Relation of generalized and central obesity to cardiovascular risk factors and prevalent coronary heart disease in a sample of American Indians: the Strong Heart Study

Associations of pedometer-measured ambulatory activity with incidence of atherosclerotic cardiovascular diseases: Strong heart family study

OBJECTIVE

Coronary heart disease has several risk factors that require a multifactorial community intervention approach in prevention efforts. Prevalence of coronary heart disease and its risk factors have been disproportionately high among American Indians. The objective of this study is to evaluate the impact of ambulatory activity levels on the development of coronary heart disease in this population.

METHODS

Using pedometer data and other lifestyle and clinical factors from 2492 participants in the Strong Heart Family Study, we examined the associations of average daily step counts with incident coronary heart disease during an 18 to 20 year follow-up.

RESULTS

After adjusting for potential confounders, participants with daily step counts in the 4th quartile (>7282 steps per day) had significantly lower odds of developing coronary heart disease compared to those in the 1st quartile (<3010 steps per day) (p = 0.035).

CONCLUSIONS

Higher daily step count (over 7282 steps per day) is significantly associated with lower incidence of coronary heart disease among American Indian participants of the Strong Heart Family Study in a 20-year follow-up period.

Associations of Binge Drinking With Vascular Brain Injury and Atrophy in Older American Indians: The Strong Heart Study

Objectives: American Indians (AIs) generally consume less alcohol than the US general population; however, the prevalence of alcohol use disorder is higher. This is the first large cohort study to examine binge drinking as a risk factor for vascular brain injury (VBI). Methods: We used linear and Poisson regression to examine the association of self-reported binge drinking with VBI, measured via magnetic resonance imaging (MRI), in 817 older AIs who participated in the Strong Heart and Cerebrovascular Disease and Its Consequences in American Indians studies. Results: Any binge drinking at multiple time-points was associated with increased sulcal (β = 0.360, 95% CI [0.079, 0.641]) and ventricle dilatation (β = 0.512, 95% CI [0.174, 0.850]) compared to no binge drinking. Discussion: These observed associations are consistent with previous findings. Identifying how binge drinking may contribute to VBI in older AIs may suggest modifiable health behaviors for neurological risk reduction and disease prevention.

Assessment of the Correlation between Severity of Coronary Artery Disease and Waist-Hip Ratio

AIM:

This study was conducted to investigate the correlation between waist/hip ratio (WHR) as a measurement of obesity and severity of coronary artery disease (CAD) assessed by angiography in Kosovo.

METHODS:

The study included 82 patients with suspected or known CAD who were referred for coronary angiography. All patients were subjected to full individual medical history, clinical examination including measurement of arterial blood pressure, body weight, height, body mass index (BMI), waist circumference, hip circumference, waist/hip ratio, and waist/height ratio. Coronary angiography was performed using standard techniques to determine the presence and severity of coronary artery lesions with the Gensini score.

RESULTS:

Among the 82 patients in the study, the mean age in the CAD group was 66.76 ± 9.12 years and the mean age in the non-CAD group was 64.80 ± 8.30 years. Patients in the CAD group had a mean BMI of 28.17 ± 3.32 kg/m² and those in the non-CAD group had a mean BMI of 28.76 ± 4.68 kg/m². Patients in the CAD group had a mean waist/height ratio of 1.76 ± 7.56 and those in the non-CAD group had a mean waist/height ratio of 0.57 ± 0.08. Patient in the CAD group had a mean waist/hip ratio of 0.93 ± 0.06 and those in the non-CAD group had a mean waist/hip ratio of 0.88 ± 0.07. Thirty-seven patients (45.1%) had no coronary artery disease (Gensini score = 0), 15 (18.3%) had mild disease (Gensini score = 1-32), 14 (17.1%) had moderate disease (Gensini score = 32-58), and 16 (19.5%) had severe disease (Gensini score ≥ 58).

CONCLUSION:

There was a significant positive correlation between waist/hip ratio and presence of CAD in Kosovar patients.

Relationship between obesity and coronary heart disease among urban Bangladeshi men and women

The aim of the study was to examine the association of different measures of obesity (body mass index or BMI, waist circumference or WC, waist to hip ratio or WHR and waist height ratio or WHtR) with coronary heart disease (CHD) in a Bangladeshi population. The study included 189 hospitalized CHD cases (133 men and 52 women) and 201 controls (137 men and 68 women). Logistic regression was done to assess the associations between obesity and CHD. The mean age was 53.1 ± 8.3 for men and 51.9 ± 8.4 for women. After adjustment for confounders the odds ratio (OR) of CHD for men was 1.69 (95% CI, 1.24-2.32), 1.94 (95% CI 1.40-2.70), and 1.32 (95% CI, 1.01-2.16) per 1 standard deviation (SD) increase in BMI, WC, and WHtR respectively. The OR for women was 2.64 (CI, 1.61-4.34), 1.82 (95% CI 1.12-2.95), 2.32 (95% CI, 1.36-3.96), and 1.94 (95% CI, 1.23-3.07) per 1 SD increase in BMI, WC, WHtR and WHR respectively. Since both total obesity and abdominal adiposity were associated with development of CHD and since measurement of WC and BMI are inexpensive, both should be included in the clinical setting for CHD risk assessment for this group of population.

Adult obesity: panel study from native Amazonians

This paper examines three morphological indicators measuring obesity among a native Amazonian population of foragers-farmers in Bolivia (Tsimane') and estimates the associations between them and standard covariates of obesity (e.g., socioeconomic status [SES]). We collected annual data from 350 non-pregnant women and 385 men ≥20 years of age from all 311 households in 13 villages during five consecutive years (2002-2006). We used three indicators to measure obesity: body-mass index (BMI), waist circumference (WC), and body fat using bioelectrical impedance analysis (BF-BIA). We ran separate individual random-effect panel multiple regressions for women and men with wealth, acculturation, health, and household food availability as key covariates, and controlled for village and year fixed effects and village×year interaction effects. Although BMI increases by a statistically significant annual growth rate of 0.64% among women and 0.37% among men over the five years, the increase does not yield significant biological meanings. Neither do we find consistent and biologically meaningful covariates associated with adult obesity.

Household cardiovascular screening in adolescents from high-risk families

BACKGROUND

Some cardiovascular risk factors identified in adults are already present in many children.

OBJECTIVE

To identify adolescents that are at risk for developing cardiovascular disease based on the presence of risk factors in their parents and their own lipid profiles, fasting plasma glucose, and blood pressure.

METHODS

182 families were selected. The adolescents were divided into two groups: group I consisted of adolescents from high-risk families and group II consisted of adolescents from healthy families.

RESULTS

For total cholesterol (TC), group I presented higher values when compared to group II (153.2 ± 26.5 mg/dL and 138.3 ± 22.0 mg/dL, respectively; p = 0.001). For low-density lipoprotein cholesterol (LDL-C), group I had higher values when compared to group II (80.2 ± 24.8 mg/dL and 62.6 ± 12.3 mg/dL, respectively; p = 0.001). For high-density lipoprotein cholesterol (HDL-C), group I had lower values when compared to group II (53.8 ± 12.3 mg/dL and 63.9 ± 13.4 mg/dL, respectively; p = 0.001). For the values of triglycerides (TG), group I presented higher values when compared to group II (86.98 ± 42.84 mg/dL and 72.50 ± 33.24 mg/dL, respectively; p = 0.014). And for fasting plasma glucose, group I had higher values when compared to group II (81.8 ± 13.2 mg/dL and 77.0 ± 9.7 mg/dL, respectively; p = 0.039). Systolic blood pressure, diastolic blood pressure, and high-sensitivity C - reactive protein did not differ between groups.

CONCLUSIONS

Adolescents from high-risk families had higher basal levels of TC, LDL-C, TG, and fasting plasma glucose and lower basal levels of HDL-C. Whether these findings will influence the development of cardiovascular risk factors or diseases in these subjects should be investigated in future studies.

The burden of cancer risk in Canada's indigenous population: a comparative study of known risks in a Canadian region

BACKGROUND

Canadian First Nations, the largest of the Aboriginal groups in Canada, have had lower cancer incidence and mortality rates than non-Aboriginal populations in the past. This pattern is changing with increased life expectancy, a growing population, and a poor social environment that influences risk behaviors, metabolic conditions, and disparities in screening uptake. These factors alone do not fully explain differences in cancer risk between populations, as genetic susceptibility and environmental factors also have significant influence. However, genetics and environment are difficult to modify. This study compared modifiable behavioral risk factors and metabolic-associated conditions for men and women, and cancer screening practices of women, between First Nations living on-reserve and a non-First Nations Manitoba rural population (Canada).

METHODS

The study used data from the Canadian Community Health Survey and the Manitoba First Nations Regional Longitudinal Health Survey to examine smoking, binge drinking, metabolic conditions, physical activity, fruit/vegetable consumption, and cancer-screening practices.

RESULTS

First Nations on-reserve had significantly higher rates of smoking (P < 0.001), binge drinking (P < 0.001), obesity (P < 0.001) and diabetes (P < 0.001), and less leisure-time physical activity (P = 0.029), and consumption of fruits and vegetables (P < 0.001). Sex differences were also apparent. In addition, First Nations women reported significantly less uptake of mammography screening (P < 0.001) but similar rates for cervical cancer screening.

CONCLUSIONS

Based on the findings of this retrospective study, the future cancer burden is expected to be high in the First Nations on-reserve population. Interventions, utilizing existing and new health and social authorities, and long-term institutional partnerships, are required to combat cancer risk disparities, while governments address economic disparities.

Incidence rates and predictors of diabetes in those with prediabetes: the Strong Heart Study

BACKGROUND

The association between prediabetes as currently defined and incident diabetes in populations with widespread obesity, insulin resistance syndrome, and diabetes is not well defined. In this article, diabetes risk factors and incidence rates in American Indians (AI) with prediabetes are examined.

METHODS

A total of 1677 AI who were nondiabetic at baseline was examined during a median 7.8-year follow-up as part of the Strong Heart Study (SHS). Risk factors for incident diabetes were measured. Prediabetes was defined according to American Diabetes Association 2003 criteria as having impaired glucose tolerance (IGT) (2-h plasma glucose [2-h PG] >or= 140 mg/dL but < 200 mg/dL) and/or impaired fasting glucose (IFG) (fasting plasma glucose [FPG] >or= 100 mg/dL but < 126 mg/dL).

RESULTS

Prediabetes was identified by FPG alone in 87.5%. Diabetes incidence in those with baseline prediabetes was 66.1/1000 person-years, with a hazard ratio (HR) of 2.35 (95% conference interval: 1.84-3.01), compared with participants with normal glucose tolerance (NGT) at baseline. Elevated A(1c), 2-h PG, and fasting insulin (FI); albuminuria; and obesity were significantly associated with conversion from prediabetes to diabetes. Younger age, elevated FI (or body mass index [BMI] in models without FI), and less physical activity were significantly associated with conversion from NGT.

CONCLUSIONS

Prediabetes is an independent predictor of conversion to type 2 diabetes in AI, and most can be identified through a fasting glucose measure. Measures of obesity, A(1c), FPG, 2-h PG, FI, albuminuria, and insulin resistance (IR) help predict this conversion. Obesity is a modifiable risk factor. Strategies to reduce obesity should be emphasized in individuals with prediabetes.

Effect of birth weight and postnatal weight gain on body composition in early infancy: The Generation R Study

BACKGROUND

Rapid postnatal weight gain is associated with obesity and type 2 diabetes in later life. The influence of rapid weight gain on body composition in early infancy is still unknown and the critical periods of weight gain for later disease are debated.

AIMS

To investigate the effect of birth weight and rapid weight gain on body composition in the first 6 months of life.

STUDY DESIGN

The Generation R Study, a population-based prospective cohort study from fetal life onwards.

SUBJECTS AND OUTCOME MEASURES

We measured body fat and fat distribution by skinfold thickness at the age of 6 weeks and 6 months in 909 Dutch term infants. Analyses were adjusted for current body mass index, sex and maternal socioeconomic status, pre-pregnancy body mass index, height and duration of breastfeeding.

RESULTS

Upward postnatal weight percentile change was associated with increased skinfold thickness, percentage body fat at 6 weeks and 6 months and a larger truncal/peripheral fat ratio at 6 months (p<0.01 for all). Birth weight was inversely associated with truncal/peripheral fat ratio (p<0.01) but not with relative body fat at 6 months.

CONCLUSION

During early postnatal rapid weight gain infants do not grow in all body tissues in equal measure. Instead, they acquire relatively large amounts of fat, which is preferentially distributed to the truncal region. Long term observational studies have to assess if such changes in body composition persist into adulthood.

Visceral adipose tissue accumulation differs according to ethnic background: results of the Multicultural Community Health Assessment Trial (M-CHAT)

BACKGROUND

It was suggested that body fat distribution differs across ethnic groups, and this may be important when considering risk of disease. Previous studies have not adequately investigated differences in discrete regions of abdominal adiposity across ethnic groups.

OBJECTIVE

We compared the relation between abdominal adipose tissue and total body fat between persons living in Canada of Aboriginal, Chinese, and South Asian origin with persons of European origin.

DESIGN

Healthy Aboriginal, Chinese, European, and South Asian participants (n = 822) aged between 30 and 65 y were matched by sex, ethnicity, and body mass index (BMI; in kg/m(2)) range. Total abdominal adipose tissue (TAT), subcutaneous abdominal adipose tissue (SAT), visceral adipose tissue (VAT), total body fat mass, lifestyle, and demographics were assessed. Relations between BMI and total body fat, TAT, SAT, and VAT and between total body fat and TAT, SAT, and VAT were investigated.

RESULTS

BMI significantly underestimated VAT in all non-European groups. Throughout a range of total body fat mass, VAT was not significantly different between the Aboriginals and the Europeans. With total body fat >9.1 kg, Chinese participants had increasingly greater amounts of VAT than did the Europeans (P for interaction = 0.008). South Asians had less VAT with total body fat >37.4 kg but more VAT below that amount than did Europeans (P for interaction < 0.001).

CONCLUSION

Compared with Europeans, the Chinese and South Asian cohorts had a relatively greater amount of abdominal adipose tissue, and this difference was more pronounced with VAT. No significant differences were observed between the Aboriginals and the Europeans.

A novel obesity locus on chromosome 4q: the Strong Heart Family Study

OBJECTIVE

Obesity is a growing and important public health problem in Western countries and worldwide. There is ample evidence that both environmental and genetic factors influence the risk of developing obesity. Although a number of genes influencing obesity and obesity-related measures have been localized, it is clear that others remain to be identified. The rate of obesity is particularly high in American Indian populations. This study reports the results of a genome-wide scan for loci influencing BMI and weight in 963 individuals in 58 families from three American Indian populations in Arizona, Oklahoma, and North and South Dakota participating in the Strong Heart Family Study.

RESEARCH METHODS AND PROCEDURES

Short tandem repeat markers were genotyped, resulting in a marker map with an average spacing of 10 centimorgans. Standard multipoint variance component linkage methods were used.

RESULTS

Significant evidence of linkage was observed in the overall sample, including all three study sites, for a locus on chromosome 4q35 [logarithm of the odds (LOD)=5.17 for weight, 5.08 for BMI]. Analyses of the three study sites individually showed that the greatest linkage support for the chromosome 4 locus came from Arizona (LOD=2.6 for BMI), but that LOD scores for weight were >1 in all three samples. Suggestive linkage signals (LOD>2) were also observed on chromosomes 5, 7, 8, and 10.

DISCUSSION

The chromosome 4 locus detected in this scan is in a region lacking any obvious positional candidate genes with known functions related to obesity. This locus may represent a novel obesity gene.

The Association of Subclinical Coronary Atherosclerosis With Abdominal and Total Obesity in Asymptomatic Men

The present study assesses and compares the association of waist circumference and body mass index with presence and severity of coronary artery calcium in asymptomatic men. The study population consisted of 451 asymptomatic men free of known coronary heart disease. The subjects were broadly divided into tertiles by waist circumference (< or =92 cm; 92.5-100 cm; > or =101 cm) and body mass index (< or =25.5 kg/m2; 25.6-28.4 kg/m2; > or =28.5 kg/m2), respectively. The risk of coronary artery calcium was two-fold higher among those with a waist circumference in the highest tertile (> or =101 cm) compared with men with waist circumference < or =92 cm. The relationship was found to be independent of body mass index, age, and conventional coronary heart disease risk factors. No significant association of body mass index with coronary artery calcium was observed. Our results are consistent with evidence that measures of central obesity, compared with body mass index, are more strongly related to clinical as well as subclinical coronary heart disease end points.

Clues to Cardiovascular Risk: An Office-Based Approach

Current tools for predicting coronary heart disease risk in the asymptomatic patient fall into 2 major categories: traditional population-based models and noninvasive imaging techniques. Population-based models that estimate cardiovascular risk are powerful clinical tools but do not utilize a large volume of patient-specific data that are readily available to the clinician and may help to identify at-risk patients. The use of high-technology noninvasive imaging has not been consistently validated and clinicians or patients often lack the resources for such testing. This paper reviews several commonly encountered historical, physical, radiologic, laboratory, and electrocardiographic markers of increased cardiovascular risk that may enhance clinicians' ability to identify individual patients at increased risk for coronary heart disease.

Synergistic effects of depressed mood and obesity on long-term cardiovascular risks in 1510 obese men and women: results from the MONICA-KORA Augsburg Cohort Study 1984-1998

OBJECTIVE

To examine the contribution of depressed mood in obese subjects on the prediction of a future coronary heart disease event (CHD).

DESIGN

A prospective population-based cohort study of three independent cross-sectional surveys with 6239 subjects, 45-74 years of age and free of diagnosed CHD, stroke and cancer. During a mean follow-up of 7 years, 179 CHD events occurred among men and 50 events among women.

SUBJECTS

A total of 737 (23%) male and 773 (26%) female subjects suffering from obesity (BMI >or=30 kg/m2).

MEASUREMENTS

Body weight determined by trained medical staff following a standardized protocol; standardized questionnaires to assess subsyndromal depressive mood and other psychosocial features.

RESULTS

The main effect of obesity to predict a future CHD (hazard ratio, HR=1.38, 95% CI 1.03-1.84; P=0.031) and the interaction term of obesity by depression (HR=1.73, 95% CI 0.98-3.05; P=0.060) were borderline significant, both covariate adjusted for multiple risk factors. Relative to the male subgroup with normal body weight and no depression, the male obese group with no depression was not at significantly increased risk for CHD events (HR=1.17, 95% CI 0.76-1.80; P=0.473) whereas CHD risk in males with both obesity and depressed mood was substantially increased (HR=2.32, 95% CI 1.45-3.72, P>0.0001). The findings for women were similar, however, not significant probably owing to lack of power associated with low event rates. Combining obesity and depressed mood resulted in a relative risk to suffer from a future CHD event of HR 1.84 (95% CI 0.79-4.26; P=0.158).

CONCLUSIONS

Depressed mood substantially amplifies the CHD risk of middle-aged obese, but otherwise apparently healthy men. The impact of depression on the obesity risk in women is less pronounced.

Coronary heart disease risk equivalence in diabetes depends on concomitant risk factors

OBJECTIVE

Diabetes has been defined as a coronary heart disease (CHD) risk equivalent, and more aggressive treatment goals have been proposed for diabetic patients.

RESEARCH DESIGN AND METHODS

We studied the influence of single and multiple risk factors on the 10-year cumulative incidence of fatal and nonfatal CHD and cardiovascular disease (CVD) in diabetic and nondiabetic men and women, with and without baseline CHD or CVD, in a population (n = 4,549) with a high prevalence of diabetes.

RESULTS

In both sexes, diabetes increased the risk for CHD (hazard ratio 1.99 and 2.93 for men and women, respectively). Diabetic men and women had a 10-year cumulative incidence of CHD of 25.9 and 19.1%, respectively, compared with 57.4 and 58.4% for nondiabetic men and women with previous CHD. The pattern was similar when only fatal events were considered. Diabetic individuals with one or two risk factors had a 10-year cumulative incidence of CHD that was only 1.4 times higher than that of nondiabetic individuals (14%). However, the 10-year incidence of CHD in diabetic subjects with multiple risk factors was >40%, and the incidence of fatal CHD was higher in these subjects than in nondiabetic subjects with previous CHD. Data for CVD showed similar patterns, as did separate analyses by sex.

CONCLUSIONS

Our results and comparisons with other available data show wide variation in the rate of CHD in diabetes, depending on the population and existing risk factors. Most individuals had a 10-year cumulative incidence >20%, but only those with multiple risk factors had a 10-year cumulative incidence that was equivalent to that of patients with CHD. Until more data are available, it may be prudent to consider targets based on the entire risk factor profile rather than just the presence of diabetes.

Health ramifications of the obesity epidemic

For the first time in human history, the numbers of overweight and underweight individuals are about the same, at 2.1 billion each. Along with the current worldwide obesity epidemic is the explosion of obesity- and overweight-related health problems, including diabetes and the metabolic syndrome, musculoskeletal disorders,cardiovascular disease, pulmonary disorders, and certain forms of cancer. Obesity and overweight account for a significant percentage of overall health care costs and contribute significantly to morbidity and mortality in the United States and around the world.

Obesity and dyslipidemia

The primary dyslipidemia related to obesity is characterized by increased triglycerides, decreased HDL levels, and abnormal LDL composition. Much work has been done to elucidate the pathogenesis of the dyslipidemia of obesity, which seems to be closely related to insulin resistance in obese individuals; however, more studies in humans are needed to further understand the metabolic mechanisms underlying the changes, and to distinguish between the roles of insulin resistance and body fat in the lipoprotein changes. The dyslipidemia associated with obesity no doubt plays a major role in the development of atherosclerosis and CVD in obese individuals. All of the components of the dyslipidemia, including higher triglycerides, decreased HDL levels, and increased small, dense LDL particles, have been shown to be atherogenic. Weight loss and exercise, even if they do not result in normalization of body weight, can improve this dyslipidemia and thus reduce CVD risk. In addition, obese individuals should be targeted for intense lipid-lowering therapy, when necessary.

Obesity in American-Indian children: prevalence, consequences, and prevention

BACKGROUND

American Indians of all ages and both sexes have a high prevalence of obesity. The health risks associated with obesity are numerous and include Type 2 diabetes mellitus, hypertension, dyslipidemia, and respiratory problems. Obesity has become a major health problem in American Indians only in the past few generations and it is believed to be associated with the relative abundance of high-fat, high-calorie foods and the rapid change from active to sedentary lifestyles.

METHODS

The authors reviewed selected literature on prevalence of obesity in American-Indian children, and health consequences of obesity.

RESULTS

Obesity is now one of the most serious public health problems facing American-Indian children, and it has grave implications for the immediate and long-term health of American-Indian youth. Unless this pattern is reversed, American-Indian populations will be burdened by an increased incidence of chronic diseases. Intervention studies are urgently needed in American-Indian communities to develop and test effective strategies for obesity prevention and treatment.

CONCLUSIONS

To be effective, educational and environmental interventions must be developed with full participation of the American-Indian communities.

Risk factor clustering in the insulin resistance syndrome and its relationship to cardiovascular disease in postmenopausal white, black, hispanic, and Asian/Pacific Islander women

The aim of this study was to examine how major components of the insulin resistance (IR) syndrome relate to each other and to cardiovascular disease (CVD) in postmenopausal women in 4 ethnic groups. Baseline data from the Women's Health Initiative (WHI) on 3,083 50- to 79-year-old women (1,635 white, 802 black, 390 Hispanic, and 256 Asian/Pacific Islander) were examined. Participants underwent a personal interview and a physical examination, blood samples were drawn, and a detailed cardiovascular history was ascertained. Factor analysis was used to assess the clustering and interdependence of groups of CVD-related IR syndrome variables. Four factors were identified. An obesity factor included IR in all groups and had a significant association with CVD in white (P =.0001) and Hispanic (P =.0024) women. A dyslipidemia factor (high-density lipoprotein [HDL], triglycerides, and HDL2: total HDL ratio) also included insulin and IR and was significantly correlated with CVD in black (P=.0006) and Hispanic (P =.0217) women and had a borderline association in white women (P =.068). Total and low-density lipoprotein (LDL) cholesterol did not relate to CVD in any group. Blood pressure was related weakly to CVD in white women (P =.0434) and strongly in black women (P =.0095). Components of the IR syndrome appear to be associated with CVD in postmenopausal women, although the magnitude of these relationships differed by ethnicity.

Birth weight, adult body composition, and subcutaneous fat distribution

OBJECTIVES

To investigate if birth weight is related to both body mass index (BMI) and distribution of subcutaneous fat at adult age.

RESEARCH METHODS AND PROCEDURES

A 9-year longitudinal study was performed in 229 subjects (192 women) with ages ranging from 27 to 36 years. Birth weight was retrieved by a questionnaire, and adult weight, height, skinfold thicknesses, and waist-to-hip ratio (WHR) were repeatedly measured at mean ages 27, 29, 31, and 36 years. BMI, sum of four skinfolds (S4S), the ratio between two truncal skinfolds and S4S (SS/S4S), and the ratio between WHR and the cross-sectional area of the left thigh were calculated with the available data.

RESULTS

The adjusted model showed that in women, birth weight was significantly negatively related to adult S4S [beta = -5.211; (-9.768 to -0.654)], waist circumference [beta = -1.449; (-2.829 to -0.069)], and SS/S4S ratio [beta = -3.579; (-5.296 to -1.862)]. In men, a significant negative association was observed between birth weight and adult WHR [beta = -1.096; (-2.092 to -0.100)] only. Other relationships showed, although not significantly, the same negative trend, namely that lower birth weight is related to higher adult body fat mass (S4S) and a more truncal subcutaneous fat distribution (SS/S4S). No associations were found between birth weight and either adult BMI or the cross-sectional area of the thigh.

DISCUSSION

Lower birth weight is, in both adult men and women, related to a higher adult subcutaneous fat mass and a more truncal distribution of subcutaneous fat, indicating a higher risk for obesity.

Relationships of resting energy expenditure with body fat distribution and abdominal fatness in Japanese population

Body fat distribution and abdominal fatness are indicators of risks for coronary heart disease. However, the relationships between resting energy expenditure (REE) and the body fat distribution or the abdominal fatness are unclear. We examined the relationships of REE with whole-body fat distribution (waist, hip and waist-to-hip ratio: WHR) and abdominal fatness (intra-abdominal fat: IF and subcutaneous fat: SF) after adjustment for body composition. 451 men and 471 women were subdivided into two groups, 40-59 years: middle-aged group and 60-79 years: elderly group. REE was measured by an indirect calorimetry system. Percentage of fat mass (%FM), fat mass (FM) and fat-free mass (FFM) were assessed by a dual-energy x-ray absorptiometry method. The IF area (IFA) and SF area (SFA) at the level of the umbilicus were measured using computed tomography. Circumference of waist and hip were measured in a standing position. The WHR, waist circumference and SFA did not significantly (p>0.05) associate with the REE after adjusting for FM, FFM and age in any of the groups. The adjusted REE was significantly and inversely correlated with hip (r=-0.159, p<0.05) and IFA (r=-0.131, p<0.05) in the elderly men. These results suggest that lower REE may contribute to greater hip and IFA rather than WHR and waist in elderly men.