Guo-Chong Chen1,2, Rhonda Arthur2, Victor Kamensky2, Jin Choul Chai2, Bing Yu3, Aladdin H Shadyab4, Matthew Allison4, Yangbo Sun5,6, Nazmus Saquib7, Robert A Wild8, Wei Bao5, Andrew J Dannenberg9, Thomas E Rohan2, Robert C Kaplan2,10, Sylvia Wassertheil-Smoller2, Qibin Qi2,11. 1. 1Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China. 2. 2Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY. 3. 3Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX. 4. 4Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA. 5. 5Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA. 6. 6Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN. 7. 7College of Medicine, Sulaiman Al Rajhi University, Al Bukayriah, Saudi Arabia. 8. 8Clinical Epidemiology and Obstetrics and Gynecology, Oklahoma University Health Sciences Center, Oklahoma City, OK. 9. 9Weill Cornell Medical College, New York, NY. 10. 10Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA. 11. 11Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.
Abstract
OBJECTIVE: To assess the relationship between body fat distribution and incident lower-extremity arterial disease (LEAD). RESEARCH DESIGN AND METHODS: We included 155,925 postmenopausal women with anthropometric measures from the Women's Health Initiative who had no known LEAD at recruitment. A subset of 10,894 participants had body composition data quantified by DXA. Incident cases of symptomatic LEAD were ascertained and adjudicated through medical record review. RESULTS: We identified 1,152 incident cases of LEAD during a median 18.8 years follow-up. After multivariable adjustment and mutual adjustment, waist and hip circumferences were positively and inversely associated with risk of LEAD, respectively (both P-trend < 0.0001). In a subset (n = 22,561) where various cardiometabolic biomarkers were quantified, a similar positive association of waist circumference with risk of LEAD was eliminated after adjustment for diabetes and HOMA of insulin resistance (P-trend = 0.89), whereas hip circumference remained inversely associated with the risk after adjustment for major cardiometabolic traits (P-trend = 0.0031). In the DXA subset, higher trunk fat (P-trend = 0.0081) and higher leg fat (P-trend < 0.0001) were associated with higher and lower risk of LEAD, respectively. Further adjustment for diabetes, dyslipidemia, and blood pressure diminished the association for trunk fat (P-trend = 0.49), yet the inverse association for leg fat persisted (P-trend = 0.0082). CONCLUSIONS: Among U.S. postmenopausal women, a positive association of upper-body fat with risk of LEAD appeared to be attributable to traditional risk factors, especially insulin resistance. Lower-body fat was inversely associated with risk of LEAD beyond known risk factors.
OBJECTIVE: To assess the relationship between body fat distribution and incident lower-extremity arterial disease (LEAD). RESEARCH DESIGN AND METHODS: We included 155,925 postmenopausal women with anthropometric measures from the Women's Health Initiative who had no known LEAD at recruitment. A subset of 10,894 participants had body composition data quantified by DXA. Incident cases of symptomatic LEAD were ascertained and adjudicated through medical record review. RESULTS: We identified 1,152 incident cases of LEAD during a median 18.8 years follow-up. After multivariable adjustment and mutual adjustment, waist and hip circumferences were positively and inversely associated with risk of LEAD, respectively (both P-trend < 0.0001). In a subset (n = 22,561) where various cardiometabolic biomarkers were quantified, a similar positive association of waist circumference with risk of LEAD was eliminated after adjustment for diabetes and HOMA of insulin resistance (P-trend = 0.89), whereas hip circumference remained inversely associated with the risk after adjustment for major cardiometabolic traits (P-trend = 0.0031). In the DXA subset, higher trunk fat (P-trend = 0.0081) and higher leg fat (P-trend < 0.0001) were associated with higher and lower risk of LEAD, respectively. Further adjustment for diabetes, dyslipidemia, and blood pressure diminished the association for trunk fat (P-trend = 0.49), yet the inverse association for leg fat persisted (P-trend = 0.0082). CONCLUSIONS: Among U.S. postmenopausal women, a positive association of upper-body fat with risk of LEAD appeared to be attributable to traditional risk factors, especially insulin resistance. Lower-body fat was inversely associated with risk of LEAD beyond known risk factors.
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