Elsevier

Ageing Research Reviews

Volume 8, Issue 4, October 2009, Pages 339-348
Ageing Research Reviews

Review
Age-related changes in total and regional fat distribution

https://doi.org/10.1016/j.arr.2009.06.001Get rights and content

Abstract

Aging is associated with progressive changes in total and regional fat distribution that have negative health consequences. Indeed, a preferential increase in abdominal fat, in particular visceral fat, combined with a decrease in lower body subcutaneous fat are commonly cited in the literature. These age-related changes in body composition can occur independent of changes in total adiposity, body weight or waist circumference, and represent a phenotype closely associated with increased morbidity and mortality risk. Tissues such as the heart, liver and skeletal muscle in the elderly have increased fat deposition, which increases risk for insulin resistance and cardiovascular disease. Furthermore, aging is associated with increased fat content within bone marrow, which exposes the elderly to fracture risk beyond that associated with low bone mineral density alone. Many of the age-associated body compositional changes cannot be detected by simple anthropometric measures alone, and the influence of gender, race or ethnicity, and physical activity patterns on these changes is unclear. This review will explore some of these age-related changes in total and regional fat distribution. Consideration will also be given to the strengths and limitations associated with some of the anthropometric methodologies employed for assessing these changes.

Introduction

Aging is a process that has deleterious effects on nearly every facet of human body composition. While the pattern and magnitude of these changes are likely influenced by gender, race or ethnicity, and physical activity patterns (Kotani et al., 1994, Kyle et al., 2001a), aging is generally associated with increases in abdominal adiposity and fat deposition in skeletal and cardiac muscle, liver, and bone marrow (Meunier et al., 1971, Kotani et al., 1994, Kyle et al., 2001a, Slawik and Vidal-Puig, 2006, Rabkin, 2007). These subtle changes in total or regional fat distribution, generally determined using sophisticated methods such as magnetic resonance image and spectroscopy (MRI and MRS), computed tomography (CT), or dual energy X-ray absorptiometry (DEXA), are not necessarily detectible using surrogate, anthropometric measures such as body weight. In fact, reductions or stability in body weight may mask increases in total and regional adiposity with aging, due to concomitant decreases in lean body mass. Assessing these changes in total or regional fat distribution with aging may be important as fat distribution has substantive effects on morbidity and mortality risk (Stevens et al., 1998, Visscher et al., 2001, Huang et al., 2005). This review will focus on age-related changes in total and abdominal adiposity as well as alterations in fat distribution within non-adipose tissue. Consideration will also be given to the methods employed to assess these changes.

Section snippets

Aging, body weight and total body fat

Aging is generally associated with increases in total adiposity over the adult lifespan (Guo et al., 1999, Gallagher et al., 2000b, Lei et al., 2006, Raguso et al., 2006), until extreme old age when fat mass may decrease (Visser et al., 2003, Raguso et al., 2006). The consequences of this loss of fat mass are not well understood, but it may be an important indicator of deterioration in health. It is suggested that increases in adiposity may be due to a chronic positive energy balance throughout

Aging and regional fat distribution

Aging is not only associated with increased adiposity, but also a redistribution in the pattern of adiposity. In some individuals, there is a progressive inability of the body to develop adequate subcutaneous adipose tissue mass to store lipid, particularly in the lower body (Kotani et al., 1994). This lipodystrophy is evidenced by the decreases in hip circumference commonly seen in White and Asian men and women as early as 60 years of age (Shimokata et al., 1989a, Baumgartner et al., 1995, Ito

Aging and abdominal fat

It is reported that aging is associated with increases in waist circumference of approximately 0.7 cm per year (Noppa et al., 1980). These increases are generally observed in both cross-sectional (Shimokata et al., 1989b, Teh et al., 1996, Ito et al., 2001) and longitudinal studies (Noppa et al., 1980, Shimokata et al., 1989a, Carmelli et al., 1991, Zamboni et al., 2003, Hughes et al., 2004), although the magnitude of the change may vary between studies. Women show a greater increase in waist

Aging and liver fat

Liver fat is a novel lipid depot that has recently been the topic of many investigations in the etiology of insulin resistance and metabolic risk. Most cases of fatty liver occur between 40 and 60 years of age (Falck-Ytter et al., 2001). However, lipid accumulation within the hepatocytes is reported to be associated with aging in some studies (Akahoshi et al., 2001, Cree et al., 2004, Fan et al., 2005, Machann et al., 2005b), but not all (Mahmood et al., 1998, Seppala-Lindroos et al., 2002,

Aging and inter- and intra-muscular fat

Within skeletal muscle there are two lipid depots: inter-muscular fat and intra-muscular fat. Inter-muscular fat is the visible muscle fat marbling that lies between the muscle fibers, whereas intra-muscular fat is lipid located within the myocyte. Both of these muscle fat depots are increased in aging (Ryan and Nicklas, 1999, Cree et al., 2004) and obesity (Kelley et al., 1999, Ryan and Nicklas, 1999, Cree et al., 2004), and may be associated with deleterious health outcomes (Pan et al., 1997,

Aging and bone marrow fat

As with many tissues in the body, there is also increased fat content in bone marrow with aging that occurs in both men and women (Justesen et al., 2001, Brown and Rosen, 2003, Yeung et al., 2005, Rosen and Bouxsein, 2006). Unlike other ectopic fat depots, bone marrow fat is generally not related to obesity in humans (Justesen et al., 2001, Kugel et al., 2001), and the deposition and age-related increase in bone marrow fat may be site specific. For example, the fat fraction in the heel is

Epicardial fat

Among the emerging depots of potential interest is the fat that surrounds the heart: namely, epicardial fat. Epicardial fat lies between the pericardium and myocardium (Fig. 4), and is thought to be more strongly related to adverse health events as compared to other fat depots surrounding the heart (Rabkin, 2007). Much of the previous research examining epicardial fat has been from autopsy results, which is considered the gold standard method (Rabkin, 2007). However, the advent of clinical

Conclusions

Aging is associated with an increase in adiposity and a redistribution of body fat, often to ectopic depots. Redistribution of fat from lower body subcutaneous fat to the abdominal or visceral region are often reported in the elderly and can occur independent of changes in total adiposity, body weight or waist circumference. For many of the age-related changes in adiposity and fat distribution, the influence of gender and race/ethnicity are still not fully elucidated. Further, it is clear that

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