Association Between Regional Adipose Tissue Distribution and Both Type 2 Diabetes and Impaired Glucose Tolerance in Elderly Men and Women
- Bret H. Goodpaster, PHD1,
- Shanthi Krishnaswami2,
- Helaine Resnick, PHD, MPH3,
- David E. Kelley, MD1,
- Catherine Haggerty, PHD, MPH2,
- Tamara B. Harris, MD, MS4,
- Ann V. Schwartz, PHD5,
- Steven Kritchevsky, PHD6 and
- Anne B. Newman, MD, MPH1
- 1Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- 2Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- 3Department of Epidemiology, Medstar Research Institute, Hyattsville, Maryland
- 4National Institute on Aging, Bethesda, Maryland
- 5Prevention Sciences Group, University of California at San Francisco, San Francisco, California
- 6University of Tennessee, Memphis, Tennessee
Abstract
OBJECTIVE—We examined whether regional adipose tissue distribution, specifically that of skeletal muscle fat and visceral abdominal fat aggregation, is characteristic of elderly individuals with hyperinsulinemia, type 2 diabetes, and impaired glucose tolerance (IGT).
RESEARCH DESIGN AND METHODS—A total of 2,964 elderly men and women (mean age 73.6 years) were recruited for cross-sectional comparisons of diabetes or glucose tolerance, generalized obesity with dual-energy X-ray absorptiometry, and regional body fat distribution with computed tomography.
RESULTS—Approximately one-third of men with type 2 diabetes and less than half of women with type 2 diabetes were obese (BMI ≥30 kg/m2). Despite similar amounts of subcutaneous thigh fat, intermuscular fat was higher in subjects with type 2 diabetes and IGT than in subjects with normal glucose tolerance (NGT) (11.2 ± 9.4, 10.3 ± 5.8, and 9.2 ± 5.9 cm2 for men; 12.1 ± 6.1, 10.9 ± 6.5, and 9.4 ± 5.3 cm2 for women; both P < 0.0001). Visceral abdominal fat was also higher in men and women with type 2 diabetes and IGT than in subjects with NGT (172 ± 79, 163 ± 72, and 145 ± 66 cm2 for men; 162 ± 66, 141 ± 60, and 116 ± 54 cm2 for women; both P < 0.0001 across groups). Higher rates of intermuscular fat and visceral abdominal fat were associated with higher fasting insulin in normal-weight (BMI <25 kg/m2) men (r = 0.24 for intermuscular fat, r = 0.37 for visceral abdominal fat, both P < 0.0001) and women (r = 0.20 for intermuscular fat, r = 0.40 for visceral abdominal fat, both P < 0.0001). These associations were not found in obese subjects.
CONCLUSIONS—Elderly men and women with normal body weight may be at risk for metabolic abnormalities, including type 2 diabetes, if they possess an inordinate amount of muscle fat or visceral abdominal fat.
- AT, adipose tissue
- CT, computed tomography
- DEXA, dual-energy X-ray absorptiometry
- Health ABC, Health, Aging and Body Composition
- HU, Hounsfield unit
- IGT, impaired glucose tolerance
- NGT, normal glucose tolerance
Footnotes
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Address correspondence and reprint requests to Bret H. Goodpaster, PhD, Department of Medicine, 809 N. MUH, University of Pittsburgh Medical Center, Pittsburgh, PA 15213. E-mail: bgood{at}pitt.edu.
Received for publication 1 August 2002 and accepted in revised form 29 October 2002.
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