Why consider fat distribution in older patients?
Dr Francesco Fantin is Assistant Professor for Geriatric Medicine, University of Verona, Italy.
It is known that ageing is associated with a progressive increase in fat mass, in particular visceral adipose tissue, and a decrease in the peripheral subcutaneous adipose tissue.
Several studies have shown the protective role of gluteo-femoral fat for cardiovascular and metabolic diseases. In the last issue of Age and Ageing we showed that arteries are less stiff in women with high levels of gluteo-femoral fat, whereas the arterial stiffness in subjects with high visceral fat mass was higher. These findings confirm and highlight the importance of fat distribution in older post-menopausal women.
Doctors rarely conduct anthropometry, such as waist and hip circumference, in clinical practice. This is a pity because these simple measurements can give information about fat distribution and therefore a patient’s cardio-metabolic risk. The waist-hip ratio (WHR) is a useful way to describe the type of fat distribution of a patient, identifying whether subjects have a central or peripheral fat distribution.
In older people it is commonly held that “a bit of fat” is protective. This is not true if we fail to consider how this fat is distributed! Visceral fat is still dangerous even in later life.
Adipose tissue, the major energy storage of the organism, is recognized to be a complex and highly active metabolic and endocrine organ. It has been shown that adipocytes, the primary composing cells of adipose tissue, provide not only a flexible storage depot for excess nutrients, but are also endocrine cells, secreting hormones which regulate energy intake and expenditure, as well as insulin metabolism and inflammation. Increased abdominal fat has been shown to be linked to higher risk of diabetes, hypertension and dyslipidemia in young as well as in older subjects. So, fat is dangerous in older people unless located in the periphery of the body.
For these reasons I encourage you to include anthropometry in the clinical examination and consider fat distribution when routinely assessing older patients.