Sex differences in fat distribution influence the association between BMI and arterial stiffness

Abstract

Context and objective: The increase in arterial stiffness in patients with the metabolic syndrome is strongly related to the amount of visceral adipose tissue. In clinical practice, anthropometric measurements such as BMI and waist circumference are commonly used to assess general and abdominal adiposity. Waist circumference is a composite measure of subcutaneous and visceral abdominal adipose tissue. As the distribution of intra-abdominal fat differs between men and women, we investigated the sex-specific associations between different anthropometric measures for general and abdominal obesity with arterial stiffness.

Methods: A cross-sectional descriptive study was performed in 1517 participants of the Nijmegen Biomedical Study, aged 50-70 years. After measurement of height, waist circumference and hip circumference, the following indices were calculated: BMI, waist-hip ratio and waist-height ratio (WHtR). Arterial stiffness was assessed by measurement of carotid-femoral pulse wave velocity (PWV). The association between the anthropometric indices and vascular stiffness was investigated by linear regression analysis adjusting for the traditional cardiovascular risk factors.

Results: BMI, waist circumference, waist-hip ratio and WHtR correlated positively with PWV in univariate analysis both in men and women (all P < 0.016). Hip circumference was only associated with PWV in women (P < 0.001). After adjustment for age and heart rate, waist circumference and WHtR (standardized beta of 0.142 and 0.141, respectively, both P < 0.001) showed the strongest associations with PWV in men, whereas in women only BMI was associated with PWV (standardized beta of 0.177, P < 0.001). In men, WHtR was independently related to increased arterial stiffness, after adjustment for BMI and traditional cardiovascular risk factors. In women, in multivariate analyses, BMI remained significantly positively associated with PWV, whereas WHtR became negatively associated with PWV.

Conclusion: Sex-related differences in adipose tissue distribution influence the association between anthropometric measures of obesity and vascular stiffness as measured with by PWV. We found that in men, WHtR showed the strongest association with PWV, whereas in women BMI was best associated with a higher PWV.