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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 6, November/December 2019
AFRICA
321
Associations between body fat distribution and
cardiometabolic risk factors in mixed-ancestry South
African women and men
Florence E Davidson, Tandi E Matsha, Rajiv T Erasmus, Andre Pascal Kengne, Julia H Goedecke
Abstract
Objective:
To investigate the relationship between body fat
distribution and cardiometabolic risk in mixed-ancestry
South African (SA) men and women, and to explore the
effect of menopausal status on these relationships in women.
Methods:
In a cross-sectional study, 207 mixed-ancestry SA
women and 46 men underwent measurement of body compo-
sition using dual-energy X-ray absorptiometry, blood pres-
sure, oral glucose tolerance, lipid profile and high-sensitivity
C-reactive protein determination. The associations between
different body fat compartments and associated cardiometa-
bolic risk factors were explored.
Results:
Men had less percentage fat mass (%FM) [26.5%
(25–75th percentiles: 19.9–32.5) vs 44.0% (39.8–48.6),
p
≤
0.001], but more central and less peripheral fat (both
p
<
0.001)
than women. Post-menopausal women had greater %FM,
waist and visceral adipose tissue (VAT), and less gynoid %FM
than pre-menopausal women (all
p
≤
0.004). After adjusting
for age and gender, VAT accounted for the greatest variance in
insulin resistance (
R
2
=
0.27), while trunk %FM and leg %FM
accounted for the greatest variance in triglyceride (
R
2
=
0.13)
and high-density lipoprotein cholesterol concentrations (
R
2
=
0.14). The association between fat mass and regional subcuta-
neous adipose tissue and cardiometabolic risk factors differed
by gender and menopausal status.
Conclusion:
Central fat was the most significant correlate of
cardiometabolic risk and lower body fat was associated with
reduced risk. These relationships were influenced by gender
and menopausal status.
Keywords:
DXA, visceral adipose tissue, subcutaneous adipose
tissue, menopause, ethnicity, gender, cardiometabolic risk
Submitted 1/3/19, accepted 6/5/19
Published online 12/9/19
Cardiovasc J Afr
2019;
30
: 321–330
www.cvja.co.zaDOI: 10.5830/CVJA-2019-028
Globally, chronic non-communicable diseases (NCDs) are
responsible formore deaths thananyother cause, withpeople from
the low- and middle-income countries being disproportionately
affected.
1
In 2012, cardiovascular diseases (CVDs) and diabetes
accounted for 46.2 and 4% of NCDs-related deaths, respectively.
1
The South African (SA) cause-of-death profile for 2012 shows
similar trends.
2
An analysis of pooled population-based studies
conducted by the NCD Risk Factor Collaboration Africa
working group found that estimates of adiposity and diabetes
prevalence in SA were higher than the global average.
3
NCD
deaths are attributable to the high prevalence of major risk
factors, including obesity, which is driven by lifestyle factors such
as poor dietary intake and physical inactivity.
4
Obesity is a well-known risk factor for CVD and metabolic
diseases,
5-7
but body fat distribution appears to be a more
significant discriminator of risk than generalised adiposity. The
association of body fat with CVD risk differs by fat depot. A
meta-analysis of 40 observational studies on the associations of
different adipose tissue depots with insulin resistance revealed
the strongest correlate of insulin resistance to be visceral adipose
tissue (VAT).
8
By contrast, the relationship between abdominal
subcutaneous adipose tissue (SAT) and cardiometabolic risk
is weaker than VAT, as shown in multi-ethnic studies in men
and women.
9,10
However, the accumulation of lower body SAT
(gluteofemoral obesity) has shown opposing associations with
cardiometabolic risk.
11-13
Body fat distribution is also gender specific, with women
having more SAT and less VAT than men.
14,15
The greater central
adiposity, in particular VAT, in men translates to higher insulin
resistance,
14
type 2 diabetes
16
and an adverse cardiometabolic risk
profile in general. The risk of cardiometabolic disease increases
with age,
17
and in women, after menopause,
18
when weight gain
and increased central adiposity are common.
19
Differences also exist in body fat distribution among different
ethnic groups.
5,20
International studies have shown that Asian
Indians have more total and central fat mass than their Caucasian
and black counterparts.
21-23
Black Africans on the other hand
have less VAT but more abdominal SAT than Caucasians,
24-27
and greater gluteofemoral fat mass compared to Caucasian
women.
27
Department of Medical Imaging and Therapeutic Sciences,
Faculty of Health and Wellness Sciences, Cape Peninsula
University of Technology, Bellville, Cape Town, South Africa
Florence E Davidson, MTech,
davidsonf@cput.ac.zaDepartment of Biomedical Sciences, Faculty of Health
and Wellness Sciences, Cape Peninsula University of
Technology/South African Medical Research Council/
Cardiometabolic Health, Bellville, Cape Town, South Africa
Tandi E Matsha, PhD
Division of Chemical Pathology, Faculty of Medicine and
Health Sciences, National Health Laboratory Service
(NHLS), University of Stellenbosch, Cape Town, South
Africa
Rajiv T Erasmus, FMC Path, FC Path, DABCC (Am Board
Certified), DHSM
Non-Communicable Diseases Research Unit, South African
Medical Research Council, Parow, Cape Town, South Africa
Andre Pascal Kengne, MD, DSCS, PhD
Julia H Goedecke, PhD