Android fat distribution

Last updated
Example of android fat accumulation in a teenage male Excess adipose tissue.jpg
Example of android fat accumulation in a teenage male

Android fat distribution describes the distribution of human adipose tissue mainly around the trunk and upper body, in areas such as the abdomen, chest, shoulder and nape of the neck. [1] This pattern may lead to an "apple"-shaped body or central obesity, and is more common in males than in females. Thus, the android fat distribution of men is about 48.6%, which is 10.3% higher than that of premenopausal women. [2] In other cases, an ovoid shape forms, which does not differentiate between men and women. Generally, during early adulthood, females tend to have a more peripheral fat distribution such that their fat is evenly distributed over their body. However, it has been found that as females age, bear children and approach menopause, this distribution shifts towards the android pattern of fat distribution, [3] resulting in a 42.1% increase in android body fat distribution in postmenopausal women. [2] This could potentially provide evolutionary advantages such as lowering a woman's center of gravity making her more stable when carrying offspring. [1]

Contents

Android fat distribution is contrasted with gynoid fat distribution, whereby fat around the hips, thighs, and bottom results in a "pear"-shaped body.

Jean Vague, a physician from Marseilles, France, was one of the first individuals to bring to attention the increased risk of developing certain diseases (e.g., diabetes and gout) in individuals with an android distribution compared to a gynoid distribution. [4] There are other health consequences beyond these, including psychological consequences.

Biology

Android fat is readily mobilized by deficits in energy balance. It is stored in different depots to gynoid fat: android fat is stored in the upper body and can present a so-called "apple-shaped" body, while gynoid fat is stored in the lower body and can result in a "pear-shaped" body. [5]

Android fat cells are mostly visceral - they are large, deposited deep under the skin and are highly metabolically active. The hormones they secrete have direct access to the liver. [6] The presence of fat in the trunk and upper body in males is facilitated by testosterone. Testosterone circulation causes fat cells to deposit around the abdominal and gluteofemoral region, whereas in women oestrogen circulation leads to fat deposits around areas such as the thighs, the hips and the buttocks. [7] Therefore, measuring a person's oestrogen to testosterone ratio can reveal their predicted gynoid to android fat distribution. [8] Android fat develops as a back-up source of energy when the male body is experiencing an imbalance, whereas gynoid fat develops after puberty, in order to better prepare the body for supporting a potential infant. [1] 50% of the variance in abdominal fat mass observed in humans is due to genetic factors. [9]

The cellular characteristics of adipose tissue in android and [gynoid] obese women are different. Android type have larger fat (hypertrophy) cells whereas gynoid type have increased number of fat cells (hyperplasia). This allows for hypertrophic obesity and hyperplastic obesity. [10] Two different receptors, alpha and beta fat cell receptors, vary in their ability to facilitate or inhibit fat mobilization. Alpha-receptors are predominately in the lower body thus more abundant in gynoid patterns and Beta-receptors are predominantly in the upper body and so more abundant in android patterns. [11]

Causes

Hormonal disorders or fluctuations can lead to the formation of a lot of visceral fat and a protruding abdomen. Medications such as protease inhibitors that are used to treat HIV and AIDS also form visceral fat. Android fat can be controlled with proper diet and exercise. [12] A poor diet with lack of exercise is likely to increase android fat level.

Health consequences

Differences in body fat distribution are found to be associated with high blood pressure, high triglyceride, lower high-density lipoprotein (HDL) cholesterol levels and high fasting and post-oral glucose insulin levels [13]

The android, or male pattern, fat distribution has been associated with a higher incidence of coronary artery disease, in addition to an increase in resistance to insulin in both obese children and adolescents. [14] Studies have also related central abdominal obesity (indicated via increased waist–hip ratio) with increases in peripheral fasting insulin levels.[ citation needed ]

Android fat is also associated with a change in pressor response in circulation. Specifically, in response to stress in a subject with central obesity the cardiac output dependent pressor response is shifted toward a generalised rise in peripheral resistance with an associated decrease in cardiac output. [15]

There are differences in android and gynoid fat distribution among individuals, which relates to various health issues among individuals. Android body fat distribution is related to high cardiovascular disease and mortality rate. People with android obesity have higher hematocrit and red blood cell count and higher blood viscosity than people with gynoid obesity. Blood pressure is also higher in those with android obesity which leads to cardiovascular disease. [16]

Women who are infertile and have polycystic ovary syndrome show high amounts of android fat tissue. In contrast, patients with anorexia nervosa have increased gynoid fat percentage [17] Women normally have small amounts of androgen, however when the amount is too high they develop male psychological characteristics and male physical characteristics of muscle mass, structure and function and an android adipose tissue distribution. Women who have high amounts of androgen and thus an increase tendency for android fat distribution are in the lowest quintiles of levels of sex-hormone-binding globulin and more are at high risks of ill health associated with android fat [18]

High levels of android fat have been associated with obesity [19] and diseases caused by insulin insensitivity, such as diabetes. [20] Insulin responsiveness is dependent on adipose cell size. The larger the adipose cell size the less sensitive the insulin. Diabetes is more likely to occur in obese women with android fat distribution and hypertrophic fat cells. [10] It is not just general obesity that is a consequence of android fat distribution but also other health consequences. There are connections between high android fat distributions and the severity of diseases such as acute pancreatitis - where the higher the levels of android fat are, the more severe the pancreatitis can be. [21] An increase in android fat distribution is positively correlated with foot pain and disability associated with foot pain. [22] Foot pain is reported to be the second most common musculoskeletal symptom in children who are obese. Even adults who are overweight and obese report foot pain to be a common problem. [23] [24]

Psychological consequences

Body fat can impact on an individual mentally. High levels of android fat have been linked to poor mental wellbeing, including anxiety, depression and body confidence issues. On the reverse, psychological aspects can impact on body fat distribution too. Women classed as being more extroverted tend to have less android body fat. [25]

Waist–hip ratio

Central obesity is measured as increase by waist circumference or waist–hip ratio (WHR). Increase in waist circumference > 102 cm (40 in.) in males and > 88 cm (35 in.) in females. However increase in abdominal circumference may be due to increasing in subcutaneous or visceral fat, and it is the visceral fat which increases the risk of coronary diseases. The visceral fat can be estimated with the help of MRI and CT scan.

Waist to hip ratio is determined by an individual's proportions of android fat and gynoid fat. A small waist to hip ratio indicates less android fat, high waist to hip ratio's indicate high levels of android fat.[ citation needed ]

As WHR is associated with a woman's pregnancy rate, it has been found that a high waist-to-hip ratio can impair pregnancy, thus a health consequence of high android fat levels is its interference with the success of pregnancy and in-vitro fertilisation. [26] Body fat distribution is also related to the sex ratio of offspring. Women with large waists (a high WHR) tend to have an android fat distribution caused by a specific hormone profile, that is, having higher levels of androgens. This leads to such women having more sons. [27]

Liposuction

Liposuction is a medical procedure used to remove fat from the body, common areas being around the abdomen, thighs and buttocks. Liposuction does not improve an individual's health or insulin sensitivity [28] and is therefore considered a cosmetic surgery. [29] Liposuction improves quality of life in everyday activities and issues regarding ones psychological state or social life after liposuction are less serious. [30] It has been found that abdominal exercise alone cannot reduce android fat around the trunk and abdomen [31] so liposuction is often a short term solution.

Another method of reducing android fat is Laparoscopic Adjustable Gastric Banding which has been found to significantly reduce overall android fat percentages in obese individuals. [32]

Individual differences

Cultural differences

Cultural differences in the distribution of android fat have been observed in several studies. Compared to Europeans, South Asian individuals living in the UK have greater abdominal fat. [33] Asian Indians living in the USA have high levels of body fat in contrast to their muscle mass and BMI [34] Newborn babies in India also show similar differences in their body fat distribution. [35] There is a difference in waist-to-hip ratio (WHRs) between Indian people and Africans living in South Africa such that Indians have greater WHRs compared to African people. [36]

A difference in body fat distribution was observed between men and women living in Denmark (this includes both android fat distribution and gynoid fat distribution), of those aged between 35 and 65 years, men showed greater body fat mass than women. Men showed a total body fat mass increase of 6.9 kg and women showed a total body fat mass increase of 4.5 kg between the ages of 35 and 65. [37] These observed differences could be due to a difference in muscularity. [38] Australian Aborigines who live a hunter gatherer lifestyle, have been noted to have high levels of obesity (with an android fat distribution) when they switch to a Westernized lifestyle. This is because in comparison to their previous lifestyle where they would engage in strenuous physical activity daily and have meals that are low in fat and high in fiber, the Westernized lifestyle has less physical activity and the diet includes high levels of carbohydrates and fats. [39]

Android fat distributions change across life course. The main changes in women are associated with menopause. Premenopausal women tend to show a more gynoid fat distribution than post-menopausal women - this is associated with a drop in oestrogen levels. An android fat distribution becomes more common post-menopause, where oestrogen is at its lowest levels. [8] [40] Older men show android fat distributions more often than younger men [41] which may be due to lifestyle changes, or hormonal changes related to age. [42] Older adults have a greater waist-to-hip ratio than young adults which indicates high levels of android fat in older adults. Computed tomography studies show that older adults have a two-fold increase in visceral fat compared to young adults. These changes in android fat distribution in older adults occurs in the absence of any clinical diseases. [43]

Related Research Articles

<span class="mw-page-title-main">Body mass index</span> Relative weight based on mass and height

Body mass index (BMI) is a value derived from the mass (weight) and height of a person. The BMI is defined as the body mass divided by the square of the body height, and is expressed in units of kg/m2, resulting from mass in kilograms (kg) and height in metres (m).

<span class="mw-page-title-main">Metabolic syndrome</span> Medical condition

Metabolic syndrome is a clustering of at least three of the following five medical conditions: abdominal obesity, high blood pressure, high blood sugar, high serum triglycerides, and low serum high-density lipoprotein (HDL).

Insulin resistance (IR) is a pathological condition in which cells in insulin-sensitive tissues in the body fail to respond normally to the hormone insulin or downregulate insulin receptors in response to hyperinsulinemia.

<span class="mw-page-title-main">Abdominal obesity</span> Excess fat around the stomach and abdomen

Abdominal obesity, also known as central obesity and truncal obesity, is the human condition of an excessive concentration of visceral fat around the stomach and abdomen to such an extent that it is likely to harm its bearer's health. Abdominal obesity has been strongly linked to cardiovascular disease, Alzheimer's disease, and other metabolic and vascular diseases.

<span class="mw-page-title-main">Adipose tissue</span> Loose connective tissue composed mostly by adipocytes

Adipose tissue is a loose connective tissue composed mostly of adipocytes. It also contains the stromal vascular fraction (SVF) of cells including preadipocytes, fibroblasts, vascular endothelial cells and a variety of immune cells such as adipose tissue macrophages. Its main role is to store energy in the form of lipids, although it also cushions and insulates the body.

<span class="mw-page-title-main">Waist</span> Part of the abdomen between the rib cage and hips

The waist is the part of the abdomen between the rib cage and hips. On people with slim bodies, the waist is the narrowest part of the torso.

<span class="mw-page-title-main">Resistin</span> Mammalian protein found in Homo sapiens

Resistin also known as adipose tissue-specific secretory factor (ADSF) or C/EBP-epsilon-regulated myeloid-specific secreted cysteine-rich protein (XCP1) is a cysteine-rich peptide hormone derived from adipose tissue that in humans is encoded by the RETN gene.

<span class="mw-page-title-main">Hyperinsulinemia</span> Abnormal increase in insulin in the bloodstream relative to glucose

Hyperinsulinemia is a condition in which there are excess levels of insulin circulating in the blood relative to the level of glucose. While it is often mistaken for diabetes or hyperglycaemia, hyperinsulinemia can result from a variety of metabolic diseases and conditions, as well as non-nutritive sugars in the diet. While hyperinsulinemia is often seen in people with early stage type 2 diabetes mellitus, it is not the cause of the condition and is only one symptom of the disease. Type 1 diabetes only occurs when pancreatic beta-cell function is impaired. Hyperinsulinemia can be seen in a variety of conditions including diabetes mellitus type 2, in neonates and in drug-induced hyperinsulinemia. It can also occur in congenital hyperinsulinism, including nesidioblastosis.

<span class="mw-page-title-main">Waist–hip ratio</span> Ratio of their circumferences

The waist–hip ratio or waist-to-hip ratio (WHR) is the dimensionless ratio of the circumference of the waist to that of the hips. This is calculated as waist measurement divided by hip measurement. For example, a person with a 75 cm waist and 95 cm hips has WHR of about 0.79.

Sagittal abdominal diameter (SAD) is a measure of visceral obesity, the amount of fat in the gut region. SAD is the distance from the small of the back to the upper abdomen. SAD may be measured when standing or supine. SAD may be measured at any point from the narrowest point between the last rib and the iliac crests to the midpoint of the iliac crests.

<span class="mw-page-title-main">Body shape</span> General shape of a human body

Human body shape is a complex phenomenon with sophisticated detail and function. The general shape or figure of a person is defined mainly by the molding of skeletal structures, as well as the distribution of muscles and fat. Skeletal structure grows and changes only up to the point at which a human reaches adulthood and remains essentially the same for the rest of their life. Growth is usually completed between the ages of 13 and 18, at which time the epiphyseal plates of long bones close, allowing no further growth.

<span class="mw-page-title-main">Sarcopenic obesity</span> Medical condition: obesity and loss of muscle

Sarcopenic obesity is a combination of two disease states, sarcopenia and obesity. Sarcopenia is the muscle mass/strength/physical function loss associated with increased age, and obesity is based off a weight to height ratio or body mass index (BMI) that is characterized by high body fat or being overweight.

<span class="mw-page-title-main">Female body shape</span> Cumulative product of the human female skeletal structure and distribution of muscle and fat

Female body shape or female figure is the cumulative product of a woman's bone structure along with the distribution of muscle and fat on the body.

<span class="mw-page-title-main">Classification of obesity</span> Overview of the classification of the condition of obesity

Obesity classification is a ranking of obesity, the medical condition in which excess body fat has accumulated to the extent that it has an adverse effect on health. The World Health Organization (WHO) classifies obesity by body mass index (BMI). BMI is further evaluated in terms of fat distribution via the waist–hip ratio and total cardiovascular risk factors. In children, a healthy weight varies with sex and age, and obesity determination is in relation to a historical normal group.

A person's waist-to-height ratio – occasionally written WHtR – or called waist-to-stature ratio (WSR), is defined as their waist circumference divided by their height, both measured in the same units. It is used as a predictor of obesity-related cardiovascular disease. The WHtR is a measure of the distribution of body fat. Higher values of WHtR indicate higher risk of obesity-related cardiovascular diseases; it is correlated with abdominal obesity.

A number of lifestyle factors are known to be important to the development of type 2 diabetes including: obesity, physical activity, diet, stress, and urbanization. Excess body fat underlies 64% of cases of diabetes in men and 77% of cases in women. A number of dietary factors such as sugar sweetened drinks and the type of fat in the diet appear to play a role.

<span class="mw-page-title-main">TOFI</span> Individual with disproportionate amount of fat

TOFI (thin-outside-fat-inside) is used to describe lean individuals with a disproportionate amount of fat stored in their abdomen. The figure to illustrate this shows two men, both 35 years old, with a BMI of 25 kg/m2. Despite their similar size, the TOFI had 5.86 litres of internal fat, whilst the healthy control had only 1.65 litres.

Tumescent liposuction is a technique that provides local anesthesia to large volumes of subcutaneous fat and thus permits liposuction.

Normal weight obesity is the condition of having normal body weight, but with a high body fat percentage, leading to some of the same health risks as obesity.

<span class="mw-page-title-main">Gynoid fat distribution</span> Female body fat around the hips, breasts and thighs

Gynoid fat is the body fat that forms around the lower body, specifically the hips, thighs and buttocks. Gynoid fat in females is used to provide nourishment for offspring, and is often referred to as 'reproductive fat'. This is because it contains long-chain polyunsaturated fatty acids (PUFAs), which are important in the development of fetuses. It is regarded as a physically attractive feature, serving as an indication towards a woman's reproductive potential.

References

  1. 1 2 3 Thornhill (2008). The Evolutionary Biology of Human Female Sexuality. Oxford University Press. ISBN   9780195340983.
  2. 1 2 Ley, CJ; Lees, B; Stevenson, JC (1992). "Sex-and menopause-associated changes in body-fat distribution". American Journal of Clinical Nutrition. 55 (5): 950–954. doi:10.1093/ajcn/55.5.950. PMID   1570802. S2CID   4481978.
  3. ↑ Wells, JCK (2007). "Sexual dimorphism of body composition". Best Practice & Research Clinical Endocrinology & Metabolism. 21 (3): 415–430. doi:10.1016/j.beem.2007.04.007. PMID   17875489.
  4. ↑ Despres, J.-P. (4 September 2012). "Body Fat Distribution and Risk of Cardiovascular Disease: An Update". Circulation. 126 (10): 1301–1313. doi: 10.1161/CIRCULATIONAHA.111.067264 . PMID   22949540.
  5. ↑ Yang, Ling; Huang, Hangkai; Liu, Zhening; Ruan, Jiaqi; Xu, Chengfu (15 May 2023). "Association of the android to gynoid fat ratio with nonalcoholic fatty liver disease: a cross-sectional study". Frontiers in Nutrition. 10. doi: 10.3389/fnut.2023.1162079 . ISSN   2296-861X. PMC   10226647 . PMID   37255941.
  6. ↑ "How does the type of fat you have affect your risk of disease?". weight-loss.yoexpert. Retrieved 21 March 2016.
  7. ↑ Furnham, A.; Tan, T.; McManus, C. (1997). "Waist-to-hip ratio and preferences for body shape: A replication and extension". Personality and Individual Differences. 22 (4): 539–549. CiteSeerX   10.1.1.517.1397 . doi:10.1016/s0191-8869(96)00241-3.
  8. 1 2 Kirchengast, S.; Gruber, D.; Sator, M.; Hartmann, B.; Knogler, W.; Huber, J. (1997). "Menopause-associated differences in female fat patterning estimated by dual-energy X-ray absorptiometry". Annals of Human Biology. 24 (1): 45–54. doi:10.1080/03014469700004762. PMID   9022905.
  9. ↑ Ali, A; Crowther, N (2005). "Body fat distribution and insulin resistance". South African Medical Journal. 95 (11): 878–880. PMID   16344887.
  10. 1 2 Sutherland, H.W; Stowers, J.M (1978). Carbohydrate Metabolism in Pregnancy and the Newborn. Springer. ISBN   978-3-540-08798-4.
  11. ↑ Plowman, Sharon; Smith, Denise (2008). Exercise Physiology for Health, Fitness, and Performance. Lippincott Williams & Wilkins. ISBN   978-0-7817-8406-1.
  12. ↑ "Liposuction Info: Fat Cells and Your Anatomy". liposuction4you. Retrieved 21 March 2016.
  13. ↑ Ali, A; Nigel, C (2005). "Body fat distribution and insulin resistance". South African Medical Journal. 95 (95): 878–880. PMID   16344887.
  14. ↑ Aucouturier, J; Meyer, M; Thivel, D; Taillardat, M; Duché, P (2009). "Effect of android to gynoid fat ratio on insulin resistance in obese youth". Archives of Pediatrics & Adolescent Medicine. 163 (9): 826–831. doi:10.1001/archpediatrics.2009.148. PMID   19736336.
  15. ↑ Fox, Caroline S.; Massaro, Joseph M.; Hoffmann, Udo; Pou, Karla M.; Maurovich-Horvat, Pal; Liu, Chun-Yu; Vasan, Ramachandran S.; Murabito, Joanne M.; Meigs, James B.; Cupples, L. Adrienne; D'Agostino, Ralph B.; O'Donnell, Christopher J. (2007). "Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study". Circulation. 116 (1): 39–48. doi: 10.1161/CIRCULATIONAHA.106.675355 . PMID   17576866.
  16. ↑ Wysocki, M; Krotkiewski, M; Braide, M; Bagge, U (3 January 1991). "Hemorheological disturbances, metabolic parameters and blood pressure in different types of obesity". Atherosclerosis. 88 (1): 21–28. doi:10.1016/0021-9150(91)90253-y. PMID   1878007.
  17. ↑ Kirchengast, S; Huber, J (2004). "Body composition characteristics and fat distribution patterns in young infertile women". Fertility and Sterility. 81 (3): 539–44. doi: 10.1016/j.fertnstert.2003.08.018 . PMID   15037399.
  18. ↑ BJORNTORP, PER (1996). "The android woman – a risky condition". Journal of Internal Medicine. 239 (2): 105–110. doi: 10.1046/j.1365-2796.1996.364690000.x . PMID   8568477. S2CID   24421479.
  19. ↑ Lewis, G; Carpentier, A; Adeli, K; Giacca, A (2003). "Disorded fat storage and mobilization in the pathogenesis of insulin resistance and type 2 diabetes". Endocrine Reviews. 23 (2): 201–229. doi: 10.1210/edrv.23.2.0461 . PMID   11943743.
  20. ↑ Blouin, K; Boivin, A; Tchernof, A (2008). "Androgens and body fat distribution". Journal of Steroid Biochemistry and Molecular Biology. 108 (3): 272–280. doi:10.1016/j.jsbmb.2007.09.001. PMID   17945484. S2CID   11133007.
  21. ↑ Mery, C. M.; Rubio, V.; Duarte-Rojo, A. E. S.; Suazo-Barahona, J.; Peláez-Luna, M.; Milke, P.; Robles-Díaz, G. (2002). "Android fat distribution as predictor of severity in acute pancreatitis". Pancreatology. 2 (6): 543–549. doi:10.1159/000066099. PMID   12435867. S2CID   19764827.
  22. ↑ Tanamas, S.; Wluka, A.; Berry, P.; Menz, H.; Strauss, B.; Davies-Tuck, M.; et al. (2012). "Relationship between obesity and foot pain and its association with fat mass, fat distribution, and muscle mass". Arthritis Care & Research. 64 (2): 262–268. doi:10.1002/acr.20663. PMID   21972207. S2CID   29045242.
  23. ↑ Hill, C.; Gill, T.; Menz, H.; Taylor, A. (2008). "Prevalence and correlates of foot pain in a population-based study: the North West Adelaide health study". Journal of Foot and Ankle Research. 1 (1): 2. doi: 10.1186/1757-1146-1-2 . PMC   2547889 . PMID   18822153.
  24. ↑ Steele JR, Mickle KJ, Munro B. Fat flat frail feet: how does obesity affect the older foot. XXII Congress of the International Society of Biomechanics; 2009.
  25. ↑ Davis, C.; Cerullo, D. (1996). "Fat distribution in young women: Associations and interactions with behavioural, physical and psychological factors". Psychology, Health & Medicine. 1 (2): 159–167. doi:10.1080/13548509608400015.
  26. ↑ Wass, P.; Waldenström, U.; Rössner, S.; Hellberg, D. (1997). "An android body fat distribution in females impairs the pregnancy rate of in-vitro fertilization-embryo transfer". Human Reproduction. 12 (9): 2057–2060. doi: 10.1093/humrep/12.9.2057 . PMID   9363729.
  27. ↑ Abu-Rmeileh, N; Watt, G; Lean, M (2011). "sex differences of offspring-parents obesity: Angely hypothesis revisited" (PDF). Human Biology. 83 (4): 523–530. doi:10.3378/027.083.0406. PMID   21846208. S2CID   2302428.
  28. ↑ Wenk, G (7 February 2016). "Your Brain on Food". Psychology Today. Retrieved 2016-03-02.
  29. ↑ Nordqvist, Christian. "What is liposuction? What are the risks and benefits of havings liposuction?". Medical News Today. Knowledge Center. Retrieved 2 March 2016.
  30. ↑ Brorson, H; Ohlin, K; Olsson, G; Langstrom, G; Wiklund, I; Stvensson, H (2006). "Quality of life following liposuction and conservative treatment of arm lymphedema". Lymphology. 39 (1): 8–25. PMID   16724506.
  31. ↑ Vispute, S. S.; Smith, J. D.; LeCheminant, J. D.; Hurley, K. S. (2011). "The effect of abdominal exercise on abdominal fat". The Journal of Strength & Conditioning Research. 25 (9): 2559–2564. doi:10.1519/jsc.0b013e3181fb4a46. PMID   21804427. S2CID   207503551.
  32. ↑ Nadler, E. P.; Reddy, S.; Isenalumhe, A.; Youn, H. A.; Peck, V.; Ren, C. J.; Fielding, G. A. (2009). "Laparoscopic adjustable gastric banding for morbidly obese adolescents affects android fat loss, resolution of comorbidities, and improved metabolic status". Journal of the American College of Surgeons. 209 (5): 638–644. doi:10.1016/j.jamcollsurg.2009.07.022. PMID   19854406.
  33. ↑ McKeigue, PM; Shah, B; Marmot, MG (1991). "Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians". Lancet. 337 (8738): 382–386. doi:10.1016/0140-6736(91)91164-p. PMID   1671422. S2CID   21350831.
  34. ↑ Banerji, MA; Faridi, N; Atluri, R; Chaiken, RL; Lebovitz, HE (1999). "Body composition visceral fat, leptin and insulin resistance in Asian Indian Men". J Clin Endocrinol Metab. 84 (1): 137–144. doi: 10.1210/jcem.84.1.5371 . PMID   9920074.
  35. ↑ Bavdekar, A; Yajnik, CS; Fall, CHD; et al. (1999). "Insulin resistance syndrome in 8-year-old Indian children". Diabetes. 48 (12): 2422–2429. doi:10.2337/diabetes.48.12.2422. PMID   10580432.
  36. ↑ Ali, A.; Crowther, N. (2005). "Body fat distribution and insulin resistance". South African Medical Journal. 95 (11): 878–880. PMID   16344887.
  37. ↑ Heitmann, BL (1991). "Body fat in the adult Danish population aged 35-65 years: an epidemiological study". International Journal of Obesity. 15 (8): 535–545. PMID   1938097.
  38. ↑ Laulu, M; Simmons, D; Rush, E; Plank, L; Chandu, V (Dec 17, 2004). "Body size, body composition, and fat distribution: a comparison of young New Zealand men of European, Pacific Island, and Asian Indian ethnicities". The New Zealand Medical Journal. 117 (1207): 117–1207. PMID   15608799.
  39. ↑ O'Dea, K (1991). "Westernization and non-insulin-dependent diabetes in Australian Aborigines". Ethnicity & Disease. 1 (2): 171–187. PMID   1668799.
  40. ↑ Ley, C. J.; Lees, B.; Stevenson, J. C. (1992). "Sex-and menopause-associated changes in body-fat distribution". The American Journal of Clinical Nutrition. 55 (5): 950–954. doi:10.1093/ajcn/55.5.950. PMID   1570802. S2CID   4481978.
  41. ↑ Mueller, W. H.; Joos, S. K. (1985). "Android (centralized) obesity and somatotypes in men: association with mesomorphy". Annals of Human Biology. 12 (4): 377–381. doi:10.1080/03014468500007911. PMID   4037721.
  42. ↑ Rimm, E. B.; Stampfer, M. J.; Giovannucci, E.; Ascherio, A.; Spiegelman, D.; Colditz, G. A.; Willett, W. C. (1995). "Body size and fat distribution as predictors of coronary heart disease among middle-aged and older US men". American Journal of Epidemiology. 141 (12): 1117–1127. doi:10.1093/oxfordjournals.aje.a117385. PMID   7771450.
  43. ↑ Schwartz, R., Shuman, W., Bradbury, V., Cain, K., Fellingham, G., & Beard, J. et al. (1990). Body Fat Distribution in Healthy Young and Older Men" Journal of Gerontology 45(6), M181-M185.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.