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      A New Body Shape Index Predicts Mortality Hazard Independently of Body Mass Index

      1 , * ,   2

      PLoS ONE

      Public Library of Science

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          Obesity, typically quantified in terms of Body Mass Index (BMI) exceeding threshold values, is considered a leading cause of premature death worldwide. For given body size (BMI), it is recognized that risk is also affected by body shape, particularly as a marker of abdominal fat deposits. Waist circumference (WC) is used as a risk indicator supplementary to BMI, but the high correlation of WC with BMI makes it hard to isolate the added value of WC.

          Methods and Findings

          We considered a USA population sample of 14,105 non-pregnant adults ( ) from the National Health and Nutrition Examination Survey (NHANES) 1999–2004 with follow-up for mortality averaging 5 yr (828 deaths). We developed A Body Shape Index (ABSI) based on WC adjusted for height and weight:

          ABSI had little correlation with height, weight, or BMI. Death rates increased approximately exponentially with above average baseline ABSI (overall regression coefficient of per standard deviation of ABSI [95% confidence interval: ]), whereas elevated death rates were found for both high and low values of BMI and WC. ( ) of the population mortality hazard was attributable to high ABSI, compared to ( ) for BMI and ( ) for WC. The association of death rate with ABSI held even when adjusted for other known risk factors including smoking, diabetes, blood pressure, and serum cholesterol. ABSI correlation with mortality hazard held across the range of age, sex, and BMI, and for both white and black ethnicities (but not for Mexican ethnicity), and was not weakened by excluding deaths from the first 3 yr of follow-up.


          Body shape, as measured by ABSI, appears to be a substantial risk factor for premature mortality in the general population derivable from basic clinical measurements. ABSI expresses the excess risk from high WC in a convenient form that is complementary to BMI and to other known risk factors.

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          Most cited references 38

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          Gluteofemoral body fat as a determinant of metabolic health.

          Body fat distribution is an important metabolic and cardiovascular risk factor, because the proportion of abdominal to gluteofemoral body fat correlates with obesity-associated diseases and mortality. Here, we review the evidence and possible mechanisms that support a specific protective role of gluteofemoral body fat. Population studies show that an increased gluteofemoral fat mass is independently associated with a protective lipid and glucose profile, as well as a decrease in cardiovascular and metabolic risk. Studies of adipose tissue physiology in vitro and in vivo confirm distinct properties of the gluteofemoral fat depot with regards to lipolysis and fatty acid uptake: in day-to-day metabolism it appears to be more passive than the abdominal depot and it exerts its protective properties by long-term fatty acid storage. Further, a beneficial adipokine profile is associated with gluteofemoral fat. Leptin and adiponectin levels are positively associated with gluteofemoral fat while the level of inflammatory cytokines is negatively associated. Finally, loss of gluteofemoral fat, as observed in Cushing's syndrome and lipodystrophy is associated with an increased metabolic and cardiovascular risk. This underlines gluteofemoral fat's role as a determinant of health by the long-term entrapment of excess fatty acids, thus protecting from the adverse effects associated with ectopic fat deposition.
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            Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men. A randomized, controlled trial.

             R. Ross,  D Dagnone,  P Jones (2000)
            The independent effects of diet- or exercise-induced weight loss on the reduction of obesity and related comorbid conditions are not known. The effects of exercise without weight loss on fat distribution and other risk factors are also unclear. To determine the effects of equivalent diet- or exercise-induced weight loss and exercise without weight loss on subcutaneous fat, visceral fat skeletal muscle mass, and insulin sensitivity in obese men. Randomized, controlled trial. University research center. 52 obese men (mean body mass index [+/-SD], 31.3 +/- 2.0 kg/m2) with a mean waist circumference of 110.1 +/- 5.8 cm. Participants were randomly assigned to one of four study groups (diet-induced weight loss, exercise-induced weight loss, exercise without weight loss, and control) and were observed for 3 months. Change in total, subcutaneous, and visceral fat; skeletal muscle mass; cardiovascular fitness; glucose tolerance and insulin sensitivity. Body weight decreased by 7.5 kg (8%) in both weight loss groups and did not change in the exercise without weight loss and control groups. Compared with controls, cardiovascular fitness (peak oxygen uptake) in the exercise groups improved by approximately 16% (P 0.2). However, these values were significantly greater than those in the control and exercise without weight loss groups (P < 0.001). Weight loss induced by increased daily physical activity without caloric restriction substantially reduces obesity (particularly abdominal obesity) and insulin resistance in men. Exercise without weight loss reduces abdominal fat and prevents further weight gain.
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              Rank-deficient and discrete Ill-posed problems, mathematical modeling and computation


                Author and article information

                Role: Editor
                PLoS One
                PLoS ONE
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                18 July 2012
                : 7
                : 7
                [1 ]Department of Civil Engineering, The City College of New York, New York, New York, United States of America
                [2 ]Middletown Medical, Middletown, New York, United States of America
                Tulane School of Public Health and Tropical Medicine, United States of America
                Author notes

                Conceived and designed the experiments: NYK JCK. Performed the experiments: NYK JCK. Analyzed the data: NYK JCK. Contributed reagents/materials/analysis tools: NYK JCK. Wrote the paper: NYK JCK.

                Krakauer, Krakauer. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                Page count
                Pages: 10
                Research Article
                Lifecourse Epidemiology
                Non-Clinical Medicine
                Health Care Policy
                Health Risk Analysis
                Health Statistics
                Public Health
                Behavioral and Social Aspects of Health
                Health Screening
                Preventive Medicine
                Social and Behavioral Sciences
                Death Rate



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