Fasting blood sugar levels showed a significant increase in the prediabetic and diabetic individuals of the three groups (lean, overweight, and obese). The mean ages are significantly higher in type 2 diabetic individuals than in normoglycemic individuals across all the three groups for both men and women (Tables 2 and 3).
Among men, BMI, BF%, and fat mass were significantly higher in the diabetic individuals than in the normoglycemic ones only in the obese group, whereas no significant differences were observed in the lean or overweight groups when we compared prediabetic and diabetics patients with normoglycemic individuals (Table 2). Visceral fat showed significantly higher levels in all prediabetic and diabetic individuals of the three groups (lean, overweight, and obese) compared with normoglycemic individuals. As regards waist circumference, it shows significant higher values in individuals with type 2 diabetes in both the overweight and obese groups, whereas the WHR showed a highly significant difference only in diabetic individuals of the obese group (Table 2).
Among women, no significant differences were observed in BF% or fat mass among the three groups. Visceral fat levels were increased in the prediabetic and diabetic individuals of the three groups but a significant difference was recorded only in the prediabetic individuals of the obese group. Moreover, waist circumference showed a significant increase in the diabetic individuals of the lean group (P<0.004); in addition, there is a tendency for an increase in the waist circumference in the prediabetic and diabetic individuals of the obese group; however, this does not reach a significant level (P=0.760). In contrast, WHR showed a significant increase among prediabetic and diabetic individuals of the lean and obese groups (Table 3).
Systolic and diastolic blood pressures were recorded. Among men, there are significant increases in both systolic and diastolic blood pressure in prediabetic and diabetic individuals of both lean and obese groups (Table 2), whereas among women, a significant increase in the systolic and diastolic blood pressure was found only among prediabetic and diabetic individuals of the obese group (Table 3).
Type 2 diabetes is an emerging epidemic of titanic proportions worldwide and in Arabic-speaking countries 1. Obesity is a major risk factor for the development of prediabetes and type 2 diabetes; it is defined by the presence of excessive of body fat, the amount of which is correlated with the development of comorbidity 23. Both total BF% and fat distribution have to be measured when estimating the risk for prediabetes and type 2 diabetes, even in individuals with a BMI less than 25 kg/m2, in particular, those over 40 years of age, especially men 24.
This study showed a highly significant increase in BF% in prediabetic and diabetic individuals compared with normoglycemic individuals. The worldwide epidemic of obesity and its association with chronic disease have also contributed to the need to study body composition 25,26 and the distribution of the components of body composition 27. The definition of obesity on the basis of body size has been challenged in different populations because of the different relationships with BF% and BMI levels 28. Therefore, a definition of obesity on the basis of body composition can help clarify this issue 27.
Of the various methods of assessing human body composition, bioelectrical impedance analysis, which was used in this study, has emerged as a promising technique because of its simplicity, low cost, high reproducibility, and patient acceptability. Studies have shown that no significant difference could be detected in the BF% estimated using BIA and that estimated using other methods such as DXA or under water weighing and dilution techniques 27–31.
As regards visceral fat, it showed significantly higher levels in all prediabetic and diabetic men of the lean, overweight, and obese groups, whereas it showed significant difference only among prediabetic women of the obese group. Sandeep et al. 36 indicated that in nondiabetic Asian Indians, the visceral, but not subcutaneous, component of abdominal fat is associated with insulin resistance, cardiovascular risk factors, and metabolic syndrome. Veilleux et al. 37 reported that visceral adipose tissue accumulation is an important predictor of metabolic alterations. Bray et al. 38 reported on the measurement of subcutaneous and visceral fat as a predictor for the development of diabetes in a subgroup of the Diabetes Prevention Program that underwent computed tomography scans at baseline. They found that, among men, higher visceral fat levels, waist circumference, BMI, and WHR significantly predicted the onset of diabetes. None of these measures was significantly better than any other. In contrast, subcutaneous fat did not predict diabetes 39.
Among women, BMI, waist circumference, WHR, and visceral fat are generally not strong predictors of diabetes. These outcomes may bebecause of the fact that women have more subcutaneous fat than men and because of the possibility that the higher levels of subcutaneous fat may have diluted the effect of visceral fat because subcutaneous fat did not predict diabetes 38.
It is possible that in lean individuals classified according to BMI, BF% is a better marker of increased obesity-associated risk than body fat distribution, especially among men 24. Further, it has been reported that an equivalent increase in body fat had lesser impact on insulin sensitivity in women than in men 40. This goes in agreement with our results which revealed that obese females had more pronounced significant differences in clinical characteristics in normoglycemic compared to prediabetic and diabetic groups.
Although general obesity is an important risk factor for many diseases, several human studies have demonstrated that regional fat distribution rather than overall fat volume is important to understand the link between obesity and metabolic disorders 41,42. Although more than 80% of the total body fat is distributed in the subcutaneous compartment and only 10–20% is distributed within visceral adipose tissue in adults 43, visceral fat is thought to play an important role in the expression of metabolic complications of obesity because of its unique position with respect to portal circulation 44 and its secretory function for various bioactive substances 45,46. The mechanism linking visceral fat with the metabolic syndrome was suggested by Trayhurn and Wood 47. They considered visceral adipose tissue to be an active endocrine organ capable of secreting many cytokines, often referred to as adipokines, that can promote inflammation and interfere with insulin action. Further, studies 48,49 have shown that subcutaneous fat and visceral fat are biologically distinct, with visceral fat demonstrating far greater proinflammatory characteristics than subcutaneous fat.
In the men of this study, significantly higher levels visceral fat were seen in all prediabetics and diabetic individuals compared with normoglycemic individuals, whereas a significant difference was observed only in the prediabetic women of the obese group. The percentage of the obese prediabetic and diabetic men having visceral fat values over the normal level was 59.1 and 81.4%, respectively, whereas the percentage of obese prediabetic and diabetic women with high visceral fat levels was 27.2 and 25.8%, respectively. This may be due to sex differences in fat distribution, as men have greater visceral fat mass than women and women have more subcutaneous fat 50.
The incidence of hypertension in patients with type 2 diabetes is ∼two-fold higher than that in age-matched individuals without the disease 51. Arafa and El Din 52 found that the prevalence of hypertension among Egyptian diabetic individuals was 75% for men and 66.9% for women. Recently, Sarry El Din et al. 53 reported that the percentages of hypertensive men among normal and diabetic adult Egyptian patients were 9.8 and 29%, respectively, whereas those of hypertensive women were 9.5 and 32.5%. The prevalence of hypertension is particularly high among obese individuals and it increases with age. This study reported coexistence of diabetes and hypertension in obese and/or elderly patients. This coincides with the results of other studies 51,54.
Type 2 diabetes is more frequent among older obese Egyptians and is associated with increased systolic and diastolic blood pressure. The present study emphasized that BF% plays an important role in the development of type 2 diabetes, and visceral fat has a key role in the development of diabetes, especially among men.
The authors thank the Science and Technology Development Fund (STDF) for funding the project entitled ‘Standardization of adult Egyptian dimensions for implementation in development of clothing industries’ (1256), the data from which was used to establish this work.
There are no conflicts of interest.
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