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Visceral Adipose Tissue Cutoffs Associated With Metabolic Risk Factors for Coronary Heart Disease in Women

¹ Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
² Division of Gerontology, University of Maryland School of Medicine and the Geriatric Research, Education and Clinical Center (GRECC), Baltimore VA Medical Center, Baltimore, Maryland
³ School of Nursing, University of Central Florida, Orlando, Florida

OBJECTIVE—This study determined whether there is a critical level of visceral adipose tissue (VAT) associated with elevated coronary heart disease (CHD) risk factors in a cohort of women >45 years of age.

RESEARCH DESIGN AND METHODS—Measurements of body composition (dual-energy X-ray absorptiometry), body fat distribution (computed tomography), fasting and 2-h postprandial (75-g) glucose concentrations, and fasting lipoprotein lipid and insulin concentrations were performed in 233 perimenopausal (9%) and postmenopausal women (age 59 ± 6 years, 79% Caucasian, 16% on hormone replacement therapy).

RESULTS—Women in the lowest VAT quintile (105 cm²) had higher concentrations of HDL and HDL₂ cholesterol, lower LDL/HDL cholesterol ratios and triglyceride concentrations, and lower fasting glucose and insulin concentrations than women in the remaining four quintiles (P values <0.05–0.001). Women in the second lowest VAT quintile (106–139 cm²) had higher HDL and HDL₂ cholesterol and lower LDL/HDL ratios than women with a VAT 163 cm² (P < 0.05). Logistic regression analyses showed that women with a VAT of 106–162 cm² are 2.5 times more likely to have a low HDL cholesterol (P < 0.05), while women with a VAT 163 cm² are 5.5 times more likely to have a low HDL cholesterol (P < 0.01) and 4.0 times more likely to have a high LDL/HDL ratio (P < 0.05) compared with women with a VAT 105 cm². Women with a VAT 163 cm² are at a higher risk of having impaired glucose tolerance (P < 0.01).

CONCLUSIONS—A VAT 106 cm² is associated with an elevated risk, and a VAT 163 cm² with an even greater risk, for these metabolic CHD risk factors compared with women with a VAT 105 cm². These values may prove useful for defining "visceral obesity" and for identifying women most likely to benefit from preventative interventions.

Abbreviations: CHD, coronary heart disease • CT, computed tomography • HRT, hormone replacement therapy • VAT, visceral adipose tissue • WHR, waist-to-hip ratio

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