OBJECTIVE: To evaluate the relationship between supine sagittal abdominal diameter (SAD) and other indicators of body fat distribution with cardiovascular (CVD) risk factors in the elderly. SUBJECTS: One-hundred and forty-six women aged from 67 to 78 y with a body mass index (BMI) ranging from 18.7 to 50.6 kgam 2 and 83 men aged between 67 and 78 y with BMI ranging from 19.8 to 37.1 kgam 2 . MEASUREMENT: Body fat distribution was assessed using anthropometric indicators: waist circumference, SAD, waist-to-hip ratio (WHR), waist-to-height ratio and SAD-to-thigh ratio. RESULTS: In women, there was a negative correlation between HDL-cholesterol and body weight, BMI, waist, SAD, WHR, waist-to-height ratio and SAD-to-thigh ratio. A signi®cant association was found between triglycerides, basal glucose, 2 h glucose during oral glucose tolerance test (OGTT), systolic blood pressure (SBP), diastolic blood pressure (DBP) and anthropometric variables. In men a negative correlation was found between HDL-cholesterol and all the anthropometric variables. A signi®cant association was found between triglycerides, DBP and body weight, BMI, waist, SAD and waist-to-height ratio. In women, after adjusting for age and BMI, a signi®cant correlation was observed between waist and HDL-cholesterol, triglycerides and basal glucose. This was also seen with SAD and SADto-thigh ratio and triglycerides, basal and 2 h glucose. In men, after adjusting for age and BMI a signi®cant correlation was found between SAD and HDL-cholesterol and triglycerides. When adjustments were made for age and waist, the correlations between BMI and metabolic variables as well between BMI and SBP and DBP were no longer signi®cant. CONCLUSIONS: Our study shows that indicators of body fat distribution are associated with CVD risk factors in the elderly independently of BMI. Our data also show that waist and SAD are the anthropometric indicators of fat distribution which are most closely related to CVD risk factors in old age.

OBJECTIVE: To ascertain in obesity the role of body fat distribution (the strongest predictor of morbility and mortality in obese subjects) in determining the degree of endothelial dysfunction, an early marker of atherosclerotic disease. SUBJECTS: 18 premenopausal women with uncomplicated obesity excluding other cardiovascular risk factors and 12 age-matched slim healthy women. MEASUREMENTS: Endothelium-dependent vasodilation, studied as diameter variation in response to an increase in shear-stress, was evaluated in the right common femoral artery of obese and slim subjects by a non invasive approach and compared to glyceril-trinitrate vasodilation. To characterize better the vascular functional andaor structural properties, we studied the arterial wall distensibility by an echo-tracking system. Adipose tissue regional distribution was determined by computerised axial tomography. RESULTS: The endothelium-dependent vasodilation was signi®cantly impaired in obese subjects (P`0.005 versus non-obese subjects) while glyceril-trinitrate vasodilation and arterial distensibility were similar in the two groups. In our obese subjects endothelial-dependent vasodilation was inversely correlated to body fat distribution (visceralasubcutaneous adipose tissue ratio: r À0.624, P 0.0058). In contrast, metabolic parameters (except C-peptide response during oral glucose tolerance test (OGTT): r À0.587, P 0.01), blood pressure values and body weight did not correlate with the endothelial function. CONCLUSION: Uncomplicated obesity per se is characterised by an alteration of the endothelial function; the degree of this vascular damage is predicted by body fat distribution independently of body weight and metabolic and other haemodynamic parameters, and correlates with an index of insulin secretion.

OBJECTIVE: To evaluate the relationships between the supine sagittal abdominal diameter (SAD) and visceral fat, as well as to evaluate intra-and inter-observer reliability of sagittal diameter measurement. PATIENTS: Twenty-eight women ranging in age from 27±78 y with a body mass index (BMI) ranging from 16.9±48.1 kg/m 2 and 23 men ranging in age from 32±75 y with BMI ranging from 20±41.6 kg/m 2 . MEASUREMENT: Body fat distribution was measured by waist circumference, waist to hip ratio (WHR), SAD, anthropometrically assessed and a single slice of computed tomography (CT) at the L4-L5 level. RESULTS: In both genders, a signi®cant association was found between visceral adipose tissue (AT) and SAD, as evaluated by CT (women r 0.80; men r 0.83, P`0.001), and SAD by anthropometry (women r 0.76; men r 0.82, P`0.001), as well as between visceral AT and waist circumference (women r 0.76, men r 0.86, P`0.001) and WHR (women r 0.57, P`0.01, men r 0.80, P`0.001). A signi®cant association was also found between subcutaneous AT and SAD by anthropometry (women r 0.79, men r 0.74, P`0.001). After adjusting for BMI, the association between subcutaneous AT and SAD was no longer signi®cant in men and only moderately signi®cant in women (r 0.42, P`0.05), while the association between visceral AT and SAD by anthropometry remained signi®cant in both genders (women r 0.63, P`0.001; men r 0.66, P`0.001). When the subjects were divided into two groups according to BMI (lean to moderately overweight women with BMI`28 and men with BMI`30 and obese women with BMI b 28 and men with BMI b 30) we found that the relationships between SAD by anthropometry, as well as SAD by CT and visceral AT, were higher in lean to moderately overweight subjects than in those who were obese. High inter-observer correlation was found concerning SAD measurement (r 0.99, P`0.001). Intra-and interobserver precision as evaluated by coef®cient of variation and intraclass correlation coef®cient for SAD measurement was very high. CONCLUSION: Our study shows the usefulness of SAD by anthropometry to predict visceral fat and its very high inter-and intra-observer precision.

We conducted a cross-sectional study of body fat distribution and metabolic variables and the interrelations among these factors in 134 women aged 18-71.9 y. Body fat distribution was measured with use of computerized tomography. A significant positive correlation was observed between age and visceral adipose tissue (VAT) and between VAT and body weight. When subjects were divided into five age groups, VAT values were significantly higher in older groups. Values for triacylglycerols, cholesterol, fasting glucose, 2-h glucose, and the sum of glucose values during an oral-glucose-tolerance test were significantly higher in older subjects. After adjustment for visceral fat, no significant differences in any metabolic variable studied, except cholesterol, were found across the five age groups. In conclusion, we found that regional body fat distribution in older women was different from that in younger subjects: older women had larger amounts o visceral fat. Values for metabolic variables were also higher in older subjects. Our data suggest that redistribution of body fat in older subjects is associated with changes in metabolic variables.

Our cross-sectional data show a significant association between body composition, fat distribution, and lung function in elderly men.