It has been hypothesized that visceral fat releases free fatty acids and adipokines and thereby exposes the liver to fat accumulation. The authors aimed to evaluate current epidemiologic evidence for an association between abdominal fat and liver fat content. Clinical and epidemiologic studies with data on abdominal fat and liver fat content were reviewed. Studies using waist circumference to estimate abdominal fat mass suggested a direct association between abdominal fat and liver fat content. Studies using imaging methods suggested a direct association between intraabdominal fat and liver fat content, but not between subcutaneous abdominal fat and liver fat content. In conclusion, clinical and epidemiologic studies of abdominal fat and liver fat content suggest a direct association between abdominal fat and liver fat content which is probably accounted for by visceral fat. However, results from the included studies do not allow strong conclusions regarding the temporal sequence of events. Future longitudinal studies are recommended to obtain additional information on associations and mechanisms. Both abdominal fat depots and other body compartments of interest should be included to further investigate the association between specific fat depots and liver fat content. Biomarkers may provide insight into underlying mechanisms.
INTRODUCTION: The aim of the present study was to quantify the impact of different dietary factors on the mortality from ischaemic heart disease in Denmark. METHODS: Relative risks and knowledge on the distribution of different dietary factors were used to estimate etiological fractions. RESULTS: It is estimated that an intake of fruit and vegetables and saturated fat as recommended would prevent 12 and 22%, respectively, of deaths from ischaemic heart disease in Denmark. An intake of fish among those at high risk for ischaemic heart disease, would lead to a 26% lower mortality, while alcohol intake among abstainers would have no significant quantitative effect. DISCUSSION: These results suggest that changes in dietary habits according to current recommendations would have an impact on public health in Denmark.
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.
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.
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.
OBJECTIVE: Smoking serves different functions for men and women. Thus, we wanted to investigate the association between smoking behaviour and intakes of selected healthy foods in men and women with special focus on differences and similarities between the two genders. DESIGN: In 1993-1997, a random sample of 80 996 men and 79 729 women aged 50-64 y was invited to participate in the study 'Diet, Cancer and Health'. In all, 27 179 men and 29 876 women attended a health examination and completed a 192-item food-frequency questionnaire (FFQ). The association between smoking status and low, median and high intakes of selected foods was examined among 25 821 men and 28 596 women. SETTING: The greater Copenhagen and Aarhus area, Denmark. RESULTS: For both men and women, smoking status group was associated with diet, such that increasing level of smoking status ranging from never smokers over ex-smokers to currently heavy smokers was associated with a lower intake of the healthy foods: fresh fruit, cooked vegetables, raw vegetables/salad, and olive oil. For wine, increasing level of smoking status category was associated with a higher fraction of abstainers and heavy drinkers. The difference between the extreme smoking status categories was larger than the difference between men and women within smoking status categories such that never smoking men in general had a higher intake of healthy foods than heavy smoking women. Correction for age, educational level, and body mass index (BMI) did not affect the results. CONCLUSION: In this middle-aged population, intake of healthy foods were associated with smoking behaviour with a dose-response type of relationship. The overall pattern was similar for men and women.
Follow-up studies have suggested that total intake of trans fatty acids (TFA) is a risk factor for gain in body weight and waist circumference (WC). However, in a cross-sectional study individual TFA isomers in adipose tissue had divergent associations with anthropometry. Our objective was to investigate the association between intake of TFA from ruminant dairy and meat products and subsequent changes in weight and WC. Furthermore, potential effect modification by sex, age, body mass index and WC at baseline was investigated.
Data on weight, WC, habitual diet and lifestyle were collected at baseline in a Danish cohort of 30,851 men and women aged 50-64 years. Follow-up information on weight and WC was collected 5 years after enrolment. The associations between intake of ruminant TFA (R-TFA) and changes in weight and WC were analysed using multiple linear regression with cubic spline modelling.
Intake of R-TFA, both absolute and energy-adjusted intake, was significantly associated with weight change. Inverse associations were observed at lower intakes with a levelling-off at intakes >1.2?g/day and 0.4 energy percentage (E %). Absolute, but not energy-adjusted, intake of R-TFA was significantly associated with WC change. An inverse association was observed at lower intakes with a plateau above an intake of 1.2?g/day.
The present study suggests that intake of R-TFA is weakly inversely associated with changes in weight, whereas no substantial association with changes in WC was found.
OBJECTIVES: To study the association between alcohol drinking pattern and obesity. DESIGN: Cross-sectional population study with assessment of quantity and frequency of alcohol intake, waist and hip circumference, height, weight, and lifestyle factors including diet. SUBJECTS: In all, 25 325 men and 24 552 women aged 50-65 y from the Diet, Cancer and Health Study, Denmark, 1993-1997 participated in the study. MEASUREMENTS: Drinking frequency, total alcohol intake, body mass index (BMI), and waist and hip circumference. RESULTS: Among men, total alcohol intake was positively associated with high BMI (>/=30 kg/m(2)), large waist circumference (>/=102 cm) and inversely associated with small hip circumference (/=88 cm), and small hips only for the highest intake (28+ drinks/week). The most frequent drinkers had the lowest odds ratios (OR) for being obese. Among men, OR for having a high BMI were 1.39 (95% confidence interval: 1.36-1.64), 1.17 (1.02-1.34), 1.00 (reference), 0.87 (0.77-0.98), and 0.73 (0.65-0.82) for drinking 1-3 days/month, 1 day/week, 2-4 days/week, 5-6 days/week, and 7 days/week, respectively. Similar estimates were found for waist circumference. Corresponding results were found for women. CONCLUSION: For a given level of total alcohol intake, obesity was inversely associated with drinking frequency, whereas the amount of alcohol intake was positively associated with obesity. These results indicate that frequent drinking of small amounts of alcohol is the optimal drinking pattern in this relation.
OBJECTIVE: To investigate whether waist and hip circumferences, in addition to body mass index (BMI), are related to all-cause mortality. We studied these associations and tested the usefulness of the waist-to-hip ratio for mortality prediction. DESIGN: A Danish prospective cohort study with data collected between 1993 and 1997. SUBJECTS: A total of 27 179 men and 29 875 women born in Denmark and aged 50-64 years were followed for a median of 6.8 years. MEASUREMENTS: BMI, waist and hip circumferences at baseline. RESULTS: The associations between hip circumference and all-cause mortality were inverse for both men and women, but only after adjustment for waist circumference, or BMI, or both. The mortality rate ratios of mutually adjusted waist and hip circumferences were 0.63 (95% CI: 0.56, 0.71), and 0.70 (95% CI: 0.63, 0.79) times higher per 10% larger hip circumference in men and women, respectively, and 1.45 (95% CI: 1.34, 1.57) and 1.22 (95% CI: 1.14, 1.31) times higher per 10% larger waist circumference. The adequacy of the waist-to-hip ratio as a substitute for separate measurements of waist and hip circumferences depended on which other variables the analysis was adjusted for, indicating that the waist-to-hip ratio should be used with precaution. CONCLUSION: When mutually adjusted, waist and hip circumferences show opposite associations with all-cause mortality, probably due to different effects of adipose tissue in the abdominal and gluteofemoral regions. The waist-to-hip ratio cannot always capture these relations adequately.
OBJECTIVE: Waist circumference is directly related to all-cause mortality when adjusted for body mass index (BMI). Body fat and fat-free body mass, when mutually adjusted, show with increasing values an increasing and decreasing relation to all-cause mortality. We investigated the association of waist circumference and body composition (body fat and fat-free mass), mutually adjusted, to all-cause mortality. DESIGN: A Danish prospective cohort study with a median follow-up period of 5.8 y. SUBJECTS: In all, 27 178 men and 29 875 women, born in Denmark, aged 50-64 y, and without diagnosis of cancer at the time of invitation. MEASUREMENTS: Waist circumference and body composition estimated from impedance measurements. Cox's regression models were used to estimate the mortality rate ratios (RR). RESULTS: Waist circumference was strongly associated with all-cause mortality after adjustment for body composition; the mortality RR was 1.36 (95% confidence intervals (CI): 1.22-1.52) times higher per 10% larger waist circumference among men and 1.30 (95% CI: 1.17-1.44) times higher among women. Adjustment for waist circumference eliminated the association between high values of the body fat mass index (BFMI) and all-cause mortality. The association between fat-free mass index (FFMI) and mortality remained unaltered. CONCLUSION: Waist circumference accounted for the mortality risk associated with excess body fat and not fat-free mass. Waist circumference remained strongly and directly associated with all-cause mortality when adjusted for total body fat in middle-aged men and women, suggesting that the increased mortality risk related to excess body fat is mainly due to abdominal adiposity.