Nutrición Hospitalaria

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Pimentel, G. D.; Moreto, F.; Takahashi, M. M.; Portero-Mclellan, K. C.; Burini, R. C.

Sagital abdominal diameter, but not waist circumference is strongly associated with glycemia,

triacilglycerols and HDL-c levels in overweight adults

Nutrición Hospitalaria, vol. 26, núm. 5, septiembre-octubre, 2011, pp. 1125-1129

Grupo Aula Médica

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Nutr Hosp. 2011:26(5):1125-1129ISSN 0212-1611 • CODEN NUHOEQ

S.V.R.318

Original

Sagital abdominal diameter, but not waist circumference is stronglyassociated with glycemia, triacilglycerols and HDL·c levelsin overweight adultsG. D. Pimentel'>, F. Moreto', M. M. Takahashi" K. C. Portero-Mclellan- and R. C. Burini-

'Departmerü ofInternal Medicine. FCM. State University of Campinas (UNICAMP). Campinas. SP. Brasil. "Botucatu MedicalSchool. Center [or Nutritional and Exercise Metabolism (CeMENutri). Departmcnt ofPublic Health. Sao Paulo State University(UNESP). Botucatu. SP. Braiil.

Abstract

Aim: To correlate the sagittal abdominal diameter(SAD) and waist circumference (WC) with metabolicsyndrome-associated abnormalities in adults.

Methods: This cross-sectional study included one­hundred twelve adults (M = 27, F = 85) aging 54.0 ± 11.2yrs and average body mass index (BMI) of 30.5 ± 9.0kg/m', The assessment included blood pressure, plasmaand anthropometric measurements.

Results: In both men and female, SAD and WC wereassociated positively with body fat% (r = 0.53 vs r = 0.55),uric acid (r = 0.45 vs r = 0.45), us-PCR (r = 0.50 vs r =0.44), insulin (r = 0.89 vs r = 0.75), insulin resistanceHOMA-IR (r = 0.86 vs r = 0.65), LDL-ox (r = 0.51 vs r =0.28), GGT (r = 0.70 vs r = 0.61), and diastolic blood pres­sure (r = 0.35 vs r = 0.33), and negatively with insulin sensi­bility QUICKI (r = -0.89 vs r = -0.82) and total choles­teroVTG ratio (r = -0.40 vs r = -0.22). Glycemia, TG, andHDL-c were associated significantly only with SAD (r =0.31; r = 39, r = -0.43, respectively).

Conclusion: Though the SAD and WC were associatedwith numerous metabolic abnormalities, only SAD corre­lated with dyslipidemia (TG and HDL-c) and hyper­glycemia (glycemia).

(Nutr Hosp. 2011;26:1125-1129)

DOI:I0.330S/nh.2011.26.S.S241Key words: Sagital abdominal diameter. Waist circumfe­

rence. Hyperglycemia. Dyslipidemia. Injlammation. Anthropo­metric measurements.

Correspondence: Gustavo Duarte Pimentel.Faculdade de Ciencias Médicas - FCM.Cidade Universitária.Tessália Vieira de Camargo, 126.13084-971 Campinas/SP. Brazil.E-mail: gupimentel@yahoo.com.br

Recibido: 2-11-2011.l." Revisión: 6-I1I-2011.Aceptado: 9-I1I-2011.

DIÁMETRO ABDOMINAL SAGITAL, PERO NOLA CIRCUNFERENCIA DE LA CINTURA SE

ASOCIA FUERTEMENTE CON LA GLUCEMIA,TRIACILGLYCEROLS y HDL-C EN ADULTOS

CON SOBREPESO

Resumen

Objetivo: Correlacionar el diámetro abdominal sagital(DAS) y la circunferencia de la cintura (CC) con lasanomalías asociadas al síndrome metabólico en adultos.

Métodos: Este estudio transversal incluyó a 112 adultos(H = 27, M = 85) con edad de 54,0 ± 11,2 años y unpromedio de índice de masa corporal (IMC) de 30,5 ± 9,0kg/m-, La evaluación incluía la presión sanguínea ymedidas plasmáticas y antropométricas.

Resultados: Tanto en hombres como mujeres, DAS yCC se asociaban positivamente con el % grasa corporal (r= 0,53 vs r = 0,55), el ácido úrico (r = 0,45 vs r = 0,45), la us­PCR (r = 0,50 vs r = 0,44), la insulina (r = 0,89 vs r = 0,75),la resistencia a la insulina HOMA-IR (r = 0,86 vs r = 0,65),la LDL-ox (r = 0,51 vs r = 0,28), GGT (r = 0,70 vs r = 0,61),Yla presión sanguínea diastólica (r = 0,35 vs r = 0,33), Ynegativamente con la sensibilidad a la insulina QUICKI(r = -0,89 vs r = -0,82) Yel cociente colesterol totaVTG (r =-0,40 vs r = -0,22). La glucemia, los TG, y la HDL-c seasociaban significativamente sólo con DAS (r = 0,31; r =0,39, r = -0,43, respectivamente).

Conclusión: Aunque DAS y CC se asociaban connumerosas anomalías metabólicas, sólo DAS se correla­cionaba con la dislipemia (TG y HDL-c) y la hiperglu­cemia (glucemia).

(Nutr Hosp. 2011;26:1125-1129)

DOI:I0.330S/nh.2011.26.S.S241Palabras clave: Diámetro abominal sagital. Circunferencia

de la cintura. Hiperglucemia. Dislipcmia. Injlamación.Medidas antropométricas.

1125

Introduction

Th e "gold standard" mea surements of visceral orintr aabd ominal obe sity are ob tained by computedtom ograph y, dua l-energy-X ray abso rptiometry, ormagnetic resonance imaging. However, they areexpensive and dua l-energy-X ray absorptio me try andco mp uted tomography involves radia tion ex posure.Th ou gh , it is impractical for epidemio log ic pu rposes,in the context of pr imary care , or in cli nic routine .l.'

Indirect anthropometric estimates of body compositionhave proven usefulness for clinica! practice and epidemi­ologic surveys because they are simple, noninvasive, andcheap. Several studies indicate that measures of abdom­inal fat are better predictors of metabolic syndrome (MS)and inf1ammation than total body adipos ity as assessed bybody mass index (BMI) in adults.':'

In adult populations, the waist circumference (WC)is the most co mmonly used indicator of abdominaladiposity and is the ma in patho log ica l finding in M S.'·?However, the re liab ility of this measure in people withsubcutaneo us fat has been questi oned '" becau se theseindividuals appear "tummy apron" .

Sag ittal abdominal diameter (SAO) is highly corre­lated with visceral adipos e tissue assessment bycomput ed tomography." Me tho do logically the SAOwould be better measurement than the WC, because thesliding of subcutaneous fat to the wais t sides when themeasure men t is taken ort hos tatica lly.v-"

Th e aim of this study was to correlate two anthropo­metric measurements (WC a nd SAO) with MS-associ­ated abnor malities in ad ults .

Materials and methods

Subjects and methods

This descriptive and cross-sectional study wasco nducted in pati ent s clinica lly se lected for lifestylemodification pro gra m "Mexa-se Pro-Saúde" (2006­200S) . One hundred twe lve patients (SS female and 27male) parti cipated of study . The criterio n for exclusionwas only subjects with liver . kidney , heart , or periph­era l vasc ular disease, as well as chro nic alcoho lic.

This study was co nducted accord ing lo the gu ide ­lin es laid down in the Oeclaration of Hel sinki and allprocedures invo lving human subjects were approvedby the Ethics Co mmi ttee of Sao Paulo State Universi ty(UNE SP, Brazil ) na 170/200S. Wr itte n informedconse nt was obtained from all subjects.

Anthropometric nteasu rements

Height was measu red to nearest O.S cm. Bodywe ight was measured to the nearest 0 .1 kg witho utshoes in light indoor clo thing . BMI was calculated asthe ratio of bod y weig ht (kg ) divided by height (m)

sq uared. WC was measure d in a supine positi onbetween the lowest rib and the iliac cres !. J3

Body fat percent age (%BF) was calc ulated from theresis tance value (ohms) infonned by bioe lectric imp ed­ance analys is (BIA ) (Biodynamics'" 4S0 model) andsubsequent application in the equation recommended bySega l et al. 14 In order to reduce possible changes in waterstatus, the participants were de manded to follow therecommendations: of avo iding drinking alcoho lic bever­ages as well as caffeine for 24 hou rs before the test,fastin g for 4 hours before the test , avoid intense exer­cising for at least 12 hours before the test, and let knowabout the use of medicine based on diure tics (in this case,the par ticipants were not submitted to the test). 13

Th e SAO was measured wit h a por table, slidingbeam, abdominal caliper (Ho ltain, Ltd .; Dyfed, Wales,UK) . The caliper's upp er arm was bro ught down to ju staboye an abdo mina l mark made midway between theiliac cres ts. a locati on that approxima tes to the L4-LSinterspace . The subject was asked to inha le and exha legen tly, and the ar m of the caliper was brou ght down totou ch the abdo mina l mark without co mpression.'

Clinica/ and biochemica l measurements

Blood pr essure was measured in the participa nt'sright arm after a S mi nut es re st by using an indire ctausc ulta tio n with a mercu ry sp hygmomano meter.Sy stolic and di astoli c bl ood pressure was defined asKorotkoff phases 1 and S. respec tive ly.

Blood samples were drawn from an an tecub ital vein,and all seru m and plasma samples were immediatel ych illed, kept on ice, centrifuged, and stored at -SO°C untilana lyzed. Fasting gluc osc, total cho lestero l, high-densitylipoprotein (HOL-c), triacilglycerols (TG), y-glutamyltransferase (GGT) and uric acid were quantified bycomrnercial kits by enzymati c colorimetry assay (LabtestDiagnostica, MG, Brazil) in a semi-automatic spectropho­tometry. Low-density lipoprotein (LOL-c) was calculatedby the equation LOL-c = total cholesterol-(HOLc-TG/S)15and LOL-c subclass by the equation (TGIHOL-c ratio) l'which is a goo d pred ict ive factor for oxid ized -LOL-c.Fasting insulin was assayed by immunochemical lumines­cence using commercial kits (OPe Medlab) in automatedequi pment (Inunulite 2000 R; OPC Medlab). The insulinresistance was calc ulated by the I-Iomeostasis ModelAssessment of insulin res istance (I-IOMA-IR) and forinsulin sensitivity the QUICKI formula.J7

Plasma by ultra- sensit ivity C-reactive protein (us ­C RP) was measured using Immulite Ki t (OPCaMedlab-Oiag nostic Produ cts Corporution, L osAnge les. CA ).

Statistica/ ana /pis

Da ta ar e presented as mea ns and standard devia­tions. The normality of the distr ibut ion within each sex

1126 Nutr Hosp, 2011;26(5):1125-1129 G. D. Pimentel et al.

Table 1Churacteristics of the study populatioti

Variables

Age (years)Bodymassindex (kg/m')Waist circumference(cm)Sagittalabdominaldiameter(cm)Bodyfat(%)

Fastingglycemia(mg/dL)

Totalcholesterol(mg)HDL-cholesterol (mg)LDL-cholesterol(mg)

Oxidized-LDL-cTriacilglycerols (mg)

Totalcholesterol/triglycerides ratioUric acid (mg/dL)

C-reactiveprotein (mglL)Fasting insulin(ng/mL)

HOMA-IRQUICKIy-glutamyl transferase(U/I)Sistolic bloodpressure (mmHg)Diastolicbloodpressure(mmHg)

Men(n=27)

53.2±9.631.3±5.9

100.9± 14.623.7±3.033.5 ±6.6

111.0± 39.6194.5± 33.749.2±9.7

119.6±30.73.7 ± 2.0

176.2± 65.51.4± 0.76.1± 1.8

0.45 ±0.209.1 ±4.6

1.3(0.3-6.8)

0.15 ± 0.0231.5 ± 20.5

122.6± 19.373.3 ± 10.5

Femaletn=85)

53.8± 10.429.5 ±6.095.7 ± 13.822.0±4.034.0 ± 7.497.6 ±37.2

198.5± 36.352.3 ± 11.5

125.7± 34.02.9 ± 2.4

147.8± 69.81.8± 0.94.5 ± 1.2

0.65 ±0.849.5 ± 8.8

4.5 (1.4-20.0)

0.15 ± 0.0326.7 ± 13.5

122.7± 14.577.0± 10.6

p value

0.820.280.17

0.140.850.250.830.390.590.300.210.22

0.002*0.470.960.830.480.640.970.39

Data arepresented asmeans andstandard deviations. ROMA-IR: Homeostasis model assessment forinsulin resistance.*p< 0.05 vs meno

group was tested for all the variables using theKolmogorov-Smirnov test. Pearsons correlationswere used to verify a possible association between WCand SAD with metabolic abnormalities and compar­isons between sexes were performed with Student'sunpaired t test. AH statistical analyses were performedby using SPSS for Windows (version 12.0; SPSS Inc,Chicago, IL). P < 0.05 was considered as statisticallysignificant.

Results

Participants showed an age averaging (mean±Sd)54.0 ± 11.2 years, BMI of 30.5 ± 9.0 kg/m-, SAD of22.4 ± 3.9 cm (23.7 ± 3.0 cm for male and 22.0 ± 4.0 cmfor female, p = 0.14), and WC of96.3 ± 13.7 cm (1Ol.0 ±14.8 cm for male and 95.4 ± 13.4 cm for female, p =0.17) (table I). Uric acid was the only measure thatdiffered between genders. Other general characteristicsof subjects studied are shown in table 1.

SAD and WC were associated positively (fig. 1)with body fat% (r = 0.53 vs r = 0.55), uric acid (r = 0.45vs r = 0.45), us-PCR (r = 0.50 vs r = 0.44), insulin (r =0.89 vs r = 0.75), HOMA-IR (r = 0.86 vs r = 0.65),oxidized-LDL-c (r = 0.51 vs r = 0.28), GGT (r = 0.70 vsr = 0.61), and diastolic blood pressure (r = 0.35 vs r =0.33), and negatively (fig. 1) with insulin sensibility

QUICKI (r = -0.89 vs r = -0.82) and total cholesterollTG ratio (r = -0.40 vs r = -0.22). Glycemia, TG, andHDL-c were associated significantly only with SAD(r = 0.31; r = 0.39, r = -0.43, respectively).Total choles­terol and LDL-c were not associated with neitheradiposity indicators.

Discussion

The relative utility of several estimates of fat distrib­ution has been controversial. Sorne investigators haveproposed that WC is a better indicator of abdominal fatdistribution than is waist-hip ratio, because it requiresonly one measurement and is more highly correlatedwith visceral fat"" and yet is suggest that predictiveequation for evaluation of abdominal obesity based onbioelectrical impedance may be very useful in the clin­ical practico." SAD has been proposed to be evenbetter than Wc. However, no large or consistent differ­ence between SAD and WC has been found in relationto visceral fat. IR The present study and othcrs>"suggest that the SAD may be also a strong predictor ofblood metabolic abnormalities.

Petersson et al. 5 demonstrated that every one­centimeter increase in SAD was associated with anincrease of CRP by 0.41 mg/l, corresponding to anincreased mean CRP level by 16%. This estimation is

SAD and metabolicabnormalities Nutr Hosp. 2011;26(5):1125-1129 1127

1.0 * O Sagital abdominal diameter

* * O Waist circumference* * * ** * *0.5 * ** .9

* '§t:2Ug

& 0.0

.S ~ f-< ;E @ ] §51~

Y oS lf '".s <- el el elo ;g § b '"O CO~ G *-0.5 :r: el *"~

*-1.0 *

Fig. l.---Correlation coefficients hetween anthropometric measurements (SAD and WC) and metabolic components . HOMA-IR: Home­ostasis model assessment for insulin resistance, y-GT: y-glutamyl transferase, us-CRP: ultra-sensitiviiy C-reactive protein, LDL-ox:low-density lipoprotein cholesterol oxidized, DEP: diastolic hlood pressure, TC/TG ratio: total cholesterolttriglycerides. HDL-c: high­density lipoprotein cholesterol, QUICKI: quantitative insulin sensitivity check indexo *1'< 0.05.

of clinical importance once elevated levels of serumCRP are associated with the MS and cardiovasculardiscases.">' Other studies have obtained a strongerassociation for SAD to insulin resistance," cardiovas­cular risk' and MS" than WC, BMI and waist-hip ratio.

In a previous study" we established the cut-off pointsfor SAD thatcorresponded to altered WC (WC > 102 cmfor men and > 88 cm for women). The established pointswere 23.1 cmfor men and 20.1 cm for women. Here weshowed that either WC or SAD correlated well withplasma markers of metabolic abnormalities.

Recently, López de la Torre> demonstrated that bothfemale and male and adults and elderly with high WCvalues are associated with diabetes. However, in thepresent study only SAD correlated with the MScomponents (TG, glycemia and HDL-c). Thus, theSAD could be seeing as an appropriate method to beused for MS diagnosis purpose.

In summary, this study shown that both SAD andWC associated with numerous metabolic abnormali­tiesoHowevcr, only SAD correlated with glycemia, TGand HDL-c, indicating that the SAD is a strong indi­cator of dyslipidemia and hyperglycemia. Thus, wesuggesting that SAD measurement should be adopt inclinical practice and epidemiological studies.

Author contributions

The work presented here was carried out in collabora­tion between all authors. GDP and RCB defined theresearch theme. GDP, KCPM, MMT and RCB designedmethods and experiments. GDP wrote the manuscript,analyzed the data and interpreted the results. FMperformed the plasma biochemistry analysis. AHauthorshave given final approval of submitted version.

Acknowledgements

This work was funded by grants from the Sao PauloState Research Foundation (FAPESP, Brazil) andCAPES, Brazil. We declare that there are no conflictsofinterest.

References

l. Fuller NJ, Jebb SA, Laskey MA, Coward WA, Elia M. Four­component model for the assessment of body composition inhumans: comparison with alternative methods, and evaluationof the density and hydration of íat-free mass. Clin Sci 1992; 82(6): 687-93.

2. Biaggi RR, Vollman MW, Nies MA, Brener CE, Flakoll PJ,Levenhagen DK, et al. Comparison of air-displacementplethysmography with hydrostatic weighing and bioelectricalimpedance analysis for the assessment of body composition inhealthy adults. Am J cu« Nutr 1999; 69 (5): 898-903.

3. Risérus D, Arnliiv J, Brismar K, Zethelius B, Berglund L,Vessby B. Sagittal abdominal diameter is a strong anthropo­metric marker of insulin resistance and hyperproinsulinemia inobesemen. Diabetes Care 2004; 27 (8): 2041-6.

4. Óhrvall M, BerglundL, Vessby B. Sagittal abdominal diametercompared with other anthropometric measurements in relationto cardiovascular risk. Int J Obes 2000; 24 (4): 497-501.

5. Petersson H, Daryani A, Risérus U. Sagittal abdominal diame­ter as a marker of inflammation and insulin resistance amongimmigrant women from the Middle East and native Swedishwomen: a cross-sectional study. Card Diaheto/2007; 6: 1-7.

6. Brekke HK, Lenner RA, Taskinen MR, Mansson JE, FunahashiT, Matsuzawa et al. Lifestyle modification improves riskfactors in type 2 diabetes relatives. Diabetes Res Clin Prac2005; 68 (1): 18-28.

7. Pimentel GD, Portero-Mclellan KC, Oliveira ER, Spada AP,Oshiiwa M, Zemdegs JC et al. Long-term nutrition educationreduces several risk factors for type 2 diabetes mellitus inBrazilians with impaired glucose tolerance. Nutr Res 2010; 30(3): 186-90.

8. Alberti KG, Zimmet P, Shaw J. The metabolic syndrome-a newworldwide definition. Lancet 2005; 366 (9491): 1059-62.

1128 Nutr Hosp, 2011;26(5):1125-1129 G. D. Pimentel et al.

9. Grundy SM. Hypcrtriglyccridcmia, insulin resistance, and themetabolic syndrome. Am J Cardiol 1992; 83 (9B): 25-9.

10. Nordhamn K. Siidergren E. Olsson E. Karlstriim B. Vessby B.Berglund L et al. Reliability of anthropometric measurementsin overweight and lean subjects: consequences for correlationsbetween anthropometric and other variables. Int J Obes 2000;24(5): 652-7.

11. Schoen RE. Thaete FL. Sankey SS. WeissIeld JL. KullerLH.Sagittal diameter in comparison with single slice CT as apredictor of total visceral adipose tissue volume. Int J ObesRelat Metab Disord 1998; 22 (4): 338-42.

12. Frenhani PB. Pimentel GD. Portero-Mclellan KC. Burini Re.Sagittal abdominal diameter as a predictor of visceral abdom­inal fat, insulin resistance, dyslipidemia and inflammation inoverweight Brazilian adults. Clin Nutr Suppl 2008; 3 (Suppl.1): 126 [Abstract].

13. Heyward VH. Stolarczyk LM. Avaliacao da composicñocorporal aplicada. I.ed. Barueri: Sao Paulo, 2000.

14. Segal KR. Van Loan M. Fitzgerald PI. Hodgdon JA. Van ItallieTB. Lean body mass estimation by bioeletrical impedanceanalysis: a four-site cross-validation study. Am J Clin Nutr1988;47 (1): 7-14.

15. Friedewald T. Levy RI. Frederickson DS. Estimation of theconcentration of low-density lipoprotein cholesterol in plasma.without use of the preparative ultraccntrifugc. Clin Chem 1972;18 (6): 499-502.

16. Tsimihodimos V. Gazi l. Kostara C. Tselepis AD. ElisaI M.Plasma lipoproteins and triacylglycerol are predictors of small,dense LDL particles. Lipids 2007; 42 (5): 403-9.

17. Levy J. Mattews DR. Hermans MP. Correct homeostasis modelassessment (HOMA) evaluation uses the computer programoDiabetes Care 1998; 21 (12): 2191-2.

18. Clasey JL. Bouchard C. Teates CD. Riblett JE. Thorner MO.Hartman ML et al. The use of anthropometric and dual-energy

X-ray absorptiometry (DXA) measures to estimate totalabdominal and abdominal visceral Iat in men and women. ObesRes 1999; 7 (3): 256-64.

19. Piernas Sánchez CM. Morales Falo EM. Zamora Navarro S.Garaulet Aza M. Study and classification of the abdominaladiposity throughout the application of the two-dimensionalpredictive equation Garaulet et al., in the clinical practice. NutrHosp 2010; 25 (2): 270-4.

20. Koenig W. Sund M. Frohlich M. Fischer HG. D Liiwel H.Diiring A et al. C-Reactive protcin, a sensitive marker ofinflammarion, predicts future risk of coronary heart disease ininitially healthy middle-aged men: results frorn the MONICA(Monitoring Trends and Determinants in CardiovascularDisease) Augsburg Cohort Study, 1984 to 1992. Circulation1999; 99 (2): 237-42.

21. Tracy RP. Lemaitre RN. Psaty BM. Ives DG. Evans RW.Cushman M et al. Relationship of C-reactive protein to risk ofcardiovascular disease in the elderly. Results from the Cardio­vascular Health Study and the Rural Health Promotion Project.Arterioscler Thromb Vasc Bio11997; 17 (6): 1121-7.

22. Valsamakis G. Chetty R. Anwar A. Banerjee AK. Barnett A.Kumar S. Association of simple anthropometric measures ofobesity with visceral Iat and the metabolic syndrome in maleCaucasian and Indo-Asian subjects. Diabet Med 2004; 21 (12):1339-45.

23. Pimentel GD. Portero-McLellan KC. Maestá N. Corrente JE.Burini RC. Accuracy of sagittal abdominal diameter aspredictor of abdominal Iat among Brazilian adults: a compara­tion with waist circumIerence.Nutr Hosp 2010; 25 (4): 656-61.

24. López de la TorreM. Bellido D. Soto A. Carreira J. HemándezMijares A. Standardisation of the waist circumference (WC) foreach range of body mass index (BMI) in adult outpatientsattended to in Endocrinology and Nutrition departments. NutrHosp 2010; 25 (2): 262-9.

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