Waist-hip Ratio Circumference Research Articles

Glucose tolerance and hyperinsulinaemia in obese women: role of adipose tissue distribution, muscle fibre characteristics and androgens

The separate independent statistical contribution of abdominal distribution of fat, hyperandrogenicity and muscle morphology to glucose intolerance and hyperinsulinaemia was analysed in 88 obese women. In univariate analyses the waist/hip circumference ratio (WHR), body fat and lean body mass were all positively associated, and SHBG levels were negatively associated with insulin and glucose values. Muscle fibre areas were positively correlated with insulin but not with glucose concentrations. Adjustment for other variables did not remove the positive association between WHR and fasting insulin and glucose concentrations. SHBG, free testosterone and type IIb fibre areas were, however, significant confounding factors in the relationship between WHR and summed insulin and glucose concentrations. We conclude that fat distribution in obese women is associated with fasting hyperglycaemia and hyperinsulinaemia, independently of androgens and muscle fibre morphology, but that reduced SHBG concentrations and increased type IIb fibre areas may partly explain increased glucose and insulin responses to an oral glucose load in abdominally obese women.

Interstitial glycerol concentration measured by microdialysis in two subcutaneous regions in humans

Interstitial glycerol concentrations were measured in the abdominal and femoral subcutaneous tissue in 10 lean and 6 obese subjects. In the lean subjects [waist-hip circumference ratio (WHR) 0.89 +/- 0.01] the fasting interstitial glycerol concentrations in the abdominal and femoral regions were 185 +/- 20 and 160 +/- 15 (SE) microM, respectively, whereas glycerol in venous plasma was considerably lower (66 +/- 5 microM). After an oral glucose load (100 g) the interstitial glycerol concentrations declined but remained higher than in plasma. In obese subjects (WHR 1.1 +/- 0.03) the fasting interstitial glycerol levels were higher, in both regions, than in lean individuals. Furthermore, interstitial glycerol in the abdominal site (291 +/- 32 microM) was significantly higher than in the femoral fat (210 +/- 13 microM; P less than 0.05), while plasma glycerol was similar to that in lean subjects (80 +/- 12 microM). Interstitial glycerol remained higher in the obese than in the lean subjects also after an oral glucose load, but the regional differences were less apparent. Thus interstitial glycerol is higher in the subcutaneous tissue than in venous blood. The data also suggest that lipolysis is enhanced in the abdominal subcutaneous tissue as compared with the femoral site in obese subjects and that lipolysis is exaggerated in both regions in obese as compared with lean individuals.

Upper body adiposity and the risk for atherosclerosis.

Since there is evidence that fat distribution is a better predictor of cardiovascular disease than the degree of obesity, some risk factors for atherosclerosis have been evaluated in middle age Type II male diabetics and in obese subjects with and without glucose intolerance. In non-insulin-dependent diabetics (NIDD), abdominal obesity reflected by the waist/hip-circumference ratio (WHR) is related to parameters of metabolic control, lipid parameters, insulin status and response, hypertension, and vascular complications. High WHR is associated with: (a) significantly (p less than 0.01) higher HbA1 values than in the group without abdominal fat distribution; (b) a highly significant (p less than 0.001) negative correlation with high-density-lipoprotein cholesterol (HDL-C) and a positive correlation with the total/HDL-C ratio, which remains after correction for the body mass index; (c) higher apolipoprotein B concentrations; and (d) an elevated atherogenic index. Both fasting and postprandial insulin and C-peptide values may be a link between abdominal fat deposits and metabolic disturbances. Obese patients with upper body fat accumulation have significantly lower HDL-C levels, and a higher prevalence of glucose intolerance and diabetes than do patients with lower body fat obesity. Fasting glycemia, insulin, and the insulin area under the curve during an oral glucose load are significantly (p less than 0.005) increased in those with the greatest WHR, which is similar to that in NIDD and central obesity. An excess of abdominally located fat, even without manifest obesity, is associated with metabolic disturbances that indicate increased risk of atherogenesis and of higher morbidity and mortality, which may be due to characteristics of abdominally located adipocytes.

Computed tomography-measured trunk fat and plasma lipoprotein levels in nonobese women

The associations between total adiposity, adipose tissue distribution measured by computed axial tomography (CAT), regional variation in fat cell size, and plasma lipoprotein levels were studied in a sample of 22 premenopausal healthy nonobese women aged 34.6 ± 3.1 years (mean ± SD) (% body fat, 27.8 ± 5.8). In these nonobese women, no associations were found between total adiposity, adipose tissue distribution, and plasma triglyceride or very-low-density lipoprotein levels. However, total adiposity (as reflected by the body density-derived fat mass and by the adipose tissue volume measured by CAT), as well as the total trunk fat areas (measured at the abdominal and thoracic levels) were positively correlated with plasma low-density lipoprotein (LDL) cholesterol (.05 > P < .01) and LDL apolipoprotein (apo) B (.05 > P < .0005) levels. Because of these associations with LDL-C and LDL apo B levels, these body fatness indicators were negatively correlated with the HDL-cholesterol/LDL-cholesterol and HDL-apo A-I/LDL-apo B ratios. However, few significant associations were observed between the proportion of abdominal fat estimated by the waist/hip circumference ratio (WHR) and the lipoprotein-lipid profile ( r = .45 and r = .44, P < .05 with HDL triglyceride (TG) and LDL-apo B LDL -cholesterol ratio, respectively). Abdominal fat cell weight showed positive correlation with the LDL-apo B LDL -cholesterol ratio, ( r = .58, P < .005), and negative correlations with HDL-apo A-I ( r = −0.51, P < .05) and HDL 2-cholesterol levels ( r = −0.51; P < .05), as well as with HDL-apo A-I/LDL-apo B and HDL 2-cholesterol/HDL 3-cholesterol ratios ( r = −.53 and r = −.52, P < .01, respectively). No associations were observed between CAT-derived mid-thigh fat area, femoral fat-cell weight, and plasma lipoprotein levels. These results suggest that a subpopulation of women who are not obese and who have normal WHR values, but who are characterized by a preferential accumulation of fat in the trunk and by a relative enlargement of abdominal fat cells, might develop an altered and potentially atherogenic lipoprotein-lipid profile.

Cigarette smoking and increased central adiposity.

To determine whether cigarette smoking is associated with central obesity in men and women. A cross-sectional survey. A geographically defined population of older white adults. Men (836) and women (1112) ages 50 to 79. None. Waist-hip circumference ratio and body mass index (weight in kg/height in m2) were measured in participants wearing light clothing without shoes. Past and current cigarette smoking habits were ascertained by a standard self-administered questionnaire. Cigarette smokers had higher waist-hip ratios than non-smokers. We observed a dose-response relation of increasing waist-hip ratio with increasing number of cigarettes smoked. Although smokers were leaner than nonsmokers, the increased waist-hip ratio in smokers was independent of body mass index and was consistent within body-mass index tertiles. The associations, seen in both sexes, were stronger in women. Cigarette smokers have more central obesity than nonsmokers. These results suggest that body fat distribution can be modified by behavioral factors such as smoking.

Obesity, adipose tissue distribution and health in women—Results from a population study in Gothenburg, Sweden

The associations between generalized obesity measured as body mass index (BMI), or adipose tissue distribution, measured as the waist/hip circumference ratio (WHR), on one hand, and a number of socioeconomic, somatic as well as psychologic and mental health variables on the other, were analysed in a population study of women (1462 participants, aged 38–60 years, participation rate 90.1%). The anthropometric measurements were adjusted for their influence on each other. BMI, but not WHR, was negatively associated with socioeconomic status and education. Increased WHR correlated to a number of somatic diseases from different organ systems, including diabetes mellitus, infectious respiratory and abdominal diseases. Even more striking were strong correlations to a number of variables indicating accident proneness as well as mental disorder, and increased use of antidepressants and tranquilizers. BMI and WHR were also associated to different personality profiles. Furthermore, the use of alcohol and smoking were positively correlated to the WHR. In contrast, most of these associations were not seen with the BMI—sometimes even negative correlations were found. Exceptions were, however, varicose veins, joint problems and surgery for gall bladder disease, which were positively correlated to BMI only. Blood pressure, plasma triglycerides and uric acid were positively correlated to both BMI and the WHR, plasma cholesterol, however, only to the WHR. Obesity (high BMI) and abdominal adipose tissue distribution (high WHR) clearly show differences in their associations to various health variables. It is hypothesized that an arousal syndrome might be a contributing factor to cause symptoms of psychological maladjustment, including psychosomatic disease. Hypothetically, in parallel, an accumulation of depot fat in the abdominal depot, might follow as a consequence of neuroendocrine dysregulation of endocrine secretions.

Association of body fat distribution with plasma lipids, lipoproteins, apolipoproteins AI and B in postmenopausal women

Associations between the distribution of body fat, measured by the waist/hip circumference ratio (WHR), and plasma lipid fractions were examined in 84 postmenopausal women. WHR was correlated r = 0.39 with body mass index (BMI). After adjustment for BMI and other covariates, WHR was positively and significantly associated with concentrations of triglycerides, apolipoprotein B, low-density lipoprotein cholesterol, and the total cholesterol/high density lipoprotein cholesterol ratio. WHR was negatively and significantly associated with concentrations of high density lipoprotein cholesterol and apolipoprotein AI. These results indicate that in postmenopausal women abdominal fat preponderance is associated with an atherogenic plasma lipid profile, independent of its association with BMI.