Body Fat Distribution and Risk of Coronary Heart Disease in Men and Women in the European Prospective Investigation Into Cancer and Nutrition in Norfolk Cohort: A Population-Based Prospective Study

Background— Body fat distribution has been cross-sectionally associated with atherosclerotic disease risk factors, but the prospective relation with coronary heart disease remains uncertain. Methods and Results— We examined the prospective relation between fat distribution indices and coronary heart disease among 24 508 men and women 45 to 79 years of age using proportional hazards regression. During a mean 9.1 years of follow-up, 1708 men and 892 women developed coronary heart disease. The risk for developing subsequent coronary heart disease increased continuously across the range of waist-hip ratio. Hazard ratios (95% CI) of the top versus bottom fifth of waist-hip ratio were 1.55 (1.28 to 1.73) in men and 1.91 (1.44 to 2.54) in women after adjustment for body mass index and other coronary heart disease risk factors. Hazard ratios increased with waist circumference, but risk estimates for waist circumference without hip circumference adjustment were lower by 10% to 18%. After adjustment for waist circumference, body mass index, and coronary heart disease risk factors, hazard ratios for 1-SD increase in hip circumference were 0.80 (95% CI, 0.74 to 0.87) in men and 0.80 (95% CI, 0.69 to 0.93) in women. Hazard ratios for body mass index were greatly attenuated when we adjusted for waist-hip ratio or waist circumference and other covariates. Conclusions— Indices of abdominal obesity were more consistently and strongly predictive of coronary heart disease than body mass index. These simple and inexpensive measurements could be used to assess obesity-related coronary heart disease risk in relatively healthy men and women.

[1]  T. Welborn,et al.  Waist–hip ratio is the dominant risk factor predicting cardiovascular death in Australia , 2003, The Medical journal of Australia.

[2]  H. Kahn,et al.  Contrasting factors associated with abdominal and peripheral weight gain among adult women , 1997, International Journal of Obesity.

[3]  Judith D. Goldberg,et al.  Applied Survival Analysis , 1999, Technometrics.

[4]  P. Rust,et al.  Body mass index and body girths as predictors of mortality in black and white women. , 1992, Archives of internal medicine.

[5]  T. Sellers,et al.  Associations of general and abdominal obesity with multiple health outcomes in older women: the Iowa Women's Health Study. , 2000, Archives of internal medicine.

[6]  J. Seidell,et al.  Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample , 1995, BMJ.

[7]  W. Haskell,et al.  Waist/hip ratio, body mass index and premature cardiovascular disease mortality in US Army veterans during a twenty-three year follow-up study. , 1992, International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity.

[8]  S. Yusuf,et al.  Obesity and the risk of myocardial infarction in 27 000 participants from 52 countries: a case-control study , 2005, The Lancet.

[9]  N. Day,et al.  Fat distribution, body mass index and blood pressure in 22 090 men and women in the Norfolk cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk) study , 2004, Journal of hypertension.

[10]  P. B. Jensen,et al.  Difference in leptin mRNA levels between omental and subcutaneous abdominal adipose tissue from obese humans. , 1996, Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme.

[11]  Mark Woodward,et al.  Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies , 2005, BMJ : British Medical Journal.

[12]  D. Jacobs,et al.  Changes in measurements of body fat distribution accompanying weight change. , 1994, International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity.

[13]  R. Peters,et al.  Macrophage migration inhibitory factor and the risk of myocardial infarction or death due to coronary artery disease in adults without prior myocardial infarction or stroke: the EPIC-Norfolk Prospective Population study. , 2004, The American journal of medicine.

[14]  P. Rust,et al.  Body mass index and body girths as predictors of mortality in black and white men. , 1992, American journal of epidemiology.

[15]  N. Day,et al.  Validity and repeatability of the EPIC-Norfolk Physical Activity Questionnaire. , 2002, International journal of epidemiology.

[16]  G. Shulman,et al.  Surgical implantation of adipose tissue reverses diabetes in lipoatrophic mice. , 2000, The Journal of clinical investigation.

[17]  K. Pennert,et al.  Distribution of adipose tissue and risk of cardiovascular disease and death: a 12 year follow up of participants in the population study of women in Gothenburg, Sweden. , 1984, British medical journal.

[18]  T. Lakka,et al.  Abdominal obesity is associated with increased risk of acute coronary events in men. , 2002, European heart journal.

[19]  F. Lönnqvist,et al.  A pilot study of long-term effects of a novel obesity treatment: omentectomy in connection with adjustable gastric banding , 2002, International Journal of Obesity.

[20]  Haskell Wl,et al.  Waist/hip ratio, body mass index and premature cardiovascular disease mortality in US Army veterans during a twenty-three year follow-up study. , 1992 .

[21]  Lauren Lissner,et al.  Hip circumference and cardiovascular morbidity and mortality in men and women. , 2004, Obesity research.

[22]  L. Pérusse,et al.  Waist and hip circumferences have independent and opposite effects on cardiovascular disease risk factors: the Quebec Family Study. , 2001, The American journal of clinical nutrition.

[23]  G A Colditz,et al.  Abdominal adiposity and coronary heart disease in women. , 1998, JAMA.

[24]  P. Björntorp.  The regulation of adipose tissue distribution in humans. , 1996, International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity.

[25]  David W. Hosmer,et al.  Applied Survival Analysis: Regression Modeling of Time-to-Event Data , 2008 .

[26]  William E Kraus,et al.  Effects of the amount of exercise on body weight, body composition, and measures of central obesity: STRRIDE--a randomized controlled study. , 2004, Archives of internal medicine.

[27]  P. J. Larsen,et al.  Novel Associations Between Bioavailable Estradiol and Adipokines in Elderly Women With Different Phenotypes of Obesity: Implications for Atherogenesis , 2004, Circulation.

[28]  T. Lohman,et al.  Anthropometric Standardization Reference Manual , 1988 .

[29]  A. Folsom,et al.  Body Mass Index, Waist/Hip Ratio, and Coronary Heart Disease Incidence in African Americans and Whites , 1998 .

[30]  J V Hajnal,et al.  Magnetic resonance imaging of total body fat. , 1998, Journal of applied physiology.

[31]  P. Wahl,et al.  Visceral adiposity and incident coronary heart disease in Japanese-American men. The 10-year follow-up results of the Seattle Japanese-American Community Diabetes Study. , 1999, Diabetes care.

[32]  N. Day,et al.  EPIC-Norfolk: study design and characteristics of the cohort. European Prospective Investigation of Cancer. , 1999, British journal of cancer.

[33]  E. Feskens,et al.  Narrow hips and broad waist circumferences independently contribute to increased risk of non‐insulin‐dependent diabetes mellitus , 1997, Journal of internal medicine.

[34]  James M Bower,et al.  The Organization of Cerebellar Cortical Circuitry Revisited , 2002, Annals of the New York Academy of Sciences.

[35]  D Spiegelman,et al.  Body size and fat distribution as predictors of coronary heart disease among middle-aged and older US men. , 1995, American journal of epidemiology.

[36]  A. Hamsten,et al.  Regional Variation in Plasminogen Activator Inhibitor-1 Expression in Adipose Tissue from Obese Individuals , 2000, Thrombosis and Haemostasis.

[37]  N. Day,et al.  Serum lipid concentration in relation to anthropometric indices of central and peripheral fat distribution in 20,021 British men and women: results from the EPIC-Norfolk population-based cohort study. , 2006, Atherosclerosis.

[38]  P. J. Larsen,et al.  Central and peripheral fat mass have contrasting effect on the progression of aortic calcification in postmenopausal women. , 2003, European heart journal.

[39]  A. Astrup,et al.  Obesity : Preventing and managing the global epidemic , 2000 .

[40]  D. Hosmer,et al.  A Simplified Method of Calculating an Overall Goodness-of-Fit Test for the Cox Proportional Hazards Model , 1998, Lifetime data analysis.

[41]  P. Soubrié,et al.  The CB1 receptor antagonist rimonabant reverses the diet‐induced obesity phenotype through the regulation of lipolysis and energy balance , 2005, FASEB journal : official publication of the Federation of American Societies for Experimental Biology.

[42]  Andrew R Coggan,et al.  Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease. , 2004, The New England journal of medicine.

[43]  M. Visser,et al.  Larger thigh and hip circumferences are associated with better glucose tolerance: the Hoorn study. , 2003, Obesity research.

[44]  C. Björkelund,et al.  Larger hip circumference independently predicts health and longevity in a Swedish female cohort. , 2001, Obesity research.

[45]  P. Björntorp,et al.  Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913. , 1984, British medical journal.

[46]  Walter C Willett,et al.  Obesity as Compared With Physical Activity in Predicting Risk of Coronary Heart Disease in Women , 2006, Circulation.

[47]  G. Miller,et al.  Alcohol consumption: protection against coronary heart disease and risks to health. , 1990, International journal of epidemiology.

[48]  J. Buring,et al.  Abdominal and total adiposity and risk of coronary heart disease in men , 2001, International Journal of Obesity.

[49]  N. Day,et al.  Cigarette smoking and fat distribution in 21,828 British men and women: a population-based study. , 2005, Obesity research.

[50]  K. Frayn,et al.  Adipose tissue as a buffer for daily lipid flux , 2002, Diabetologia.

[51]  C. Bouchard,et al.  Genetic and nongenetic determinants of regional fat distribution. , 1993, Endocrine reviews.

[52]  B. Nicklas,et al.  Dietary restriction and walking reduce fat deposition in the midthigh in obese older women. , 2000, The American journal of clinical nutrition.

[53]  P. Björntorp.  "Portal" adipose tissue as a generator of risk factors for cardiovascular disease and diabetes. , 1990, Arteriosclerosis.

[54]  Claus Christiansen,et al.  Peripheral Adiposity Exhibits an Independent Dominant Antiatherogenic Effect in Elderly Women , 2003, Circulation.

[55]  W. Kannel,et al.  Hazards of obesity--the Framingham experience. , 2009, Acta medica Scandinavica. Supplementum.

[56]  Giel Nijpels,et al.  Associations of hip and thigh circumferences independent of waist circumference with the incidence of type 2 diabetes: the Hoorn Study. , 2003, The American journal of clinical nutrition.

[57]  A Tremblay,et al.  Estimation of deep abdominal adipose-tissue accumulation from simple anthropometric measurements in men. , 1991, The American journal of clinical nutrition.