What in popular slang is called “beer belly”, culturally associated with stability and happiness – since it generally appears in men between 35 and 40 years old, while in many cases they already live as a couple, have children and life is more or less on the right track –, in reality there are few happy things and a lot of worries. This has been demonstrated a recent studypresented at the latest meeting of the Radiological Society of North America (RSNA), which linked the accumulation of abdominal fat to “dangerous” changes in the structure of the heart that go beyond those attributable to a high body mass index (BMI) and which increase the risk of developing cardiovascular problems.
Researchers analyzed cardiovascular magnetic resonance images of more than 2,200 adults aged 46 to 78 without known cardiovascular disease. What they observed was that those with a high waist-to-hip ratio showed signs of concentric hypertrophy on MRI, a remodeling of the heart in which the heart muscle thickens without the overall size of the heart increasing, leading to less blood flow than the body needs.
“We have known for a long time that abdominal obesity is much more specific than obesity in general in predicting cardiovascular disease. What this study carried out by radiologists reveals is that, thanks to magnetic resonance imaging, it can demonstrate subtle changes in cardiac hypertrophy even before cardiovascular disease manifests,” explains Ignacio Fernández Lozano, president of the Spanish Society of Cardiology (SEC).
According to the results of the study, this relationship between abdominal fat and changes in the structure of the heart is observed more clearly in men than in women. This difference, according to Jennifer Erley, a radiologist at the University Medical Center Hamburg-Eppendorf (Germany) and lead author of the study, could be explained by the fact that men are more likely to suffer from abdominal obesity at an earlier age due to the protective effects that estrogen provides women before menopause. “Men are therefore exposed longer than women to pro-inflammatory visceral fat, which could explain the results of the study,” adds the researcher.
“Men and premenopausal women accumulate fat in different places. They, usually, in the hips, and we in the abdomen,” explains Manuel Landecho, specialist in internal medicine at Clínica Universidad de Navarra (CUN), focused on cardiovascular risk, obesity and health promotion. This different location of fat accumulation would also explain, according to Landecho, why men present more risks for cardiovascular health. “It is not the same thing that fat releases its mediators from the pelvic girdle into the general circulation and that, in one way or another, it is diluted in the circulatory flow; that the fact that abdominal fat does it from the visceral compartment has a greater pro-inflammatory effect on the liver, kidneys, pancreas… Therefore, it has a much greater impact on health, fundamentally cardiovascular, but also on cancer”, he thought.
BMI is insufficient to assess cardiovascular risk associated with obesity
Another piece of information can be highlighted by the study presented at the American Society of Radiology congress. When the BMI of more than 2,000 participants was taken into account, 69% of men and 56% of women were overweight or obese. However, when we take into account the waist-hip index (WHR), this percentage reaches 91% in men and 64% in women.
Currently, BMI, an index calculated from a person’s weight and height, continues to be a widely used tool for determining obesity. Concretely, a BMI between 25 and 29.9 would be associated with being overweight, while a BMI greater than 30 would correspond to a diagnosis of obesity. However, for Jennifer Erley, BMI is not the best index to measure obesity because it does not take into account differences in fat distribution and wrongly classifies tall people as well as very muscular people as “obese”. “However, people who accumulate visceral fat and at the same time experience loss of muscle mass due to lack of exercise will be classified as ‘normal weight’ using BMI for a long time, probably too long,” he argues.
In this sense, a recent study published in The Lancet, concluded that waist-to-height ratio outperforms BMI in predicting heart disease risk, which is particularly important in people with a BMI less than 30 but a high height index, who may underestimate their true risk of suffering from cardiovascular disease.
“We should also not demonize BMI, because it can be useful, but the truth is that the waist-height ratio is much more reliable and is a simple and effective way to detect the risk of cardiovascular disease early, even when the BMI and other parameters such as cholesterol and blood pressure of patients seem normal,” says Manuel Landecho.
According to the expert, calculating the waist-to-height ratio is simple and can be done from home. For a person measuring, for example, 1.80 meters, the waist circumference should not exceed 90 cm. Above this ratio of 0.5, it would be advisable to consult a doctor to detect possible risks early and establish preventive measures such as regular physical exercise or improving diet, since abdominal fat, despite the name “beer belly”, is not only due to the consumption of beer, but also to the consumption of any type of alcoholic beverage and high-calorie foods such as soft drinks and junk food.
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