A distribuição da gordura corporal está relacionada ao risco para eventos cardiovasculares em 10 anos: Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil)

Abstract

INTRODUCTION: The localization of body fat seems to influence differently in the development of cardiovascular diseases, in which gluteofemoral fat would be protective and the thoracic fat would be deleterious. OBJECTIVE: To estimate the association between the fat ratio of lower body limb and trunk fat with cardiovascular disease risk in adults participating in the Longitudinal Adult Health Study (ELSA-Brasil) and whether there is an effect modification by sex on this relationship. METHODS: Participants from the second wave of examinations and interviews (2012-2014) of ELSA-Brasil, were eligible for this analysis. ELSA-Brasil is a multicenter cohort consisting of 15,105 active or retired civil servants aged 35 to 74, belonging to universities and research institutions were eligible for this analysis. Individuals with previous cardiovascular disease (n = 877), BMI <18.5 (n = 95) and elderly aged ≥ 65 years (n = 2,125) were excluded. The outcome variable of this study was the percentage risk for cardiovascular disease at ten years assessed by the Framingham risk score (FRS). The explanatory variable of interest was the ratio between the fat in the lower body limbs and the trunk, in kilograms (kg), measured by an electrical bioimpedance device (InBody 230). The magnitudes of these associations were estimated by the arithmetic mean ratios (AMR) and their 95% confidence intervals using generalized linear models. All analyses were stratified by sex and subsequent adjustments were made in the unadjusted model (Model 1) as follows: age, self-reported race-skin color, educational attainment (Model 2); alcohol consumption, leisure physical activity (Model 3); hypolipidemic drug use and menopausal status for women (Model 4). To confirm the presence or effect modification by sex, the interaction term was included in the final model (Model 4) using the total population. Analyzes were performed using Stata 15.0 software. RESULTS: Of the 10,225 individuals included in the present study, 44.58% were men and mean age of 52.32 (SD= 6.63) years. Men were lower educated, had more excessive alcohol use, frequency of intense physical activity, higher systolic blood pressure and total cholesterol levels, lower HDL cholesterol levels, a higher frequency of diabetes and median percentage of risk for cardiovascular disease compared to women. However, women had higher mean quantity of lower limbs and trunk fat in all cardiovascular risk categories when compared to men. After complete adjustment (Model 4), we observed that the higher the ratio between lower body limb and trunk fat content, the lower the cardiovascular risk at 10 years and this effect was stronger in females [Arithmetic Mean Ratio (AMR) for men: 0.69; 95% CI 0.64 - 0.74; AMR for women: 0.23; 95% CI 0.18 - 0.29]. CONCLUSION: In individuals with higher body fat accumulation located in the lower limbs region, it seems to have a protective effect on the development of cardiovascular diseases even in the presence of trunk fat deposits. As women genetically have higher quantity of gluteofemoral fat in their body composition, a stronger protective effect compared to men was observed.