Intermuscular adipose tissue (IMAT) is associated with metabolic abnormalities similar to those associated with visceral adipose tissue (VAT). Increased IMAT has been found in obese human immunodeficiency virus (HIV)-infected women. We hypothesized that IMAT, like VAT, would be similar or increased in HIV-infected persons compared with healthy controls, despite decreases in subcutaneous adipose tissue (SAT) found in HIV infection. In the second FRAM (Study of Fat Redistribution and Metabolic Change in HIV infection) exam, we studied 425 HIV-infected subjects and 211 controls (from the Coronary Artery Risk Development in Young Adults study) who had regional AT and skeletal muscle (SM) measured by magnetic resonance imaging (MRI). Multivariable linear regression identified factors associated with IMAT and its association with metabolites. Total IMAT was 51% lower in HIV-infected participants compared with controls (P = 0.003). The HIV effect was attenuated after multivariable adjustment (to −28%, P < 0.0001 in men and −3.6%, P = 0.70 in women). Higher quantities of leg SAT, upper-trunk SAT, and VAT were associated with higher IMAT in HIV-infected participants, with weaker associations in controls. Stavudine use was associated with lower IMAT and SAT, but showed little relationship with VAT. In multivariable analyses, regional IMAT was associated with insulin resistance and triglycerides (TGs). Contrary to expectation, IMAT is not increased in HIV infection; after controlling for demographics, lifestyle, VAT, SAT, and SM, HIV+ men have lower IMAT compared with controls, whereas values for women are similar. Stavudine exposure is associated with both decreased IMAT and SAT, suggesting that IMAT shares cellular origins with SAT.
Many beliefs about obesity persist in the absence of supporting scientific evidence (presumptions); some persist despite contradicting evidence (myths). The promulgation of unsupported beliefs may yield poorly informed policy decisions, inaccurate clinical and public health recommendations, and an unproductive allocation of research resources and may divert attention away from useful, evidence-based information.
Using Internet searches of popular media and scientific literature, we identified, reviewed, and classified obesity-related myths and presumptions. We also examined facts that are well supported by evidence, with an emphasis on those that have practical implications for public health, policy, or clinical recommendations.
We identified seven obesity-related myths concerning the effects of small sustained increases in energy intake or expenditure, establishment of realistic goals for weight loss, rapid weight loss, weight-loss readiness, physical-education classes, breast-feeding, and energy expended during sexual activity. We also identified six presumptions about the purported effects of regularly eating breakfast, early childhood experiences, eating fruits and vegetables, weight cycling, snacking, and the built (i.e., human-made) environment. Finally, we identified nine evidence-supported facts that are relevant for the formulation of sound public health, policy, or clinical recommendations.
False and scientifically unsupported beliefs about obesity are pervasive in both scientific literature and the popular press. (Funded by the National Institutes of Health.)
Previous cross-sectional studies found that a single magnetic resonance imaging (MRI) slice predicts total visceral and subcutaneous adipose tissue (VAT and SAT) volumes well. We sought to investigate the accuracy of trunk single slice imaging in estimating changes of total VAT and SAT volume in 123 overweight and obese subjects who were enrolled in a 24-week CB-1R inverse agonist clinical trial (weight change, −7.7±5.3 kg; SAT change, −5.4±4.9 L, VAT change, −0.8±1.0 L). VAT and SAT volumes at baseline and 24 weeks were derived from whole body MRI images. The VAT area 5–10 cm above L4–L5 (A+5–10) (R2=0.59–0.70, P<0.001) best predicted changes in VAT volume but the strength of these correlations were significantly lower than those at baseline (R2=0.85–0.90, P<0.001). Furthermore, the L4–L5 slice poorly predicted VAT volume changes (R2=0.24–0.29, P<0.001). Studies will require 44–69% more subjects if (A+5–10) is used and 243–320% more subjects if the L4–L5 slice is used for equivalent power of multi slice total volume measurements of VAT changes. Similarly, single slice imaging predicts SAT loss less well than cross-sectional SAT (R2=0.31–0.49 vs. R2=0.52–0.68, p<0.05). Results stayed the same when examined in men and women separately. A single MRI slice 5–10 cm above L4–L5 is more powerful than the traditionally used L4–L5 slice in detecting VAT changes, but in general single slice imaging poorly predicts VAT and SAT changes during weight loss. For certain study designs, multi-slice imaging may be more cost effective than single slice imaging in detecting changes for VAT and SAT.
Visceral adipose tissue; subcutaneous adipose tissue; clinical trial; magnetic resonance imaging; computed tomography; body composition
Based on cross-sectional analyses, it was suggested that hip circumference divided by height1.5 minus 18 (the body adiposity index, BAI), could directly estimate percent body fat without the need for further correction for sex or age. We compared the prediction of percent body fat, as assessed by dual-energy x-ray absorptiometry (PBFDXA), by BAI, BMI, and circumference (waist and hip) measurements among 1151 adults who had a total body scan by DXA and circumference measurements from 1993 through 2006. After accounting for sex, we found that PBFDXA was related similarly to BAI, BMI, waist circumference, and hip circumference. In general, BAI overestimated PBFDXA among men (3.9%) and underestimated PBFDXA among women (2.5%), but the magnitudes of these biases varied with the level of body fatness. The addition of covariates and quadratic terms for the body size measures in regression models substantially improved the prediction of PBFDXA, but none of the models based on BAI could more accurately predict PBFDXA than could those based on BMI or circumferences. We conclude that the use of BAI as an indicator of adiposity is likely to produce biased estimates of percent body fat, with the errors varying by sex and level of body fatness. Although regression models that account for the non-linear association, as well as the influence of sex, age and race, can yield more accurate estimates of PBFDXA, estimates based on BAI are not more accurate than those based on BMI, waist circumference, or hip circumference.
To investigate associations between anthropometric measurements and total body fat, abdominal adipose tissue, and cardiovascular disease risk factors in a large biracial sample.
Patients and Methods
This study is limited to cross-sectional analyses of data from participants attending a baseline visit between January 26, 1996, and February 1, 2011. The sample included 2037 individuals aged 18 to 69 years: 488 African American women (24%), 686 white women (34%), 196 African American men (9%), and 667 white men (33%). Anthropometry included weight; hip circumference; waist circumference; waist-hip, waist-height, and weight-height ratios; body adiposity index; and body mass index. Body fat and percentage of fat were measured by dual-energy x-ray absorptiometry, and abdominal visceral and subcutaneous adipose tissue were measured by computed tomography. Bivariate correlations, logistic regression models, and receiver operator characteristic curves were used, and analyses were stratified by sex and race.
In each sex-by-race group, all anthropometric measures were highly correlated with percentage of fat, fat mass, and subcutaneous adipose tissue and moderately correlated with visceral adipose tissue, with the exception of the waist-hip ratio. The odds of having an elevated cardiometabolic risk were increased more than 2-fold per SD increase for most anthropometric variables, and the areas under the curve for each anthropometric measure were significantly greater than 0.5.
Several common anthropometric measures were moderately to highly correlated with total body fat, abdominal fat, and cardiovascular disease risk factors in a biracial sample of women and men. This comprehensive analysis provides evidence of the linkage between simple anthropometric measurements and the purported pathways between adiposity and health.
AUC, area under the curve; BAI, body adiposity index; BMI, body mass index; CT, computed tomography; CVD, cardiovascular disease; DXA, dual-energy x-ray absorptiometry; HC, hip circumference; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; PCLS, Pennington Center Longitudinal Study; ROC, receiver operating characteristic; SAT, subcutaneous adipose tissue; VAT, visceral adipose tissue; WC, waist circumference
Although widely applied as a phenotypic expression of adiposity in population and gene-search studies, body mass index (BMI) is also acknowledged to reflect muscularity even though relevant studies directly measuring skeletal muscle (SM) mass are lacking. The current study aimed to fill this important gap by applying advanced imaging methods to test the hypothesis that, after controlling first for adiposity, SM mass is also a significant determinant of BMI in a population-based sample.
Whole-body magnetic resonance imaging scans were completed in CARDIA Study subjects aged 33-45 years. Physical activity (PA) levels, alcohol intake, and adequacy of food intake were assessed by standardized questionnaires.
58 African-American (AA) and 78 Caucasian (C) men; 63 AA and 64 C women.
Whole-body AT and SM volumes.
AT was significantly predicted by not only BMI, but PA and alcohol intake with total model R2s of 0.68 (p<0.0001) for men and 0.89 (p<0.0001) for women. Men had more SM than AT at all levels of BMI while SM predominated in women at lower BMIs (C <26 kg/m2; AA <28 kg/m2). Both AT and SM contributed a similar proportion of between-subject variation in BMI in men. In contrast, AT contributed ~30% more than SM to the variation in BMI in women. Developed allometric models indicated SM associations with AT, PA, and race after adjusting for height. There was little association of age, lifestyle factors, or race with BMI after controlling for both AT and SM.
Variation in muscularity provides a mechanistic basis for the previously observed non-specificity of BMI as a phenotypic expression of adiposity. These quantitative observations have important implications when choosing adiposity measures in population and gene-search studies.
Body Composition; Ethnicity; Obesity; Body Mass Index
Recent research has shown an inverse relationship between bone marrow adipose tissue (BMAT) and bone mineral density (BMD). There is a lack of evidence at the macro-imaging level to establish whether increased BMAT is a cause or effect of bone loss. This cross-sectional study compared the BMAT and BMD relationship between a younger adult group at or approaching peak bone mass (PBM) (age 18.0-39.9 yrs) and an older group with potential bone loss (PoBL) (age 40.0-88 yrs).
Pelvic BMAT was evaluated in 560 healthy men and women with T1-weighted whole body magnetic resonance imaging. BMD was measured using whole body dual-energy x-ray absorptiometry.
An inverse correlation was observed between pelvic BMAT and pelvic, total, and spine BMD in the younger PBM group (r=-0.419 to -0.461, P<0.001) and in the older PoBL group (r=-0.405 to -0.500, P<0.001). After adjusting for age, sex, ethnicity, menopausal status, total body fat, skeletal muscle, subcutaneous and visceral adipose tissue, neither subject group (younger PBM vs. older PoBL) nor its interaction with pelvic BMAT significantly contributed to the regression models with BMD as dependent variable and pelvic BMAT as independent variable (P=0.434 to 0.928).
Our findings indicate that an inverse relationship between pelvic BMAT and BMD is present both in younger subjects who have not yet experienced bone loss and also in older subjects. These results provide support at the macro-imaging level for the hypothesis that low BMD may be a result of preferential differentiation of mesenchymal stem cells from osteoblasts to adipocytes.
body composition; bone marrow adipose tissue; bone mineral density; dual-energy X-ray absorptiometry; magnetic resonance imaging; aging
Elia (1992) identified the specific resting metabolic rates (Ki) of major organs and tissues in young adults with normal weight: 200 for liver, 240 for brain, 440 for heart and kidneys, 13 for skeletal muscle, 4.5 for adipose tissue and 12 for residual mass (all units in kcal/kg per day). The aim of the present study was to assess the applicability of Elia’s Ki values for obese adults. A sample of young women (n = 80) was divided into two groups, nonobese (BMI <29.9 kg/m2) and obese (BMI 30.0–43.2 kg/m2). This study was based on the mechanistic model: REE = Σ (Ki × Ti), where REE is whole-body resting energy expenditure measured by indirect calorimetry and Ti is the mass of individual organs and tissues measured by magnetic resonance imaging. For each organ/tissue, the corresponding Elia’s Ki value was analyzed respectively for nonobese and obese groups by using stepwise univariate regression analysis. Elia’s Ki values were within the range of 95% confidence intervals (CIs) in the nonobese group. However, Elia’s Ki values were outside the right boundaries of 95% CIs in the obese group and a corresponding obesity-adjusted coefficient was calculated as 0.98, indicating that Elia’s values overestimate Ki by 2.0% in obese adults. Obesity-adjusted Ki values were 196 for liver, 235 for brain, 431 for heart and kidneys, 12.7 for skeletal muscle, 4.4 for adipose tissue, and 11.8 for residual mass. In conclusion, although Elia’s Ki values were validated in nonobese women, obesity-adjustments are appropriate for application in obese women.
Although dietary weight loss counseling usually employs a 500-1000 kcal/d energy deficit to induce weight loss of 0.5-1 kg/wk, this rate of weight loss is rarely achieved in research settings. Biological factors, such as changes in metabolic rate, are partly responsible but would account for a small deviation from expected weight loss. There must be other factors, behavioral or related to study design and implementation that affect the rate of weight loss observed.
To examine factors that influence the rate of weight loss obtained in clinical studies.
Thirty-five weight loss studies published between 1995 and 2009 were identified that used dietary counseling to induce weight loss in healthy subjects. Studies were included if they had a duration of at least 6 wk, used a strategy to counsel subjects to reduce free-living energy intakes, and reported weight loss data based on a completers analysis. Variables that were associated with the rate of weight loss among age, gender (% female subjects), initial body weight, frequency of dietary counseling, placebo use, exercise level, study length, and prescribed energy deficit were examined using linear regression analysis.
Study length was negatively related to the rate of weight loss (P<0.0001) whereas subject age (P<0.002), subject age squared (P=0.0073), initial body weight (P=0.0003), frequency of dietary counseling (P=0.0197), and prescribed energy deficit (P<0.0001) were positively related to the rate of weight loss observed in clinical studies.
These findings provide a tool for investigators and clinical dietitians to predict the rate of weight loss that can be expected within a population given the age, initial body weight, frequency of dietary counseling, and energy deficit prescription. These data, from clinical studies, suggest that the rate of weight loss is greater in older and heavier subjects and with higher contact frequency and caloric restriction.
Obesity; duration; weight loss; caloric deficit; dietary counseling; diet
Changes in body fat distribution and abnormal glucose metabolism are common in HIV-infected patients. We hypothesized that HIV-infected participants would have a higher prevalence of impaired glucose tolerance (IGT) compared with control subjects.
RESEARCH DESIGN AND METHODS
A total of 491 HIV-infected and 187 control participants from the second examination of the Study of Fat Redistribution and Metabolic Change in HIV Infection (FRAM) underwent glucose tolerance testing (GTT). Multivariable regression was used to identify factors associated with GTT parameters.
The prevalence of impaired fasting glucose (IFG) (>110 mg/dL) was similar in HIV-infected and control participants (21 vs. 25%, P = 0.23). In those without IFG, the prevalence of IGT was slightly higher in HIV-infected participants compared with control subjects (13.1 vs. 8.2%, P = 0.14) and in HIV+ participants with lipoatrophy versus without (18.1 vs. 11.5%, P = 0.084). Diabetes detected by GTT was rare (HIV subjects 1.3% and control subjects 0%, P = 0.65). Mean 2-h glucose levels were 7.6 mg/dL higher in the HIV-infected participants (P = 0.012). Increased upper trunk subcutaneous adipose tissue (SAT) and decreased leg SAT were associated with 2-h glucose and IGT in both HIV-infected and control participants. Adjusting for adipose tissue reduced the estimated effects of HIV. Exercise, alcohol use, and current tenofovir use were associated with lower 2-h glucose levels in HIV-infected participants.
In HIV infection, increased upper trunk SAT and decreased leg SAT are associated with higher 2-h glucose. These body fat characteristics may identify HIV-infected patients with normal fasting glucose but nonetheless at increased risk for diabetes.
The aim of this study was to develop and compare two DXA-based four-compartment [body weight = body cell mass (BCM) + extracellular fluid (ECF) + extracellular solids (ECS) + fat] cellular level models.
Research Methods and Procedures
Total body potassium (TBK) model: BCM from TBK by whole-body counting—ECFTBK = LST − [BCMTBK + 0.73 × osseous mineral (Mo)]. Bromide model: ECF from sodium bromide dilution—BCMBROMIDE = LST − (ECFBROMIDE + 0.73 × Mo); Mo and LST measurements came from DXA. The two approaches were evaluated in 99 healthy men and 118 women.
BCM estimates were highly correlated (r = 0.97, p < 0.001), as were ECF estimates (r = 0.87, p < 0.001); a small statistically significant mean difference was present (mean ± SD; BCMTBK model, 30.4 ± 8.9 kg; BCMBROMIDE, 31.4 ± 9.3 kg; Δ = 1.0 ± 2.8 kg; p < 0.001; ECFTBK, 18.5 ± 4.2 kg; ECFBROMIDE, 17.5 ± 3.6 kg; Δ = 1.0 ± 2.8 kg; p < 0.001). A high correlation (r = 0.97, p < 0.001) and good agreement (38.9 ± 9.5 vs. 38.9 ± 9.5 kg; Δ = 0.0 ± 2.4 kg; p = 0.39) were present between TBW, derived as the sum of intracellular water from TBK and ECW from bromide, and measured TBW by 2H2O dilution.
Two developed four-compartment cellular level DXA models, one of which is appropriate for use in most clinical and research settings, provide comparable results and are applicable for BCM and ECF estimation of subject groups with hydration disturbances.
whole body counting; nutritional assessment; DXA; body cell mass; bromide dilution
The functions of leptin receptors (LRs) are cell-type specific. At the blood-brain barrier, LRs mediate leptin transport that is essential for its CNS actions, and both endothelial and astrocytic LRs may be involved. To test this, we generated endothelia specific LR knockout (ELKO) and astrocyte specific LR knockout (ALKO) mice. ELKO mice were derived from a cross of Tie2-cre recombinase mice with LR-floxed mice, whereas ALKO mice were generated by a cross of GFAP-cre with LR-floxed mice, yielding mutant transmembrane LRs without signaling functions in endothelial cells and astrocytes, respectively. The ELKO mutation did not affect leptin half-life in blood or apparent influx rate to the brain and spinal cord, though there was an increase of brain parenchymal uptake of leptin after in-situ brain perfusion. Similarly, the ALKO mutation did not affect blood-brain barrier permeation of leptin or its degradation in blood and brain. The results support our observation from cellular studies that membrane-bound truncated LRs are fully efficient in transporting leptin, and that basal levels of astrocytic LRs do not affect leptin transport across the endothelial monolayer. Nonetheless, the absence of leptin signaling at the BBB appears to enhance the availability of leptin to CNS parenchyma. The ELKO and ALKO mice provide new models to determine the dynamic regulation of leptin transport in metabolic and inflammatory disorders where cellular distribution of LRs is shifted.
Leptin; BBB; Transport; Endothelial cells; Astrocytes; CNS effects
Obesity is related to increased risk of several health complications, including depression. Many studies have reported improvements in mood with weight loss, but results have been equivocal. The present meta-analysis examined changes in symptoms of depression that were reported in trials of weight loss interventions. Between-groups comparisons of different weight loss methods (e.g., lifestyle modification, diet alone, pharmacotherapy) were examined, as were within-group changes for each treatment type.
MEDLINE was searched for articles published between 1950 and January 2009. Several obesity-related terms were intersected with terms related to depression. Results were filtered to return only studies of human subjects, published in English.
Of 5971 articles, 394 were randomized controlled trials. Articles were excluded if they did not report mean changes in weight or symptoms of depression, included children or persons with psychiatric disorders (other than depression), or provided insufficient data for analysis. Thirty-one studies (n = 7937) were included. Two authors independently extracted a description of each study treatment, sample characteristics, assessment methods, and changes in weight and symptoms of depression. Treatments were categorized as: lifestyle modification, non-dieting, dietary counseling, diet-alone, exercise-alone, pharmacotherapy, placebo, or control interventions.
Random effects models found that lifestyle modification was superior to control and non-dieting interventions for reducing symptoms of depression, and marginally better than dietary counseling and exercise-alone programs. Exercise-alone programs were superior to controls. No differences were found for comparisons of pharmacologic agents and placebos. Within-group analyses found significant reductions in symptoms of depression for nearly all active interventions. A meta-regression found no relationship between changes in weight and changes in symptoms of depression in lifestyle modification interventions.
On average, obese individuals in weight loss trials experienced reductions in symptoms of depression. Future studies should examine incidence and resolution of clinically significant depressive disorders with weight loss interventions.
Depression; Meta-Analysis; Diet; Exercise; Lifestyle; Pharmacotherapy; Obesity
The specific resting metabolic rates (Ki, in kcal/kg per day) of major organs and tissues in the Reference Man were suggested in 1992 by Elia: 200 for liver, 240 for brain, 440 for heart and kidneys, 13 for skeletal muscle, 4.5 for adipose tissue and 12 for the residual mass. However, it is unknown whether gender influences the Ki values. The aim of the present study was to compare the Ki values observed in non-elderly non-obese men to the corresponding values in women.
Elia’s Ki values were evaluated based on a mechanistic model: REE = Σ(Ki × Ti), where REE is whole-body resting energy expenditure measured by indirect calorimetry and Ti is the mass of major organs and tissues measured by magnetic resonance imaging. Marginal 95% confidence intervals (CIs) for the model-estimated Ki values were calculated by stepwise univariate regression analysis. Subjects were non-elderly (age 20 - 49 yrs) non-obese (BMI 18.5 - 29.9 kg/m2) men (n = 49) and women (n = 57).
The measured REE (REEm) and the mass of major organs and skeletal muscle were all greater in the men than in women. The predicted REE by Elia’s Ki values were correlated with REEm in men (r = 0.87) and women (r = 0.86, both P <0.001). Elia’s Ki values were within the range of 95% CIs for both men and women groups, revealing that gender adjustment is not necessary.
Elia’s proposed adult Ki values are valid in both non-elderly non-obese men and women. Further studies are needed to explore the potential influences of age and obesity on Ki values in humans.
Gender; Magnetic resonance imaging; Organ mass; Stepwise univariate regression analysis; Tissue mass
Magnetic Resonance Imaging (MRI) is increasingly being used in children to quantify adipose tissue (AT) and skeletal muscle (SM) in vivo. it is unclear whether the every 5 cm whole body MRI protocol used in adults is appropriate when applied in children. Whole body MRI continuous 1 cm thick slices were acquired in 73, aged 5–17-year-old healthy children. images were segmented into subcutaneous (SAT), visceral (VAT), intermuscular At (IMAT), and SM. the percentage difference between volumes measured by the continuous protocol and volumes estimated with protocols of different between-slice intervals (i.e., interval = 2, 3, 4 and 5 cm) was larger with an increase in interval size, depot size, weight and body mass index percentile. For group comparisons, studies will require less than 5.4% more subjects if an every 5 cm protocol is used for equivalent power as the every 1 cm protocol. For individual subject comparisons, interval protocols can be used to reliably distinguish between subjects who differ in SM or SAT volume by 0.14 to 0.64 l (i.e., 1 to 5% of SM or SAT volume) or more, or in VAT or IMAT volume by 0.06 to 0.21 l (i.e., 10 to 30% of VAT or IMAT volume) or more. the every 5 cm image acquisition protocol can be considered as accurate as the contiguous protocol for group comparisons in children, as well as for comparison of SM and SAT among individual children. however, a smaller slice interval protocol would be more accurate for comparison of VAT or IMAT among individual children.
Magnetic resonance imaging; body composition; skeletal muscle; subcutaneous adipose tissue; visceral adipose tissue; intermuscular adipose tissue; measurement error
Precision and accuracy of the quantitative magnetic resonance (QMR) system for measuring fat in phantoms and total body fat (TBF) in humans were investigated. Measurements were made using phantoms: oil, beef with water, beef with oil, and humans with oil and water. TBFQMR in humans was compared with TBF by a four-compartment model (TBF4C). The coefficient of variation (CV) for replicate TBFQMR was 0.437%. QMR fat was lower at 23 °C vs. 37 °C. The fat increase in QMR phantom studies was consistent with the oil increase. When oil was added with humans, the increase in TBFQMR was >250 g for the initial 250 g of oil. With additional oil increments, the increase in TBFQMR was consistent with the amount of oil added. When water was added with humans, the TBFQMR increased independent of the amount of water added. TBFQMR was significantly less (mean ± s.e.) than TBF4C (females: −0.68 ± 0.27 kg, males: −4.66 ± 0.62 kg; P = 0.0001), TBFBV (females: −1.90 ± 0.40 kg; males: −5.68 ± 0.75 kg; P = 0.0001), and TBFD2O for males, but greater for females (1.19 ± 0.43 kg vs. −3.69 ± 0.81 kg for males; P = 0.0003). TBFQMR was lower than TBFiDXA with the difference greater in males (P = 0.001) and decreased with age (P = 0.011). The strong linear relationships between TBFQMR and TBF4C, TBFBV, and TBFD2O with slopes consistent with unity suggest that modifications are required to improve the accuracy. Should the latter be accomplished, QMR holds promise as a highly precise, rapid, and safe, noninvasive method for estimating the amount of and changes in TBF in overweight and severely obese persons.
Despite their widespread use in research and fitness settings, Durnin and Womersley’s (DW) 1974 prediction equations using skinfold thickness to estimate body fat percent by hydrodensitometry have not been systematically evaluated in racial or ethnic groups using body fat percent measured by dual-energy x-ray absorptiometry (%BFDXA) as the standard.
This cross-sectional, population-based study examined whether the DW skinfold equations predict %BFDXA in a large, multiracial sample. Four skinfold measures (biceps, triceps, subscapular, and suprailiac), other clinical anthropometrics, and %BFDXA were obtained from 1675 healthy adults, age 18–110 yr, who were classified into four racial or ethnic categories: Caucasian, African American, Hispanic, or Asian. Predicted body fat percent using DW equations was compared with %BFDXA and evaluated within race/ethnicity- and sex-specific groups.
Mean body fat percent predicted by DW equations was significantly different from %BFDXA in four of eight race/ethnicity- and sex-specific groups, particularly in Asian women and African American men (3.3 and 2.4 percentage point overestimates, respectively, P < 0.0001). New linear regression equations were developed estimating %BFDXA specific to each race/ethnicity and sex group, using the original DW skinfold sites. Body weight, height, and waist circumference independently predicted fat percent and were also included in the new equations.
The 1974 DW equations did not predict %BFDXA uniformly in all races or ethnicities. Using %BFDXA as the criterion measure, the original DW skinfold equations have been updated specific to sex and race/ethnicity while maintaining the DW options for a minimalistic model using fewer predictors.
DUAL-ENERGY X-RAY ABSORPTIOMETRY; BODY COMPOSITION; ANTHROPOMETRICS; ETHNICITY
Skeletal muscle (SM) mass decreases with advanced age and with disease in HIV infection. It is unknown whether age-related muscle loss is accelerated in the current era of antiretroviral therapy and which factors might contribute to muscle loss among HIV-infected adults. We hypothesized that muscle mass would be lower and decline faster in HIV-infected adults than in similar-aged controls.
Whole-body 1H-magnetic resonance imaging was used to quantify regional and total SM in 399 HIV-infected and 204 control men and women at baseline and 5 years later. Multivariable regression identified associated factors.
At baseline and Year 5, total SM was lower in HIV-infected than control men. HIV-infected women were similar to control women at both time points. After adjusting for demographics, lifestyle factors, and total adipose tissue, HIV infection was associated with lower Year 5 SM in men and higher SM in women compared with controls. Average overall 5-year change in total SM was small and age related, but rate of change was similar in HIV-infected and control men and women. CD4 count and efavirenz use in HIV-infected participants were associated with increasing SM, whereas age and stavudine use were associated with decreasing SM.
Muscle mass was lower in HIV-infected men compared with controls, whereas HIV-infected women had slightly higher SM than control women after multivariable adjustment. We found evidence against substantially faster SM decline in HIV infected versus similar-aged controls. SM gain was associated with increasing CD4 count, whereas stavudine use may contribute to SM loss.
Sarcopenia; Lipoatrophy; Fat redistribution; Body composition
Obesity and motor vehicle crash (MVC) injuries are two parallel epidemics in the United States. An important unanswered question is if there are sex differences in the associations between the presence of obesity and non-fatal MVC injuries.
To further understand the association between obesity and non-fatal motor vehicle crash injuries, particularly the sex differences in these relations.
We examined this question by analyzing data from the 2003 to 2007 National Automotive Sampling System Crashworthiness Data System (NASS CDS). A total of 10, 962 drivers who were aged 18 years or older and who survived frontal collision crashes were eligible for study.
Male drivers experienced a lower rate of overall non-fatal MVC injuries than did female drivers (38.1% vs. 52.2%) but a higher rate of severe injuries (0.7% vs. 0.2%). After adjusting for change in velocity (ΔV) during the crashes, obese male drivers showed a much higher risk [logistic coefficients of BMI for moderate, serious, and severe injury are 0.0766, 0.1470, and 0.1792, respectively; all p<0.05] of non-fatal injuries than did non-obese male drivers and these risks increased with injury severity. Non-fatal injury risks were not found to be increased in obese female drivers. The association between obesity and risk of non-fatal injury was much stronger for male drivers than for female drivers.
The higher risk of non-fatal MVC injuries in obese male drivers might result from their different body shape and fat distribution compared with obese female drivers. Our findings should be considered for obesity reduction, traffic safety evaluation and vehicle design for obese male drivers and provide testable hypotheses for future studies.
The lack of a universally accepted definition of the term “leptin resistance” led the National Institutes of Health to hold a workshop, “Toward a Clinical Definition of Leptin Resistance”. Leptin resistance is generally defined as the failure of endogenous or exogenous leptin to promote anticipated salutary metabolic outcomes in states of over-nutrition or obesity, although the hormone's inability to promote desired responses in specific situations results from multiple molecular, neural, behavioral, and environmental mechanisms. Thus, the term “leptin resistance” does not imply a single specific mechanism, but rather connotes distinct meanings across investigators and in different contexts. Clinically, exploiting behavioral and metabolic sensitivity to the hormone, rather than elaborating a universal, quantifiable definition of “leptin resistance”, is the goal and specific predictors of sensitivity should be established. It is clear that the availability of relevant human data is limited, however, and a substantial amount of new information must be acquired and disseminated to accomplish these goals.
Leptin; obesity; genetic models; humans; therapy
Dual-energy x-ray absorptiometry (DXA) can provide accurate measurements of body composition. Few studies have compared the relative validity of DXA measures with anthropometric measures such as body mass index (BMI) and waist circumference (WC). The authors compared correlations of DXA measurements of total fat mass and fat mass percent in the whole body and trunk, BMI, and WC with obesity-related biologic factors, including blood pressure and levels of plasma lipids, C-reactive protein, and fasting insulin and glucose, among 8,773 adults in the National Health and Nutrition Examination Survey (1999–2004). Overall, the magnitudes of correlations of BMI and WC with the obesity-related biologic factors were similar to those of fat mass or fat mass percent in the whole body and trunk, respectively. These observations were largely consistent across different age, gender, and ethnic groups. In addition, in both men and women, BMI and WC demonstrated similar abilities to distinguish between participants with and without the metabolic syndrome in comparison with corresponding DXA measurements. These data indicate that the validity of simple anthropometric measures such as BMI and WC is comparable to that of DXA measurements of fat mass and fat mass percent, as evaluated by their associations with obesity-related biomarkers and prevalence of metabolic syndrome.
absorptiometry, photon; adiposity; body mass index; nutrition surveys; waist circumference
Visceral obesity is associated with insulin resistance, but the association of other regional adipose depots with insulin resistance is not understood. In HIV infection, buffalo hump (upper trunk fat) is associated, but the association of upper trunk fat with insulin resistance has not been examined in controls. To determine the independent association of adipose depots other than visceral with insulin resistance, we performed a cross-sectional analysis of controls and HIV-infected subjects in the Fat Redistribution and Metabolic Change in HIV Infection (FRAM) study, who had measurements of glucose, insulin, and adipose tissue volumes by whole-body magnetic resonance imaging. We studied 926 HIV-positive persons from 16 academic medical center clinics and trials units with demographic characteristics representative of US patients with HIV infection and 258 FRAM controls from the population-based Coronary Artery Risk Development in Young Adults study. We measured visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) volume in the legs, arms, lower trunk (back and abdomen), and upper trunk (back and chest) and assessed their association with the homeostasis model of assessment (HOMA) and HOMA >4 by stepwise multivariable analysis. The prevalence of HOMA >4 as a marker of insulin resistance was 28% among controls compared with 37% among HIV-infected subjects (P = 0.005). Among controls, those in the highest tertile of upper trunk SAT volume had an odds ratio (OR) of 9.0 (95% confidence interval [CI]: 2.4 to 34; P = 0.001) for having HOMA >4 compared with the lowest tertile, whereas in HIV-positive subjects, the OR was lower (OR = 2.09, 95% CI: 1.36 to 3.19; P = 0.001). Among controls, the highest tertile of VAT volume had an OR of 12.1 (95% CI: 3.2 to 46; P = 0.0002) of having HOMA >4 compared with the lowest tertile, whereas in HIV-positive subjects, the OR was 3.12 (95% CI: 2.0 to 4.8; P < 0.0001). After adjusting for VAT and upper trunk SAT, the association of other SAT depots with HOMA >4 did not reach statistical significance. Thus, VAT and upper trunk SAT are independently associated with insulin resistance in controls and in HIV-infected persons.
buffalo hump; fat distribution; insulin resistance; lipodystrophy; visceral obesity
The metabolic syndrome is an important cluster of coronary heart disease risk factors with common insulin resistance. The extent to which the metabolic syndrome is associated with demographic and potentially modifiable lifestyle factors in the US population is unknown.
Metabolic syndrome–associated factors and prevalence, as defined by Adult Treatment Panel III criteria, were evaluated in a representative US sample of 3305 black, 3477 Mexican American, and 5581 white men and nonpregnant or lactating women aged 20 years and older who participated in the cross-sectional Third National Health and Nutrition Examination Survey.
The metabolic syndrome was present in 22.8% and 22.6% of US men and women, respectively (P=.86). The age-specific prevalence was highest in Mexican Americans and lowest in blacks of both sexes. Ethnic differences persisted even after adjusting for age, body mass index, and socioeconomic status. The metabolic syndrome was present in 4.6%, 22.4%, and 59.6% of normal-weight, overweight, and obese men, respectively, and a similar distribution was observed in women. Older age, postmenopausal status, Mexican American ethnicity, higher body mass index, current smoking, low household income, high carbohydrate intake, no alcohol consumption, and physical inactivity were associated with increased odds of the metabolic syndrome.
The metabolic syndrome is present in more than 20% of the US adult population; varies substantially by ethnicity even after adjusting for body mass index, age, socioeconomic status, and other predictor variables; and is associated with several potentially modifiable lifestyle factors. Identification and clinical management of this high-risk group is an important aspect of coronary heart disease prevention.
Resting energy expenditure (REE)-power relationships result from multiple underlying factors including weight and height. In addition, detailed body composition, including fat free mass (FFM) and its components, skeletal muscle mass and internal organs with high metabolic rates (i.e. brain, heart, liver, kidneys), are major determinants of REE. Since the mass of individual organs scales to height as well as to weight (and, thus, to constitution), the variance in these associations may also add to the variance in REE. Here we address body composition (measured by magnetic resonance imaging) and REE (assessed by indirect calorimetry) in a group of 330 healthy volunteers differing with respect to age (17–78 years), sex (61% female) and BMI (15.9–47.8 kg/m2). Using three dimensional data interpolation we found that the inter-individual variance related to scaling of organ mass to height and weight and, thus, the constitution-related variances in either FFM (model 1) or kidneys, muscle, brain and liver (model 2) explained up to 43% of the inter-individual variance in REE. These data are the first evidence that constitution adds to the complexity of REE. Since organs scale differently as weight as well as height the “fit” of organ masses within constitution should be considered as a further trait.