The impact of body fat and its distribution on risk factors for cardiovascular disease in black South African women

Doctoral Thesis


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University of Cape Town

Obesity and obesity-related diseases are a large global problem in both developed and developing nations. In South Africa, a country currently undergoing epidemiological transition, the prevalence of obesity is high, particularly in urban black women. Early detection of overweight and obese individuals is essential for the management of obesity and its related co-morbidities; however, there is no ethnic-specific field measure of body fat percent validated for use in black South African women. Further, despite high levels of adiposity, these women have an atypical presentation of cardiovascular disease (CVD) risk factors, presenting with relatively low levels of visceral adipose tissue (VAT) and a favourable lipid profile compared to white women. As a result of this atypical presentation of CVD risk factors, a high prevalence of “healthy obesity” has been reported, although the determinants of this phenotype have not been systematically investigated. In addition, the applicability of commonly used diagnostic criteria for the determination of insulin resistance, which include enlarged waist circumference and dyslipidemia as components, has not been investigated in this population. Therefore, the overall aim of this thesis was to investigate the impact of body fat and its distribution on the presentation and identification of CVD risk factors in relatively young black South African women, prior to the onset of CVD. More specifically, the objectives were; i) to determine if near infrared interactance (NIR) is a valid field measure of body fat percent in South African women; ii) to determine the agreement between International Diabetes Federation (IDF) and National Cholesterol Education Program (Adult treatment panel III) (ATP III) metabolic syndrome criteria and the degree to which these criteria can predict insulin resistance, and explore the extent to which these phenomena can be explained by body fat and its distribution; iii) to identify determinants of the “metabolically healthy obese” (MHO) and “metabolically obese normal weight” (MONW) phenotypes; and iv) to complete a preliminary investigation of the association between polymorphisms within genes that encode for proteins involved in tissue-specific glucocorticoid metabolism and obesity, body fat distribution and CVD risk factors in black South African women. As obesity is associated with increased risk of cardiovascular disease, accurate quantification of body fatness is particularly important in health risk appraisal. However, in developing countries, “gold standard” measures of body fat percent such as underwater weighing and dual energy x-ray absorptiometry (DXA) are not always practical, as access to facilities and resources are limited. Therefore, a valid field measure of body fat percent is needed for the purpose of health risk appraisal. NIR is a potentially useful field measure of body fat percent that is currently used in South Africa for this purpose. However, NIR cannot be used with confidence in South Africa until it has been validated in different ethnic populations. Therefore, the first study in this thesis examined the validity of singlesite NIR (Futrex-6100 A/ZL) as a measure of body fat percent compared to the criterion method of DXA in black and white South African women.

Includes abstract.

Includes bibliographical references (p. 183-214).