Abstract
OBJECTIVE: To test the hypothesis that an elevated ratio of subscapular to triceps skinfold thickness (SFR), a measure of truncal obesity, is associated with increased incidence of stroke independent of overweight.
DESIGN: Data from the NHANES I Epidemiologic Follow-up Study were analyzed.
SUBJECTS: A cohort of 3652 women and 3284 men with complete data who had no history of stroke at baseline in 1971–1975.
MEASUREMENTS: Incidence of stroke diagnosed at hospital discharge or death during the follow-up period through 1992; triceps and subscapular skinfold thickness (SSF) and body mass index (BMI) at baseline.
RESULTS: In a complex relationship, higher SFR was associated with a mildly but significantly increased incidence of stroke only in white male former smokers. In white men, SSF showed a U-shaped association with stroke risk. In white men, stroke risk was elevated in the top quartile of BMI only in never smokers. In black women, stroke risk was significantly elevated in the bottom compared to the top quartile of BMI. No significant associations were seen in white women or black men.
CONCLUSIONS: In white men, SSF showed a U-shaped association with stroke risk, which was elevated in the top quartile of BMI only in never smokers. Surprisingly, stroke risk was elevated in black women with the lowest BMI. More studies of these associations are needed, especially in black women.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
National Institutes of Health . Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report Obes Res 1998 6 (Suppl 2): 51S–185S.
Gillum RF, Mussolino ME, Madans J . Body fat distribution and hypertension incidence: the NHANES I Epidemiologic Follow-up Study Int J Obes Relat Metab Disord 1998 22: 127–134.
Gillum RF . The association of body fat distribution with hypertension, hypertensive heart disease, coronary heart disease, diabetes and cardiovascular risk factors in men and women aged 18–79 y J Chron Dis 1987 40: 421–428.
Gillum RF . The association of the ratio of waist to hip girth with blood pressure, serum cholesterol, and serum uric acid in children and youths aged 6–17 y J Chron Dis 1987 40: 413–420.
Folsom AR, Prineas RJ, Kaye SA, Munger RG . Incidence of hypertension and stroke in relation to body fat distribution and other risk factors in older women Stroke 1990 21: 701–706.
Walker SP, Rimm EB, Ascherio A, Kawachi I, Stampfer MJ, Willett WC . Body size and fat distribution as predictors of stroke among US men Am J Epidemiol 1996 144: 1143–1150.
National Center for Health Statistics, Miller HW . Plan and operation of the Health and Nutrition Examination Survey, United States, 1971–73. Vital and Health Statistics, Series 1, no. 10a and b. DHEW publication no. (HSM) 73-1310 Health Services and Mental Health Administration US Government Printing Office: Washington, DC 1973.
National Center for Health Statistics, Cohen BB, Barbano HE, Cox CS et al. Plan and operation of the NHANES I Epidemiologic Follow-up Study: 1982–84. Vital and Health Statistics, Series 1, no. 22. DHHS publication no. (PHS) 87-1324 Public Health Service US Government Printing Office: Washington, DC 1987.
Finucane FF, Freid VM, Madans JH, Cox CS, Rothwell ST, Barbano HE, Feldman JJ . Plan and operation of the NHANES I Epidemiologic Follow-up Study, 1986. National Center for Health Statistics. Vital and Health Statistics, Series 1, no. 25 Public Health Service/US Government Printing Office: Washington, DC 1987.
Cox CS, Rothwell ST, Madans JH, Finucane FF, Fried VM, Kleinman JC, Barbano HE, Feldnan JJ . Plan and operation of the NHANES I Epidemiologic Follow-up Study, 1987. National Center for Health Statistics. Vital and Health Statistics, Series 1, no. 27 National Center for Health Statistics: Washington DC 1992.
Cox CS, Mussolino ME, Rothwell ST, Madans JH, Feldman JJ . Plan and operation of the NHANES I Epidemiologic Follow-up Study, 1992. Vital and Health Statistics, Series 1, no. 35 National Center for Health Statistics: Washington, DC 1997.
Madans JH, Kleinman JC, Cox CS, Barbano HE, Feldman JJ, Cohen B, Finucane FF, Cornoni-Huntley J . Ten years after NHANES I: report of initial follow-up, 1982–84 Public Health Rep 1986 101: 465–473.
National Center for Health Statistics, Johnson CL, Fulwood R, Abraham S, Bryner JD . Basic data on anthropometric measurements and angular measurements of the hip and knee joints for selected age groups 1–74 y of age, United States, 1971–75. Vital and Health Statistics, Series 11, no. 219. DHHS publication no. (PHS) 81-1669 Public Health Service US Government Printing Office: Washington, DC 1981.
National Center for Health Statistics, Roberts J, Maurer K . Blood pressure levels of persons 6–74 y, United States, 1971–74. Vital and Health Statistics, Series 11, no. 203. DHEW publication no. (HRA) 78–1648 Health Resources Administration US Government Printing Office: Washington, DC 1977.
McLaughlin JK, Dietz MS, Mehl ES, Blot WJ . Reliability of surrogate information on cigarette smoking by type of informant Am J Epidemiol 1987 126: 144–146.
Machlin SR, Kleinman JC, Madans JH . Validity of mortality analysis based on retrospective smoking information Stat Med 1989 8: 997–1009.
SAS technical report P-229 . SAS/STAT Software: changes and enhancements SAS Institute: Cary, NC 1992 433–480.
Shah BV, Barnwell BG, Bieler GS . SUDAAN user's manual: software for analysis of correlated data, release 6.40 Research Triangle Institute: Research Triangle Park, NC 1995.
Ingram DD, Makuc DM . Statistical issues in analyzing the NHANES I Epidemiologic Follow-up Study. Vital and Health Statistics, Series 2, no. 121 National Center for Health Statistics: Washington, DC 1994 1–30.
Reaven GM, Lithell H, Landsberg L . Hypertension and associated metabolic abnormalities—the role of insulin resistance and the sympathoadrenal system New Engl J Med 1996 334: 374–381.
Hall JE, Brands MW, Hildebrandt DA, Mizelle HL . Obesity-associated hypertension: hyperinsulinemia and renal mechanisms Hypertension 1992 19 (Suppl I): I-45–I-55.
Egan BM, Stepniakowski K . Vascular alpha-adrenergic tone in obesity and salt-sensitive hypertension. In: Laragh JH, Brenner BM (eds) Hypertension: pathophysiology, diagnosis, and management 2nd edn. Raven Press: New York 1995 2693–2702.
Greenwood MRC, Kava R, West DB, Savard R . Fat distribution and metabolism in animal studies. In: Bouchard C, Johnston FE (eds) Fat distribution during growth and later health outcomes Liss: New York 1988 285–295.
Spiegelman D, Israel RG, Bouchard C, Willett WC . Absolute fat mass, percent body fat, and body-fat distribution: which is the real determinant of blood pressure and serum glucose? Am J Clin Nutr 1992 55: 1033–1044.
Siervogel RM, Baumgartner RN . Fat distribution and blood pressures. In: Bouchard C, Johnston FE (eds) Fat distribution during growth and later health outcomes Liss: New York 1988 243–261.
Freedman DS, Williamson DF, Croft JB, Ballew C, Byers T . Relation of body fat distribution to ischemic heart disease. The National Health and Nutrition Examination Survey I (NHANES I) Epidemiologic Follow-up Study Am J Epidemiol 1995 142: 53–63.
Rexrode KM, Hennekens CH, Willett WC, Colditz GA, Stampfer MJ, Rich-Edwards JW, Speizer FE, Manson JE . A prospective study of body mass index, weight change, and risk of stroke in women JAMA 1997 277: 1539–1545.
Pamuk ER, Williamson DF, Madans J, Serdula MK, Kleinman JC, Byers T . Weight loss and mortality in a national cohort of adults, 1971–1987 Am J Epidemiol 1992 136: 686–697.
Rumpel C, Harris TB, Madans J . Modification of the relationship between the Quetelet Index and mortality by weight-loss history among older women Ann Epidemiol 1993 3: 343–350.
Harris TB, Ballard-Barbasch R, Madans J, Makuc DM, Feldman JJ . Overweight, weight loss, and risk of coronary heart disease in older women: the NHANES I Epidemiologic Follow-up Study Am J Epidemiol 1993 137: 1318–1327.
Rebuffe-Scrive M . Metabolic differences in fat depots. In: Bouchard C, Johnston FE (ed) Fat distribution during growth and later health outcomes Liss: New York 1988 163–173.
Goodpaster BH, Thaete FL, Simoneau J, Kelley DE . Subcutaneous abdominal fat and thigh muscle composition predict insulin sensitivity independently of visceral fat Diabetes 1997 46: 1579–1585.
Abate N, Garg A, Peshock RM, Stray-Gunderson J, Grundy SM . Relationships of generalized and regional adiposity and insulin sensitivity in men J Clin Invest 1995 96: 88–98.
Seidell JC, Bouchard C . Visceral fat in relation to health: is it a major culprit or simply an innocent bystander? Int J Obes Relat Metab Disord 1997 21: 626–631.
Malina RM . Regional body composition: age, sex, and ethnic variation In: Roche AF, Heymsfield SB, Lohman TG (eds). Human body composition Human Kinetics: Champaign, IL 1996 217–255.
Terry RB, Page WF, Haskell WL . Waist/hip ratio, body mass index and premature cardiovascular disease mortality in US Army veterans during a twenty-three year follow-up study Int J Obes Relat Metab Disord 1992 16: 417–423.
Kannel WB, Cupples LA, Ramaswami R, Stokes J III, Kreger BE, Higgins M . Regional obesity and risk of cardiovascular disease: the Framingham Study J Clin Epidemiol 1991 44: 183–190.
Welin L, Svardsudd K, Wilhelmsen L, Larsson B, Tibblin G . Analysis of risk factors for stroke in a cohort of men born in 1913 New Engl Med 1987 317: 521–526.
Larsson B, Svardsudd K, Welin L, Wilhelmsen L, Bjorntorp P, Tibblin G . Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 y follow-up of participants in the study of men born in 1913 Br Med J 1984 288: 1401–1404.
Folsom AR, Rasmussen ML, Chambless LE, Howard G, Cooper LS, Schmidt MI, Heiss G . Prospective associations of fasting insulin, body fat distribution, and diabetes with risk of ischemic stroke Diabetes Care 1999 22: 1077–1083.
Pyorala M, Miettinen H, Laakso M, Pyorala K . Hyperinsulinemia and risk of stroke in healthy middle-aged men: the 22-year follow-up results of the Helsinki Policemen Study Stroke 1998 29: 1860–1866.
Curb JD, Marcus EB . Body fat, coronary heart disease, and stroke in Japanese men Am J Clin Nutr 1991 53: 16125S–1615S.
Abbott RD, Behrens GR, Sharp DS, Rodriguez BL, Burchfiel CM, Ross GW, Yano K, Curb JD . Body mass index and thromboembolic stroke in nonsmoking men in older age. The Honolulu Heart Program Stroke 1994 25: 2370–2376.
Shinton R, Shipley M, Rose G . Overweight and stroke in the Whitehall Study J Epidemiol Community Health 1991 45: 138–142.
Hammond EC, Garfinkel L . Coronary heart disease, stroke, and aortic aneurysm: factors in the etiology Arch Environ Health 1969 19: 167–182.
Shinton R, Sagar G, Beevers G . Body fat and stroke: unmasking the hazards of overweight and obesity J Epidemiol Community Health 1995 49: 259–264.
Shaper AG, Wannamethee SG, Walker M . Body weight: implication for the prevention of coronary heart disease, stroke, and diabetes mellitus in a cohort study of middle aged men Br Med J 1997 314: 1311–1317.
Goldstein LB . Accuracy of ICD-9-CM coding for the identification of patients with acute ischemic stroke: effect of modifier codes Stroke 1998 29: 1602–1604.
Liebson CL, Naessens JM, Brown RD, Whisnant JP . Accuracy of hospital discharge abstracts for identifying stroke Stroke 1994 25: 2348–2355.
Broderick J, Brott T, Kothari R, Miller R, Khoury J, Pancioli A, Mills D, Minneci L, Shukla R . The Greater Cincinnati/Northern Kentucky Stroke Study: preliminary first-ever and total incidence rates of stroke among blacks Stroke 1998 29: 415–421.
Koester RS, Hunter GR, Snyder S, Khaled MA, Berland LL . Estimation of computerized tomography derived abdominal fat distribution Int J Obes Relat Metab Disord 1992 16: 543–554.
Despres JP, Prudhomme D, Pouliot MC, Tremblay A, Bouchard C . Estimation of deep abdominal adipose tissue accumulation from simple anthropometric measurements in men Am J Clin Nutr 1991 54: 471–477.
Cornoni-Huntley JC, Harris TB, Everett DF, Albanes D, Micozzi MS, Miles TP, Feldman JJ . An overview of body weight of older persons, including the impact on mortality: the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study J Clin Epidemiol 1991 44: 743–753.
Durazo-Arvizu RA, McGee DL, Cooper RS, Liao Y, Luke A . Mortality and optimal body mass index in a sample of the US population Am J Epidemiol 1998 147: 739–749.
Acknowledgements
The NHANES I Epidemiologic Follow-up Study has been developed and funded by these agencies: National Center for Health Statistics; National Institute on Aging; National Cancer Institute; National Institute of Child Health and Human Development; National Heart, Lung and Blood Institute; National Institute of Mental Health; National Institute of Diabetes and Digestive and Kidney Diseases; National Institute of Arthritis and Musculoskeletal and Skin Diseases; National Institute of Allergy and Infectious Diseases; National Institute of Neurological and Communicative Disorders and Stroke; Centers for Disease Control; US Department of Agriculture. The field work was conducted by Westat Inc. (contract numbers 233-80-2049 and 282-84-2111).
Author information
Authors and Affiliations
Appendix
Appendix
Sex and race-specific cut-off points for quartiles of ratio of subscapular to triceps skinfold, subscapular skinfold and body mass index
SFR
White men: 1,<1.07; 2, 1.07–1.32; 3, 1.33–1.69; 4,>1.69.
White women: 1,<0.60; 2, 0.60–0.79; 3, 0.80–0.99; 4,>0.99.
Black men: 1,<1.25; 2, 1.25–1.54; 3, 1.55–1.99; 4,>1.99.
Black women: 1,<0.81; 2, 0.81–0.99; 3, 1.00–1.21; 4,>1.21.
SSF
White men: 1,<11.0; 2, 11.0–14.9; 3, 15.0–20.9; 4,>20.9.
White women: 1,<12.5; 2, 12.5–18.9; 3, 19.0–25.9; 4,>25.9.
Black men: 1,<8.5; 2, 8.5–13.9; 3, 14.0–21.9; 4,>21.9.
Black women: 1,<16.0; 2, 16.0–24.9; 3, 25.0–33.4; 4,>33.4.
BMI
White men: 1,<23.2; 2, 23.2–25.6; 3, 25.7–27.8; 4,>27.8.
White women: 1,<22.5; 2, 22.5–25.2; 3, 25.3–28.9; 4,>28.9.
Black men: 1,<21.8; 2, 21.8–24.5; 3, 24.6–27.9; 4,>27.9.
Black women: 1,<24.1; 2, 24.1–27.4; 3, 27.5–32.2; 4,>32.2.
Rights and permissions
About this article
Cite this article
Gillum, R., Mussolino, M. & Madans, J. Body fat distribution, obesity, overweight and stroke incidence in women and men: the NHANES I Epidemiologic Follow-up Study. Int J Obes 25, 628–638 (2001). https://doi.org/10.1038/sj.ijo.0801590
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.ijo.0801590
Keywords
This article is cited by
-
Serum ferritin levels and the development of metabolic syndrome and its components: a 6.5-year follow-up study
Diabetology & Metabolic Syndrome (2014)
-
The influence of pericardial fat upon left ventricular function in obese females: evidence of a site-specific effect
Journal of Cardiovascular Magnetic Resonance (2014)
-
Impact of overweight and obesity on hospitalization: race and gender differences
International Journal of Obesity (2009)
-
Geschlechtsspezifische negative inotrope Wirkung von Übergewicht?
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie (2008)
-
Regional fat localizations and racial/ethnic variations in odds of hypertension in at-risk American adults
Journal of Human Hypertension (2006)