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    Monday, December 14, 2009

    Thin Thighs Associated with Increased Risk for Death, Cardiovascular Disease

    Thin Thighs Associated with Increased Risk for Death, Cardiovascular Disease
    Adults with very thin thighs may be at increased risk for cardiovascular disease and death, BMJ reports. Published 3 September 2009, doi:10.1136/bmj.b3292
    Cite this as: BMJ 2009;339:b3292

    Researchers measured thigh circumference in some 2800 men and women, aged 35 to 65, and then followed them for about 10 years to assess incident cardiovascular disease, coronary heart disease (CHD), and mortality.

    In adjusted analyses, a thigh circumference below roughly 24 inches (60 cm) was associated with significantly elevated risk for death and cardiovascular disease (but not CHD), with risk increasing as circumference decreased. While a circumference above 24 inches appeared to be protective, the benefit did not continue to increase with increasing circumference. As a potential underlying mechanism, the authors cite research suggesting that low subcutaneous thigh fat results in poor glucose and lipid metabolism. They and an editorialist call for further research to confirm these findings.

    Participants 1436 men and 1380 women participating in the Danish MONICA project, examined in 1987-8 for height, weight, and thigh, hip, and waist circumference, and body composition by impedance.

    Main outcome measures 10 year incidence of cardiovascular and coronary heart disease and 12.5 years of follow-up for total death.
    Results A small thigh circumference was associated with an increased risk of cardiovascular and coronary heart diseases and total mortality in both men and women. A threshold effect for thigh circumference was evident, with greatly increased risk of premature death below around 60 cm. Above the threshold there seemed to be no additional benefit of having larger thighs in either sex. These findings were independent of abdominal and general obesity, lifestyle, and cardiovascular risk factors such as blood pressure and lipid concentration.

    Conclusion A low thigh circumference seems to be associated with an increased risk of developing heart disease or premature death. The adverse effects of small thighs might be related to too little muscle mass in the region. The measure of thigh circumference might be a relevant anthropometric measure to help general practitioners in early identification of individuals at an increased risk of premature morbidity and mortality. Several studies have shown a U-shaped association between body mass index (BMI) and mortality, suggesting both a high and a low BMI are associated with premature death. More recent data suggest that while the increased risk seen with a high BMI is mirrored by the risk associated with a high body fat mass, the risk observed at low BMI seems more closely linked to the risk associated with low fat free mass than low fat mass. A larger hip circumference relative to BMI and waist circumference seems a strong inverse predictor of both morbidity and mortality. In this context, a recent study suggested that lower body muscle mass is particularly related to the development of type 2 diabetes. Indeed, studies have reported that insulin resistance could be provoked in lower body muscle, such as leg muscle, but not in arm muscle,8 9 suggesting that the size of the lower body muscle might have great relevance for developing type 2 diabetes. These findings are in line with results from a study among patients with chronic obstructive pulmonary disease, a condition characterized by wasting of muscle, particularly of the lower extremities, which found that the cross sectional area of mid-thigh muscle was a far better predictor of mortality than BMI. Lower body fat, however, might also offer cardioprotection through endocrine secretion of various adipokines, such as adiponectine, a peptide with apparent anti-inflammatory properties.

    The asuthors found independent inverse associations between thigh circumference and total death and morbidity from cardiovascular disease in both men and women that were particularly evident when thigh circumference was below a threshold of around 60 cm. Above this threshold there did not seem to be any further benefit of having larger thighs. The increased risk associated with smaller thigh circumferences was seen independently of percentage body fat mass and height or of waist circumference and BMI for all end points, suggesting that for any given degree of general and abdominal obesity, smaller thighs are a disadvantage to health and survival for both sexes. Further analyses with adjustment for systolic blood pressure, total cholesterol and triglyceride concentrations, and alcohol weakened the associations only slightly, and suggested that associations between thigh size and the end points were not mediated by differences in these variables. Some power was lost, however, by the inclusion of more covariates and the associations between thigh circumference and particularly coronary heart disease did not remain significant. Their analyses indicated that associations were independent of heavy smoking as measured by pack years, and associations seemed to be stronger for smokers than for never smokers, but this difference was not significant, probably because of too few end points in the two groups of the stratified analysis.

    Low BMI and low fat free mass are associated with early mortality
    High BMI, waist circumference, waist to hip ratio, and low hip circumference are also associated with early mortality
    Among both men and women, smaller thighs were associated with increased risk of cardiovascular disease and total mortality
    A threshold effect for smaller thigh circumference was seen at around 60 cm; above this threshold the protective effect of having larger thighs carried no further survival advantage
    A focus on thigh circumference might help medical providers identify individuals who are at increased risk of early morbidity and mortality

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


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