PAPER

Relationship of obesity distribution and peripheralarterial occlusive disease in elderly men

A Planas1, A Clara2*, J-M Pou3, F Vidal-Barraquer2, A Gasol1, A de Moner1, C Contreras1 andJ Marrugat4

1Pubilla Casas Primary Health Center, Hospitalet de Llobregat, Spain; 2Vascular Surgery Department, Hospital del Mar,Barcelona, Spain; 3Department of Endocrinology, Hospital de Sant Pau, Barcelona, Spain; and 4Lipids and CardiovascularEpidemiology Unit, Institut Municipal dInvestigacio Me`dica, Barcelona, Spain

OBJECTIVE: To examine the relationships between total body fatness and abdominal fat distribution with peripheral arterialdisease.DESIGN: Cross-sectional.SUBJECTS: Population-based sample of 708 men aged 5574.MEASUREMENTS: Body mass index (BMI) to estimate total body fatness and waist-to-hip ratio for abdominal fat distribution;peripheral arterial disease defined by ankle=brachial index

Definitive diagnosis of PAOD was established when an

ABI1.5) suggestive of arterial calcification and were

excluded from the study. A random sample of 80 normal-

range ABI performed by primary physicians was verified by

the vascular laboratory: no false-negative cases were found.

Adjusted odds ratio for categorised BMI and WHR of PAOD

were estimated using unconditional logistic regression. In

order to control for potential confounding factors, all vari-

ables related to PAOD and obesity measurements with

P

though the weight or BMI remains stable or may even

decrease because of the loss of lean body mass.11 The fact

that most PAOD occurs in older men, may have contributed

to the null association observed between BMI and PAOD.

WHR is an indicator of visceral fat.18 An increase in intra-

abdominal adipose tissue is associated with hyperinsuline-

mia,19 which has been associated with cardiovascular

disease. Although this relationship may be due to related

risk factors, high insulin concentrations have been recently

described as an independent predictor of CHD in men.20

Rather than a direct atherogenic effect, hyperinsulinemia

could be a marker of other abnormalities not adequately

assessed by study of conventional risk factors. This hypoth-

esis may help to explain why an increased WHR is associated

with cardiovascular diseases, and in our case with PAOD.

In the present study, special attention was paid to obtain-

ing precise measurements of the main variables. Weight,

height, waist and hip circumferences were obtained directly

by physicians. PAOD was assessed by resting ABI since it

permits identification, by a simple method, of a significant

subset with subclinical disease (95% sensitivity for detecting

angiogram-positive PAOD).

The results of this study indicate that an increased WHR is

associated with PAOD independently of other recognised risk

factors. The strength of the association seems to be relatively

weak and there is no clear evidence of a trend between

the degree of WHR and likelihood of PAOD. However, one

should remember that PAOD is an essentially smoking-

dependent disease and that many other recognised CVD

risk factors fall in a similar degree of association with PAOD.

Acknowledgements

The authors wish to acknowledge the valuable contributions

of Rosa Faro for her task in vascular laboratory, Marco Pavesi

for assistance in statistical analysis and Christine OHara for

English revision of the manuscript. This work was funded by

grant FIS 98=0013 from the Fondo de Investigacion Sanitaria,

Madrid, and, in part, by grant CIRIT 1997 SGR 00218 from

the Generalitat of Catalonia.

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Obesity and peripheral arterial occlusive diseaseA Planas et al

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International Journal of Obesity