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Body fat distribution, inflammation and cardiovascular disease
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Cardiovascular disease (CVD) is one of the major health issues of our time. The prevalence of CVD is increasing, both in industrialized and in developing countries, and causes suffering and a decreased quality of life for millions of people worldwide. CVD can have multiple etiologies, but the main underlying cause is atherosclerosis, which causes blood clot formation and obstructs vital arteries.

Multiple risk factors of atherosclerosis have been identified, and body fatness is one of the most important ones. 

The main aims of this thesis were to investigate the relation between body fatness and: CVD risk factors (paper I), incident stroke (paper II), and overall mortality (paper III). The results showed that abdominal obesity is strongly associated with both CVD risk factors and stroke incidence (papers I-II). The results also suggested that a substantial part of the association between increased body fat and stroke can be explained by an increase in traditional stroke risk factors associated with increased body fat (paper II). A gynoid fat distribution, with a high share of fat located around the hip, is, on the other hand, associated with lower risk factor levels in both men and women, and with a decreased risk of stroke in women (papers I-II). This illustrates the importance of assessing the overall distribution of body fat rather, than solely focusing on total body fatness.

In elderly women, total body fat was found to be associated with increased survival, while abdominal fat moderately increased mortality risk (paper III). Lean mass (fat-free mass) was strongly associated with increased survival among elderly men and women (paper III).

Erythrocyte sedimentation rate (ESR) is an indicator of inflammation and, possibly, an indicator of atherosclerotic disease. In paper IV, the relationship between ESR in young adulthood and the later risk of myocardial infarction (MI) was studied. Results showed that higher levels of ESR were associated with a higher MI risk, in a dose-responsive manner, and was independent of other well-established risk factors.

In summary, both total and regional fat distribution are associated with CVD risk factors and stroke, but do not seem to correspond to an increase in mortality risk among the elderly. Also, inflammation, detected as an increase in ESR, is associated with long term MI risk in young men. 

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2011. , 95 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1451
Keyword [en]
fat mass, lean mass, fat distribution, stroke, myocardial infarction, cardiovascular disease, cardiovascular risk factors, inflammation, dual energy x-ray absorptiometry, mortality, erythrocyte sedimentation rate
National Category
Family Medicine Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-49833ISBN: 978-91-7459-305-1 (print)OAI: oai:DiVA.org:umu-49833DiVA: diva2:457964
Public defence
2011-12-16, Bergasalen, by 27, 90185 Norrlands Universitetssjukhus, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2011-11-25 Created: 2011-11-21 Last updated: 2011-11-25Bibliographically 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: 2017-12-13Bibliographically approved
2. Abdominal and gynoid adiposity and the risk of stroke
Open this publication in new window or tab >>Abdominal and gynoid adiposity and the risk of stroke
Show others...
2011 (English)In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 35, no 11, 1427-1432 p.Article in journal (Refereed) Published
Abstract [en]

Background: Previous studies have indicated that fat distribution is important in the development of cardiovascular disease (CVD). We investigated the association between fat distribution, as measured by dual energy X-ray absorptiometry (DXA), and the incidence of stroke.

Methods: A cohort of 2751 men and women aged 40 years was recruited. Baseline levels of abdominal, gynoid and total body fat were measured by DXA. Body mass index (BMI, kg m(-2)) was calculated. Stroke incidence was recorded using the regional stroke registry until subjects reached 75 years of age.

Results: During a mean follow-up time of 8 years and 9 months, 91 strokes occurred. Of the adiposity indices accessed abdominal fat mass was the best predictor of stroke in women (hazard ratio (HR)=1.66, 95% confidence interval (CI)=1.23-2.24 per standard deviation increase), whereas the ratio of gynoid fat to total fat mass was associated with a decreased risk of stroke (HR=0.72, 95% CI=0.54-0.96). Abdominal fat mass was the only of the adiposity indices assessed that was found to be a significant predictor of stroke in men (HR=1.49, 95% CI=1.06-2.09). The associations between abdominal fat mass and stroke remained significant in both women and men after adjustment for BMI (HR=1.80, 95% CI=1.06-3.07; HR=1.71, 95% CI=1.13-2.59, respectively). However, in a subgroup analyses abdominal fat was not a significant predictor after further adjustment for diabetes, smoking and hypertension.

Conclusion: Abdominal fat mass is a risk factor for stroke independent of BMI, but not independent of diabetes, smoking and hypertension. This indicates that the excess in stroke risk associated with abdominal fat mass is at least partially mediated through traditional stroke risk factors.International Journal of Obesity advance online publication, 22 February 2011; doi:10.1038/ijo.2011.9.

Place, publisher, year, edition, pages
Nature Publishing Group, 2011
Keyword
fat mass, fat distribution, abdominal fat, gynoid fat, stroke cox proportional hazard model
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-44034 (URN)10.1038/ijo.2011.9 (DOI)21343905 (PubMedID)
Available from: 2011-05-18 Created: 2011-05-18 Last updated: 2017-12-11Bibliographically approved
3. Body composition and mortality risk in later life
Open this publication in new window or tab >>Body composition and mortality risk in later life
2012 (English)In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 41, no 5, 677-681 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: body mass index is used widely to define overweight and obesity. Both high and low body mass indices are associated with increased mortality risk during middle age, but the relationship is less clear in later life. Thus, studies on the relationships between other aspects of body composition and mortality among older subjects are needed.

OBJECTIVE: to investigate associations between different aspects of body composition and mortality in older people.

METHODS: the study population comprised 921 participants aged ≥65 years who underwent dual-energy X-ray (DXA) absorptiometric examination at the Sports Medicine Unit, Umeå University. The main reason for admission was clinical suspicion of osteoporosis. Total, abdominal and gynoid fat masses and lean body mass were measured by DXA absorptiometry at baseline, and the cohort was followed (mean duration, 9.2 years) for mortality events.

RESULTS: during follow-up, 397 participants died. Lean mass was associated negatively with mortality in men and women (P < 0.001). Total fat mass showed a U-shaped association with mortality in men (P < 0.01) and a negative association in women (P < 0.01). A higher ratio of abdominal to gynoid fat mass increased mortality risk in women (P = 0.04), but not in men (P = 0.91).

CONCLUSIONS: lean mass is associated strongly with survival in older subjects. Greater fat mass is protective in older women, whereas very low or very high fat mass increases the risk of death in men. Further research is needed to better understand the mechanisms underlying these associations.

Place, publisher, year, edition, pages
Oxford University Press, 2012
Keyword
Fat mass, fat distribution, lean mass, mortality, dual energy x-ray absorptiometry, dual energy x-ray absorptiometry (DXA), older people
National Category
Geriatrics
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-49831 (URN)10.1093/ageing/afs087 (DOI)22820447 (PubMedID)
Available from: 2011-11-21 Created: 2011-11-21 Last updated: 2017-12-08Bibliographically approved
4. Erytrocyte sedimenation rate in young adulthood is associated with myocardial infarction later in life
Open this publication in new window or tab >>Erytrocyte sedimenation rate in young adulthood is associated with myocardial infarction later in life
(English)Article in journal (Refereed) Submitted
National Category
Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-49832 (URN)
Available from: 2011-11-21 Created: 2011-11-21 Last updated: 2011-11-25Bibliographically approved

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