title: Asymptomatic Achilles tendon pathology is associated with a central fat distribution in men and a peripheral fat distribution in women: a cross sectional study of 298 individuals.
abstract: BACKGROUND
  Adiposity is a modifiable factor that has been implicated in tendinopathy. As tendon pain reduces physical activity levels and can lead to weight gain, associations between tendon pathology and adiposity must be studied in individuals without tendon pain. Therefore, the purpose of this study was to determine whether fat distribution was associated with asymptomatic Achilles tendon pathology.
  
  
  METHODS
  The Achilles tendons of 298 individuals were categorised as normal or pathological using diagnostic ultrasound. Fat distribution was determined using anthropometry (waist circumference, waist hip ratio [WHR]) and dual-energy x-ray absorptiometry.
  
  
  RESULTS
  Asymptomatic Achilles tendon pathology was more evident in men (13%) than women (5%) (p = 0.007). Men with tendon pathology were older (50.9 +/- 10.4, 36.3 +/- 11.3, p < 0.001), had greater WHR (0.926 +/- 0.091, 0.875 +/- 0.065, p = 0.039), higher android/gynoid fat mass ratio (0.616 +/- 0.186, 0.519 +/- 0.142, p = 0.014) and higher upper-body/lower body fat mass ratio (2.346 +/- 0.630, 2.022 +/- 0.467, p = 0.013). Men older than 40 years with a waist circumference >83 cm had the greatest prevalence of tendon pathology (33%). Women with tendon pathology were older (47.4 +/- 10.0, 36.0 +/- 10.3, p = 0.008), had less total fat (17196 +/- 3173 g, 21626 +/- 7882 g, p = 0.009), trunk fat (7367 +/- 1662 g, 10087 +/- 4152 g, p = 0.003) and android fat (1117 +/- 324 g, 1616 +/- 811 g, p = 0.005). They had lower central/peripheral fat mass ratios (0.711 +/- 0.321 g, 0.922 +/- 0.194 g, p = 0.004) than women with normal tendons. Women with tendon pathology were more often menopausal (63%, 13%, p = 0.002).
  
  
  CONCLUSIONS
  Men with Achilles tendon pathology were older and had a central fat distribution. Women with tendon pathology were older and had a peripheral fat distribution. An interaction between age and waist circumference was observed among men.
authors.affiliation: School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia. jega@deakin.edu.au
authors.forename: James E
authors.initials: JE
authors.lastname: Gaida
authors.forename: Håkan
authors.initials: H
authors.lastname: Alfredson
authors.forename: Zoltan S
authors.initials: ZS
authors.lastname: Kiss
authors.forename: Shona L
authors.initials: SL
authors.lastname: Bass
authors.forename: Jill L
authors.initials: JL
authors.lastname: Cook
mesh_terms: D015502:Absorptiometry, Photon; D000125:Achilles Tendon / Q000000981:diagnostic imaging / Q000473:pathology*; D000273:Adipose Tissue / Q000502:physiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000886:Anthropometry / Q000379:methods; D050218:Body Fat Distribution; D015992:Body Mass Index; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000503:physiopathology*; D012727:Sex Characteristics; D012737:Sex Factors; D013314:Stress, Mechanical; D052256:Tendinopathy / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D014463:Ultrasonography; D016474:Weight-Bearing / Q000502:physiology; D055815:Young Adult