Body Fatness and Fat Distribution as Predictors of Metabolic Abnormalities and Early Carotid Atherosclerosis
- Rieko Takami, MD1,
- Noriyuki Takeda, MD2,
- Makoto Hayashi, MD1,
- Akihiko Sasaki, MD2,
- Shinichi Kawachi, MD2,
- Koji Yoshino, MD2,
- Kazuhisa Takami, MD2,
- Kazuya Nakashima, MD2,
- Akifumi Akai, MD1,
- Noriyoshi Yamakita, MD1 and
- Keigo Yasuda, MD2
- 1Department of Internal Medicine, Matsunami General Hospital, Kasamatsu, and the
- 2Third Department of Internal Medicine, Gifu University School of Medicine, Gifu, Japan
Abstract
OBJECTIVE—To test the hypothesis that intra-abdominal fat plays a primary role over general adiposity for metabolic abnormalities and atherosclerosis.
RESEARCH DESIGN AND METHODS—We cross-sectionally studied 849 Japanese men aged 50.3 ± 8.5 years (range 20–78) with BMI 23.5 ± 2.9 kg/m2. Intimal-medial thickness (IMT) of the carotid artery was measured by ultrasound. General adiposity was assessed by BMI. Waist circumference and waist-to-hip ratio (WHR) were used as a surrogate measure for abdominal fat. Abdominal subcutaneous fat area (ASF) and intra-abdominal fat area (IAF) were measured by computed tomography. Correlations between these measures and carotid IMT were analyzed. The interaction of generalized adiposity (BMI) and IAF in relation to metabolic variables, such as glucose tolerance, insulin resistance, and serum lipids, was also evaluated.
RESULTS—BMI, waist circumference, WHR, ASF, and IAF were all correlated with carotid IMT. Adjustment for BMI eliminated the associations between IMT and waist circumference, ASF, and IAF. In contrast, WHR retained a significant correlation with IMT. BMI and IAF were associated with insulin resistance, glucose tolerance, HDL cholesterol, and blood pressure independently of each other. IAF was an independent correlate for serum triglyceride, but BMI was not.
CONCLUSIONS—The primary importance of IAF over general adiposity for carotid atherosclerosis was not confirmed. Caution is recommended when using WHR as a measure of abdominal fat. The roles of IAF for metabolic abnormalities may be more limited than conventionally thought. BMI and WHR are simple and better clinical predictors for carotid atherosclerosis versus IAF.
- ADA, American Diabetes Association
- ASF, abdominal subcuatenous fat area
- AUC-IRI, area under the curve of immunoreactive insulin
- AUC-PG, AUC of plasma glucose
- CT, computed tomography
- FPG, fasting plasma glucose
- HOMA-IR, homeostasis model assessment of insulin resistance
- IAF, intra-abdominal fat area
- IGT, impaired glucose tolerance
- IMT, intimal-medial thickness
- NCEP, National Cholesterol Education Program
- OGTT, oral glucose tolerance test
- WHR, waist-to-hip ratio
Footnotes
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Address correspondence and reprint requests to Noriyuki Takeda, MD, Third Department of Internal Medicine, Gifu University School of Medicine, 40 Tsukasa-machi, Gifu 500-8705, Japan. E-mail: ntkd{at}cc.gifu-u.ac.jp.
Received for publication 17 November 2000 and accepted in revised form 9 March 2001.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
