Sex differences in body composition and association with cardiometabolic risk

Abstract

BackgroundBody composition differs between men and women, with women having proportionally more fat mass and men more muscle mass. Although men and women are both susceptible to obesity, health consequences differ between the sexes. The purpose of our study was to assess sex differences in body composition using anatomic and functional imaging techniques, and its relationship to cardiometabolic risk markers in subjects with overweight/obesity.MethodsAfter written informed consent, we prospectively recruited 208 subjects with overweight/obesity who were otherwise healthy (94 men, 114 women, age 37 ± 10 years, BMI 35 ± 6 kg/m2). Subjects underwent dual-energy X-ray absorptiometry (DXA) and computed tomography (CT) for fat and muscle mass, proton MR spectroscopy (1H-MRS) for intrahepatic (IHL) and intramyocellular lipids (IMCL), an oral glucose tolerance test, serum insulin, lipids, and inflammatory markers. Men and women were compared by Wilcoxon signed rank test. Linear correlation and multivariate analyses between body composition and cardiometabolic risk markers were performed.ResultsWomen and men were of similar mean age and BMI (p ≥ 0.2). Women had higher %fat mass, extremity fat, and lower lean mass compared to men (p ≤ 0.0005). However, men had higher visceral adipose tissue (VAT) and IMCL and higher age-and BMI-adjusted IHL (p < 0.05). At similar age and BMI, men had a more detrimental cardiometabolic risk profile compared to women (p < 0.01). However, VAT in women, and IMCL in men, were more strongly associated with cardiometabolic risk markers, while more lower extremity fat was associated with a more favorable cardiometabolic profile in women compared to men (p ≤ 0.03).ConclusionsAlthough the male pattern of fat distribution is associated with a more detrimental cardiometabolic risk profile compared to women of similar age and BMI, VAT is more strongly associated with cardiometabolic risk markers in women, while IMCL are more detrimental in men. Lower extremity fat is relatively protective, in women more than in men. This suggests that detailed anatomic and functional imaging, rather than BMI, provides a more complete understanding of metabolic risk associated with sex differences in fat distribution.

Low skeletal muscle mass is associated with arterial stiffness in community-dwelling Chinese aged 45 years and older

“…To our knowledge, this relation was proved in both genders for the first time. Possible reasons for the conflicting results between men and women included that: 1) the level of baPWV, muscle mass or other covariates were significantly different between gender groups, 2) the sample size in the subgroup was limited for examining the potential associations, 3) some androgens [32,33] and the different distribution of body composition in men and women [34,35] might have potential effect on this relation.…”

Low skeletal muscle mass is associated with arterial stiffness in community-dwelling Chinese aged 45 years and older

“…To our knowledge, this relation was proved in both genders for the first time. Possible reasons for the conflicting results between men and women included that: 1) the level of baPWV, muscle mass or other covariates were significantly different between gender groups, 2) the sample size in the subgroup was limited for examining the potential associations, 3) some androgens [32,33] and the different distribution of body composition in men and women [34,35] might have potential effect on this relation.…”

Quantitative Imaging of Body Composition

“…In contrast to increased VAT volume, accumulation of SAT in the pelvis and thigh regions was shown to be fairly protective against cardiometabolic risk. [86][87][88] Skeletal muscles of the pelvis, thigh, and lower leg are commonly evaluated in the scope of aging and disease due to their significant role in functional ability and regulation of insulin metabolism. Fatty infiltration and atrophy of pelvic musculature is found to be associated with hip osteoarthritis, iatrogenic injury during hip replacement surgery, and neuromuscular disorders such as limb-girdle muscular dystrophies and Miyoshi distal myopathy, and post-polio syndrome.…”