Ran Xing-wu, Li Xiao-song, Tong Nan-wei, Li Qi-fu, Tang Bao-de, Li Xiu-jun
Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2004 Sep;35(5):699-703.
To investigate the distribution of body fat and analyze its characteristics and relationship with metabolic variables in obese Chinese.
In this observational, cross sectional study, the total body fat mass was measured using body mass index (BMI), and as an index of intra-abdominal fat accumulation, the ratio of the visceral (VA) to abdominal subcutaneous (SA) adipose area (VSR) was determined using a computed tomography (CT) scans made at the level of L4/L5 in 309 obese human subjects (male 88; female 221). Blood pressure (BP), fasting serum lipids such as triglycerides (TG), total cholesterol (TC), high density lipoprotein(HDL-c), low density lipoprotein (LDL-c), and serum uric acid (UA) were also determined.
(1) There were no differences between the male and the female subjects in regard to age, BMI, SBP, LDL-c and HDL-c. SA was significantly greater in women, whereas VA and VSR were significantly greater in men; DBP, UA, TC and TG were significantly higher in men than in women. (2) In both men and women, VSR was significantly higher in obese Chinese than in obese European and Americans. Age, TG and LDL-c were higher in subjects with visceral fat obesity (VFO) than in those with subcutaneous fat obesity (SFO). In males, TC,UA were significantly higher in VFO than in SFO. (3) 57 paired cases of male and female subjects matched for VSR were studied, and significant higher levels of serum UA and TG were noted in the male than in the female subjects. (4) After being adjusted for age and BMI, the analyses of partial correlation showed that in both men and women, VSR was positively correlated with TG and LDL-c, and SA was negatively correlated with LDL-c. In men, VA was positively correlated with SBP, and SA was negatively correlated with TG. In women, VA was positively correlated with TG, LDL-c; SA was negatively with LDL-c, but it was positively correlated with HDL-c and UA. (5) Stepwise multiple regression analysis showed that SA, VA, VSR were independent predictor for TG and LDL-c, SBP, and TC respectively (adjusting R2=0.079, 0.193, 0.122, 0.072, P=0.005, 0.000, 0.001, 0.007, respectively) in males. In females. VSR was an independent predictor for TG and LDL-c (adjusting R2=0.024, 0.113, P=0.012, 0.000 respectively); both BMI and SA were important predictors for UA and HDL-c, and SA was an important predictor for SBP.
The above data suggest that in obese Chinese, the body fat distribution is characterized by central obesity, the cardiovascular risk factors are not only associated with general obesity but more closely associated with regional body fat distribution (VFO), and the relationships between regional body fat distribution and metabolic variables vary with gender.
探讨中国肥胖人群体脂分布情况，分析其特征以及与代谢变量的关系。
在这项观察性横断面研究中，采用体重指数（BMI）测量总体脂肪量，并使用计算机断层扫描（CT）在309名肥胖受试者（男性88名；女性221名）的L4/L5水平测定内脏（VA）与腹部皮下（SA）脂肪面积比（VSR），作为腹内脂肪堆积指标。同时测定血压（BP）、空腹血脂如甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白（HDL-c）、低密度脂蛋白（LDL-c）以及血清尿酸（UA）。
（1）男性和女性受试者在年龄、BMI、收缩压、LDL-c和HDL-c方面无差异。女性的SA显著更大，而男性的VA和VSR显著更大；男性的舒张压、UA、TC和TG显著高于女性。（2）在男性和女性中,中国肥胖人群的VSR均显著高于肥胖欧美人群。内脏脂肪型肥胖（VFO）受试者的年龄、TG和LDL-c高于皮下脂肪型肥胖（SFO）受试者。在男性中，VFO受试者的TC、UA显著高于SFO受试者。（3）对57对VSR匹配的男性和女性受试者进行研究，发现男性受试者的血清UA和TG水平显著高于女性。（4）在调整年龄和BMI后，偏相关分析表明，在男性和女性中，VSR与TG和LDL-c呈正相关，SA与LDL-c呈负相关。在男性中，VA与收缩压呈正相关，SA与TG呈负相关。在女性中，VA与TG、LDL-c呈正相关；SA与LDL-c呈负相关，但与HDL-c和UA呈正相关。（5）逐步多元回归分析表明，在男性中，SA、VA、VSR分别是TG和LDL-c、收缩压和TC的独立预测因子（调整R2分别为0.079、0.193、0.122、0.072，P分别为0.005、0.000、0.001、0.007）。在女性中，VSR是TG和LDL-c的独立预测因子（调整R2分别为0.024、0.113，P分别为0.012、0.000）；BMI和SA都是UA和HDL-c的重要预测因子，SA是收缩压的重要预测因子。
上述数据表明，中国肥胖人群体脂分布以中心性肥胖为特征，心血管危险因素不仅与总体肥胖有关，而且与局部体脂分布（VFO）关系更为密切，局部体脂分布与代谢变量的关系因性别而异。
