[Current diagnostic methods of the specific distribution of adipose tissue]

The classification of obesity into male or the android type and female or the gynoid type dates from the first clinical observations of J. Vague in the distant 1947. Researches carried out in the recent years show that in the android type of obesity there is an insulin resistance and hyperinsulinism as a metabolic bases for accelerated atherosclerosis. These insights imposed a need to determine body composition, and within it also the mass and the fat tissue distribution. The simplest anthropometric parameter which gives us insight into the nutritional status is BMI, while waist/hip ratio (WHR) offers orientation for the fat tissue distribution.

The subcutaneous fat tissue is measured by standard calipers. A particularly important anthropometric parameter which has been increasingly applied in the recent years is the sagittal abdominal diameter (SAD) measured by a simple caliper constructed by Kahn. This anthropometric indicator measures only the visceral fat tissue. As for other techniques, in the first place one should mention measuring of body density which presents a relation between the body mass an volume. Tetrapolar bioelectric impedance analysis is based on measuring the resistance of the body exposed to the impact of alternating current of 50 kHz and the strength of 800 microA. Double photon absorptiometry and X ray absorptiometry are precise methods for the determination of body composition, but they require expensive equipment and X ray absorptiometry also exposes the organism to certain radiation. Radio-isotopic techniques are based on measuring the total body liquid by marked deuterium or tritium and measuring of the total body potassium. Infrared spectrometry is a simple and not a particularly reliable method based on application of two sources of monochromatic light. Ultrasonographic measuring of fat tissue is a very favoured technique by which one can measure both the subcutaneous and visceral fat tissue. Measuring is carried out by transducer of 7.5 mHz for the subcutaneous and 3.5 mHz for visceral fat tissue. It is certain that fat-tissue depots can be most exactly measured by computerized tomography and nuclear magnetic resonance which, however, require a very expensive equipment.

Modern concept of obesity implies an obligatory determination not only of the degree, but, which is even more important, of the type of obesity. Within these activities, besides the techniques already used so far (BMI, WHR), it is recommended to introduce measuring of the visceral fat tissue by SAD and ultrasonographic measuring of both fat-tissue depots into the everyday routine work.