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Skinny Legs a Risk for Cardiovascular Disease and Death (The Chicken Leg Syndrome)

Friday, September 18, 2009 Posted by Peter Janiszewski, PhD

This post was chosen as an Editor's Selection for ResearchBlogging.orgIn prior posts, I have described the results of countless research, including my own studies which suggest that independent of how much you weigh – the location of that excess storage is a key determinant of your health risk. Indeed, over the last couple of years I have published 2 separate studies which show that regardless of your weight, having a big belly (being apple shaped) can increase your risk of type-2 diabetes (men and women) as well as erectile dysfunction among men (see all pertinent studies discussed in this post below).

Additionally, it has also been known that for a given size of your belly – the smaller your hips or thighs, the greater your risk of a number of diseases. Indeed, along with Drs. Jen Kuk and Bob Ross, I had previously shown in another study that for a given amount of belly fat, having more fat in the buttocks, hips, and thighs was actually associated with a healthier metabolic profile among both men and women.

All this evidence is often simplistically summed up as the difference between apple (android) or pear-shaped (gynoid) obesity, with the latter being largely benign.

A very recent study published in the British Medical Journal has investigated the influence of thigh circumference on prospective risk of cardiovascular disease and death, and the results are making quite a few headlines.

In the study, Heitmann and Frederiksen assessed longitudinal (over time) data on 1436 men and 1380 women looking for occurrence of cardiovascular disease and mortality.

Over the approximately 10 years of follow-up, 257 men and 155 women died while 263 men and 140 women developed cardiovascular disease.

The authors found that for a given body mass index (BMI) or waist circumference, men and women with smaller thighs had an increased risk of dying and of developing cardiovascular disease compared to those with larger thighs. However, there was a threshold for this effect, such that only people with thigh circumferences below approximately 60cm were at increased risk of dying. People with thigh circumferences higher than 60cm didn’t seem to get any additional benefit from having bigger thighs.

The explanation for why smaller thighs may predispose someone to a risk of cardiovascular disease or mortality is still up in the air. The two schools of thought suggest the problem lies in either not enough muscle mass or too little fat mass in the lower body. Indeed, as I briefly mentioned above, all else being equal, those with less lower body fat tend to be less healthy than those with more.

However, there is another plausible explanation for these findings, which the authors did not at all explore. A couple of years ago, Dr. Jen Kuk and I were interested in seeing what exactly a large hip or thigh circumference was predicting in reference to someone’s body composition, when other measures such as their BMI or waist circumference are also considered. In a study we published in the American Journal of Clinical Nutrition, we showed that while a large hip or thigh predicts more lower body fat mass and muscle mass, it was also a predictor of LESS visceral fat – the fat inside your belly, that has been shown repeatedly to be the strongest predictor of health risk.

In other words, our results suggest that the risk of disease and death associated with a small thigh circumference in the recent study, can be explained by increased storage of the dangerous visceral fat. It would seem that if the body can't store your excess calories in the legs (where the health risk is minimal) it stores it in more dangerous depots, such as inside your belly, where the excess fat is more likely to cause trouble.

While I coudld literally go on for hours on this topic, I should quit my rambling there – it is dangerous when you get someone who works in an area of interest (body composition, in this case) to discuss their research – it may never end…

Have a great weekend,


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Heitmann, B., & Frederiksen, P. (2009). Thigh circumference and risk of heart disease and premature death: prospective cohort study BMJ, 339 (sep03 2) DOI: 10.1136/bmj.b3292

Janiszewski, P., Janssen, I., & Ross, R. (2007). Does Waist Circumference Predict Diabetes and Cardiovascular Disease Beyond Commonly Evaluated Cardiometabolic Risk Factors? Diabetes Care, 30 (12), 3105-3109 DOI: 10.2337/dc07-0945

Janiszewski, P., Kuk, J., & Ross, R. (2008). Is the reduction of lower-body subcutaneous adipose tissue associated with elevations in risk factors for diabetes and cardiovascular disease? Diabetologia, 51 (8), 1475-1482 DOI: 10.1007/s00125-008-1058-0

Kuk JL, Janiszewski PM, & Ross R (2007). Body mass index and hip and thigh circumferences are negatively associated with visceral adipose tissue after control for waist circumference. The American journal of clinical nutrition, 85 (6), 1540-4 PMID: 17556690

Janiszewski, P., Janssen, I., & Ross, R. (2009). Abdominal Obesity and Physical Inactivity Are Associated with Erectile Dysfunction Independent of Body Mass Index Journal of Sexual Medicine, 6 (7), 1990-1998 DOI: 10.1111/j.1743-6109.2009.01302.x

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6 Response to "Skinny Legs a Risk for Cardiovascular Disease and Death (The Chicken Leg Syndrome)"

  1. Yoni Freedhoff Said,

    My brother-in-law (who works with me) has such skinny legs that I'll often show them to medical residents rotating through my practice.

    Posted on September 18, 2009 at 1:39 PM

  2. Lan Said,

    Do you think this might explain the increased risk of some Asian/Middle-Eastern populations even at a 'normal' BMI? I see a lot of men from these populations that are very skinny except for a belly.

    Posted on September 18, 2009 at 2:32 PM

  3. Travis Saunders, MSc Said,

    Thanks for the insight Yoni :)

    Great comment Lan.

    For a given BMI, Asian individuals typically have more abdominal fat than Caucasians, which places them at increased health risk at a lower BMI. I'm not sure about lower body fat in Asian individuals, but it wouldn't be surprising if they had lower amounts of lower body fat than Caucasians as well.

    I think this would go along with Peter's argument that it might not be the lack of leg fat that puts you at health risk, but that the lack of leg fat is a marker for increased visceral fat. It is probably this increased visceral fat that's really responsible for most of the health risk.

    Posted on September 18, 2009 at 2:45 PM

  4. Peter Janiszewski, PhD (Cand.), MSc Said,

    @ Lan As far as I know, this issue has not been investigated in the literature. It would be a very simple study to perform.

    I am rather tempted myself to do it...

    Thanks very much for the idea Lan - great thinking. If this ever makes it to publication, an acknowledgement will be in order:)

    Posted on September 18, 2009 at 3:02 PM

  5. Lan (Lyn) Said,

    Cool! I'll look forward to seeing the study, then. (Since my Ph.D. is in English lit, I won't be doing it myself!).

    Lyn ("Lan" was a typo!)

    Posted on September 18, 2009 at 3:10 PM

  6. Anonymous Said,

    I am skinny overall, I am a girl, I have a thin waist and skinny legs, does this mean I'm at risk too??

    Posted on April 3, 2010 at 12:18 PM


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We are PhD students in the School of Kinesiology and Health Studies at Queen's University in Kingston, Ontario. Our research focuses on the relationships between obesity, physical activity, and health risk. This blog is our attempt to consider the many "cures" for obesity that we read about on a daily basis. Enjoy.


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