Showing papers on "Abdominal obesity published in 2001"
TL;DR: Relatively new data suggest that abdominal obesity in adults, with its associated enhanced morbidity, occurs particularly in those who had lower birth weights and early childhood stunting, and will now be needed to estimate the full impact of the worldwide obesity epidemic.
Abstract: The recent World Health Organization (WHO) agreement on the standardized classification of overweight and obese, based on body mass index (BMI), allows a comparable analysis of prevalence rates worldwide for the first time. In Asia, however, there is a demand for a more limited range for normal BMIs (i.e., 18.5 to 22.9 kg/m(2) rather than 18.5 to 24.9 kg/m(2)) because of the high prevalence of comorbidities, particularly diabetes and hypertension. In children, the International Obesity Task-Force age-, sex-, and BMI-specific cutoff points are increasingly being used. We are currently evaluating BMI data globally as part of a new millennium analysis of the Global Burden of Disease. WHO is analyzing data in terms of 20 or more principal risk factors contributing to the primary causes of disability and lost lives in the 191 countries within the WHO. The prevalence rates for overweight and obese people are different in each region, with the Middle East, Central and Eastern Europe, and North America having higher prevalence rates. In most countries, women show a greater BMI distribution with higher obesity rates than do men. Obesity is usually now associated with poverty, even in developing countries. Relatively new data suggest that abdominal obesity in adults, with its associated enhanced morbidity, occurs particularly in those who had lower birth weights and early childhood stunting. Waist measurements in nationally representative studies are scarce but will now be needed to estimate the full impact of the worldwide obesity epidemic.
1,183 citations
TL;DR: It is suggested that environmental, perinatal and genetic factors induce neuroendocrine perturbations followed by abdominal obesity with its associated comorbidities.
Abstract: 'Stress' embraces the reaction to a multitude of poorly defined factors that disturb homeostasis or allostasis. In this overview, the activation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system have been utilized as objective measurements of stress reactions. Although long-term activation of the sympathetic nervous system is followed by primary hypertension, consequences of similar activation of the HPA axis have not been clearly defined. The focus of this overview is to examine whether or not repeated activation of these two stress centres may be involved in the pathogenesis of abdominal obesity and its comorbidities. In population studies adrenal hormones show strong statistical associations to centralization of body fat as well as to obesity. There is considerable evidence from clinical to cellular and molecular studies that elevated cortisol, particularly when combined with secondary inhibition of sex steroids and growth hormone secretions, is causing accumulation of fat in visceral adipose tissues as well as metabolic abnormalities (The Metabolic Syndrome). Hypertension is probably due to a parallel activation of the central sympathetic nervous system. Depression and 'the small baby syndrome' as well as stress exposure in men and non-human primates are followed with time by similar central and peripheral abnormalities. Glucocorticoid exposure is also followed by increased food intake and 'leptin resistant' obesity, perhaps disrupting the balance between leptin and neuropeptide Y to the advantage of the latter. The consequence might be 'stress-eating', which, however, is a poorly defined entity. Factors activating the stress centres in humans include psychosocial and socioeconomic handicaps, depressive and anxiety traits, alcohol and smoking, with some differences in profile between personalities and genders. Polymorphisms have been defined in several genes associated with the cascade of events along the stress axes. Based on this evidence it is suggested that environmental, perinatal and genetic factors induce neuroendocrine perturbations followed by abdominal obesity with its associated comorbidities.
1,126 citations
TL;DR: Comparison of body fatness, of abdominal fat accumulation, and of the features of the insulin resistance syndrome across quintiles of CRP revealed major differences in bodyfatness and in indices of abdominal AT accumulation between the lowest and the highest CRP quintiles, whereas no significant differences were found for variables of the plasma lipoprotein-lipid profile.
Abstract: —Recent studies have suggested that elevated plasma C-reactive protein (CRP) levels are associated with the features of insulin resistance syndrome. In the present study, we have examined the contribution of body composition measured by hydrostatic weighing and of abdominal adipose tissue (AT) accumulation assessed by computed tomography to the variation in plasma CRP levels associated with atherogenic dyslipidemia of the insulin resistance syndrome in a sample of 159 men, aged 22 to 63 years, covering a wide range of adiposity (body mass index values from 21 to 41 kg/m2). Plasma CRP levels showed positive and significant correlations with body fat mass ( r =0.41, P <0.0001), waist girth ( r =0.37, P <0.0001), and visceral AT accumulation measured by computed tomography at L4 to L5 ( r =0.28, P <0.0003). Although CRP levels were associated with plasma insulin levels measured in the fasting state and after a 75-g oral glucose load, no significant correlations were found with plasma lipoprotein levels. Finally, comparison of body fatness, of abdominal fat accumulation, and of the features of the insulin resistance syndrome across quintiles of CRP revealed major differences in body fatness and in indices of abdominal AT accumulation between the lowest and the highest CRP quintiles, whereas no significant differences were found for variables of the plasma lipoprotein-lipid profile. These results suggest that obesity and abdominal AT accumulation are the critical correlates of elevated plasma CRP levels found in men with atherogenic dyslipidemia of the insulin resistance syndrome.
623 citations
TL;DR: Limited evidence suggests that exercise-induced weight loss is associated with reductions in abdominal obesity as measured by waist circumference or imaging methods; however, at present there is insufficient evidence to determine a dose-response relationship between physical activity, and abdominal or visceral fat.
Abstract: Purpose: This review was undertaken to determine whether exercise-induced weight loss was associated with corresponding reductions in total, abdominal, and visceral fat in a dose-response manner. Methods: A literature search (MEDLINE, 1966-2000) was performed using appropriate keywords to identify studies that consider the influence of exercise-induced weight loss on total and/or abdominal fat. The reference lists of those studies identified were cross-referenced for additional studies. Results: Total fat. Review of available evidence suggested that studies evaluating the utility of physical activity as a means of obesity reduction could be subdivided into two categories based on study duration. Short-term studies (≤16 wk, N = 20) were characterized by exercise programs that increased energy expenditure by values double (2200 vs 1100 kcal.wk -1 ) that of long-term studies (≥26 wk, N = 11). Accordingly, short-term studies report reductions in body weight (-0.18 vs -0.06 kg.wk -1 ) and total fat (-0.21 vs -0.06 kg.wk -1 ) that are threefold higher than those reported in long-term studies. Moreover, with respect to dose-response issues, the evidence from short-term studies suggest that exercise-induced weight loss is positively related to reductions in total fat in a dose-response manner. No such relationship was observed when the results from long-term studies were examined. Abdominal fat. Limited evidence suggests that exercise-induced weight loss is associated with reductions in abdominal obesity as measured by waist circumference or imaging methods; however, at present there is insufficient evidence to determine a dose-response relationship between physical activity, and abdominal or visceral fat. Conclusion: In response to well-controlled, short-term trials, increasing physical activity expressed as energy expended per week is positively related to reductions in total adiposity in a dose-response manner. Although physical activity is associated with reduction in abdominal and visceral fat, there is insufficient evidence to determine a dose-response relationship.
327 citations
TL;DR: Results indicate that CLA supplementation for 4 weeks in obese men with the metabolic syndrome may decrease abdominal fat, without concomitant effects on overall obesity or other cardiovascular risk factors.
Abstract: BACKGROUND: Abdominal obesity is strongly related to metabolic disorders. Recent research suggests that dietary conjugated linoleic acid (CLA) reduces body fat and may improve metabolic variables in animals. The metabolic effects of CLA in abdominally obese humans have not yet been tested. OBJECTIVE: To investigate the short-term effect of CLA on abdominal fat and cardiovascular risk factors in middle-aged men with metabolic disorders. METHODS: Twenty-five abdominally obese men (waist-to-hip ratio (WHR), 1.05 0.05; body mass index (BMI), 32 2.7 kg=m 2 (mean s.d.)) who were between 39 and 64-y-old participated in a double-blind randomised controlled trial for 4 weeks. Fourteen men received 4.2 g CLA=day and 10 men recieved a placebo. The main endpoints were differences between the two groups in sagittal abdominal diameter (SAD), serum cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides, free fatty acids, glucose and insulin. RESULTS: At baseline, there were no significant differences between groups in anthropometric or metabolic variables. After 4 weeks there was a significant decrease in SAD (cm) in the CLA group compared to placebo (Pa 0.04, 95% CI; 71.12, 70.02). Other measurements of anthropometry or metabolism showed no significant differences between the groups. CONCLUSIONS: These results indicate that CLA supplementation for 4 weeks in obese men with the metabolic syndrome may decrease abdominal fat, without concomitant effects on overall obesity or other cardiovascular risk factors. Because of the limited sample size, the effects of CLA in abdominal obesity need to be further investigated in larger trials with longer duration. International Journal of Obesity (2001) 25, 1129 ‐ 1135
282 citations
TL;DR: There are few studies of ethnic differences in cardiovascular disease (CVD) risk factors in older populations, and these studies are likely to be limited by the low number of studies conducted on different ethnic groups.
Abstract: CONTEXT: There are few studies of ethnic differences in cardiovascular disease (CVD) risk factors in older populations.
OBJECTIVES: To examine the association of ethnicity on CVD risk factors, after accounting for socioeconomic status (SES), and to examine health behaviors among those with CVD risk factors.
DESIGN: Third National Health and Nutrition Examination Survey, 1988–1994.
SETTING: Eighty-nine mobile examination centers.
PARTICIPANTS: 700 black, 628 Mexican-American, and 2192 white women and men age 65 to 84 years.
MEASUREMENTS: Ethnicity in relation to type II diabetes mellitus, physical inactivity, abdominal obesity, hypertension, cigarette smoking and non-high-density lipoprotein cholesterol (non-HDL-C).
RESULTS: After accounting for age and SES, both black and Mexican-American women had significantly higher prevalences of type II diabetes than white women. In addition, black women were significantly more likely to have abdominal obesity and hypertension and to be physically inactive than white women. Black men had significantly higher prevalences of hypertension and physical inactivity than white men. However, black men had lower prevalences of abdominal obesity than white men, and black women had lower prevalences of high non-HDL-C than white women. Among those with CVD risk factors, health behaviors were in need of improvement, especially among Mexican-American women whose primary language was Spanish.
CONCLUSIONS: In this national sample of older women and men, black and Mexican American women and black men were at the greatest risk for CVD. These findings parallel the heightened risk of CVD among younger ethnic minority populations and argue for appropriate primary and secondary prevention programs, modified for the language, cultural, and medical needs of older ethnic minorities.
276 citations
TL;DR: The dysmetabolic syndrome is a leading cause of morbidity and mortality in women under the age of 40 and is a major cause of disability in women aged 40 and over.
Abstract: The first unifying definition for the metabolic syndrome was proposed by WHO in 1998. In accordance to this, patients with type 2 diabetes mellitus or impaired glucose tolerance have the syndrome if they fulfil two of the criteria: hypertension, dyslipidaemia, obesity/abdominal obesity and microalbuminuria. Persons with normal glucose tolerance (NGT) should also be insulin resistant. About 40% of persons with impaired glucose tolerance (IGT) and 70% of patients with type 2 diabetes have features of the syndrome. Importantly, presence of the dysmetabolic syndrome is associated with reduced survival, particularly because of increased cardiovascular mortality. The dysmetabolic syndrome most likely results from interplay between several genes and an affluent environment. Compatible with the thrifty gene theory, common variants in genes regulating lipolysis, thermogenesis and glucose uptake in skeletal muscle account for a large part of such thrifty genes. However, hitherto unknown genes may still be identified by random gene approaches.
253 citations
TL;DR: This is the first documentation that abdominal obesity is associated with accelerated progression of atherosclerosis, and supports the view that it is an important cardiovascular risk factor.
221 citations
TL;DR: The differences found in the composition and metabolism of perivisceral, omental, and subcutaneous fats may indicate that their atherogenic capacities also differ.
217 citations
TL;DR: Small HDL particle size appears to represent another feature of the high TG- low HDL cholesterol dyslipidemia found in viscerally obese subjects characterized by hyperinsulinemia.
206 citations
TL;DR: Body fat distribution has independent effects on lung function that are more prominent in men than women, and larger values of WHR were associated with greater reductions of forced vital capacity in 1 s.
01 Jan 2001
TL;DR: The aim of the study was to investigate the relationship between diet, physical activity, alcohol consumption and smoking and the prevalence of obesity in Finland and to investigate factors associated with BMI and obesity.
Abstract: 7List of original publications 9Abbreviations 101. Introduction 112. Review of the literature 132.1. Definitions and classification of obesity 132.1.1. BMI as a measure for assessing obesity 132.1.2. Abdominal obesity 162.1.3. Other anthropometric measures for assessing obesity 202.2. Prevalence and trends in obesity 212.2.1. Obesity in Finland 222.2.2. Obesity elsewhere in Europe 232.2.3. Obesity in countries outside Europe 302.3. Factors associated with BMI and obesity 312.3.1. Demographic factors: gender, age and ethnicity 322.3.2. Sociocultural factors: educat ion and family situation 342.3.3. Dietary intake, physical activity, alcohol consumption and smoking.383. Aims of the study 474. Subjects and methods 484.1. Participants 484.2. Measurements 514.2.1. Anthropometric measurements 514.2.2. Questionnaire 514.3. Statistical methods 545. Results 565.1. BMI and prevalence of obesity 565.1.1. Age 585.1.2. Education 605.1.3. Occupation 62
Journal Article•
TL;DR: Present treatment consists of sensible lifestyle changes, including weight loss to attain healthy body weight, 30 minutes of accumulated moderate-intensity physical activity per day and increased dietary fiber intake.
Abstract: Insulin resistance can be linked to diabetes, hypertension, dyslipidemia, cardiovascular disease and other abnormalities. These abnormalities constitute the insulin resistance syndrome. Because resistance usually develops long before these diseases appear, identifying and treating insulin-resistant patients has potentially great preventive value. Insulin resistance should be suspected in patients with a history of diabetes in first-degree relatives; patients with a personal history of gestational diabetes, polycystic ovary syndrome or impaired glucose tolerance; and obese patients, particularly those with abdominal obesity. Present treatment consists of sensible lifestyle changes, including weight loss to attain healthy body weight, 30 minutes of accumulated moderate-intensity physical activity per day and increased dietary fiber intake. Pharmacotherapy is not currently recommended for patients with isolated insulin resistance.
TL;DR: The case has been made for considering HDL-C in tandem with triglycerides (TG) as synergistic coronary risk factors, and areas requiring further research are identified.
Abstract: A working group meeting was convened from January 7 to 8, 2000, in Naples, Florida, to assess low HDL cholesterol (HDL-C) concentration as a risk factor for coronary heart disease (CHD). The 30 speakers and discussants at this 2-day meeting included specialists in epidemiology, endocrinology, molecular biology, public health, lipid metabolism, cardiovascular medicine, and preventive cardiology from the United States, Europe, and Australia (Appendix). The group’s wide-ranging presentations and discussions considered the latest knowledge on HDL metabolism and the effects of interventions for raising HDL-C levels on the development of atherosclerosis. It was generally accepted that low HDL-C may be a marker for the metabolic syndrome, an enhanced atherosclerotic disease state that is also associated with an impaired response to insulin, hypertriglyceridemia, and abdominal obesity. Therefore, beyond risk assessment based on LDL cholesterol (LDL-C) alone, the case has been made for considering HDL-C in tandem with triglycerides (TG) as synergistic coronary risk factors.1 The following article summarizes the participants’ discussion of low HDL-C as an independent CHD risk factor and identifies areas requiring further research.
Although population studies indicate that a high level of HDL-C in general protects against CHD,2 3 a high HDL-C concentration in any given individual may not necessarily confer cardioprotection. The atherogenicity of low HDL-C seems to be influenced by an array of genetic and environmental factors.
Tangier disease, a disorder caused by mutations in the ATP-binding cassette transporter 1 ( ABC1 ) gene,4 is characterized by the absence of normal HDL, with only a very small quantity of abnormal HDL present. However, early atherosclerosis (before 40 years) is not a consistent feature of this disorder.5 In men of Japanese ancestry in Hawaii, mutations in the gene for plasma cholesteryl ester transfer protein ( CETP ), which transfers cholesteryl ester from HDL to TG-rich lipoproteins, have …
TL;DR: Weight loss, although associated with favorable modification of multiple risk factors for CHD, has not been shown to independently and definitively reduce CHD risk.
TL;DR: Carotid and femoral atherosclerosis, cardiovascular risk factors and C‐reactive protein in relation to smokeless tobacco use or smoking in 58‐year‐old men is studied.
Abstract: Objectives. To examine the associations between smokeless tobacco use, smoking, cardiovascular risk factors, inflammation and ultrasound-assessed measures of atherosclerosis in the carotid and femoral arteries. Subjects. The study was performed in a population-based sample of clinically healthy men (n = 391) all 58 years old. Exclusion criteria were cardiovascular or other clinically overt diseases or continuous medication with cardiovascular drugs. Methods. The habits of smoking and oral moist snuff use were assessed by questionnaires. C-reactive protein (CRP) was assessed by high sensitive enzyme-linked immunosorbent assay (ELISA). Intima-media thickness (IMT) in the carotid bulb, the common carotid artery and the common femoral artery and plaque occurrence were measured by ultrasound. Results. The use of oral moist snuff was associated with serum triglycerides and waist-hip ratio (WHR), but not with CRP or ultrasound-assessed measures of subclinical atherosclerosis. Smoking, on the other hand, was associated with CRP, the components in the metabolic syndrome and IMT as well as plaques in the carotid and femoral arteries. In comparison to never-smokers the current smokers had higher values of WHR, triglycerides, C-reactive protein and IMT in carotid bulb and femoral artery. Ex-smokers were in general more obese and had a femoral IMT that was in-between that of never-smokers and current smokers. Conclusions. Tobacco smoking, but not oral moist snuff use, was associated with carotid and femoral artery IMT, and increased levels of CRP. Current smoking was also associated with abdominal obesity. Ex-smokers though, are generally more obese. Smoking was also associated with hyperinsulinaemia, dyslipidaemia and high blood pressure, i.e. the metabolic syndrome. The inhaled smoke from the combustion of tobacco seems to be an important aetiological factor in the atherosclerotic process.
TL;DR: In this economically deprived population, now constituting approximately 30–50% of the urban population of major cities in India, such adverse dietary, anthropometric and metabolic factors are predictors of early and accelerated atherosclerosis.
Abstract: Objectives: The intra-country rural to urban migrant populations undergo radical socio-economic and lifestyle changes in a developing country. Therefore, it is an interesting sample in which to study nutrition pattern, anthropometry and metabolic profile. The aim of this study was to assess nutrient profile and its association with the anthropometry, percentage body fat (%BF) and blood lipids in the urban slum dwellers in northern India. Design: A cross sectional epidemiological descriptive study. Settings: The study was conducted in urban slum colony of Gautam Nagar, situated in a southern area of New Delhi. Subjects: The data was recorded in 227 subjects (52 males and 175 females). Results: The diets averaged approximately 59–60% of energy from carbohydrates, 12–13% energy from protein, and 24–27% energy from dietary total fat. Lower intake of monounsaturated fatty acids (MUFA), a low ratio of n-6/n-3 fatty acids, a high ratio of polyunsaturated and saturated fatty acids, a high intake of erucic acid, and a low consumption of fibre and vitamin E intake were significant observations. Although their mean body mass index (BMI) was in a low range (20.5±4.2), %BF was high in females (26.7±8.6%; P=0.001), and a high prevalence of abdominal obesity was observed in both males (22%) and females (16%). Moreover, there was high prevalence of hypercholesterolemia, hypertriglyceridemia and, in particular, low levels of high-density lipoprotein cholesterol. Those consuming a high-fat diet (>30%) also consumed high MUFA, n-3 fatty acids, saturated fat and dietary cholesterol. Carbohydrate intake as percentage energy was a significant predictor of the levels of triacylglycerol in males, while in females significant predictors for triacylglycerol include intake of carbohydrate as percentage energy, age, %BF and BMI. Conclusion: In this economically deprived population, now constituting approximately 30–50% of the urban population of major cities in India, such adverse dietary, anthropometric and metabolic factors are predictors of early and accelerated atherosclerosis. Sponsorship: This study was fully supported by a financial grant from the Science and Society Division, Department of Science and Technology, Ministry of Science and Technology, Government of India. European Journal of Clinical Nutrition (2001) 55, 727–734
TL;DR: It is hypothesized that lower dose provocative and suppressive tests than those used to diagnose hypercortisolism of tumour origin or adrenal insufficiency would shed some light on the characteristics of the HPA axis activity in relation with body fat distribution.
Abstract: OBJECTIVES Obesity with abdominal body fat distribution (A-BFD) and hypothalamic-pituitary-adrenal (HPA) axis activity are somehow linked, but the exact interactions still need clarification. Obese subjects display normal circulating plasma cortisol concentrations with normal circadian rhythms. However, when the HPA axis is pharmacologically challenged, body fat distribution matters and then A-BFD obese women differ from those with subcutaneous body fat distribution (P-BFD). We hypothesized that lower dose provocative and suppressive tests than those used to diagnose hypercortisolism of tumour origin or adrenal insufficiency would shed some light on the characteristics of the HPA axis activity in relation with body fat distribution. PATIENTS AND METHODS Fifty premenopausal obese women were grouped according to their body fat mass distribution. Their plasma cortisol responses to (i) two low doses of dexamethasone (0.25 and 0.5 mg) with (ii) low dose of the ACTH analogue tetracosactrin (1 microg) were assessed. Salivary cortisol was also determined during the ACTH test. RESULTS A-BFD differed from P-BFD women in terms of HPA axis responsiveness. They had comparatively: (i) increased nocturnal cortisol excretion (9.38 +/- 2.2 vs. 6.82 +/- 0.91 nmol/micromol creatinine, A-BFD vs. P-BFD, respectively, P = 0.03); (ii) increased salivary cortisol response to ACTH stimulation (1 microg) [salivary cortisol peak: 33.4 (14.1-129) vs. 28.5 (13.2-42.8) nmol/l; salivary AUC: 825 (235-44738) vs. 537 (69-1420) nmol/min/l; A-BFD vs. P-BFD, P = 0.04 for both]; and (iii) increased pituitary sensitivity to dexamethasone testing [postdexamethasone (0.25 mg) plasma cortisol levels: 163 (26-472) vs. 318 (26-652) nmol/l and postdexamethasone (0.5 mg) plasma cortisol levels: 26 (26-79) vs. 33 (26-402) nmol/l; A-BFD vs. P-BFD, P = 0.01 for both). CONCLUSIONS These data demonstrate differences in the HPA axis activity and sensitivity to glucocorticoids between obese women differing in their body fat distribution, with both enhanced negative and positive feedback in those with abdominal obesity. Several mechanisms may explain these differences: central vs. peripheral hypotheses. Thus, abdominal obesity does not appear to be linked solely to one pathophysiological hypothesis.
TL;DR: This study examined whether this variant was associated with altered sensitivity to glucocorticoids as well as obesity with its related metabolic and haemodynamic abnormalities in a cohort of Swedish men born in Gothenburg, Sweden, in 1944.
Abstract: Editorial by Sorensen and Echwald
Chronically elevated cortisol levels can increase body fat, as seen clearly in Cushing's syndrome. Subjects with abdominal obesity share many of the hormonal, metabolic, and circulatory characteristics of people with Cushing's syndrome. A dysfunctional glucocorticoid receptor may add to the adverse health effects of excessive cortisol concentrations.
An Asn363Ser polymorphism in exon 2 of the glucocorticoid receptor gene (GRL) might be associated with overweight and an increased sensitivity to exogenous glucocorticoids.1 We therefore examined whether this variant was associated with altered sensitivity to glucocorticoids as well as obesity with its related metabolic and haemodynamic abnormalities in a cohort of Swedish men.2
Subjects (a total of 284 men) were randomly selected from a larger cohort of men born in Gothenburg, Sweden, in 1944. The design of the study has been described elsewhere.3 Measurements reported here were carried out in Gothenburg during …
TL;DR: It is suggested that there are independent and additive effects of exercise training and HRT on the reduction in fat mass and improvement in insulin action in postmenopausal women; the effect of H RT on insulin action may be mediated, in part, through changes in central adiposity.
Abstract: The independent and combined effects of exercise training and hormone replacement therapy (HRT) on body composition, fat distribution, glucose tolerance, and insulin action were studied in postmeno...
TL;DR: There is an association between the GRL BclI polymorphism and increased AVF levels independent of the level of total body fat, and the α2-ADR DraI variant is associated with a lower cross-sectional area of abdominal total fat.
Abstract: OBJECTIVE: To investigate whether interactions between glucocorticoid receptor (GRL), lipoprotein lipase (LPL) and adrenergic receptor (ADR) gene markers contribute to individual differences in indicators of adiposity and abdominal obesity, including visceral fat level. DESIGN AND SUBJECTS: Cross-sectional study; 742 individuals from the phase 2 of the Quebec Family Study cohort. MEASUREMENTS: Total body fat assessed by hydrodensitometry and the sum of six skinfolds. Abdominal fat areas measured by computed tomography and adjusted for age, sex and total fat mass in all analyses. GRL Bcl I, α2A-ADR Dra I and β2-ADR Ban I markers were typed by Southern blot, and other markers by polymerase chain reaction technique. RESULTS: It is confirmed that the 4.5 kb allele of the GRL BclI polymorphism is associated with a higher amount of abdominal visceral fat (AVF) depot (P for trend<0.001) independent of the level of total body fat. Furthermore, the α2-ADR Dra I variant is associated with lower cross-sectional areas of abdominal total (P=0.003) and subcutaneous (P=0.012) adipose tissue. Gene–gene interactions between GRL and α2-ADR genes affecting overall adiposity (P=0.016) as well as between GRL and β2-ADR genes (P=0.049) having influence on total abdominal fat levels were observed. When the three genes were considered together in the same analysis, significant interactions having influence on overall adiposity (P=0.017), abdominal total (P=0.032) and visceral fat (P=0.002) were observed. About 1–2% of the total variation in total fatness and abdominal fat was explained by these gene–gene interactions. CONCLUSION: There is an association between the GRL BclI polymorphism and increased AVF levels independent of the level of total body fat. The α2-ADR DraI variant is associated with a lower cross-sectional area of abdominal total fat. Numerous interactions between GRL and ADR markers on overall adiposity and total abdominal fat as well as between GRL, LPL and ADR genes on overall adiposity, abdominal total and visceral fat suggest that the genetic architecture of body fat content and adipose tissue distribution is complex although some genes, like GRL, may have ubiquitous effects.
TL;DR: Within 1 to 3 months, GH therapy accelerates lean tissue accrual, especially the water and protein components, but has a smaller effect on reducing fat mass.
Abstract: Growth hormone (GH) deficiency in children results in increased body fat, reduced fat-free mass (FFM) including muscle (protein) and bone, and abdominal obesity. Thus, proper GH secretion likely has major developmental influences on later health risks including cardiovascular diseases and osteoporosis. However, the in vivo control of the development of the body composition and fat distribution by GH has not yet been accurately investigated using children with GH deficiency as a model. We determined the effect of GH therapy (GH replacement, n = 3; GH + physiologic cortisol and thyroxine replacement, n = 3) on body composition, the proportional composition of the FFM, and body fat distribution in GH-deficient prepubertal children compared with healthy control children (n = 6) not treated with GH. The GH-deficient and control children were initially matched for gender, bone age, and weight. As assessed by a 4-compartment model, GH therapy reduced percent body fat during the first 3 months of therapy but not thereafter. This change was primarily due to FFM, which increased 3-fold more in the GH-deficient group and accounted for 91.5% of the increase in body weight. Fat mass increased in the controls but was unchanged in the GH-deficient group. Therapy temporarily increased the proportional contribution of water to the FFM, decreased the proportion of mineral, and slightly increased the proportion of protein. Using magnetic resonance imaging (MRI), abdominal visceral fat was reduced in the GH-deficient group and unchanged in the controls. Abdominal subcutaneous fat measured in the same image was not changed. The abdominal and suprailiac skinfold thicknesses also were not decreased in the GH-deficient group. In conclusion, within 1 to 3 months, GH therapy accelerates lean tissue accrual, especially the water and protein components, but has a smaller effect on reducing fat mass. GH therapy has site-specific effects on reducing abdominal adiposity.
TL;DR: It is suggested that the missense mutation in the MC4R gene could contribute to the variability in body mass, abdominal fat distribution and leptin concentrations in the general population, and the G/A mutation exhibits evidence of associations with diurnal cortisol levels.
Abstract: Aims/hypothesis:
The melanocortin-4 receptor (MC4-R) regulates food intake and possibly energy expenditure, and the inactivation of the MC4-R by gene targeting results in obesity, a phenotype strongly associated with Type II (non-insulin-dependent) diabetes mellitus. In our study, we addressed the hypothesis that a G?A substitution at codon 103 (Val-103Ile) of the MC4R gene influences abdominal obesity, insulin, glucose, and lipid metabolism as well as circulating hormones, including salivary cortisol.
TL;DR: Findings indicate that the association between abdominal obesity and hyperglycemia is stronger in the presence of a parental history of diabetes, and blood glucose screening may be warranted at lower levels of waist circumference in individuals with a parentalHistory of diabetes.
Abstract: OBJECTIVE —To examine whether the association between abdominal obesity and hyperglycemia differs according to the presence of a parental history of diabetes RESEARCH DESIGN AND METHODS —We conducted a cross-sectional study of 3,068 men and women, aged 20–65 years, without known diabetes who were fasting participants of a population-based study in three Dutch towns Hyperglycemia was defined as a fasting plasma glucose concentration of 61 mmol/l (American Diabetes Association criterion) Waist circumference was categorized according to previously defined waist action levels All estimates were adjusted for age and town RESULTS —The regression coefficients for the association between waist circumference and fasting plasma glucose were larger in participants who had a parental history of diabetes than in those who did not (men β = 031 vs 016 mmol/SD, P [for interaction] = 0003; women β = 024 vs 011 mmol/SD, P = 0002) Furthermore, larger waist circumference (men ≥94 vs P = 003; women 136 vs 59%, P = 005) Adjustment for physical activity, alcohol intake, smoking, and educational level did not materially change the results CONCLUSIONS —These findings indicate that the association between abdominal obesity and hyperglycemia is stronger in the presence of a parental history of diabetes Blood glucose screening may be warranted at lower levels of waist circumference in individuals with a parental history of diabetes
TL;DR: The secular increase in waist circumferences in both men and women occurring over a short time period indicates a need for prevention given the already high absolute weight, BMI and waist circumference levels in the population.
Abstract: Aims To assess temporal changes in body fat distribution, body mass index and obesity in Augsburg, Germany. Methods Waist circumference, weight and height were measured in two independent samples of 4804 and 4792, men and women, aged 25–74 years, in the MONICA Augsburg surveys 1989/90 and 1994/95. Abdominal obesity was defined as waist circumference greater than the 80th gender-specific percentile (men:103, women: 92 cm) in the 1989/90 population. Obesity was defined as a body mass index (BMI) ≥ 30 kg/m2. Results Age-standardized mean waist circumference increased by more than 1 cm (p-value < 0.00003) in both men and women while BMI increased by 0.3–0.4 kg/m2 (p-value < 0.01). We observed both a shift to higher values in the waist circumference distribution plus – particularly in women older than 45 years – a substantial right shift in the top of the distribution. Moreover, survey participants in 1994/95 who were at the higher end of the BMI distributions were disproportionately more obese than their respective peers in 1989/90. The prevalence of abdominal obesity rose by 3.3 % in men and 3.6 % in women, while the prevalence of obesity rose by 2 % from 17 % in men and by 2.5 % from 19 % in women. Conclusions While changes in the Augsburg population may not be as alarming as in other countries, the secular increase in waist circumferences in both men and women occurring over a short time period indicates a need for prevention given the already high absolute weight, BMI and waist circumference levels in the population.
TL;DR: Abdominal obesity, readily assessed by the measurement of WHR or waist circumference, was for the first time shown prospectively to be independently associated with the deterioration of glucose tolerance in a Chinese population.
Abstract: AIMS: The association between obesity and type 2 diabetes has been found to be consistent across different ethnic populations. Our aim was to study the contribution of obesity to the development of type 2 diabetes in a non-obese Chinese population with a high prevalence of diabetes (9.8% in 1995–1996). METHODS: Six-hundred and forty-four non-diabetic subjects were recruited from the Hong Kong Cardiovascular Risk Factor Prevalence Study (1995–1996). This was a community-based population study which involved the use of a 75 g oral glucose tolerance test and 1985 World Health Organization diagnostic criteria. Their glycemic status was reassessed at 2 y. RESULTS: In subjects with impaired glucose tolerance (n=322), the annual progression rate to diabetes (4.8%; 95% CI 2.5–7.1%), was 8-fold that in control subjects (0.6%; 95% CI 0.0–1.4%; P<0.001). Baseline waist–hip ratio (WHR; OR per unit increase=1.05; 95% CI 1.02–1.07, P=0.0003) and post-load 2 h plasma glucose (OR per unit increase=2.02; 95% CI 1.76–2.34, P<0.0001) were significantly associated with glycemic status at 2 y in stepwise polytomous logistic regression analysis. Subjects with high baseline waist circumference or WHR (≥median) were more likely to have worsening of glucose tolerance at 2 y than those with low waist circumference (
TL;DR: In Americans, hypertension is a public health problem that is closely linked to abdominal adiposity, and an important research challenge therefore is to determine the best way to regulate body weight under conditions of food abundance.
Abstract: Objective: Waist circumference (WC) cut-points of ≥102 cm and ≥88 cm for men and women, respectively, representing abdominal obesity have been recommended for determining obesity related co-morbidities. However, these cut-points carry the component of generalised obesity estimated by body mass index (BMI). The aim of this investigation was to determine whether abdominal obesity free of the influence of overall heaviness is associated with increased risk of hypertension in a representative sample of white and black Americans. Methods: Data (n = 11114) from the Third US National Health and Nutrition Examination Survey were used in this investigation. Standardised residual values from the linear regression of WC on BMI were used to define abdominal obesity status. The risk of hypertension associated with abdominal obesity was estimated from the logistic regression model, adjusting for age, smoking and alcohol. We also estimated the public health consequences of abdominal obesity from the population attributable fraction of hypertension. Results: Relative to white, black race/ethnicity was associated with ∼1.8 and ∼2.7 greater risk of hypertension in men and women, respectively, adjusting for abdominal obesity, age, smoking and alcohol consumption. Having larger than expected waist girths were associated with 1.58 and 1.39 increased risk of hypertension in black men and black women, respectively, adjusting for confounders. Population attributable risks of hypertension due to abdominal obesity were approximately 24.9% and 15.9%, in black men and black women, respectively. Conclusions: In Americans, hypertension is a public health problem that is closely linked to abdominal adiposity. An important research challenge therefore is to determine the best way to regulate body weight under conditions of food abundance. There is a need to clarify how lifestyle habits promote large waist sizes leading to abdominal adiposity and associated cardiovascular disease in the US, particularly among black Americans.
TL;DR: As undernutrition coexists with overnutrition throughout the Asia-Pacific, focusing efforts to improve nutrition during pregnancy will need to be combined with programs to prevent weight gain in adults if CHD and other chronic diseases are to be effectively tackled in the region.
Abstract: The level of obesity within the Pacific Islands is extremely high and so is the prevalence of weight-related morbidity and mortality. In contrast, the level of obesity, as defined by the standard WHO classification, remains relatively low in most Asian countries, yet rates of obesity-related disease, such as diabetes and cardiovascular disease are increasing rapidly. Many Asian races appear to be susceptible to the development of excessive abdominal fatness, even at low levels of body mass index (BMI). In addition, the health consequences of weight gain appear to occur at much lower levels of BMI and are more intense than in those of European origin. The exact reasons for these ethnic variations in the development of coronary heart disease (CHD) remain unclear. It is likely that genetic differences contribute to this variation in CHD risk, but different dietary and physical activity patterns may also play a role. The advent of modernisation has resulted in marked changes in the level of physical activity and the food supply available throughout the Asia‐Pacific region. There has been a shift towards higher intakes of fats (particularly animal fats and vegetable oils) and sugars. Urbanisation and occupational restructuring have reduced daily physical activity levels. As a result, the population mean BMI and consequent illness is increasing in many countries within the region. Recent studies have shown that infants who were undernourished in utero and then born small have a greater risk of developing abdominal obesity and related morbidity as adults. As undernutrition coexists with overnutrition throughout the Asia‐Pacific, focusing efforts to improve nutrition during pregnancy will need to be combined with programs to prevent weight gain in adults if CHD and other chronic diseases are to be effectively tackled in the region.
TL;DR: The high prevalence of overweight and obesity is now evident in poor and relatively isolated rural communities of Mexico.
Abstract: Objective: To establish the nutritional status of previously studied rural populations. Design and subjects: A total of 139 households with 245 males and 301 females from four relatively isolated Mexican rural communities were randomly selected to be surveyed in 1996. Results: Underweight was not a problem in either children or adults. In children 50 y by 2.0 units; the male data were essentially unchanged. The prevalence of abdominal obesity in women, based on waist measurements and WHO cut-off points was high with 25% of women having elevated values despite a normal BMI; 43% of the overweight women had substantial increases in waist measurements, indicative of high risk, as did 91% of obese women. The men's waist measurements were greater in relation to both BMI and body fat but the prevalence of values in excess of the suggested sex-specific WHO limits was less than half that of women. Conclusions: The high prevalence of overweight and obesity is now evident in poor and relatively isolated rural communities of Mexico. Sponsorship: The Chronic Disease Office, from the Ministry of Health in Mexico partially financed this study. European Journal of Clinical Nutrition (2001) 55, 833–840
TL;DR: To examine the factors influencing the levels of sex hormone‐binding globulin (SHBG) in normal postmenopausal women by assessing the relationship between SHBG and measured anthropometric, metabolic and hormonal variables.
Abstract: OBJECTIVE To examine the factors influencing the levels of sex hormone-binding globulin (SHBG) in normal postmenopausal women by assessing the relationship between SHBG and measured anthropometric, metabolic and hormonal variables.
DESIGN Cross-sectional, observational study.
SUBJECTS and METHODS Seventy normal postmenopausal women aged 47–71 years (mean 58 years), participated in the study. Information was collected on medical, reproductive and smoking history, alcohol use, dietary intake and physical activity. Body composition measurements using dual-energy absorptiometry, and analyses of biochemical and hormonal indices were performed.
RESULTS Bivariate correlation coefficients indicated that SHBG was inversely related to body weight (r = − 0·44), fat mass (r = − 0·35), and abdominal obesity (r = − 0·42). It was also inversely related to the glucose and insulin levels during an oral glucose tolerance test (− 0·24 < r < − 0·40), serum oestradiol (r = − 0·26), and physical activity (r = − 0·24). Multiple regression analysis indicated that significant independent correlates of SHBG concentration were fat mass, physical activity, alcohol intake, serum oestradiol, and insulin-like growth factor-1, all having a negative impact on SHBG.
CONCLUSIONS From these observed associations, it is concluded that maintenance of body weight, moderate alcohol consumption, and physical activity will tend to reduce SHBG concentrations in postmenopausal women, thereby increasing the levels of free oestradiol. This mechanism could mediate the beneficial effects of these factors in preventing the development of osteoporosis and cardiovascular disease.