Introduction

Human males and females differ greatly in terms of body composition and body fat distribution. In fact, such substantial gross anatomical differences attributable to regional adipose tissue partitioning are practically unique to this species (1). Vague (2, 3) first documented this sex difference in relation to disease risk, stating that men are usually characterized by a body fat distribution pattern that he termed "android," with adipose accumulation in the abdominal region, whereas women often display a body fat distribution pattern that he termed "gynoid," with a greater proportion of their adipose tissue in the gluteal and femoral regions (Fig. 1). One of the seminal articles by Vague in 1956 concluded that "android obesity, with upper body predominance and pronounced muscle-blood development, leads to metabolic disturbances. It not only is associated with premature atherosclerosis and diabetes, but it is also the usual cause of diabetes in the adult in 80 to 90 per cent of the cases" (3).

Over the past 20 years, consistent with these initial observations, large accumulation of abdominal adipose tissue has emerged as a critical determinant of obesity-related metabolic alterations, which are known to increase the risk of type 2 diabetes and cardiovascular disease in both males and females (4-6). The amount of fat located inside the abdominal cavity on anatomical structures such as the greater omentum and mesentery, also termed intra-abdominal or visceral fat, can be quantified using computed tomography (Fig. 2) or magnetic resonance imaging. Studies using these techniques have shown that excess visceral fat accumulation is now recognized as the most prevalent manifestation of the metabolic syndrome and represents an essential feature of the current worldwide obesity epidemic (7).

Fig. 1. Body fat distribution patterns in humans. Adapted from (3).

Gynoid obesity Android obesity

Fig. 1. Body fat distribution patterns in humans. Adapted from (3).

The present chapter will provide an overview of the existing sex differences in energy balance, body composition, and body fat distribution in humans. The link between visceral adipose tissue accumulation and metabolic alterations as well as the teleological significance and mechanisms underlying this sex dimorphism will also be discussed.

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