Relationships between abdominal body fat distribution and cardiovascular risk factors: an explanation for women's healthier cardiovascular risk profile. The DESIR Study

OBJECTIVE: To assess whether the extent of abdominal fat distribution, as m easured by the waist to hip ratio (WHR), might account for the sex differen ces in the levels of cardiovascular risk factors. DESIGN: Cross-sectional age-matched study. SUBJECTS: 1264 men and 1264 premenopausal women, aged 30 - 49 y, free from known cardiovascular diseases and diabetes, included in the prospective stu dy, D.E.S.I.R. MEASUREMENTS: (1) body mass index (BMI), WHR and blood pressures; (2) fasti ng concentrations of blood glucose, insulin, lipids and lipoprotein subfrac tions, and apolipoproteins; and (3) smoking status, physical activity, and alcohol consumption. RESULTS: After taking into account age and BMI, there were gradual relation ships, within and across sexes, between WHR and the levels of most lipids a nd lipoproteins, of fasting glucose and insulin, and, to a lesser extent, o f blood pressures. In particular, men and women with similar BMI and WHR ha d similar levels of triglycerides. Multivariate regression analysis showed that the variance of cardiovascular risk factors explained by the model was increased when sex was included, after controlling for age, BMI and lifest yle habits (all P < 0.01). If WHR was included in the model, sex had no add itional effect on total cholesterol (P > 0.09 for change in total r(2)) or triglycerides (P > 0.40 for change in total r(2)). In contrast, for other c ardiovascular risk factors, adjustment for covariates and WHR did not fully eliminate the sex differences, although WHR increased the variance explain ed with or without additional control for sex (all P < 0.01). CONCLUSION: The continuous increase of cardiovascular risk factors with WHR , especially for lipids and lipoproteins, suggests that the abdominal body fat distribution may partially explain the relative unhealthier cardiovascu lar risk profile of men.