As nursing students, my classmates and I learned that it was better to be a pear than an apple.  Our nutrition professor taught us the limitations of simple BMI calculations, favoring hip-to-waist ratio measurements as more accurate determinants of long-term health.  We were to hone in on patients who carried excess weight in their waistlines instead of in their hips or buttocks.  These patients, we were told, were predisposed to obesity, cardiovascular problems, and diabetes.  Research carried out by California's Kaiser Permanente adds another warning for apple-shaped individuals.  As determined by their study, people with centralized fat stores, even if they are of normal weight, are 2.72 times more likely to develop Alzheimer's disease later in life.

The biochemical mechanism by which abdominal adiposity leads to illness is murky.  Some scientists suggest that the presence of additional stores of adipose tissue surrounding visceral organs interferes with normal metabolic processes.  It has also been proposed that abdominal adipose cells may release toxic substances into the vessels of vital organs, contributing to atherosclerosis and eventual occlusion of these vessels.  Study authors believe that the degeneration of brain activity and progressive memory loss characteristic of Alzheimer's disease may be a long-term consequence of this damaging vascular process.  

The new study, just published in the journal Neurology, analyzes 1960s and 1970s charts of 6,583 then middle-aged patients whose abdominal circumference was measured and recorded.  Incidence of dementia later in life was then compared against the documented degree of abdominal obesity.

Certain demographic factors including sex, education, age, and medical conditions like heart disease or stroke are known to affect the onset of dementia.  After the Kaiser study controlled for these factors, apple-shaped individuals were almost three times more likely to develop Alzheimer's disease than those who did not have excess central adiposity. 

An echo from my nursing school classroom, Kaiser's take home message is that even people whose overall body mass index falls within normal range carry health risks if they have pot bellies.  Researchers found that patients within a healthy weight range who possessed excess abdominal fat were 89 percent more likely to go on to develop dementia in their 70s and 80s.

So, how should we as nurses apply this new information to our clinical practices?

As always, prevention and education are critical.  Our patients should be informed of the important correlation between body shape and disease incidence.  In the ranking of risk factors, love handles are better than beer bellies. All of us need to know this in order to target our personal and professional approaches to health, wellness, and reducing personal risk. 

We do not want to overly alarm our patients nor do we want to imply that genetic tendencies outweigh behavioral practices.  Careful attention to dietary choices, favoring foods high in fiber and low in saturated fat, is smart no matter one's body type.  Additionally, a commitment to weight-bearing and cardiovascular exercise has profound health benefits for people of all shapes and sizes.  Remind patients that smoking cessation reduces the risk of obesity, cardiovascular disease, and diabetes across the board.  A few extra sit-ups are always a good idea, for both apples and pears.

References

Allday, E. (27 march 2008).  Another reason to get rid of the belly fat:  dementia.  San

Francisco Chronicle.

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