On the relationships between mineral metabolism, obesity and fat distribution

Alterations in calcium metabolism have been associated with cardiovascular risk factors. An altered binding of calcium to plasma proteins and raised levels of parathyroid hormone (PTH) have been described in morbid obesity. In the present study, indices of mineral metabolism were related to obesity (body mass index, BMI) and fat distribution (waist to hip ratio, w/h) in 194 subjects with a wide range of BMI and w/h. The ratio of total serum calcium to plasma ionized calcium (Ca2+) was found to be significantly correlated to both BMI (r = 0.20, P < 0.02) and w/h (r = 0.22, P < 0.005). Serum phosphate was also correlated to both of the indices of obesity in an inverse way (r = -0.24, P < 0.0008 for BMI and r = -0.33, P < 0.0001 for w/h). These relationships were still significant when the influences of age, sex and serum creatinine were included in the multiple regression analysis. This kind of analysis also disclosed that w/h was superior to BMI as a determinant of serum phosphate and the total calcium/Ca2+ ratio in serum. PTH was not significantly correlated to any of the indices of obesity. In conclusion, fat distribution rather than obesity per se was found to be associated with an altered mineral metabolism.