**Epidemiology of Abdominal Obesity**

Epidemiology of Abdominal Obesity

Maria Teresa Anselmo Olinto,

Heloísa Theodoro and Raquel Canuto Maria Teresa Anselmo Olinto, Heloísa Theodoro and Raquel Canuto

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/65342

#### Abstract

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70 Adiposity - Epidemiology and Treatment Modalities

Abdominal obesity (AO) is associated with endothelial dysfunction, inflammation, insulin resistance, diabetes mellitus, hypercholesterolemia, metabolic syndrome, and cancer. AO is a multifactorial disorder arising from genetic, environmental, socioeconomic, and behavioral factors. Thus, in this chapter, we devote ourselves to the exercise of trying to explain the epidemiology of AO in adults. We showed the increasing prevalence of AO around the world, and a gender difference in this determination was observed. Among women, the population group who is the most affected by AO, a higher prevalence of AO is observed in individuals living in low- or middle-income countries (LMIC), who are older, multiparous, and in the menopausal transition, and who belong to the poorest strata and have lower educational level. While among men, the risk of AO is positively associated with socioeconomic status, particularly in LMIC. Regarding behavioral factors (eating frequency, sleep duration, physical activity, and smoking), gender differences are difficult to be detected due to the lack of studies investigating their association with AO according to sex. However, the current evidence suggests that men benefit more from consuming a greater number of meals a day and women are more affected by the harmful effects of physical inactivity. We argued AO, despite biological conditions associated with behavior factors, should be examined as an important issue of gender inequality in health, possibly mediated by socioeconomic and behavioral differences between men and women.

Keywords: abdominal obesity, waist circumference, epidemiology, gender, income

## 1. Introduction

Obesity is a worldwide epidemic. Beyond the fat mass per se, the pattern of fat distribution has a profound influence on cardiometabolic risk. Visceral abdominal fat (VAF) is metabolically

© 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons

Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and eproduction in any medium, provided the original work is properly cited.

active and pro-inflammatory and presents a higher cardiometabolic risk association and calcification of the coronary arteries than the body mass index (BMI) and has more impact on health than subcutaneous fat, presenting a risk factor for increased incidence of metabolic syndrome [1, 2].

Abdominal obesity (AO) is directly associated with increased VAF, and it is also associated with endothelial dysfunction, inflammation, insulin resistance, diabetes mellitus, hypercholesterolemia, metabolic syndrome [MetS], and cancer [1, 3].

There are several methods available to measure AO. Waist circumference (WC) provides an indicator of central adiposity that is the most practical and easiest method used in large-scale epidemiological studies [4]. It is a good predictor of cardiometabolic morbidity and mortality, and it has also a positive association with visceral abdominal fat. However, WC does not allow us to differentiate between visceral fat and subcutaneous fat; methods such as absorptiometry by dual energy X-ray (DEXA), impedance, or densitometry can be used to handle this differentiation [5–7].

WC measurement requires correct and standardized procedures, which depend mainly on training and adequate equipment. A standardized technique requires that the person being measured removes bulky or tight garments, as well as shoes with heels, empties their bladder then stands in the upright position, with arms loosely positioned to the side. The tape is passed around the body and positioned mid-way between the iliac crest and costal margin of the lower rib, ensuring that it


Table 1. Waist circumference cutoffs recommended for the diagnosis of abdominal obesity according to ethnicity and gender [9].

is horizontally oriented and untwisted. The subject is asked to look ahead and breathe out; the measurement is taken at the end of expiration; then, the procedure is repeated [7, 8].

In addition, the definition of cutoffs should consider the characteristics of the study population. In 2009, a method to standardize the diagnosis of metabolic syndrome was established, upon discussions held by the International Diabetes Federation (IDF) and the American Heart Association/National Heart, Lung, and Blood Institute. In this context, it was suggested that ethnicity and gender should be considered for the diagnosis of AO [9] (Table 1).

AO is a multifactorial disorder arising from genetic, environmental, socioeconomic, and behavioral factors. These factors differ in their respective contributions to the AO epidemic. In this chapter, we devote ourselves to the exercise of trying to explain the epidemiology of AO. First, we describe the worldwide prevalence of AO. Then, the possible biological and socioeconomic factors that are associated with AO are demonstrated, according to the sex/gender differences. Finally, we describe the role of important behavioral factors determining AO.
