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Body Fat Percent by Bioelectrical Impedance Analysis and Risk of ...

Body Fat Percent by Bioelectrical Impedance Analysis and Risk of ...

Table 2.

Table 2. Body Fat Percent and Prevalence of Coronary Artery Disease in Men Body fat percent Categories No. of Subjects excess body fat [1,2]. There is increasing evidence that dietary fat is particularly more conducive to weight gain than complex carbohydrates. We have reported that Indian rural subjects consuming low-fat diets and having physically demanding occupations have significantly lower body-mass indices and lower rates of obesity than urban subjects consuming relatively higher fat diets [7–9]. It is possible that hepatic handling of insulin is modulated by habitual fat intake, and, on a high-fat diet, insulin secretion may rise to suppress hepatic glucose production resulting in insulin resistance characterized by greater body fat percent, particularly in the abdomen [7–9]. Higher fat diet appears to be a risk factor of higher body fat percent [11]. We found a positive correlation of age with body-fat percent (Table 1). The criteria for normal body fat may change with age. A high body-fat content for a 20-year-old man may be considered normal for someone who is 50 years old. Clinical (known � Rose Questionnaire) Electrocardiographic (Silent) n (%) High-fat (�25%) 357 45 (12.6) 22 (6.1) 67 (18.7) Over-fat (20–25%) 230 13 (5.6) 5 (2.2) 18 (7.8) Normal-fat (10–20%) 200 6 (3.0) 4 (2.0) 10 (5.0) Under-fat (�10%) 63 — 2 (3.2) 2 (3.2) Total 850 64 (7.5) 33 (3.9) 97 (11.4) Mentel-Haenzel X 2 15.63 12.15 18.54 p-value �0.001 �0.01 �0.001 Table 3. Prevalence of Coronary Risk Factors in Relation to Body Fat Percent in Men Body fat percent No. of subjects Cholesterol (�5.18 mmol/L) Blood pressure (�140/90 mmHg) Total Diabetes mellitus Smoking Sedentary lifestyle High-fat (�25%) 357 177 (49.5) 131 (36.6) 36 (10.0) 88 (24.6) 255 (71.4) Over-fat (20–25%) 230 95 (41.3) 74 (32.1) 17 (7.3) 57 (24.7) 125 (54.3) Normal-fat (10–20%) 200 25 (12.5) 16 (8.1) 8 (4.0) 55 (27.5) 80 (40.0) Under-fat (�10%) 63 4 (6.3) 3 (4.7) 2 (3.1) 26 (41.2) 4 (6.3) Total 850 301 (35.4) 224 (26.3) 63 (7.4) 226 (26.5) 464 (54.5) Mentel-Haenzel X 2 10.52 11.68 16.12 �5.92 9.12 p-value �0.01 �0.01 �0.001 �0.05 �0.01 Table 4. Risk Factor Levels in Relation to Body Fat Percent Body fat percent Body mass index (kg/m 2 ) Total cholesterol (mmol/L) HDL cholesterol (mmol/L) Triglycerides (mmol/L) Blood Pressures (mmHg) Systolic Diastolic High-fat (�25%) 24.8�4.3 5.42�0.8 1.16�0.3 1.92�0.6 130�16 87�11 Over-fat (20–25%) 23.7�3.8 5.08�0.6 1.17�0.2 1.66�0.5 127�15 84�9 Normal-fat (10–20%) 22.0�3.1 4.56�0.6 1.18�0.2 1.34�0.5 121�13 81�9 Under-fat (�10%) 21.1�2.7 3.62�0.5 1.13�0.1 1.26�0.4 118�10 77�7 Kendall’s T 0.081 0.058 �0.088 0.098 0.089 0.096 t-value 3.37** 2.76* 2.46* 2.61* 2.71* 1.05 Values in parentheses are mean � 1 standard deviation. HDL�High density lipoprotein, *�p�0.01, **�p�0.001. Body Fatness and Coronary Disease in India We also found a higher prevalence of hypertension, hypercholesterolemia, diabetes mellitus and sedentary lifestyle in association with greater body-fat percent. It is possible that higher body-fat percent predisposes these risk factors, mainly by causing insulin resistance and central obesity. However abdominal obesity based on waist-hip ratio among Thai women did not influence blood lipids which were related to body-fat percent [18]. It seems that excess body-fat percent in conjunction with a sedentary lifestyle, directly predisposes individuals to these risk factors. It is possible that excess of body-fat percent acts conjointly with other variables in increasing the prevalence of CAD. Presence of coronary risk factors among high-fat and over-fat subjects may increase the prevalence of CAD and the excess burden of ill health noted in other studies [23]. Magnetic resonance imaging, computarised axial tomography and body density derived from underwater weighing are JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION 271

Body Fatness and Coronary Disease in India Table 5. Mean Levels of Clinical and Biochemical Risk Factors and their Correlation with Body Fat Percent (Spearman’s Rank Correlation) Risk Factors Men Mean (standard deviation) r Body fat percent 25.8�4.6 — Mean age (years) 42.8�10 0.45* Body fat weight (kg) 17.8�3.2 0.08* Lean weight (kg) 46.6�3.3 0.02 Lean mass percent 74.2�6.7 0.04 Body weight (kg) 64.4�7 0.07 Height (cm) 165.6�16 0.03 Body mass index (kg/m 2 ) 23.6�4.1 0.15* Waist/hip ratio 0.90�0.18 0.14* Systolic blood pressure (mmHg) 126�17 0.09* Diastolic blood pressure (mmHg) 84�12 0.08 Total cholesterol (mmol/L) Low density lipoprotein 4.92�0.8 0.04 cholesterol (mmol/L) High density lipoprotein 2.81�0.7 0.06 cholesterol (mmol/L) �1.15�0.3 0.08* Triglycerides (mmol/L) 1.67�0.5 0.12* * �p�0.01, ** �p�0.001. other more accurate methods for measuring the body fat percent. However these methods are difficult and expensive for a population study when compared to bioelectrical impedance analysis [2,18]. We also observed that smoking was more common among under-fat subjects. Smoking is known to cause loss of appetite and decrease energy intake [24]. It is not clear why under-fat subjects, despite greater smoking, had a lower prevalence of CAD. It is possible that greater physical activity due to physically demanding occupations and low-fat diet may have protected these subjects against risk of CAD. We can not exclude possible bias; selection, nonresponse and measurement error, confounding by variables not measured, chance variation in a small sample and lack of generalizability to other populations or to women are the major limitations of this study. In conclusion, the findings of our study indicate that bodyfat percent was positively associated with CAD and the coronary risk factors hypertension, body mass index, diabetes mellitus and sedentary lifestyle. It is possible that increased physical activity and a decrease in body weight may be of benefit in the prevention of excess body-fat percent and CAD. REFERENCES 1. World Health, Organization Study Group: “Diet, Nutrition and Prevention of Chronic Diseases.” Geneva: World Health Organization, 1990. 2. Bjorntorp P: Visceral obesity: A civilization syndrome. Obes Res 1:206–222, 1993. 3. Manson JE, Willet WC, Stamfer MJ, Colditz GA, Hunter DJ, Susan BS, Hankinson SE, Hennekens CH, Speizer FE: Body weight and mortality among women. N Engl J Med 333:677–685, 1995. 4. Mckeigue PM, Ferrie JE, Pierpoint T, Marmot MG: Association of early onset coronary heart disease in south Asian men with glucose intolerance and hyperinsulinemia Circulation 87:152–161, 1993. 5. Mckeigue PM, Shah B, Marmot MG: Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in south Asians. Lancet 337:382–386, 1991. 6. Mckeigue PM, Pierpoint T, Ferrie JE, Marmot MG: Relationship of glucose intolerance and hyperinsulinemia to body fat patterns in south Asians and Europeans. Diabetologia 35:785–791, 1992. 7. Snehlatha C, Ramachandran A, Vijay V, Vishwanathan M: Differences in plasma insulin responses in urban and rural Indians: A study in south Indians. Diab Med 11:445–448, 1994. 8. Singh RB, Ghosh S, Niaz MA, Gupta S, Bishnoi I, Sharma JP: Epidemiologic study of diet and coronary risk factors in relation to central obesity and insulin levels in rural and urban populations of north India. Int J Cardiol 47:245–255, 1995. 9. Singh RB, Niaz MA, Rastogi V, Ghosh S, Beegom R, Rastogi SS, Postiglione A: Prevalence of coronary artery disease and coronary risk factors in the elderly rural and urban populations of north India. The Indian lifestyle and heart study in elderly. Cardiol Elder 4:111–117, 1996. 10. Kushner RF, Schoeller DA: Estimation of total body water by bioelectrical impedance analysis. Am J Clin Nutr 44:417–424, 1996. 11. Tuckner LA, Kano MJ: Dietary fat and body fat: A multivariate study of 205 adult females. Am J Clin Nutr 56:616–622, 1992. 12. Singh RB, Beegom R, Ghosh S, Niaz MA, Rastogi V, Rastogi SS, Singh NK: Epidemiological study of hypertension and its determinants in an urban population of north India. J Human Hyper 11:679–685, 1997. 13. Rose G, Blackburn H, Gillum RF, Prineas RJ: “Cardiovascular Survey Methods.” Geneva: World Health Organization, 1982. 14. Indian Consensus Group. Indian consensus for prevention of hypertension and coronary artery disease: A joint scientific statement of Indian Society of Hypertension and International College of Nutrition. J Nutr Environ Med 6:309–318, 1996. 15. The Fifth Report of the WHO/ISH Mild Hypertension Liaison Committee: 1993, Guideline for the management of mild hypertension: Memorandum from a World Health Organization/ International Society of Hypertension meeting. Hypertension, 22: 392–403, 1993. 16. Singh RB, Ghosh S, Niaz MA, Rastogi V: Validation of physical activity and socioeconomic status questionnaire in relation to food intakes for the Five City Study and proposed classifications for Indians. J Asso Phys India 45:603–607, 1997. 17. Gupta R, Prakash H, Majumdar S, Sharma S, Gupta VP: Prevalence of coronary heart disease and coronary risk factors in an urban population of Rajasthan. Ind Heart J 47:331–338, 1995. 18. Leelahagul P, Soipet S, Achariyont P, Pakpeankitvalana R, Tanphaichitra V: Influence of body composition on risk factors for coronary heart disease in Thai women. Asia Pac J Clin Nutr 4:79–80, 1995. 19. Kissebah AH, Vydelingum N, Murray R: Relation of body fat distribution to metabolic complications of obesity. J Clin Endocrinol Metab 54:254–260, 1962. 272 VOL. 18, NO. 3

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