Distribuição periférica da gordura, fenótipo associado ao lipedema e menor prevalência de doença cardiometabólica em mulheres: estudo transversal (NHANES 2011-2018)

Alexandre Campos Moraes Amato; Juliana Lelis Spirandeli Amato; Daniel Augusto Benitti

doi:10.1590/1677-5449.202600751

Original Article

Distribuição periférica da gordura, fenótipo associado ao lipedema e menor prevalência de doença cardiometabólica em mulheres: estudo transversal (NHANES 2011-2018)

Peripheral fat distribution, the lipedema-associated phenotype, and lower prevalence of cardiometabolic disease in women: a cross-sectional study (NHANES 2011-2018)

Alexandre Campos Moraes Amato; Juliana Lelis Spirandeli Amato; Daniel Augusto Benitti

http://dx.doi.org/10.1590/1677-5449.202600751 J Vasc Bras, vol.25, e20260075, 2026

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Resumo

Contexto: A distribuição da gordura corporal pode ser mais relevante para o risco cardiometabólico do que a adiposidade total. O critério de Buso identifica, por absorciometria de raios X de dupla energia (dual-energy X-ray absorptiometry, DXA), um padrão de distribuição periférica (ginoide) da gordura associado ao lipedema, sem estabelecer seu diagnóstico clínico.

Objetivos: Avaliar a associação entre o fenótipo de distribuição periférica da gordura e o desfecho cardiometabólico composto em mulheres com diferentes níveis de gordura corporal.

Métodos: Estudo transversal com 4.986 mulheres de 20-59 anos do National Health and Nutrition Examination Survey (NHANES) 2011-2018. O fenótipo foi definido pela razão gordura das pernas/gordura total ≥ 0,383, medida por DXA. O desfecho composto incluiu diabetes, hipertensão, colesterol alto, pré-diabetes e doença cardiovascular. Foram utilizados modelos de regressão logística ponderados pelo desenho amostral, com análises estratificadas por gordura corporal e correção para múltiplas comparações.

Resultados: O fenótipo esteve associado a menores chances do desfecho composto (odds ratio = 0,49; intervalo de confiança de 95%: 0,41-0,60; p < 0,001). Não houve evidência de interação estatisticamente significativa com a categoria de gordura corporal (p = 0,110). Na faixa de 25-38% de gordura corporal, a prevalência do desfecho foi de 22,3% entre mulheres com o fenótipo e 49,4% entre aquelas sem o fenótipo.

Conclusões: O fenótipo de distribuição periférica da gordura esteve associado a menores chances do desfecho cardiometabólico composto em diferentes níveis de gordura corporal. O delineamento transversal não permite estabelecer temporalidade ou causalidade.

Palavras-chave

distribuição da gordura corporal; composição corporal; absorciometria de fóton; doenças cardiovasculares; obesidade; lipedema

Abstract

Background: Body fat distribution may be more relevant for cardiometabolic risk than total adiposity. The Buso criterion uses dual-energy X-ray absorptiometry (DXA) to identify a peripheral (gynoid) fat distribution pattern associated with lipedema, without establishing a clinical diagnosis of the condition.

Objectives: To evaluate the association between the peripheral fat distribution phenotype and the composite cardiometabolic outcome in women with different levels of body fat.

Methods: Cross-sectional study of 4,986 women aged 20-59 years from the National Health and Nutrition Examination Survey (NHANES) 2011-2018. The phenotype was defined as the ratio of leg fat to total fat ≥0.383, as measured by DXA. The composite outcome included diabetes, hypertension, high cholesterol, prediabetes, and cardiovascular disease. Survey-weighted logistic regression models were used, with analyses stratified by body fat and correction for multiple comparisons.

Results: The phenotype was associated with lower odds of the composite outcome (odds ratio = 0.49; 95% CI, 0.41-0.60; p < 0.001). There was no evidence of statistically significant interaction with the total fat category (p = 0.110). In the 25-38% body fat range, the outcome had a prevalence of 22.3% in women with the phenotype versus 49.4% in those without the phenotype.

Conclusions: The peripheral fat distribution phenotype was associated with lower odds of the composite cardiometabolic outcome across different levels of body fat. The cross-sectional design does not allow establishing temporality or causality.

Keywords

body fat distribution; body composition; absorptiometry, photon; cardiovascular diseases; obesity; lipedema

References

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Submitted date:
04/16/2026

Accepted date:
08/23/2026

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">

Distribuição periférica da gordura, fenótipo associado ao lipedema e menor prevalência de doença cardiometabólica em mulheres: estudo transversal (NHANES 2011-2018)

Peripheral fat distribution, the lipedema-associated phenotype, and lower prevalence of cardiometabolic disease in women: a cross-sectional study (NHANES 2011-2018)

Alexandre Campos Moraes Amato; Juliana Lelis Spirandeli Amato; Daniel Augusto Benitti

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