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Body composition and body fat distribution in relation to later risk of acute myocardial infarction: a Danish follow-up study

International Journal of Obesity volume 35, pages 1433–1441 (2011)Cite this article

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Abstract

Introduction:

Obesity is a modifiable risk factor for acute myocardial infarction (MI), but lean body mass (LBM) may also be an important factor. Low LBM may increase the risk of MI and LBM may modify the effect of obesity on MI. Thus, the inability of the classical anthropometric measures to evaluate LBM may lead to misclassification of MI risk in both lean and obese persons. We investigated the associations between incident MI and bioelectrical impedance analyses (BIA) derived measures of body composition in combination with body mass index (BMI) and anthropometric measures of body fat distribution.

Methods and results:

From 1993 to 1997, 27 148 men and 29 863 women, aged 50 to 64 year, were recruited into the Danish prospective study Diet, Cancer and Health. During 11.9 years of follow-up we identified 2028 cases of incident MI (1487 men and 541 women). BMI, waist circumference (WC), hip circumference and BIA of body composition including body fat mass (BFM), body fat percentage and LBM were measured at baseline. We used Cox proportional hazard models with age as time axis and performed extensive control for confounding. Weight, BMI, classical estimates of abdominal obesity and BIA estimates of obesity showed significant positive associations with incident MI. However, BFM adjusted for WC showed no association. Low LBM was associated with a higher risk of incident MI in both genders, and high LBM was associated with a higher risk in men.

Conclusion:

Obesity was positively associated with MI. Estimates of obesity achieved by BIA seemed not to add additional information to classical anthropometric measures regarding MI risk. Both high and low LBM may be positively associated with MI.

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References

  1. European Heart Network. 2008. Available at: http://www.ehnheart.org.

  2. Kesteloot H, Sans S, Kromhout D . Dynamics of cardiovascular and all-cause mortality in Western and Eastern Europe between 1970 and 2000. Eur Heart J 2006; 27: 107–113.

    Article  PubMed  Google Scholar 

  3. Berghofer A, Pischon T, Reinhold T, Apovian CM, Sharma AM, Willich SN . Obesity prevalence from a European perspective: a systematic review. BMC Public Health 2008; 8: 200.

    Article  PubMed  PubMed Central  Google Scholar 

  4. WHO. Obesity and overweight, 2010. Available at: http://www.who.int/dietphysicalactivity/publications/facts/obesity/en/.

  5. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364: 937–952.

    Article  PubMed  Google Scholar 

  6. Canoy D, Boekholdt SM, Wareham N, Luben R, Welch A, Bingham S et al. Body fat distribution and risk of coronary heart disease in men and women in the European prospective investigation into cancer and nutrition in Norfolk cohort: a population-based prospective study. Circulation 2007; 116: 2933–2943.

    Article  PubMed  Google Scholar 

  7. Parker ED, Pereira MA, Stevens J, Folsom AR . Association of hip circumference with incident diabetes and coronary heart disease: the atherosclerosis risk in Communities study. Am J Epidemiol 2009; 169: 837–847.

    Article  PubMed  PubMed Central  Google Scholar 

  8. 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 year follow up of participants in the study of men born in 1913. Br Med J (Clin Res Ed) 1984; 288: 1401–1404.

    Article  CAS  Google Scholar 

  9. Lapidus L, Bengtsson C, Larsson B, Pennert K, Rybo E, Sjostrom L . Distribution of adipose tissue and risk of cardiovascular disease and death: a 12 year follow up of participants in the population study of women in Gothenburg, Sweden. Br Med J (Clin Res Ed) 1984; 289: 1257–1261.

    Article  CAS  Google Scholar 

  10. Bogers RP, Bemelmans WJ, Hoogenveen RT, Boshuizen HC, Woodward M, Knekt P et al. Association of overweight with increased risk of coronary heart disease partly independent of blood pressure and cholesterol levels: a meta-analysis of 21 cohort studies including more than 3 00 000 persons. Arch Intern Med 2007; 167: 1720–1728.

    Article  PubMed  Google Scholar 

  11. Williams SR, Jones E, Bell W, Davies B, Bourne MW . Body habitus and coronary heart disease in men. A review with reference to methods of body habitus assessment. Eur Heart J 1997; 18: 376–393.

    Article  CAS  PubMed  Google Scholar 

  12. Rimm EB, Stampfer MJ, Giovannucci E, Ascherio A, Spiegelman D, Colditz GA et al. Body size and fat distribution as predictors of coronary heart disease among middle-aged and older US men. Am J Epidemiol 1995; 141: 1117–1127.

    Article  CAS  PubMed  Google Scholar 

  13. Chan DC, Watts GF, Barrett PH, Burke V . Waist circumference, waist-to-hip ratio and body mass index as predictors of adipose tissue compartments in men. QJM 2003; 96: 441–447.

    Article  CAS  PubMed  Google Scholar 

  14. Baumgartner RN, Heymsfield SB, Roche AF . Human body composition and the epidemiology of chronic disease. Obes Res 1995; 3: 73–95.

    Article  CAS  PubMed  Google Scholar 

  15. Bigaard J, Frederiksen K, Tjonneland A, Thomsen BL, Overvad K, Heitmann BL et al. Body fat and fat-free mass and all-cause mortality. Obes Res 2004; 12: 1042–1049.

    Article  PubMed  Google Scholar 

  16. Heitmann BL, Erikson H, Ellsinger BM, Mikkelsen KL, Larsson B . Mortality associated with body fat, fat-free mass and body mass index among 60-year-old swedish men—a 22-year follow-up. The study of men born in 1913. Int J Obes Relat Metab Disord 2000; 24: 33–37.

    Article  CAS  PubMed  Google Scholar 

  17. Tjonneland A, Olsen A, Boll K, Stripp C, Christensen J, Engholm G et al. Study design, exposure variables, and socioeconomic determinants of participation in diet, cancer and health: a population-based prospective cohort study of 57 053 men and women in Denmark. Scand J Public Health 2007; 35: 432–441.

    Article  PubMed  Google Scholar 

  18. Heitmann BL . Prediction of body water and fat in adult Danes from measurement of electrical impedance. A validation study. Int J Obes 1990; 14: 789–802.

    CAS  PubMed  Google Scholar 

  19. Andersen TF, Madsen M, Jorgensen J, Mellemkjoer L, Olsen JH . The Danish National Hospital Register. A valuable source of data for modern health sciences. Dan Med Bull 1999; 46: 263–268.

    CAS  PubMed  Google Scholar 

  20. Joensen AM, Jensen MK, Overvad K, Dethlefsen C, Schmidt E, Rasmussen L et al. Predictive values of acute coronary syndrome discharge diagnoses differed in the Danish National Patient Registry. J Clin Epidemiol 2009; 62: 188–194.

    Article  PubMed  Google Scholar 

  21. Korn EL, Graubard BI, Midthune D . Time-to-event analysis of longitudinal follow-up of a survey: choice of the time-scale. Am J Epidemiol 1997; 145: 72–80.

    Article  CAS  PubMed  Google Scholar 

  22. Harell Jr FE . Regression Modeling Strategies. Springer-Verlag: New York, 2001.

    Book  Google Scholar 

  23. Stata 10.1, StataCorp Lp, 2010. Available at: http://www.stata.com.

  24. Rothman KJ, Greenland S . Modern Epidemiology 2nd edn. Lippincott Williams and Wilkins: Philadelphia, 1998.

    Google Scholar 

  25. Li R, Chambless L . Test for additive interaction in proportional hazards models. Ann Epidemiol 2007; 17: 227–236.

    Article  PubMed  Google Scholar 

  26. Sonne-Holm S, Sorensen TI, Jensen G, Schnohr P . Influence of fatness, intelligence, education and sociodemographic factors on response rate in a health survey. J Epidemiol Community Health 1989; 43: 369–374.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Pischon T, Boeing H, Hoffmann K, Bergmann M, Schulze MB, Overvad K et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med 2008; 359: 2105–2120.

    Article  CAS  PubMed  Google Scholar 

  28. Wagner DR, Heyward VH . Techniques of body composition assessment: a review of laboratory and field methods. Res Q Exerc Sport 1999; 70: 135–149.

    Article  CAS  PubMed  Google Scholar 

  29. Schutz Y, Kyle UU, Pichard C . Fat-free mass index and fat mass index percentiles in Caucasians aged 18-98 y. Int J Obes Relat Metab Disord 2002; 26: 953–960.

    Article  CAS  PubMed  Google Scholar 

  30. Canoy D . Distribution of body fat and risk of coronary heart disease in men and women. Curr Opin Cardiol 2008; 23: 591–598.

    Article  PubMed  Google Scholar 

  31. Fujimoto WY, Bergstrom RW, Boyko EJ, Chen KW, Leonetti DL, Newell-Morris L et al. Visceral adiposity and incident coronary heart disease in Japanese-American men. The 10-year follow-up results of the Seattle Japanese-American Community Diabetes Study. Diabetes Care 1999; 22: 1808–1812.

    Article  CAS  PubMed  Google Scholar 

  32. Janssen I, Heymsfield SB, Allison DB, Kotler DP, Ross R . Body mass index and waist circumference independently contribute to the prediction of nonabdominal, abdominal subcutaneous, and visceral fat. Am J Clin Nutr 2002; 75: 683–688.

    Article  CAS  PubMed  Google Scholar 

  33. Charlson ME, Pompei P, Ales KL, MacKenzie CR . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373–383.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank the Danish Cancer Society for the funding of the Diet, Cancer and Health study. The present study was funded by the Danish Heart Foundation (08-10-R68-A2176-B994-22514 and 09-4-R72-A2346-22544) as well as the Danish Obesity Research Centre (DanORC) and the Hepatic and Adipose Tissue and Functions in the Metabolic Syndrome (HEPADIP).

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Authors and Affiliations

  1. Department of Cardiology, Center for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark

    J G Stegger, E B Schmidt, T Obel & K Overvad

  2. Institute of Preventive Medicine, University of Copenhagen, Copenhagen, Denmark

    T L Berentzen & T I A Sørensen

  3. Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark

    A Tjønneland

  4. Department of Epidemiology, School of Public Health, Aarhus University, Aarhus, Denmark

    K Overvad

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  1. J G Stegger
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Correspondence to J G Stegger.

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Stegger, J., Schmidt, E., Obel, T. et al. Body composition and body fat distribution in relation to later risk of acute myocardial infarction: a Danish follow-up study. Int J Obes 35, 1433–1441 (2011). https://doi.org/10.1038/ijo.2010.278

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