Quality of life in relation to overweight and body fat distribution.

OBJECTIVES: This study quantified the impairment of quality of life attributable to body fatness by using the standardized SF-36 Health Survey. METHODS: Tertiles of waist circumference and body mass index (BMI) in 1885 men and 2156 women aged 20 to 59 years in the Netherlands in 1995 were compared. RESULTS: The odds ratios and 95% confidence intervals of subjects with the largest waist circumferences, compared with those in the lowest tertile, were 1.8 (1.3, 2.4) in men and 2.2 (1.7, 2.9) in women with difficulties in bending, kneeling, or stooping; 2.2 (1.4, 3.7) in men and 1.7 (1.2, 2.6) in women with difficulties in walking 500 m; and 1.3 (1.0, 1.9) in men and 1.5 (1.1, 1.9) in women with difficulties in lifting or carrying groceries. Anthropometric measures were less strongly associated with social functioning, role limitations due to physical or emotional problems, mental health, vitality, pain, or health change in 1 year. The relationship between quality of life measures and BMI were similar to those between quality of life measures and waist circumference. CONCLUSIONS: Large waist circumferences and high BMIs are more likely to be associated with impaired quality of life and disability affecting basic activities of daily living.     

Obesity and body fat distribution in relation to the incidence of non-insulin-dependent diabetes mellitus. A prospective cohort study of men in the normative aging study.

The relation between the abdominal accumulation of body fat, total-body adiposity, and blood glucose level and the risk of non-insulin-dependent diabetes mellitus was evaluated prospectively among 1,972 male participants in the Department of Veterans Affairs Normative Aging Study cohort. The risk of non-insulin-dependent diabetes mellitus was assessed by means of the proportional hazards model; 226 cases of diabetes occurred among the 1,972 men (mean age at entry, 41.9 years; range, 22-80 years) over 35,496 person-years of observation. The relation of body mass index to diabetes risk was partly explained by body fat distribution; after adjusting for age, the ratio of abdominal circumference to hip breadth, and cigarette smoking, men in the top tertile for body mass index had a 1.3-fold greater risk of diabetes than did men in the lowest tertile (95% confidence interval 0.9-1.8). Moreover, after adjusting for age, body mass index, and cigarette smoking, men in the top tertile for the ratio of abdominal circumference to hip breadth had a 2.4-fold greater risk of diabetes than did men in the lowest tertile (95% confidence interval 1.7-3.7). When blood glucose was analyzed as a continuous outcome variable, the findings were consistent, i.e., a positive association with abdominal fat independent of total-body adiposity. These results confirm previous reports of a prospective relation between abdominal adiposity and the risk of diabetes and provide prospective evidence of a relation between blood glucose levels and both body fat distribution and obesity.     

Smoking initiation and cessation in relation to body fat distribution based on data from a study of Swedish women.

In a representative sample of Swedish women, smokers were significantly less obese than nonsmokers. However, a smoker was likely to have significantly more upper-body fat than a nonsmoker of similar body mass index. Women who quit smoking experienced less upper-body fat deposition than would be expected by their accompanying weight gain, suggesting that weight gained as a consequence of smoking cessation is not preferentially deposited in the region associated with increased cardiovascular risk.     

The association of girth measurements with disease in 32,856 women

Most epidemiologic studies which evaluate the association between obesity and disease consider only total adipose tissue and ignore its distribution. The present study used data from a national survey of women in TOPS (a weight reduction organization) in 1969. The purpose of this study was to evaluate the distribution of adipose tissue as a risk factor for disease using girth, height, and weight measurements in 21,065 women 40-59 years of age and 11,791 women 20-39 years of age. It was found that an index of body fat distribution, the ratio of waist girth to hip girth, was significantly associated with diabetes, hypertension, and gallbladder disease in women aged 40-59 and with menstrual abnormalities in women aged 20-39. Relatively more fat around the waist (as compared to hips) was associated with higher disease prevalence even among women with comparable total body fat. These findings suggest that indices based only on weight and height may not adequately characterize the risks associated with obesity.     

妊娠期糖尿病对新生儿体脂含量的影响研究

目的 探讨妊娠期糖尿病(GDM)和新生儿体脂含量的关系。方法 采用前瞻性队列研究,将孕早期孕妇纳入队列,随访至胎 儿出生。于孕24~28周,进行口服葡萄糖耐量试验(OGTT),将研究对象分为正常组和GDM组。孕妇分娩前,留取空腹血;胎儿出生24小时内,进行体格测量。使用t检验比较新生儿体 脂质量、体脂百分含量之间的差异;多元线性回归分析GDM和新生儿体脂含量之间的关系。结果 GDM组新生儿体脂质量(0.62±0.27) kg、体脂百分含量(17.68 ±5.22)%均高于正常组,差异具有统计学意义 (P<0.001)。多元线性回归结果表明分娩孕周、孕前体质指数(BMI)、空腹血糖、血脂水平是新生儿体脂百分含量的危险因素( P<0.05)。结论 GDM增加新生儿的体脂含量,应早发现、早干预,以降低新生儿体脂含量。     

The implications of body fat mass and fat distribution for cognitive function in elderly women

OBJECTIVE: To investigate how body fat mass, an established source of endogenous estrogen after menopause, influences cognitive impairment in elderly women. RESEARCH METHODS AND PROCEDURES: Study participants were 5607 generally healthy postmenopausal women with mean age of 63.8 years at baseline followed for an average of 7.3 years. Cognitive function assessed at follow-up using the short Blessed test was related to baseline body weight, the yearly change in weight, and follow-up measures of body fat depots assessed by DXA. Cognitive function was also related to various surrogates of lifetime estrogen exposure. RESULTS: Women with the worst cognitive performance (score >or= 9) at follow-up were the ones who lost the most body weight and revealed the lowest central fat mass (CFM). The association of weight loss with worse cognitive performance was apparent across all age groups except for those more than 80 years old. In the multivariate logistic model, the risk of cognitive impairment was 18% lower in women in the second quartile of CFM (p = 0.14), 32% lower in the third (p = 0.01), and 48% lower in the fourth (p < 0.001) compared with those in the first quartile. CFM showed significant correlation with the simultaneously measured serum estradiol (r = 0.25; p < 0.001). Cognitive score showed an inverse linear relationship with the duration of reproductive period and bone mineral density assessed at follow-up. DISCUSSION: These findings argue for a protective association of body fat mass with cognitive impairment in elderly women. This association seems to involve a more prominent exposure to endogenous estrogens.     

Diet composition, energy intake, and exercise in relation to body fat in men and women

This study examined the relationships among body fat, diet composition, energy intake, and exercise in adults. Male (n = 107) and female (n = 109) adults aged 18-71 y (36.6 +/- 1.0 y, means +/- SEM) were hydrostatically weighed to determine body fat (5.7-49.0% of total weight). Diet and exercise behaviors were determined by use of a questionnaire. As body fat increased, percent of energy intake derived from fat increased (p less than 0.001) whereas the percent from carbohydrate decreased (p less than 0.001). There was no relationship between energy intake and adiposity although leanness and exercise were related (p less than 0.001). When subgroups of lean and obese subjects were compared, the lean subjects derived approximately 29% of their energy from fat and 53% from carbohydrate vs 35% and 46%, respectively, for the obese subjects. No differences were found between groups for energy intake but the lean individuals exercised more often than did the obese individuals. These data suggest that diet composition may play as important a role in fat deposition as do energy intake and lack of exercise.     

Increased incidence of diabetes mellitus in relation to abdominal adiposity in older women

The relationship between body fat distribution, measured by the ratio of waist-to-hip circumferences (WHR), and the 2 year incidence of diabetes mellitus was examined in a cohort of 41,837 women aged 55-69 years. The 399 women who reported the new onset of diabetes had a significantly greater mean body mass index (kg/m2) and WHR than non-cases. After adjustment for body mass index (BMI), age and education level using multivariate logistic regression, WHR was a significant independent predictor of diabetes in a dose-response fashion. Cases were 4.6 times (95% CI = 3.8, 5.6) more likely than non-cases to be in the upper tertile of WHR and 2.2 times (95% CI = 1.8, 2.7) more likely to be in the middle tertile. Women in the highest tertiles of both WHR and BMI had a 14.4-fold (95% CI = 9.5, 21.9) higher risk of diabetes than women in the lowest tertiles. These results demonstrate that increased abdominal adiposity is a significant independent risk factor for the development of diabetes mellitus in older women.     

The influence of body fat content and bone diameter measurements on body dissatisfaction in adult women

This study investigated the simultaneous influence of various anthropometric factors on body dissatisfaction in adult women while controlling for psychological and behavioral factors known to covary with it. Multiple regression analyses confirmed that neu-rotidsm, skeletal frame size, and percent body fat were positively, and age and physical activity inversely, related to dissatisfaction. Subsequent analyses substituted separate bone diameter measurements in place of the composite frame size variable and found that hip diameter, correcting for fatness, was a more salient factor in the determination of body dissatisfaction than the more general estimate of frame size. In pursuit of the perfect ultra-slender body women are encouraged to diet and exercise for weight loss more than ever before. It appears, however, that anatomical factors that are resistant to change by caloric restriction or physical activity, are a significant influence in the degree to which women report discontent with their body shape. © 1994 by John Wiley & Sons, Inc.     

Changes in body weight and body fat distribution as risk factors for clinical diabetes in US men

Although previous studies have linked obesity to diabetes, the risks associated with weight gain or changes in body fat distribution have not been fully elucidated. The authors therefore prospectively examined the relations between changes in body weight and body fat distribution (1986-1996) and the subsequent risk of diabetes (1996-2000) among 22,171 men in the Health Professionals Follow-up Study. Weight gain was monotonically related to risk, and for every kilogram of weight gained, risk increased by 7.3%. A gain in abdominal fat was positively associated with risk, independent of the risk associated with weight change. Compared with men who had a stable waist, men who increased waist circumference by 14.6 cm or more had 1.7 (95% confidence interval: 1.0, 2.8) times the risk of diabetes after controlling for weight gain. In contrast, men who lost more than 4.1 cm in hip girth had 1.5 (95% confidence interval: 1.0, 2.3) times the risk of diabetes compared with men with stable hip circumference. Fifty-six percent of the cases of diabetes in this cohort could be attributed to weight gain greater than 7 kg, and 20 percent of the cases could be attributed to a waist gain exceeding 2.5 cm. Our findings underscore the critical importance of maintaining weight and waist to reduce the risk of diabetes.     

Measures of adiposity and body fat distribution in relation to serum folate levels in postmenopausal women in a feeding study

OBJECTIVE: To assess the associations between serum folate concentration and measures of adiposity in postmenopausal women. DESIGN: This study was conducted as a cross-sectional analysis within the control segment of a randomized, crossover trial in which postmenopausal women (n=51) consumed 0 g (control), 15 g (one drink) and 30 g (two drinks) alcohol (ethanol)/day for 8 weeks as part of a controlled diet. Subjects in one treatment arm were crossed-over to another arm after a 2- to 5-week washout period. Body mass index (BMI) was measured, and dual energy X-ray absorptiometry (DEXA) scan administered to the women during the control (0 g alcohol) treatment, and a blood sample from this group was collected at baseline and week 8 of each diet period and analyzed for folate, B12, homocysteine and methylmalonic acid. SETTING: This study was conducted at the Beltsville Human Nutrition Research Center, MD, USA. RESULTS: In multivariate analysis, women who were overweight had a 12% lower, and obese women had a 22% lower serum folate concentrations compared to normal weight women (P-trend=0.02). Vitamin B12 also decreased with increasing BMI (P-trend=0.08). Increased BMI, percent body fat, and absolute amounts of central and peripheral fat were all significantly associated with decreased serum folate, but were unrelated to serum B12, homocysteine or methylmalonic acid. CONCLUSIONS: Our data show that adiposity is associated with lower serum folate levels in postmenopausal women. With obesity at epidemic proportions, these data, if confirmed by prospective or randomized controlled studies, have important public health implications.     

Glycemic index and glycemic load in relation to changes in body weight, body fat distribution, and body composition in adult Danes

BACKGROUND: A diet with a high glycemic index (GI) and glycemic load (GL) may promote overconsumption of energy and increase the risk of weight gain. OBJECTIVE: The objective of the study was to investigate the relation between GI and GL of habitual diets and subsequent 6-y changes in body weight, body fat distribution, and body composition in a random group of adult Danes. DESIGN: A prospective cohort study was conducted in a subsample of men and women from the Danish arm of the Monitoring Trends and Determinants in Cardiovascular Disease study. The subsample comprised 185 men and 191 women born in 1922, 1932, 1942, or 1952. A baseline health examination and a dietary history interview were carried out in 1987 and 1988; a follow-up health examination was performed in 1993 and 1994. RESULTS: Positive associations between GI and changes in body weight (DeltaBW), percentage body fat (Delta%BF), and waist circumference (DeltaWC) were observed in women after adjustment for covariates. Significant GI x sex x physical activity interactions for DeltaBW, Delta%BF, and DeltaWC were observed, and the associations in the sedentary women were particularly positive. No significant associations with GI were observed in men, and no significant associations with GL were observed in either sex. CONCLUSIONS: High-GI diets may lead to increases in BW, body fat mass, and WC in women, especially in sedentary women, which suggests that physical activity may protect against diet-induced weight gain. No associations with GI were observed in men, which suggests sex differences in the association between GI and obesity development.     

Increased body fat percentage and physical inactivity are independent predictors of gestational diabetes mellitus in South Asian women

OBJECTIVE: This study aims to identify lifestyle predictors of gestational diabetes mellitus (GDM) in South Asian women. Pre-gravid body mass index, body composition, rate of weight gain during pregnancy, physical activity (PA) and dietary intake were studied. DESIGN: Prospective cohort study (n=611) of South Asian women at Aga Khan University Hospital antenatal clinic in Karachi, Pakistan. Weight, height and body fat % were measured and data on PA, diet and socio-economic covariates were collected at baseline. A glucose screen was performed at 29.8+/-2.6 weeks. RESULTS: Using logistic regression analysis for the full cohort, the risk of GDM increased with older maternal age (odds ratio (OR) 1.13, confidence interval (CI) 1.06-1.21), increased body fat % (OR 1.07, CI 1.03-1.13) and the risk was inversely associated with PA (100 kcal) (OR 0.79-0.99, CI 0.89). Using a nested case (n=49) control (n=98) design to study dietary intake, the risk of GDM decreased with increasing protein (% energy) in the diet (OR 0.75, CI 0.60-0.95). CONCLUSIONS: Body fat %, physical inactivity and, possibly, diet quality are important modifiable risk factors for GDM. 2006.     

老年人体质量指数、体脂总量及分布与血脂异常的相关性

目的 观察老年人体质量指数、总体脂肪及分布与血脂异常的相关性.方法 连续定点抽取2013年10月至2014年3月在北京协和医院接受年度体检的395名健康老年人进行调查.采用多频生物电阻抗测定体质量、总体脂肪(TBF)、腹部脂肪(AF)、内脏脂肪(VF)、内脏脂肪面积(VFA)和腰臀围比值(WHR),并测定血清三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C).分析体质量指数(BMI)、TBF及分布与血脂异常的相关性.结果 老年男性肥胖(17.8％比9.6％,P=0.036)、超重(49.6％比30.4％,P=0.000)和血脂异常(67.0％比44.8％,P=0.000)发生率均显著高于女性.女性表现为TBF％显著增高(60.0％比41.1％,P=0.001).TC分别与TBF (P =0.020)、AF (P =0.018)、VF (P=0.015)和VFA (P =0.017)呈正相关;TG分别与BMI(P=0.000)、TBF(P=0.000)、WHR(P=0.000)、AF(P=0.000)、VF (P =0.000)和VFA (P=0.000)呈正相关;LDL-C分别与BMI (P =0.049)、TBF (P =0.005)、AF(P=0.004)、VF (P=0.003)和VFA (P=0.004)呈正相关,而HDL-C分别与BMI(P=0.000)、TBF(P=0.020)、WHR(P=0.000)、AF (P=0.021)、VF (P=0.024)和VFA (P=0.022)呈负相关.BMI、TBF、WHR、AF、VF和VFA预测血脂异常风险的受试者工作特征曲线均在参考线上方.超重和肥胖组TBF(P=0.000)、WHR(P=0.000)、AF (P=0.000)、VF (P=0.000)、VFA (P=0.000)、TG (P =0.000)和LDL-C(女性:P=0.021)均显著高于体质量正常组.结论 肥胖/超重和体脂总量超标及腰围增大,可增加老年人血脂异常的发生风险.     

妊娠期糖尿病孕妇体重指数与围产结局的关系

目的 观察妊娠期糖尿病孕妇体重指数(BMI)对围产结局的影响.方法 合并妊娠期糖尿病孕妇149例,依照BMI范围分为正常组(18.5≤BMI ＜25)、过重组(25≤BMI＜ 28)及肥胖组(28≤BMI ＜32);比较各组一般资料、BMI、空腹血糖及围产结局的差异性,分析BMI对不良围产结局的预测价值.结果 各组孕产妇的妊娠次数、生产次数、流产情况及孕周等一般资料差异无统计学意义(P＞0.05);子痫前期发生率的组间差异无统计学意义(P＞0.05),羊水过多、胎膜早破、胎儿窘迫及早产的组间差异均有统计学意义(P＜0.05);妊娠期间,各组患者血糖值差异有统计学意义(P＜0.05).简单线性回归分析表明,入院时、妊娠中晚期的血糖值和BMI均呈正相关性(R2=0.3996、0.443、0.4914,均P＜0.05).本组新生儿的主要并发症为巨大儿、新生儿窒息、低血糖、高胆红素及湿肺,各项并发症的组间差异均有统计学意义(P＜0.05).结论 妊娠期糖尿病孕产妇BMI水平与血糖成正相关,对孕期并发症有重要影响,能够从一定程度上预测不良围产结局.     

Relationship of obesity to diabetes: influence of obesity level and body fat distribution

The relationship of clinical diabetes to body fat distribution and obesity level was examined in 15,532 women. After adjusting for relative weight, all upper body segment girth measurements (neck, bust, and waist) had strong positive associations with diabetes. In contrast, the lower body segment girth measurement (hips) had an equally strong but inverse association with diabetes. Based upon waist-to-hip girth ratio, women were divided into four subgroups. The prevalence of diabetes increased with increasing values of this ratio. Women in the upper quartile had about three times the prevalence of diabetes as women of comparable obesity level in the lowest quartile. Women with both upper body fat predominance and severe obesity had a relative risk of diabetes 10.3 times as great as nonobese subjects with lower body fat predominance. The results suggest that localization of fat in the upper body segment and severe obesity are two distinct additive risks for diabetes.     

Influence of body size and body fat distribution on risk of uterine leiomyomata in U.S. black women

BACKGROUND: Uterine leiomyomata are a major source of morbidity in black women. We prospectively investigated the risk of self-reported uterine leiomyomata in relation to body mass index (BMI), weight change, height, waist and hip circumferences, and waist-to-hip ratio in a large cohort of U.S black women. METHODS: Data were derived from the Black Women's Health Study, a U.S. prospective cohort study of black women who complete biannual mailed health questionnaires. From 1997 through 2001, we followed 21,506 premenopausal women with intact uteri and no prior diagnosis of uterine leiomyomata. Cox regression models were used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs). RESULTS: After 70,345 person-years of follow up, 2146 new cases of uterine leiomyomata confirmed by ultrasound (n = 1885) or hysterectomy (n = 261) were self-reported. Compared with the thinnest women (BMI <20.0 kg/m), the multivariate IRRs for women with BMIs of 20.0-22.4, 22.5-24.9, 25.0-27.4, 27.5-29.9, 30.0-32.4, and 32.5+ kg/m were 1.34 (95% CI = 1.02-1.75), 1.39 (1.07-1.81), 1.45 (1.12-1.89), 1.47 (1.11-1.93), 1.36 (1.02-1.80), and 1.21 (0.93-1.58), respectively. IRRs were larger among parous women. Weight gain since age 18 was positively associated with risk, but only among parous women. No other anthropometric measures were associated with risk. CONCLUSIONS: BMI and weight gain exhibited a complex relation with risk of uterine leiomyomata in the Black Women's Health Study. The BMI association was inverse J-shaped and findings were stronger in parous women. Weight gain was positively associated with risk among parous women only.