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Epidemiology and Population Health

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

International Journal of Obesity volume 45, pages 2490–2498 (2021)Cite this article

Subjects

Abstract

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.

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Fig. 1: Combined effect of upper and lower adiposity depots on cardiometabolic traits (unadjusted for total fat).
Fig. 2: Combined effect of upper and lower adiposity depots on cardiometabolic traits (adjusted for total fat).

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

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Acknowledgements

The authors would like to thank all the participants, fieldworkers, collaborators and supporting staff who have worked on this project.

Funding

The study was partly funded by internal research grants from the Christian Medical College, Vellore (IRB 8920/05-2014), Indian Institute of Public Health, India (WTP Project grant/09-2012). Vellore Birth Cohort adult follow-up was supported by the British Heart Foundation (BHF_RG/98001 and BHF_CS/15/4/31493).

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Authors and Affiliations

  1. Department of Biostatistics, Christian Medical College, Vellore, India

    Mahasampath Gowri S & Belavendra Antonisamy

  2. Department of Clinical Biochemistry, Christian Medical College, Vellore, India

    Finney S. Geethanjali

  3. Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India

    Nihal Thomas, Felix Jebasingh & Thomas V. Paul

  4. Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Churchill Hospital, Oxford, UK

    Fredrik Karpe & Senthil K. Vasan

  5. NIHR Oxford Biomedical Research Centre, OUH Foundation Trust, Oxford, UK

    Fredrik Karpe

  6. MRC Environmental Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK

    Clive Osmond, Caroline H. D. Fall & Senthil K. Vasan

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Contributions

MSG, BA, FK, CHDF, CO and SKV provided substantial contribution to conception and design, acquisition of data, or analysis and interpretation of data. FSG, NT, FJ and TVP were involved in the acquisition of data. MGS and SKV drafted the first version of the manuscript. All authors were involved in the revision of the manuscript and approved the final version to be published. MSG and SKV are accountable for all aspects of the work and the accuracy and integrity of the data.

Corresponding authors

Correspondence to Mahasampath Gowri S or Senthil K. Vasan.

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This study was approved by the institutional review board of the Christian Medical College and Hospital, Vellore and all participants provided informed consent.

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Gowri S, M., Antonisamy, B., Geethanjali, F.S. et al. Distinct opposing associations of upper and lower body fat depots with metabolic and cardiovascular disease risk markers. Int J Obes 45, 2490–2498 (2021). https://doi.org/10.1038/s41366-021-00923-1

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