Your paunch may well hide cardiac risks

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New Delhi– A typical young Indian male marries, and a few months later he develops a noticeable paunch. His mother and mother-in-law are pleased as punch, perceiving the paunch as a sign of his wellbeing of his being “looked after well” by his wife.

But is it all good?

Observational studies have linked abdominal adiposity with cardiometabolic disease — but it is yet unclear whether it is a surrogate for obesity in general or it plays a causal role.

New genetic evidence is supporting the idea that people who are predisposed to carrying fat in their belly as opposed to their hips and thighs are also at greater risk for developing heart disease and Type 2 diabetes, says Dr (Col) Anil Dhall, Director, Cardiovascular Sciences, at Venkateshwar Hospital here.

Citing a recent study reported in JAMA, Dhall said those with higher waist-to-hip ratios seemed to have higher levels of triglycerides, 2-hour glucose, and systolic (higher) blood pressure.

The abdominal fat cells could secrete a lot of bad factors that go into the blood and that actually leads to delayed clearance of the fat from the blood, which leads to higher levels of triglyceride-rich lipoproteins.

Something about the visceral fat is different from the fat that is in the thighs and hips, but further research is needed to clarify it. Very little is known about what the factors are that lead to the apple shape versus the pear shape. And it’s impossible to model in animals because they just have a totally different body fat distributions than humans.

For the long term, understanding the genetics “that actually change the body fat distribution away from abdominal adiposity… may actually be as beneficial as focusing on the overall weight”, potentially leading to the development of safe and effective medications for weight loss, Dhall said.

Physicians often focus more on overall weight or BMI of their patients, and not specifically where the fat is stored.

But the waist-to-hip ratio is “an easily available marker for who is at particularly high risk for diabetes and heart disease”, observes Dhall.


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