{"doi":"10.2337/dc21-1565","title":"Body Fat Distribution, Cardiometabolic Traits, and Risk of Major Lower-Extremity Arterial Disease in Postmenopausal Women","abstract":"OBJECTIVE: To assess the relationship between body fat distribution and incident lower-extremity arterial disease (LEAD). RESEARCH DESIGN AND METHODS: We included 155,925 postmenopausal women with anthropometric measures from the Women's Health Initiative who had no known LEAD at recruitment. A subset of 10,894 participants had body composition data quantified by DXA. Incident cases of symptomatic LEAD were ascertained and adjudicated through medical record review. RESULTS: We identified 1,152 incident cases of LEAD during a median 18.8 years follow-up. After multivariable adjustment and mutual adjustment, waist and hip circumferences were positively and inversely associated with risk of LEAD, respectively (both P-trend < 0.0001). In a subset (n = 22,561) where various cardiometabolic biomarkers were quantified, a similar positive association of waist circumference with risk of LEAD was eliminated after adjustment for diabetes and HOMA of insulin resistance (P-trend = 0.89), whereas hip circumference remained inversely associated with the risk after adjustment for major cardiometabolic traits (P-trend = 0.0031). In the DXA subset, higher trunk fat (P-trend = 0.0081) and higher leg fat (P-trend < 0.0001) were associated with higher and lower risk of LEAD, respectively. Further adjustment for diabetes, dyslipidemia, and blood pressure diminished the association for trunk fat (P-trend = 0.49), yet the inverse association for leg fat persisted (P-trend = 0.0082). CONCLUSIONS: Among U.S. postmenopausal women, a positive association of upper-body fat with risk of LEAD appeared to be attributable to traditional risk factors, especially insulin resistance. Lower-body fat was inversely associated with risk of LEAD beyond known risk factors.","journal":"Diabetes Care","year":2021,"id":185758,"datarank":0.4392242941787101,"base_score":2.0794415416798357,"endowment":2.0794415416798357,"self_citation_contribution":0.31191623125197543,"citation_network_contribution":0.1273080629267347,"self_endowment_contribution":0.31191623125197543,"citer_contribution":0.1273080629267347,"corpus_percentile":null,"corpus_rank":null,"citation_count":7,"citer_count":7,"citers_with_citation_signal":5,"citers_with_endowment":5,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9188,"is_data_producer":true,"deposit_databanks":{"figshare":["10.2337/figshare.16775866"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":720929,"name":"Rhonda Arthur","orcid":"0000-0002-3241-2945","position":1,"is_corresponding":false},{"id":493322,"name":"Victor Kamensky","orcid":null,"position":2,"is_corresponding":false},{"id":368855,"name":"Jin Choul Chai","orcid":"0000-0001-9521-6135","position":3,"is_corresponding":false},{"id":51217,"name":"Bing Yu","orcid":"0000-0003-4818-1077","position":4,"is_corresponding":false},{"id":272433,"name":"Aladdin H. Shadyab","orcid":"0000-0002-9693-0522","position":5,"is_corresponding":false},{"id":264287,"name":"Matthew Allison","orcid":"0000-0003-0777-8272","position":6,"is_corresponding":false},{"id":245942,"name":"Yangbo Sun","orcid":"0000-0003-0377-4450","position":7,"is_corresponding":false},{"id":11827,"name":"Nazmus Saquib","orcid":"0000-0002-2819-2839","position":8,"is_corresponding":false},{"id":247249,"name":"Robert A. Wild","orcid":"0000-0002-1298-265X","position":9,"is_corresponding":false},{"id":245947,"name":"Wei Bao","orcid":"0000-0002-7301-5786","position":10,"is_corresponding":false},{"id":279302,"name":"Andrew J. Dannenberg","orcid":"0000-0002-1901-6497","position":11,"is_corresponding":false},{"id":243124,"name":"Thomas E. Rohan","orcid":"0000-0001-6897-4045","position":12,"is_corresponding":false},{"id":21964,"name":"Robert C. 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