People with central fat distribution in both sexes tend to have a distinct body shape, said to resemble that of an apple (Figure 4.7), a physical characteristic of men (termed 'android' by Vague) which tends to be associated with metabolic abnormalities and chronic diseases (26-31).
Body circumferences and their ratios are used to indicate the distribution of body fat. The most important variations, in terms of health associations, are between the amounts of fat in internal, mainly intra-abdominal sites, as distinct from subcutaneous sites (Figure 4.8). The 'gold standard' for measuring fat depots in these sites is scanning by MRI (Figure 4.2). CT gives almost equal information but the small radiation exposure limits its acceptability.
The ratio of waist-to-hip circumferences (Figure 4.4) was the first anthropometric method developed from epidemiological research as an indicator of fat distribution in relation to metabolic diseases. Waist-to-hip ratio is related more closely to the ratio of intra-abdominal fat/extra-abdominal fat mass than the absolute amount of intra-abdominal fat mass (32), and has been shown to relate to mortality from coronary heart disease and type 2 diabetes independent of BMI (28,29). Most of the value in indicating body fat is derived from waist circumference, the hip circumference probably reflecting several other body tissues such as bones and muscles. The waist-to-hip ratio may have some particular value in reflecting diseases which involve muscle reduction as well as fat deposition, e.g. type 2 diabetes (33).
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