Addressing health disparities. Measuring body composition as a complementary predictor of cardiovascular risk
Abstract
Introduction. Obesity, increased waist circumference and elevated visceral fat are positively correlated with cardiovascular disease (CVD) risk, in contrast to Mediterranean Diet. Objective: To analyze the association between increased waist circumference (WC), visceral fat (VF), body mass index (BMI), age, sex, total cholesterol, total fat percentage, muscle mass and adherence to a Mediterranean Diet.
Methods. 566 office workers with increased WC (WHO criteria) were included in this multicentre, cross-sectional observational study, when they attended to their job-specific health checkup in Madrid (2023). BMI and body fat distribution (VF, total fat and muscle mass) was obtained using bioimpedance (TANITA™). Sex, age, waist circumference, total cholesterol and PREDIMED questionnaire (adherence to Mediterranean diet) were also collected.
Results. 95.3% of the employees were obese or overweight (BMI). 76.3% had increased TF or were in the obese range. 63% had medium or low adherence to the Mediterranean diet. 50.5% had normal visceral fat. 51.2% had normal cholesterol levels. High VF showed a statistically significant association (P<0.001) with BMI ≥30 (obesity).Being male was associated to greater obesity (P<0.001), high VF (P<0.001) and lower adherence to the Mediterranean diet (P<0.03).Being a woman was associated to high TF (P<0.001).A low adherence to the Mediterranean diet was associated to more VF (P<0.017).
Conclusions.Individual CVR prediction can be completed by clinicians using tools like bioimpedance that considers sex, VF, TF, in addition to BMI and WC.
References
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8. Neeland, I. J., Poirier, P., & Després, J. P. (2018). Cardiovascular and Metabolic Heterogeneity of Obesity: Clinical Challenges and Implications for Management. Circulation, 137(13), 1391–1406. https://doi.org/10.1161/CIRCULATIONAHA.117.029617
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12. Kang, P. S., & Neeland, I. J. (2023). Body Fat Distribution, Diabetes Mellitus, and Cardiovascular Disease: an Update. Current cardiology reports, 25(11), 1555–1564. https://doi.org/10.1007/s11886-023-01969-5
13. Jabłonowska-Lietz, B., Wrzosek, M., Włodarczyk, M., & Nowicka, G. (2017). New indexes of body fat distribution, visceral adiposity index, body adiposity index, waist-to-height ratio, and metabolic disturbances in the obese. Kardiologia polska, 75(11), 1185–1191. https://doi.org/10.5603/KP.a2017.0149
14. Sugiura, T., Dohi, Y., Takagi, Y., Yoshikane, N., Ito, M., Suzuki, K., Nagami, T., Iwase, M., Seo, Y., & Ohte, N. (2020). Relationships of Obesity-Related Indices and Metabolic Syndrome with Subclinical Atherosclerosis in Middle-Aged Untreated Japanese Workers. Journal of atherosclerosis and thrombosis, 27(4), 342–352. https://doi.org/10.5551/jat.50633
15. Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J [Internet]. 2021 [citado el 9 de septiembre de 2022];42(34):3227–337. Disponible en: https://academic.oup.com/eurheartj/article/42/34/3227/6358713?login=false
16. Amato, M. C., Giordano, C., Galia, M., Criscimanna, A., Vitabile, S., Midiri, M., Galluzzo, A., & AlkaMeSy Study Group (2010). Visceral Adiposity Index: a reliable indicator of visceral fat function associated with cardiometabolic risk. Diabetes care, 33(4), 920–922. https://doi.org/10.2337/dc09-1825
17. Holmes, C. J., & Racette, S. B. (2021). The Utility of Body Composition Assessment in Nutrition and Clinical Practice: An Overview of Current Methodology. Nutrients, 13(8), 2493. https://doi.org/10.3390/nu13082493
18. Polcrova, A., Pavlovska, I., Maranhao Neto, G. A., Kunzova, S., Infante-Garcia, M. M., Medina-Inojosa, J. R., Lopez-Jimenez, F., Mechanick, J. I., Nieto-Martinez, R., Stokin, G. B., Pikhart, H., & Gonzalez-Rivas, J. P. (2021). Visceral fat area and cardiometabolic risk: The Kardiovize study. Obesity research & clinical practice, 15(4), 368–374. https://doi.org/10.1016/j.orcp.2021.03.005
19. Nakanishi, N., Nakamura, K., Suzuki, K., Matsuo, Y., & Tatara, K. (2000). Associations of body mass index and percentage body fat by bioelectrical impedance analysis with cardiovascular risk factors in Japanese male office workers. Industrial health, 38(3), 273–279. https://doi.org/10.2486/indhealth.38.273
20. Castellano JM, Narula J, Castillo J. Promoción de la salud cardiovascular global: Estrategias, retos y oportunidades. Rev Esp Cardiol. 2014;67(9):724-30. Disponible en: https://www.revespcardiol.org/es-promocion-salud-cardiovascularglobalestrategias-articulo-S0300893214001742
21. Álvarez-Pérez, J., Sánchez-Villegas, A., Díaz-Benítez, E. M., Ruano-Rodríguez, C., Corella, D., Martínez-González, M. Á., Estruch, R., Salas-Salvadó, J., Serra-Majem, L., & PREDIMED Study Investigators (2016). Influence of a Mediterranean Dietary Pattern on Body Fat Distribution: Results of the PREDIMED-Canarias Intervention Randomized Trial. Journal of the American College of Nutrition, 35(6), 568–580. https://doi.org/10.1080/07315724.2015.1102102
22. de Lorgeril, M., Salen, P., Martin, J. L., Monjaud, I., Delaye, J., & Mamelle, N. (1999). Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation, 99(6), 779–785. https://doi.org/10.1161/01.cir.99.6.779
23. George, E. S., Reddy, A., Nicoll, A. J., Ryan, M. C., Itsiopoulos, C., Abbott, G., Johnson, N. A., Sood, S., Roberts, S. K., & Tierney, A. C. (2022). Impact of a Mediterranean diet on hepatic and metabolic outcomes in non-alcoholic fatty liver disease: The MEDINA randomised controlled trial. Liver international : official journal of the International Association for the Study of the Liver, 42(6), 1308–1322. https://doi.org/10.1111/liv.15264
24. Konieczna, J., Ruiz-Canela, M., Galmes-Panades, A. M., Abete, I., Babio, N., Fiol, M., Martín-Sánchez, V., Estruch, R., Vidal, J., Buil-Cosiales, P., García-Gavilán, J. F., Moñino, M., Marcos-Delgado, A., Casas, R., Olbeyra, R., Fitó, M., Hu, F. B., Martínez-Gonzalez, M. Á., Martínez, J. A., Romaguera, D., … Salas-Salvadó, J. (2023). An Energy-Reduced Mediterranean Diet, Physical Activity, and Body Composition: An Interim Subgroup Analysis of the PREDIMED-Plus Randomized Clinical Trial. JAMA network open, 6(10), e2337994. https://doi.org/10.1001/jamanetworkopen.2023.37994
25. Colesterol y prevención primaria de la enfermedad cardiovascular: El debate continúa. INFAC. 2022;30(7):65-75. Euskadi.eus. Recuperado el 20 de mayo de 2024, de https://www.euskadi.eus/contenidos/informacion/cevime_infac_2022/es_def/adjuntos/INFAC_Vol_30_7_colesterol_enfermedad_cardiovascular.pdf
26. Arrobas Velilla, T., Guijarro, C., Campuzano Ruiz, R., Rodríguez Piñero, M., Valderrama Marcos, J. F., Pérez Pérez, A., Botana López, M. A., Morais López, A., García Donaire, J. A., Obaya, J. C., Castilla Guerra, L., Pallares Carratalá, V., Egocheaga Cabello, I., Salgueira Lazo, M., Castellanos Rodrigo, M. M., Mostaza Prieto, J. M., Gómez Doblas, J. J., & Buño Soto, A. (2023). Documento de consenso para la determinación e informe del perfil lipídico en laboratorios clínicos españoles. Clinica e investigacion en arteriosclerosis: publicacion oficial de la Sociedad Espanola de Arteriosclerosis, 35(2), 91–100. https://doi.org/10.1016/j.arteri.2022.10.002
27. Soliman G. A. (2018). Dietary Cholesterol and the Lack of Evidence in Cardiovascular Disease. Nutrients, 10(6), 780. https://doi.org/10.3390/nu10060780
28. Lupattelli, G., Pirro, M., Mannarino, M. R., Siepi, D., Roscini, A. R., Schillaci, G., & Mannarino, E. (2012). Visceral fat positively correlates with cholesterol synthesis in dyslipidaemic patients. European journal of clinical investigation, 42(2), 164–170. https://doi.org/10.1111/j.1365-2362.2011.02572.x
29. Waist Circumference, & Ratio, W.-H. (s/f). Report of a WHO Expert Consultation. Who.int. Recuperado el 23 de mayo de 2024, de https://iris.who.int/bitstream/handle/10665/44583/9789241501491_eng.pdf?sequence=1
30. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects: Ethical principles for medical research involving human subjects. JAMA [Internet]. 2013;310(20):2191–4. Disponible en: http://dx.doi.org/10.1001/jama.2013.281053
31. BOE-A-2018-16673 Ley Orgánica 3/2018, de 5 de diciembre, de Protección de Datos personales y garantía de los derechos digitales. Consultado: 13 de mayo de 2024. Disponible en: https://www.boe.es/eli/es/lo/1999/12/13/15/con/20181206
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34. Cámara N, Cámara R, Carratalá JA, Ferrándiz M, Ferrando A, Martí V. Evaluación de la adherencia a dieta mediterránea mediante encuesta Predimed desde la farmacia comunitaria valenciana. Farm Comunitarios. 6(Suplemento 1)
Published
2024-09-23
Section
Original Articles
