia, insulin secretion and anthropometric measures in black South African women.MethodsA convenience sample of HIV-infected women on first-line ART for a median of 16 months at baseline, had the following evaluations twice, at baseline and after approximately 5 years: anthropometry, including skin fold thicknesses, blood pressure, oral glucose test, and insulin. Insulin sensitivity and secretion (HOMA-IR, IGI and DIo) were estimated.ResultsAt baseline more than half the 103 women were using stavudine and efavirenz. The median interval between baseline and follow-up evaluation was 66 months. Weight, waist circumference, and waist-hip ratio increased over time, while limb skinfold thickness decreased over time. Systolic and diastolic blood pressure increased significantly and the proportion of participants with hypertension increased from 3.9 to 15.5% (p < 0.001). There were increases from baseline in plasma glucose concentrations at 30 and 120 min; insulin concentrations at 0 and 30 min; and IGI and DIo. The proportion of participants with diabetes increased from 1 to 7.5% (p = 0.070).ConclusionIn black South African women with long-term exposure to ART, increases in hypertension and possibly diabetes were observed. Participants experienced an increase in central fat and a decrease in peripheral fat distribution. Early identification and management of these metabolic changes are important, especially in a region with the highest HIV-infected population in the world.

Body Fat Accumulation is Associated with Early Arterial Changes in HIVInfected Children

Background: Antiretroviral therapy (ART) has greatly improved clinical outcomes in human immunodeciency virus (HIV) infection in adults and children. However, emerging data link ART to clinical lipodystrophy and premature atherosclerosis. We examined the impact of body fat changes on blood pressure and endothelial function in HIV infected children with and without ART. Methods: Central and peripheral body fat distribution was assessed in 68 HIV infected children. In all children blood pressure was measured and high resolution ultrasound was used to determine endothelium dependent dilatation (flow mediated dilatation-FMD) in the brachial artery. Results: From the 68 HIV infected children, 46 were on ART. There was no evidence of clinical lipodystrophy with ART in this cohort. Total cholesterol was increased in children on ART (p<0.001). FMD was significantly lower in those on ART compared to antiretroviral naive children (p<0.01). Increased BMI and waist as well as peripheral body circumference measurements in the arm and thigh were associated with higher systolic blood pressure (p<0.05 and p<0.01 respectively). An inverse association was noted between peripheral body composition measurements (zcalf and zthigh) and FMD (p<0.05 for both). Conclusion: HIV-infected children on ART have deranged lipids and evidence of early arterial abnormalities. Increased body fat accumulation is associated with reduced endothelial function and elevated blood pressure in HIVinfected children. These findings suggest that healthy dietary intake and weight control would be advisable in HIV infected children for optimal vascular disease prevention.

A 360-degree overview of body composition in healthy people: Relationships among anthropometry, ultrasonography, and dual-energy x-ray absorptiometry

ObjectiveThe aim of this study was to test the relationship between anthropometry, ultrasonography, and dual-energy x-ray absorptiometry (DXA) for the assessment of body composition in clinical practice. MethodsThe study was carried out in Italian blood donor volunteers belonging to five different age groups (18–70 y old; 25 men and 25 women per group; N = 250 participants; n = 125 men, n = 125 women). A complete history was collected and routine blood analyses were performed to confirm healthy status. All participants were submitted to whole-body DXA (tricompartmental analysis, regional, and total body), ultrasonography (abdominal adiposity evaluation), and anthropometric measurements. DXA was used as gold standard and its biomarkers were taken as reference for fat–lean mass balance, central–peripheral fat distribution, central or visceral fat, and subcutaneous fat. ResultsAnthropometric and ultrasound parameters were closely associated with most of DXA parameters. Composite markers representative of central and abdominal visceral fat compartments were significantly correlated with waist circumference, waist-to-hip ratio, and intra-abdominal fat thickness by ultrasound, in both men and women (P < 0.025). As expected, subcutaneous depots were significantly correlated with maximum subcutaneous fat thickness measured by ultrasonography (P < 0.025). ConclusionsBoth anthropometry and ultrasonography provide a reliable estimate of visceral adipose tissue in a non-obese population compared with DXA, whereas anthropometry prediction of subcutaneous adiposity is weak. Physicians should be aware of the limits of these techniques for the assessment of body composition.

Regional fat distribution and cardiometabolic risk in healthy postmenopausal women

BackgroundRegional fat distribution is an important determinant of cardiometabolic risk after menopause. The aim of the present study was to investigate the association between indices of fat distribution obtained by Dual-energy X-ray Absorptiometry (DXA) and representative cardiometabolic risk factors in a cohort of healthy postmenopausal women. MethodsIn this cross-sectional study, cardiometabolic risk factors were correlated with a variety of central and peripheral fat depots obtained by DXA, in a total of 150 postmenopausal women, free of diabetes and cardiovascular disease (age 54±7years, BMI 29.6±5.8kg/m2, mean±1 SD). ResultsAfter adjusting for age and total adiposity, DXA-derived indices of central and peripheral fat distribution displayed opposite associations (positive versus negative) with the examined cardiometabolic risk factors. In multivariate regression analysis, thoracic fat mass % was an independent predictor of blood pressure, HOMA index and triglycerides, abdominal fat mass % was an independent predictor of high sensitivity C-reactive protein, and abdominal-to-gluteofemoral fat ratio was an independent predictor of high density lipoprotein cholesterol. An index of peripheral fat distribution, gluteofemoral fat mass %, proved to be the most important determinant of metabolic syndrome (Odds Ratio 0.76, 95% confidence intervals 0.67–0.87, p<0.001), independent of total and central adiposity. ConclusionDXA-derived indices of regional fat distribution such as thoracic, abdominal and gluteofemoral fat, correlate significantly with cardiometabolic risk factors in healthy postmenopausal women, and may serve as clinically useful tools for evaluating cardiometabolic risk after menopause.

Diabetes and Cardiovascular Disease Outcomes in the Metabolically Healthy Obese Phenotype

OBJECTIVETo determine the correlates of the “metabolically healthy obese” (MHO) phenotype and the longitudinal risks of diabetes and cardiovascular disease (CVD)/stroke associated with this phenotype.RESEARCH DESIGN AND METHODSThe North West Adelaide Health Study is a prospective cohort study of 4,056 randomly selected adults aged ≥18 years. Participants free of CVD/stroke and not underweight (n = 3,743) were stratified by BMI categories and metabolic risk, defined as having two or more International Diabetes Federation metabolic syndrome criteria, excluding waist circumference.RESULTSCorrelates of the MHO (n = 454 [12.1%]) included smoking, socioeconomic disadvantage, and physical inactivity. Compared with metabolically healthy normal-weight subjects (n = 1,172 [31.3%]), the MHO were more likely to develop metabolic risk (15.5 vs. 33.1%, P < 0.001) and incident diabetes (odds ratio 2.09 [95% CI 0.87–5.03]) but not CVD/stroke (1.16 [0.58–2.29]) during 5.5–10.3 years of follow-up. These risks were not seen in MHO subjects maintaining metabolic health (n = 188 [67%]). Sustained metabolic health in obese participants was associated with age ≤40 years and lower waist circumference. Compared with the metabolically at-risk obese, MHO women demonstrated a significantly higher (mean [SE]) percentage of leg fat (49.9 [0.5] vs. 53.2 [0.7]) and lower waist circumference (104 [0.6] vs. 101 cm [0.8]), despite no significant differences in overall adiposity.CONCLUSIONS“Healthy” obesity was a transient state for one-third of subjects. Persistence of a MHO phenotype, which was associated with favorable outcomes, was related to younger age and a more peripheral fat distribution. The MHO phenotype may be sustained by promoting lower waist circumferences.

Body composition determinants of metabolic phenotypes of obesity in nonobese and obese postmenopausal women

Although obesity is typically associated with increased cardiovascular risk, a subset of obese individuals display a normal metabolic profile ("metabolically healthy obese," MHO) and conversely, a subset of nonobese subjects present with obesity-associated cardiometabolic abnormalities ("metabolically obese nonobese," MONO). The aim of this cross-sectional study was to identify the most important body composition determinants of metabolic phenotypes of obesity in nonobese and obese healthy postmenopausal women. We studied a total of 150 postmenopausal women (age 54 ± 7 years, mean ± 1 SD). Based on a cardiometabolic risk score, nonobese (body mass index [BMI] ≤ 27) and obese women (BMI > 27) were classified into "metabolically healthy" and "unhealthy" phenotypes. Total and regional body composition was assessed with dual-energy X-ray absorptiometry (DXA). In both obese and nonobese groups, the "unhealthy" phenotypes were characterized by frequent bodyweight fluctuations, higher biochemical markers of insulin resistance, hepatic steatosis and inflammation, and higher anthropometric and DXA-derived indices of central adiposity, compared with "healthy" phenotypes. Indices of total adiposity, peripheral fat distribution and lean body mass were not significantly different between "healthy" and "unhealthy" phenotypes. Despite having increased fat mass, MHO women exhibited comparable cardiometabolic parameters with healthy nonobese, and better glucose and lipid levels than MONO. Two DXA-derived indices, trunk-to-legs and abdominal-to-gluteofemoral fat ratio were the major independent determinants of the "unhealthy" phenotypes in our cohort. The "metabolically obese phenotype" is associated with bodyweight variability, multiple cardiometabolic abnormalities and an excess of central relative to peripheral fat in postmenopausal women. DXA-derived centrality ratios can discriminate effectively between metabolic subtypes of obesity in menopause.

Body size and endometriosis: results from 20 years of follow-up within the Nurses' Health Study II prospective cohort

Is there a relationship between body mass index (BMI), body shape and endometriosis? Endometriosis is inversely associated with early adult BMI and may correlate with a peripheral body fat distribution. The literature suggests an inverse relation between endometriosis and BMI, although few studies have specifically explored this association in depth. Prospective cohort study using data collected from 116 430 female nurses from September 1989 to June 2011 as part of the Nurses' Health Study II cohort. PARTICIPANTS/MATERIALS, METHODS AND SETTING: Cases were restricted to laparoscopically confirmed endometriosis. Weight at age 18 and height were reported at baseline, and current weight was updated every 2 years. Waist and hip measurements were first taken in 1993 and updated in 2005. Rate ratios (RR) and 95% confidence intervals (CI) were calculated using Cox proportional hazards models with time-varying covariates. A total of 5504 incident cases of endometriosis were reported during 1 299 349 woman-years (incidence rate = 385 per 100 000 woman-years). BMI at age 18 and current BMI were each significantly inversely associated with endometriosis (P-value, test for linear trend <0.0001). Both associations were stronger among infertile women. Obese infertile women with current BMIs of 35-39.9 kg/m(2) and ≥ 40 kg/m(2) had a 55% (95% CI 0.30-0.67) and a 62% (95% CI 0.23-0.62) lower risk of endometriosis, respectively, compared with the low-normal BMI referent (18.5-22.4 kg/m(2)). Rates of endometriosis were nearly 3-fold higher in women with waist-to-hip ratios <0.60 (RR = 2.78, 95% CI 1.38-5.60) compared with those with waist-to-hip ratios between 0.70 and 0.79, although the sample size for this category was very small. Although women with undiagnosed endometriosis certainly remain in the comparison population even in this prospective cohort study, the community prevalence of endometriosis in an asymptomatic population is very low. Moreover, the characteristics of this small proportion of undiagnosed cases are diluted among the >90 000 women accurately defined as being endometriosis-free and are, therefore, unlikely to impact on effect estimation. Although geographically diverse, the NHS II cohort is overwhelmingly Caucasian, which may limit generalizability to more ethnically diverse populations. WIDER IMPLICATIONS OF THE STUDY: The results of this study suggest that endometriosis is inversely associated with early adult BMI and may correlate with a peripheral body fat distribution.

Plasminogen activator inhibitor-1 in children with central obesity: Effect on left ventricular function

Aim The aim of the study was to investigate the Plasminogen activator inhibitor-1 (PAI-1) expression in obese children and to clarify its role with respect to left ventricular (LV) function. Patients and methods This study included 69 obese children and adolescents, 40 lean healthy controls. Children were considered obese according to body mass index (BMI) percentile for age and sex curves of growth for our population. Each subject’s fat distribution was assessed by measuring waist hip ratio (WHR). Obese children with peripheral fat distribution were excluded. Exclusion criteria included hypertension, endocrine, cardiovascular, renal, insulin dependent or independent diabetes mellitus and smoking habits. Laboratory investigations included measurement of plasma PAI-1 antigen. Determination of total serum cholesterol, low density lipoprotein, high density lipoprotein, triglycerides, blood glucose and fasting serum insulin. Echocardiography study was obtained by two dimensionally guided M mode. Results BMI and WHR were significantly higher in obese compared to lean children (P 0.05). Plasma PAI-1 were significantly higher in obese compared to controls (P = 0.03). A significant direct correlation was revealed between PAI-1 in comparison to WHR, fasting insulin and LVM/H. Plasma PAI -1 and WHR were independent predictors of LVM/H. Conclusions Obese children with central fat distribution showed an increase in plasma PAI-1 antigen. Also PAI-1 contributes directly to the complication of obesity including type 2 diabetes and cardiovascular disease.

Genome-Wide Association Study to Identify Common Variants Associated with Brachial Circumference: A Meta-Analysis of 14 Cohorts

Brachial circumference (BC), also known as upper arm or mid arm circumference, can be used as an indicator of muscle mass and fat tissue, which are distributed differently in men and women. Analysis of anthropometric measures of peripheral fat distribution such as BC could help in understanding the complex pathophysiology behind overweight and obesity. The purpose of this study is to identify genetic variants associated with BC through a large-scale genome-wide association scan (GWAS) meta-analysis. We used fixed-effects meta-analysis to synthesise summary results across 14 GWAS discovery and 4 replication cohorts comprising overall 22,376 individuals (12,031 women and 10,345 men) of European ancestry. Individual analyses were carried out for men, women, and combined across sexes using linear regression and an additive genetic model: adjusted for age and adjusted for age and BMI. We prioritised signals for follow-up in two-stages. We did not detect any signals reaching genome-wide significance. The FTO rs9939609 SNP showed nominal evidence for association (p<0.05) in the age-adjusted strata for men and across both sexes. In this first GWAS meta-analysis for BC to date, we have not identified any genome-wide significant signals and do not observe robust association of previously established obesity loci with BC. Large-scale collaborations will be necessary to achieve higher power to detect loci underlying BC.

Asymptomatic Achilles tendon pathology is associated with a central fat distribution in men and a peripheral fat distribution in women: a cross sectional study of 298 individuals

BackgroundAdiposity is a modifiable factor that has been implicated in tendinopathy. As tendon pain reduces physical activity levels and can lead to weight gain, associations between tendon pathology and adiposity must be studied in individuals without tendon pain. Therefore, the purpose of this study was to determine whether fat distribution was associated with asymptomatic Achilles tendon pathology.MethodsThe Achilles tendons of 298 individuals were categorised as normal or pathological using diagnostic ultrasound. Fat distribution was determined using anthropometry (waist circumference, waist hip ratio [WHR]) and dual-energy x-ray absorptiometry.ResultsAsymptomatic Achilles tendon pathology was more evident in men (13%) than women (5%) (p = 0.007). Men with tendon pathology were older (50.9 ± 10.4, 36.3 ± 11.3, p < 0.001), had greater WHR (0.926 ± 0.091, 0.875 ± 0.065, p = 0.039), higher android/gynoid fat mass ratio (0.616 ± 0.186, 0.519 ± 0.142, p = 0.014) and higher upper-body/lower body fat mass ratio (2.346 ± 0.630, 2.022 ± 0.467, p = 0.013). Men older than 40 years with a waist circumference >83 cm had the greatest prevalence of tendon pathology (33%). Women with tendon pathology were older (47.4 ± 10.0, 36.0 ± 10.3, p = 0.008), had less total fat (17196 ± 3173 g, 21626 ± 7882 g, p = 0.009), trunk fat (7367 ± 1662 g, 10087 ± 4152 g, p = 0.003) and android fat (1117 ± 324 g, 1616 ± 811 g, p = 0.005). They had lower central/peripheral fat mass ratios (0.711 ± 0.321 g, 0.922 ± 0.194 g, p = 0.004) than women with normal tendons. Women with tendon pathology were more often menopausal (63%, 13%, p = 0.002).ConclusionsMen with Achilles tendon pathology were older and had a central fat distribution. Women with tendon pathology were older and had a peripheral fat distribution. An interaction between age and waist circumference was observed among men.