Distinct opposing associations of upper and lower body fat depots with metabolic and cardiovascular disease risk markers

• Published in: International Journal of Obesity Vol. 45; no. 11; pp. 2490 - 2498
• Main Authors: Gowri S, Mahasampath, Antonisamy, Belavendra, Geethanjali, Finney S., Thomas, Nihal, Jebasingh, Felix, Paul, Thomas V., Karpe, Fredrik, Osmond, Clive, Fall, Caroline H. D., Vasan, Senthil K.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-11-2021; Nature Publishing Group
• Subjects: 692/163/2743/137/773; 692/163/2743/393; 692/499; 692/699/75; Adipose tissue; Adipose Tissue - growth & development; Adipose Tissue - physiopathology; Adipose tissues; Adult; Anthropometry; Blood pressure; Body composition; Body fat; Body Mass Index; Cardiovascular disease; Cardiovascular diseases; Cross-Sectional Studies; Diabetes mellitus (non-insulin dependent); Distribution; Dual energy X-ray absorptiometry; Epidemiology; Female; Glucose; Health aspects; Health Promotion and Disease Prevention; Health risks; Heart Disease Risk Factors; Heart diseases; Humans; Hypertension; Hypertriglyceridemia; India; Insulin; Insulin resistance; Internal Medicine; Lipids; Male; Markers; Medicine; Medicine & Public Health; Metabolic Diseases; Metabolic Diseases - metabolism; Metabolic Diseases - physiopathology; Metabolism; Physiological aspects; Public Health; Regression analysis; Risk; Risk factors; India
• ISSN: 0307-0565; 1476-5497
• DOI: 10.1038/s41366-021-00923-1

Background
To examine the associations of total and regional adiposity with metabolic and cardiovascular disease (CVD) risk markers.
Methods
This cross-sectional study included 1080 (53.8% men, aged 39–44 years) individuals from South India. Anthropometry (height, weight, waist and hip circumference), body composition assessment using dual-energy X-ray absorptiometry (DXA), blood pressure (BP), and plasma glucose, insulin and lipids were measured. Regression analysis was used to examine associations of standardized fat measurements with type 2 diabetes (T2D), insulin resistance (IR), hypertension and hypertriglyceridemia and continuous measurements of BP, glucose, insulin, HOMA-IR and lipids. Contour plots were constructed to visualize the differential effect of upper and lower fat depots.
Results
DXA-measured fat depots were positively associated with metabolic and CVD risk markers. After adjusting for fat mass index, upper body fat remained positively, while lower body fat was negatively associated with risk markers. A one standard deviation (SD) increase in android fat showed higher odds ratios (ORs) for T2D (6.59; 95% CI 3.17, 13.70), IR (4.68; 95% CI 2.31, 9.50), hypertension (2.57; 95% CI 1.56, 4.25) and hypertriglyceridemia (6.39; 95% CI 3.46, 11.90) in men. A 1 SD increase in leg fat showed a protective effect with ORs for T2D (0.42; 95% CI 0.24, 0.74), IR (0.31; 95% CI 0.17, 0.57) and hypertriglyceridemia (0.61; 95% CI 0.38, 0.98). The magnitude of the effect was greater with DXA-measured fat compared with anthropometry.
Conclusion
At any level of total body fat, upper and lower body fat depots demonstrate opposite risk associations with metabolic and CVD risk markers in Asian Indians.