Anatomic fat depots and cardiovascular risk: a focus on the leg fat using nationwide surveys (KNHANES 2008-2011) - PubMed (original) (raw)

Anatomic fat depots and cardiovascular risk: a focus on the leg fat using nationwide surveys (KNHANES 2008-2011)

Eugene Han et al. Cardiovasc Diabetol. 2017.

Abstract

Background: Although central fat is a well-known risk factor for cardiovascular disease (CVD) and cardiometabolic disorders, the effect of other regional fats or muscle distribution on CVD risk has not been fully investigated.

Methods: This was a cross-sectional study using nationally representative samples of 15,686 subjects from the 2008-2011 Korea National Health and Nutrition Examination Survey. Individual CVD risk was evaluated in adults aged ≥20 without prior CVD, using atherosclerotic cardiovascular disease (ASCVD) risk equations according to the 2013 ACC/AHA guidelines. Body composition was assessed by dual X-ray absorptiometry.

Results: Ratio of leg fat to total fat (LF/TF ratio) was the most predictive for CVD among body fat or muscle distribution parameters (AUC = 0.748, 95% CI 0.741-0.755). ASCVD risk score was gradually increased with decreased LF/TF ratio (P < 0.001), and individuals whose LF/TF ratio in lowest tertile tended to belong to the high-risk (10-year risk >10%) group compared to those in the highest tertile (OR = 6.25, 95% CI 5.60-6.98). Subjects in the lowest tertile showed increased risk of cardiometabolic risk factor components including obesity, hypertension, diabetes, dyslipidemia, chronic kidney disease, and albuminuria (OR range 2.57-11.24, all P < 0.001). In addition, a higher LF/TF ratio was associated with decreased ASCVD risk, even in subjects with multiple CVD risk factors. Multiple logistic regression analyses also demonstrated this association (OR = 1.85, 95% CI 1.36-2.52).

Conclusions: Among various body composition parameters, LF/TF ratio was superior in predicting higher CVD risk and a higher LF/TF ratio was independently associated with decreased risk of CVD and each cardiometabolic risk factor.

Keywords: Cardiovascular disease risk factors; Metabolic syndrome; Obesity; Risk score.

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Figures

Fig. 1

Fig. 1

The flow diagram of subject inclusion and exclusion in the Korean National Health and Nutrition Examination Surveys (KNHANES IV and V)

Fig. 2

Fig. 2

Regional body fat distributions, receiver operating characteristic (ROC) curves, and high ACC/AHA ASCVD risk. a ROC curves to predict high ACC/AHA ASCVD risk (>10%) for each regional fat. b ROC curves to predict high ACC/AHA ASCVD risk for other regional fat ratios and waist circumference. c Proportion of individuals with high ACC/AHA ASCVD risk by leg fat and total fat tertiles. d Proportion of individuals with ACC/AHA ASCVD risk score tertiles by LF/TF ratio. **P < 0.001

Fig. 3

Fig. 3

Difference in ACC/AHA ASCVD risk according to LF/TF ratio tertiles, subgroup analysis. Proportion of individuals with high ACC/AHA ASCVD risk (>10%) stratified by a hypertension, b diabetes, c metabolic syndrome, d insulin resistance (HOMA-IR), and e central obesity. f Number of cardiovascular risk factors according to LF/TF tertiles. Risk factors are obesity, hypertension, diabetes, hyper LDL-cholesterolemia, and hypertriglyceridemia. HTN hypertension, DM diabetes mellitus, MetS metabolic syndrome, HOMA-IR homeostasis model assessment of insulin resistance

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