Diabetes Care
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Diabetes Care 29:1417-1419, 2006
DOI: 10.2337/dc06-0441
© 2006 by the American Diabetes Association
This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Lemieux, I.
Right arrow Articles by Mauriège, P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Lemieux, I.
Right arrow Articles by Mauriège, P.
Social Bookmarking
Add to CiteULike   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?

Cardiovascular and Metabolic Risk
Brief Report

Waist Girth Does Not Predict Metabolic Complications in Severely Obese Men

Isabelle Lemieux, PHD1, Vicky Drapeau, PHD1,2, Denis Richard, PHD1,3, Jean Bergeron, MD, MSC4, Picard Marceau, MD5, Simon Biron, MD5 and Pascale Mauriège, PHD1,2

1 Laval Hospital Research Center, Laval University, Québec, Canada
2 Division of Kinesiology, Social and Preventive Medicine, Laval University, Québec, Canada
3 Department of Anatomy and Physiology, Laval University, Québec, Canada
4 Lipid Research Center, CHUL Research Center, Laval University, Québec, Canada
5 Department of Surgery, Laval Hospital, Laval University, Québec, Canada

Address correspondence and reprint requests to Pascale Mauriège, PhD, Division of Kinesiology, PEPS, Room 2148, Laval University, Québec, Canada G1K 7P4. E-mail: pascale.mauriege{at}kin.msp.ulaval.ca


   INTRODUCTION
TOP
 INTRODUCTION
RESEARCH DESIGN AND METHODS
 RESULTS
 CONCLUSIONS
 References
 
The epidemic of obesity has received considerable attention because of its increasing prevalence and its deleterious impact on health (1–6). In this regard, the metabolic syndrome has been recognized as a prevalent cause of cardiovascular disease, and the National Cholesterol Education Program Adult Treatment Panel III guidelines (7) have proposed clinical tools for the identification of individuals characterized by this syndrome. However, there is considerable metabolic heterogeneity among equally overweight/obese individuals. While some patients show a relatively "normal" metabolic risk profile despite being obese, others who are moderately overweight can nevertheless be characterized by metabolic complications (8,9).

Thus, it is not uncommon to find severely obese patients with minimal changes in their metabolic risk profile, suggesting that they may be at lower cardiovascular disease risk than what could be expected from their massive obesity. Therefore, the aim of the present study was to examine the relationships between selected features of the metabolic syndrome and waist circumference as a crude marker of abdominal obesity in moderately and severely obese men.


   RESEARCH DESIGN AND METHODS
TOP
 INTRODUCTION
 RESEARCH DESIGN AND METHODS
RESULTS
 CONCLUSIONS
 References
 
Informed written consent was obtained from all patients, and studies were conducted according to the Helsinki Declaration. The reference group consisted of moderately obese men (n = 97) of the Québec Health Survey (10,11) with BMI values between 30 and 40 kg/m2. A group of 84 men with BMI ≥40 kg/m2 underwent biliopancreatic diversion for severe obesity. Patients with hepatotoxic medication or exposure, history of hepatitis, prior weight loss surgery, or elevated consumption of alcohol were excluded from the present study.

For moderately obese men, anthropometric measurements were obtained according to standardized procedures. A fasting lipid profile was performed at the St. Michael’s Lipid Research Laboratory in Toronto. Fasting glycemia was determined using the glucose oxidase assay.

Severely obese patients were weighed either on a detectomedical or on an electronic Toledo scale (weight < or ≥136-kg). Waist girth was measured at the widest circumference of the umbilicus level. The fasting lipid profile and glycemia were determined according to routine methods of the Laval Hospital.

In moderately obese men, blood pressure was recorded with an appropriate cuff size but with a large cuff in severely obese men.

Pearson correlation coefficients were calculated to quantify the univariate associations among variables. Analyses were performed with SAS.


   RESULTS
TOP
 INTRODUCTION
 RESEARCH DESIGN AND METHODS
 RESULTS
CONCLUSIONS
 References
 
The prevalence of the metabolic syndrome was similar in moderately and severely obese men (29 and 32%, respectively). Although characterized by greater adiposity indexes, severely obese men displayed a better plasma lipoprotein-lipid profile than moderately obese men. Plasma cholesterol and LDL cholesterol concentrations were lower in severely obese men despite a comparable use of hypolipidemic medication in the two groups. However, systolic and diastolic blood pressures were higher in men with severe obesity (P ≤ 0.02), although a greater proportion of severely obese men (27.4 vs. 13.7%, P ≤ 0.02) was on antihypertensive medication. Significant relationships between waist circumference and HDL cholesterol concentrations (r = –0.33, P ≤ 0.001) or the total-to-HDL cholesterol ratio (r = 0.21, P ≤ 0.04) were only found in moderately obese men (Fig. 1). A positive association was found between waist girth and systolic blood pressure only in the severely obese group (r = 0.27, P ≤ 0.02).


Figure 1
View larger version (16K):
[in this window]
[in a new window]
  		Figure 1— Relationships of waist circumference to HDL cholesterol levels (A), the total-to-HDL cholesterol ratio (B), and systolic blood pressure (C) among moderately (•) and severely ({circ}) obese men.

 

   CONCLUSIONS
TOP
 INTRODUCTION
 RESEARCH DESIGN AND METHODS
 RESULTS
 CONCLUSIONS
References
 
The prevalence of the metabolic syndrome among severely obese men is not as high as expected from their large adipose mass. This finding corroborates previous findings observed in morbidly obese individuals (12). In patients with elevated BMI values (34–77 kg/m2), no relationship was found between obesity and lipid levels (13). The prevalence of dyslipidemia and of metabolic syndrome also appears to be independent of BMI in patients displaying a high degree of obesity (14). Finally, a low prevalence of the metabolic syndrome has been reported in severely obese pre- and postmenopausal women (15).

A possible explanation for the low prevalence of the metabolic syndrome among severely obese men could be attributable to inherent characteristics of visceral versus subcutaneous adipose depots. A high lipolytic activity of visceral adipocytes drained by the portal vein has already been proposed to be an important factor linking intra-abdominal adiposity to metabolic complications (16,17). One could therefore suppose that severely obese men were not characterized by a greater visceral fat accumulation compared with moderately obese men. However, previous studies have shown that two visceral depots (round ligament and mesenteric adipose tissues) were characterized by a lower fatty acid release and a greater fatty acid uptake than the omentum in severely obese women, suggesting a protective role of some intra-abdominal fat depots against obesity-related metabolic complications (18–20).

Our findings are also compatible with the notion that localization of excess fat, rather than body fatness, is a health hazard. Among subjects carefully matched for total-body fat but with high versus low visceral adipose tissue, we had previously shown that viscerally obese patients had the most disturbed metabolic risk profile (9,21). Waist circumference is the best correlation of abdominal obesity (22,23), and the higher the waist circumference, generally, the more deteriorated is the metabolic risk profile. However, the lack of relationship between waist girth and the lipid profile in severely obese men suggests that this anthropometric index is not a suitable marker of a deteriorated lipoprotein-lipid profile in severe obesity.

In summary, no difference in the prevalence of the metabolic syndrome was found between moderately and severely obese men. These results provide evidence that massive obesity is a metabolic phenotype distinct from moderate obesity. Further studies are needed to investigate whether differences in metabolic and/or secretory adipose cell capacities of distinct intra-abdominal depots could explain the absence of further deteriorations in severely obese men.


   Acknowledgments
 
This study has been supported by the Merck Frosst/CIHR (Canadian Institutes of Health Research) Research Chair on Obesity.

We express our gratitude to the subjects for their collaboration.


   Footnotes
 
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

Received for publication February 24, 2006. Accepted for publication February 28, 2006.


   References
TOP
 INTRODUCTION
 RESEARCH DESIGN AND METHODS
 RESULTS
 CONCLUSIONS
 References
 

  1. Barrett-Connor EL: Obesity, atherosclerosis, and coronary artery disease. Ann Intern Med 103:1010–1019, 1985[Medline]
  2. Kissebah AH, Freedman DS, Peiris AN: Health risk of obesity. Med Clin North Am 73:111–138, 1989[Medline]
  3. Hubert HB, Eaker ED, Garrison RJ, Castelli WP: Life-style correlates of risk factor change in young adults: an eight-year study of coronary heart disease risk factors in the Framingham offspring. Am J Epidemiol 125:812–831, 1987[Abstract/Free Full Text]
  4. Hu FB, Manson JE, Stampfer MJ, Colditz G, Liu S, Solomon CG, Willett WC: Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med 345:790–797, 2001[Abstract/Free Full Text]
  5. Faloia E, Giacchetti G, Mantero F: Obesity and hypertension. J Endocrinol Invest 23:54–62, 2000[Medline]
  6. Denke MA, Sempos CT, Grundy SM: Excess body weight: an under-recognized contributor to dyslipidemia in white American women. Arch Intern Med 154:401–410, 1994[Abstract]
  7. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 285:2486–2497, 2001[Free Full Text]
  8. Després JP, Moorjani S, Ferland M, Tremblay A, Lupien PJ, Nadeau A, Pinault S, Thériault G, Bouchard C: Adipose tissue distribution and plasma lipoprotein levels in obese women: importance of intra-abdominal fat. Arteriosclerosis 9:203–210, 1989[Abstract/Free Full Text]
  9. Pouliot MC, Després JP, Nadeau A, Moorjani S, Prud’homme D, Lupien PJ, Tremblay A, Bouchard C: Visceral obesity in men: associations with glucose tolerance, plasma insulin, and lipoprotein levels. Diabetes 41:826–834, 1992[Abstract]
  10. Lemieux I, Alméras N, Mauriège P, Blanchet C, Dewailly E, Bergeron J, Després JP: Prevalence of "hypertriglyceridemic waist" in men who participated in the Quebec Health Survey: association with atherogenic and diabetogenic metabolic risk factors. Can J Cardiol 18:725–732, 2002[Medline]
  11. Scarsella C, Alméras N, Mauriège P, Blanchet C, Sauvé L, Dewailly E, Bergeron J, Després JP: Prevalence of metabolic alterations predictive of cardiovascular disease risk in the Quebec population. Can J Cardiol 19:51–57, 2003[Medline]
  12. Wolf AM, Beisiegel U, Kortner B, Kuhlmann HW: Does gastric restriction surgery reduce the risks of metabolic diseases? Obes Surg 8:9–13, 1998[Medline]
  13. Dixon JB, O’Brien P: A disparity between conventional lipid and insulin resistance markers at body mass index levels greater than 34 kg/m(2). Int J Obes Relat Metab Disord 25:793–797, 2001[Medline]
  14. Adami GF, Ravera G, Marinari GM, Camerini G, Scopinaro N: Metabolic syndrome in severely obese patients. Obes Surg 11:543–545, 2001[Medline]
  15. Drapeau V, Lemieux I, Richard D, Bergeron J, Tremblay A, Biron S, Marceau P, Mauriège P: Metabolic profile in severely obese women is less deteriorated than expected when compared to moderately obese women. Obes Surg 16:501–509, 2006[Medline]
  16. Björntorp P: Visceral obesity: a "civilization syndrome". Obes Res 1:206–222, 1993[Medline]
  17. Kissebah AH, Krakower GR: Regional adiposity and morbidity. Physiol Rev 74:761–811, 1994[Free Full Text]
  18. Mauriège P, Marette A, Atgié C, Bouchard C, Thériault G, Bukowiecki LK, Marceau P, Biron S, Nadeau A, Després JP: Regional variation in adipose tissue metabolism of severely obese premenopausal women. J Lipid Res 36:672–684, 1995[Abstract]
  19. Marette A, Mauriège P, Marcotte B, Atgié C, Bouchard C, Thériault G, Bukowiecki LJ, Marceau P, Biron S, Nadeau A, Després JP: Regional variation in adipose tissue insulin action and GLUT4 glucose transporter expression in severely obese premenopausal women. Diabetologia 40:590–598, 1997[Medline]
  20. Fried SK, Leibel RL, Edens NK, Kral JG: Lipolysis in intraabdominal adipose tissue of obese women. Obes Res 1:443–448, 1993[Medline]
  21. Després JP, Nadeau A, Tremblay A, Ferland M, Moorjani S, Lupien PJ, Thériault G, Pinault S, Bouchard C: Role of deep abdominal fat in the association between regional adipose tissue distribution and glucose tolerance in obese women. Diabetes 38:304–309, 1989[Abstract]
  22. Seidell JC, Oosterlee A, Deurenberg P, Hautvast JGAJ, Ruijs JHJ: Abdominal fat depots measured with computed tomography: effects of degree of obesity, sex, and age. Eur J Clin Nutr 42:805–815, 1988[Medline]
  23. Pouliot MC, Després JP, Lemieux S, Moorjani S, Bouchard C, Tremblay A, Nadeau A, Lupien PJ: Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol 73:460–468, 1994[Medline]

Add to CiteULike CiteULike   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 Arterioscler. Thromb. Vasc. Bio.Home page
J.-P. Despres, I. Lemieux, J. Bergeron, P. Pibarot, P. Mathieu, E. Larose, J. Rodes-Cabau, O. F. Bertrand, and P. Poirier
Abdominal Obesity and the Metabolic Syndrome: Contribution to Global Cardiometabolic Risk
Arterioscler. Thromb. Vasc. Biol., June 1, 2008; 28(6): 1039 - 1049.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Lemieux, I.
Right arrow Articles by Mauriège, P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Lemieux, I.
Right arrow Articles by Mauriège, P.
Social Bookmarking
Add to CiteULike   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Diabetes Diabetes Care Clinical Diabetes Diabetes Spectrum