Having a ‘beer belly’ increases risk for deadly diseases more than overall body weight, study suggests
Excess belly fat is a better indicator of heart failure risk than a measure of overall obesity, according to new research.
Radiologists in Germany have determined that a high waist-to-hip ratio (WHR) is often associated with anatomical changes in the heart.
Having a high WHR means the body stores more fat around the abdomen than the hips, a sign of abdominal obesity, which is a stronger predictor of organ health than Body Mass Index (BMI).
A high WHR signals the presence of harmful visceral fat around the organs, which floods the body with inflammatory chemicals and disrupts hormones.
The inflammation and hormone imbalance directly damage the heart, thickening its walls, shrinking its chambers and forcing it to work harder until it can no longer keep up, increasing the risk of heart disease and heart attack.
A high amount of visceral fat is also linked to high blood pressure, a major risk factor for heart disease, and it interferes with the normal activity of blood vessels and contributes to high cholesterol.
Researchers determined that in people with a high WHR, the lining of the heart’s chambers where blood transits becomes thicker, but the heart remains the same size, reducing those chambers’ capacities for blood.
As the heart struggles to pump blood at this reduced capacity, the risk of heart attack, heart disease, stroke, and sudden cardiac death climbs.
Even in people without diagnosed heart disease, high levels of abdominal fat were linked to early, subtle changes in heart muscle and structure, detectable only by advanced cardiac MRI (stock)
While visceral fat is the invisible type that encases organs, subcutaneous fat around the abdomen, thighs, arms and other parts of the body is the type that is visible on the outside.
WHR more precisely measures how and where fat is distributed, with fat around the abdomen associated with the highest risks for a range of diseases.
In addition to their link with a thickened heart muscle and smaller heart chambers, high levels of abdominal fat combined with general obesity, measured with BMI, were tied to subtle changes in the heart in men, detectable only with advanced cardiac MRIs.
Dr Jennifer Erley, lead study author from the University Medical Center Hamburg-Eppendorf, Germany, said in a statement: ‘Rather than focusing on reducing overall weight, middle-aged adults should focus on preventing abdominal fat accumulation through regular exercise, a balanced diet and timely medical intervention, if necessary.’
Researchers measured obesity and WHR of more than 2,200 adults ages 46 to 78 without known heart disease.
According to researchers’ Body Mass Index (BMI) measurements, 69 percent of men and 56 percent of women were overweight or obese. Using WHR, 91 percent of men and 64 percent of women met the World Health Organization’s criteria for obesity.
To measure WHR, measure the waist at its narrowest point and the hips at their widest, then divide the waist number by the hip number.
If the result is above 0.90 for men or 0.85 for women, they have an indicator of abdominal obesity and an increased risk for heart disease, as defined by the WHO.
General obesity, as measured by BMI, was more often associated with enlarged heart chambers across all participants.
Abdominal obesity was associated with increased heart muscle thickness and smaller heart chamber volumes.
A thickened heart muscle has reduced capacity to pump blood and therefore can cause lightheadedness, dizziness and difficulty breathing.
It can have potentially deadly consequences. The thickened heart muscle can cause abnormal rhythms and weaken the heart’s pumping ability, leading to heart failure and triggering atrial fibrillation, which heightens the risk of stroke from blood clots.
It is also a leading cause of sudden cardiac death, particularly in young athletes.
Changes in the heart were more pronounced in men than women, particularly in the right ventricle, which pumps oxygen-depleted blood to the lungs.
Researchers believe this may reflect early-stage stress on the heart related to how abdominal obesity affects breathing and lung pressure.
Having a larger amount of fat around the abdomen causes physical and chemical changes in the body.
One way it does this is by making breathing harder, and this breathing difficulty can, over time, put extra stress on the heart before any diagnosable heart disease develops.
Dr Erley said: ‘The sex-specific differences suggest that male patients may be more vulnerable to the structural effects of obesity on the heart, a finding not widely reported in earlier studies.’
The more extensive heart damage seen in men could be due to an earlier onset of more severe abdominal obesity or the cardioprotective effect of estrogen in women, Dr Erley said.
The mystery of why men tend to store fat in their bellies while pre-menopausal women store it in their hips and thighs boils down not just how the body breaks down fat but where it takes it in.
The cells in men’s body fat appear to be more aggressive at pulling fatty acids from the blood and storing them, especially right after a meal.
For women, estrogen acts as a regulator, promoting fat storage in subcutaneous deposits. It boosts the activity of lipoprotein lipase (LPL), the enzyme that pulls fat from the bloodstream, specifically in the lower body.
At the same time, women are more efficient at clearing liver-made fats from blood circulation, redirecting that energy to subcutaneous stores, resulting in a pear-shaped formation.
Men, on the other hand, are biologically designed to funnel fat straight to the visceral abdomen to be stored in and around the organs.
People with the highest VAI scores (visceral fat levels) had higher heart disease risk, with the band between the dotted lines indicating the precision of that estimate. The solid center line shows an average 14.4 percent higher risk of heart disease for every 0.5-unit increase
A key driver is their typical higher fat intake. This prompts the gut to produce larger, more numerous fat transport particles called chylomicrons.
In 2023, researchers from China analyzed US health data from 2011 to 2020, focusing on two reliable markers of hidden belly fat, visceral fat index and lipid accumulation product (LAP), a visceral fat and metabolic warning score.
Using this data, they studied their combined link to predicted 10-year heart disease risk.
Among 1,547 adults with an average age of 57, the majority of whom were men, higher visceral fat scores strongly predicted greater heart disease risk.
Those with the highest visceral fat index levels had over 15 times the risk compared to those with the lowest levels.
Similarly, the highest LAP levels were linked to nearly 17 times the risk.
A large-scale meta-analysis of 17 studies, involving over 824,000 people, confirmed that a high visceral fat score is a significant and independent predictor of major heart and vascular problems.
People with the highest visceral fat scores had approximately a 93 percent higher risk for heart disease, a 97 percent higher risk of cardiovascular death and a 64 percent higher risk for stroke, compared to those with the lowest scores.
The authors behind the latest research, to be presented this week at the annual meeting of the Radiological Society of North America, encouraged doctors to be more proactive in checking people’s visceral fat levels early on with the same or greater frequency that they check people’s overall weight.
