The association between fibrinolysis markers and body composition in black adults in the North West Province of South Africa
INTRODUCTION - Plasminogen activator inhibitor type-1 (PAI-1) has a known relationship with obesity and more specifically with central obesity. Traditionally the physiological contribution of PAI-1 is seen as an indicator of fibrinolysis with increased PAI-1 levels contributing to decreased fibrinolysis. In more recent years, assays have been developed that not only uses proxy markers, such as PA-1, which is considered to be representative of fibrinolysis , but global assays that report on the global fibrinolytic potential of an individual, often reported as clot lysis time (CLT). Investigations into the relationship of CLT with obesity are scarce. Preliminary evidence shows that the relationship of CLT with obesity may differ from that of PAI-1 with obesity although in depth investigations in this regard are lacking. Therefore, the aim of this study was to investigate the association between fibrinolysis markers (PAI-1act and CLT) and various markers of body composition in the South African Prospective Urban and Rural Epidemiology (PURE) data collected during 2010. METHODS - Data collected in the PURE study in 2010 were cross-sectionally analysed. The participants (n = 1288) were apparently healthy black South-African men and women 35 years and older, residing in urban and rural settlements in the North-West Province. Experimental methods included anthropometric measurements such as height, weight, hip circumference, waist circumference, skinfolds (triceps, chest, abdominal, thigh and supra iliac skinfolds) and body composition measurements by means of air-displacement plethysmography and biolelectrical impedance analysis. Laboratory analysis of fibrinolysis markers, PAI-1act and CLT were also performed. MAIN FINDINGS - In men, similarities were seen regarding the relationship between PAI-1act and body composition markers and the relationships observed between CLT and body composition markers. In contrast, in the women more and stronger associations were observed between CLT and body composition markers compared to that observed between PAI-1act and body composition markers. CLT showed a linear relationship with body composition markers where PAI-1act levels plateaued at higher body composition categories. Possible reasons for the observed differences may be related to differences in adipose tissue distribution and sequence of accumulation between men and women. PAI-1 is associated with visceral adipose tissue (VAT) where high amounts of stromal cells are found. In men preferential accumulation of VAT may explain similarities in the relationship of PAI-1act with body composition and that of CLT with body composition. Proportionally less VAT, but more subcutaneous adipose tissue in women may explain the observed increase in CLT compared to PAI-1act levels that plateaued over body composition tertiles and categories. CONCLUSION - PAI-1act has a stronger association with central obesity while CLT has a stronger association with total body fat. In women PAI-1act and CLT showed different associations with body composition markers, whereas associations of PAI-1act and CLT with body composition were similar in men. PAI-1act is strongly influenced by type of body fat accumulation whereas CLT is associated with obesity independent of type and sequence of body fact accumulation. Significant associations observed between CLT and body composition variables are, therefore, at least in part, independent of PAI-1act. Additional factors such as, thrombin activatable fibrinolysis inhibitor (TAFI), α-2-antiplasmin, plasminogen, prothrombin and fibrin clot structure that influence CLT and are also related to obesity may additionally contribute to the link between CLT and obesity.
- Health Sciences