Sjöström C D, Lissner L, Sjöström L
Department of Medicine, University of Göteborg, Sweden.
Obes Res. 1997 Nov;5(6):519-30. doi: 10.1002/j.1550-8528.1997.tb00572.x.
Relationships between 2-year changes in body composition (estimated from computed tomography-validated anthropometry based on sagittal trunk diameter, weight, and height), adipose tissue (AT) distribution, and cardiovascular risk factors (blood pressure, lipids, glucose, insulin, uric acid) were examined in 842 treated adults with severe obesity with weight changes from -95.5 to +30.6 kg. Although the change (delta) of visceral AT mass (expressed in % total AT) for a given change in body mass index (delta BMI) was 6-fold larger in men than in women, delta waist and delta waist/hip were similar in both sexes. In men, risk factor changes were similarly related to delta waist, delta bodyweight, and delta BMI, whereas in women, delta bodyweight seemed to be the single independent variable with the highest explanatory power. In multivariate regressions adjusted for delta BMI and baseline conditions, delta visceral AT mass was more strongly associated with risk factor changes than were delta waist and delta waist/hip. When using a three-compartment model (lean body mass, subcutaneous and visceral AT masses) plus neck and thigh girths (indicators of subcutaneous AT distribution), risk factor changes were related both to delta subcutaneous and delta visceral AT masses but not to delta lean body mass. In agreement with cross-sectional findings, delta neck was positively and delta thigh was negatively related to some risk factor changes. Thus, the use of waist as a single risk factor indicator seems less effective for epidemiological studies than the simple anthropometric measures presented here, which are able to separate the effects of visceral AT mass, subcutaneous AT mass, and subcutaneous AT distribution on metabolic parameters under both cross-sectional and longitudinal conditions.
在842名接受治疗的重度肥胖成年人中，研究了身体成分（根据基于矢状躯干直径、体重和身高的计算机断层扫描验证的人体测量学估计）的两年变化、脂肪组织（AT）分布与心血管危险因素（血压、血脂、血糖、胰岛素、尿酸）之间的关系，这些人的体重变化范围为-95.5至+30.6千克。尽管在体重指数（ΔBMI）发生给定变化时，男性内脏AT质量的变化（以总AT的百分比表示）比女性大6倍，但男女的Δ腰围和Δ腰臀比相似。在男性中，危险因素变化与Δ腰围、Δ体重和ΔBMI的关系相似，而在女性中，Δ体重似乎是具有最高解释力的单一独立变量。在针对ΔBMI和基线条件进行调整的多变量回归中，与Δ腰围和Δ腰臀比相比，Δ内脏AT质量与危险因素变化的关联更强。当使用三室模型（瘦体重、皮下和内脏AT质量）加上颈部和大腿围度（皮下AT分布的指标）时，危险因素变化与皮下和内脏AT质量的变化均相关，但与瘦体重变化无关。与横断面研究结果一致，Δ颈部与某些危险因素变化呈正相关，Δ大腿与某些危险因素变化呈负相关。因此，对于流行病学研究而言，将腰围作为单一危险因素指标似乎不如这里提出的简单人体测量方法有效，后者能够在横断面和纵向条件下区分内脏AT质量、皮下AT质量和皮下AT分布对代谢参数的影响。
