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Adipose tissue, the skeleton and cardiovascular disease
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Cardiovascular disease (CVD) is the leading cause of death in the Western World, although the incidence of myocardial infarction (MI) has declined over the last decades. However, obesity, which is one of the most important risk factors for CVD, is increasingly common. Osteoporosis is also on the rise because of an aging population. Based on considerable overlap in the prevalence of CVD and osteoporosis, a shared etiology has been proposed. Furthermore, the possibility of interplay between the skeleton and adipose tissue has received increasing attention the last few years with the discovery that leptin can influence bone metabolism and that osteocalcin can influence adipose tissue.

A main aim of this thesis was to investigate the effects of fat mass distribution and bone mineral density on the risk of MI. Using dual-energy x-ray absorptiometry (DEXA) we measured 592 men and women for regional fat mass in study I. In study II this was expanded to include 3258 men and women. In study III 6872 men and women had their bone mineral density measured in the total hip and femoral neck using DEXA. We found that a fat mass distribution with a higher proportion of abdominal fat mass was associated with both an adverse risk factor profile and an increased risk of MI. In contrast, a higher gynoid fat mass distribution was associated with a more favorable risk factor profile and a decreased risk of MI, highlighting the different properties of abdominal and gynoid fat depots (study I-II). In study III, we investigated the association of bone mineral density and risk factors shared between CVD and osteoporosis, and risk of MI. We found that lower bone mineral density was associated with hypertension, and also tended to be associated to other CVD risk factors. Low bone mineral density was associated with an increased risk of MI in both men and women, apparently independently of the risk factors studied (study III).

In study IV, we investigated 50 healthy, young men to determine if a high-impact loading intervention in the form of a series of jumps would lead to changes in glucose and lipid metabolism. We found that the intervention group had significantly lowered serum glucose levels compared to the control group. Changes in all metabolic parameters favored the intervention group with an increase in lipolysis from baseline and a decrease in cholesterol.

In summary, the proportion of abdominal and gynoid fat mass displayed contrasting associations to both CVD risk factors and MI risk. Abdominal fat mass was associated with a higher risk while a high proportion of gynoid fat mass was associated with a lower risk. Bone mineral density displayed an inverse association with MI risk, seemingly independently of CVD risk factors, suggesting other explanations to a shared pathogenesis. Finally, high impact loading on the skeleton in young, healthy men decreased serum glucose levels and tended to improve other metabolic parameters, suggesting that the skeleton can affect energy metabolism.

Place, publisher, year, edition, pages
Umeå: Umeå university , 2011. , 87 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1417
Keyword [en]
Men, women, regional fat mass, bone mineral density, myocardial infarction, osteocalcin, high impact, longitudinal
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-42083ISBN: 978-91-7459-186-6OAI: oai:DiVA.org:umu-42083DiVA: diva2:409328
Public defence
2011-04-29, Aulan, Vårdvetarhuset, Umeå Universitet, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2011-04-08 Created: 2011-04-05 Last updated: 2011-04-08Bibliographically approved
List of papers
1. Abdominal and gynoid fat mass are associated with cardiovascular risk factors in men and women
Open this publication in new window or tab >>Abdominal and gynoid fat mass are associated with cardiovascular risk factors in men and women
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2008 (English)In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 93, no 11, 4360-4366 p.Article in journal (Refereed) Published
Abstract [en]

CONTEXT: Abdominal obesity is an established risk factor for cardiovascular disease (CVD). However, the correlation of dual-energy x-ray absorptiometry (DEXA) measurements of regional fat mass with CVD risk factors has not been completely investigated.

OBJECTIVE: The aim of this study was to investigate the association of estimated regional fat mass, measured with DEXA and CVD risk factors.

DESIGN, SETTING, AND PARTICIPANTS: This was a cross-sectional study of 175 men and 417 women. DEXA measurements of regional fat mass were performed on all subjects, who subsequently participated in a community intervention program.

MAIN OUTCOME MEASURES: Outcome measures included impaired glucose tolerance, hypercholesterolemia, hypertriglyceridemia, and hypertension. RESULTS: We began by assessing the associations of the adipose measures with the cardiovascular outcomes. After adjustment for confounders, a sd unit increase in abdominal fat mass was the strongest predictor of most cardiovascular variables in men [odds ratio (OR)=2.63-3.37; P<0.05], whereas the ratio of abdominal to gynoid fat mass was the strongest predictor in women (OR=1.48-2.19; P<0.05). Gynoid fat mass was positively associated with impaired glucose tolerance, hypertriglyceridemia, and hypertension in men (OR=2.07-2.15; P<0.05), whereas the ratio of gynoid to total fat mass showed a negative association with hypertriglyceridemia and hypertension (OR=0.42-0.62; P<0.005).

CONCLUSIONS: Abdominal fat mass is strongly independently associated with CVD risk factors in the present study. In contrast, gynoid fat mass was positively associated, whereas the ratio of gynoid to total fat mass was negatively associated with risk factors for CVD.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-19088 (URN)10.1210/jc.2008-0804 (DOI)18728169 (PubMedID)
Available from: 2009-03-04 Created: 2009-03-04 Last updated: 2015-04-29Bibliographically approved
2. Abdominal and gynoid adipose distribution and incident myocardial infarction in women and men
Open this publication in new window or tab >>Abdominal and gynoid adipose distribution and incident myocardial infarction in women and men
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2010 (English)In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 34, no 12, 1752-1758 p.Article in journal (Refereed) Published
Abstract [en]

In summary, fat distribution was a strong predictor of the risk of MI in women, but not in men. These different results may be explained by the associations found between fat distribution and hypertension, impaired glucose tolerance and hypertriglyceridemia.

Keyword
abdominal fat; myocardial infarction; risk; men; women
National Category
Family Medicine
Identifiers
urn:nbn:se:umu:diva-40854 (URN)10.1038/ijo.2010.102 (DOI)000285242900009 ()20498655 (PubMedID)
Available from: 2011-03-11 Created: 2011-03-11 Last updated: 2015-04-22Bibliographically approved
3. Low bone mineral density is associated with increased risk for myocardial infarction in men and women
Open this publication in new window or tab >>Low bone mineral density is associated with increased risk for myocardial infarction in men and women
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2012 (English)In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 23, no 3, 963-970 p.Article in journal (Refereed) Published
Abstract [en]

Summary The association between bone mineral density (BMD) and myocardial infarction (MI) was investigated in 6872 men and women. For both men and women lower BMD in the femoral neck and hip was associated with increased risk of MI largely independent of smoking, hypertension, hypertriglyceridemia and diabetes.

Purpose The relationship between bone mineral density (BMD) and cardiovascular disease isn’t completely understood. The objective of this prospective study was to investigate the risk of myocardial infarction (MI) in relation to bone mineral density and to determine if cardiovascular risk factors could explain this association.

Methods Dual X-ray absorptiometry (DEXA) was performed in 5490 women and 1382 men to determine total hip and femoral neck bone mineral density (BMD, g/cm²) and estimate femoral neck volumetric BMD (vBMD, g/cm³) . During a mean follow-up time of 5.7 years 117 women and 79 men suffered an initial MI.

Results After adjustment for age and BMI, lower BMD of the femoral neck and total hip was associated with increased risk of MI for both women (hazard ratio (HR)=1.33, 95% confidence interval (CI): 1.08-1.66 per standard deviation (SD) decrease in femoral neck BMD) and men (HR=1.74, 95% CI: 1.34-2.28 per SD decrease in total hip BMD). After additional adjustment for smoking, hypertension, hypertriglyceridemia and diabetes the associations were slightly attenuated in men (HR=1.42-1.88 in the age and BMI-adjusted model versus 1.33-1.77 in the fully adjusted model) while similar attenuations were seen in women (HR=1.06-1.25 versus 1.05-1.22).

Conclusion Lower BMD was associated with an increase in MI risk for both men and women. Women had consistently lower HRs compared to men in all models. Adjusting for smoking, hypertension, hypertriglyceridemia and diabetes did not distinctively weaken these associations.

Place, publisher, year, edition, pages
London: Springer, 2012
Keyword
Bone density, Myocardial infarction, Cohort study, Men, Women
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-42506 (URN)10.1007/s00198-011-1631-0 (DOI)
Available from: 2011-04-08 Created: 2011-04-08 Last updated: 2015-04-29Bibliographically approved
4. High impact loading on the skeleton is associated with a decrease in glucose levels in young men
Open this publication in new window or tab >>High impact loading on the skeleton is associated with a decrease in glucose levels in young men
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2012 (English)In: Clinical Endocrinology, ISSN 0300-0664, E-ISSN 1365-2265, Vol. 77, no 6, 823-827 p.Article in journal (Refereed) Published
Abstract [en]

Objective The skeleton has been suggested to be involved in energy metabolism through osteocalcin (OC), an osteoblast-specific molecule. The objective of this study was to investigate whether high impact exercise stimulating bone formation would lead to changes in glucose and lipid metabolism independent of cardiorespiratory effects, and if OC mediates this association.

Design Prospective intervention study.

Methods Fifty men aged 20-32 years were allocated to an intervention group or a control group. The intervention group completed six different types of jumps in sets of five, with the frequency of these exercises gradually increasing over 8 weeks. At baseline and after 8 weeks, glycerol concentrations were measured in fat tissue as a marker of lipolysis by using microdialysis. Blood samples were assayed for OC and markers of glucose and lipid metabolism. Physical activity was measured using an accelerometer.

Results After adjustment for confounders at baseline and changes in physical activity during the intervention period, the intervention was associated with a decrease in levels of glucose (p = 0.04), adrenalin (p = 0.03) and OC (p=0.04) after adjusting for baseline levels and changes in physical activity. No other differences between the groups were significant, although the trends of the metabolic variables favored the intervention group.

Conclusions The results of this study suggest that high impact loading on the skeleton may affect glucose metabolism independent of the level of aerobic exercise.

Place, publisher, year, edition, pages
Blackwell Publishing, 2012
Keyword
High impact loading, skeleton, osteocalcin, glucose
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-42508 (URN)10.1111/j.1365-2265.2012.04461.x (DOI)
Available from: 2011-04-08 Created: 2011-04-08 Last updated: 2013-03-19Bibliographically approved

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