When is comes to body fat distribution, it’s better to be a pear than to be an apple if you have heart disease. In other words, it’s better to have your body fat distributed over your hips and thighs (a pear) than in your belly (an apple). Those were the findings of research that was recently published in the May 10 issue of the Journal of the American College of Cardiology. It has always been controversial as to what type of body fat carries an increased risk for patients with heart disease. Researchers from the United States, Denmark, Korea and France decided to answer the question by studying the effects of central obesity and total obesity on the survival of patients with coronary artery disease. Central obesity was evaluated by looking at waist circumference and waist-hip ratio. Total obesity was evaluated by looking at body mass index or BMI. BMI is calculated using a person’s height and weight and classifies the measurement into four categories which include underweight, normal weight, overweight, obesity, and morbid obesity. The study analyzed data from 16,000 patients who had a diagnosis of coronary artery disease and showed that patients who had central obesity had greater than 2 times the risk of death than those patients who carried extra weight in other parts of their body. Central obesity is usually caused by intra-abdominal or visceral fat which accumulated around the body organs. Intra-abdominal or visceral fat is metabolically more active, contributes to insulin resistance and diabetes, and releases fatty acids, cholesterol, and other compounds into the blood which then go on to damage the lining of coronary arteries. Body fat clearly matters when it comes to a person’s risk for heart disease. This study shows that belly fat is much more dangerous than overall obesity. The study also suggests that BMI, which is a measure of overall obesity, is not a good measure of the risk that obesity plays with respect to heart disease. This was suggested by the study finding that even if your BMI was normal but you had increase central obesity, your mortality risk from heart disease was still elevated. The study also gives new evidence to explain the “obesity paradox” – findings which have shown that overall obesity can be protective once a person is diagnosed with heart disease. Thus, doctors should start measuring waist size instead of weight and height when assessing a patient’s risk of heart disease.
Thais Coutinho et. al. (2011) “Central Obesity and Survival in Subjects With Coronary Artery Disease: A Systematic Review of the Literature and Collaborative Analysis With Individual Subject Data ” J Am Coll Cardiol 57: 1877-1886.