Relations of body habitus, fitness level, and cardiovascular risk factors including lipoproteins and apolipoproteins in a rural and urban Costa Rican population.

Abstract

Increased general and abdominal obesity has been independently associated with diabetes, increased risk of stroke, and coronary artery disease (CAD). It is more prevalent in developed countries and in urban areas of nonindustrialized nations than in less developed and rural areas. To evaluate the associations between general and abdominal obesity (as determined by total body fat, waist to hip ratio, umbilical to triceps ratio, and umbilical to subscapular ratio) with glucose, plasma lipoproteins, apolipoprotein (apo) A-I and B concentrations, and low density lipoprotein (LDL) particle size (LDL 1-7), we randomly selected 222 men and 243 women from rural and urban areas of Puriscal, Costa Rica. Abdominal obesity, as assessed by the waist to hip ratio, was independently and significantly associated with higher triglyceride levels (p<0.01) and with lower high density lipoprotein cholesterol levels (p<0.05) in men and women and with higher glucose levels (/?<0.05) and smaller LDL particle size (p<0.01) in women. Abdominal obesity, as assessed by the umbilical to subscapular ratio, was independently and significantly associated with higher total cholesterol (p<0.005) and apo B (p<0.01) levels. Umbilical to triceps ratio was positively associated with blood pressure in men. Urban men had increased general and abdominal obesity (/><0.0001), number of cigarettes smoked per day (p<0.0001), and diastolic blood pressure (p<0.05) and had a decreased fitness level (p<0.0001) as well as higher (/?<0.05) plasma glucose, triglyceride, and total cholesterol concentrations and lower (p<0.05) apo A-I and HDL cholesterol levels compared with rural men. The differences between rural and urban women were not as striking. Urban women had increased general and abdominal obesity, glucose, and apo B levels (/?<0.05) and a decreased fitness level (/><0.0001). Our data indicate that general and abdominal obesity, increased cigarette smoking, diastolic blood pressure, and decreased fitness level are more prevalent in an urban than in a rural area in Costa Rica, particularly in men. The higher prevalence of such risk factors in the urban area is associated with a more atherogenic plasma lipoprotein profile. (Arteriosclerosis and Thrombosis 1991;ll:1077-1088) G eneral and abdominal obesity has been independently associated with increased levels of cardiovascular disease (CVD) risk factors and mortality and with increased death rates for all causes.1 -5 Although the prevalence of CVD risk factors is lower in developing countries than in industrialized nations, 6 the incidence of mortalityFrom the Lipid Metabolism Laboratory (H.C., L

LDL size and subclass pattern in a biethnic population.

“…Both obesity and an unfavorable body fat distribution are associated with small, dense LDL in men and women from Costa Rica. 32 We have shown that the most important determinant of LDL size or pattern is the triglyceride concentration, with an overall correlation of -.628. This correlation was similar in Mexican Americans and non-Hispanic whites and was also similar in men and women.…”

Change in LDL particle size is associated with change in plasma triglyceride concentration.

“…15 Triglyceride and HDL cholesterol levels are partially determined through genetic transmission, but environmental effects also play a substantial role. 19 - 23 A recent study of twin congruity in the National Heart, Lung, and Blood Institute Twin Study indicated no statistically significant differences in LDL size between the monozygotic and dizygotic twins. 18 The magnitude of change in LDL size in the present study was far greater than we had initially predicted.…”

A study in the relationships between leptin, insulin, and body fat in Asian subjects

“…The waist was de®ned as the narrowest circumference between the costal margin and the iliac crest, and the hip was de®ned as the widest circumference between the waist and the thigh. 23,24 Blood pressure was evaluated with a mercury sphygmomanometer in the left arm with the subject in a sitting position following a 5 min rest. Two readings were taken for each subject and the mean value used in analysis.…”