Effects of obesity on abdominal wall morphology and diastasis recti abdominis in women

Year 2025, Volume: 19 Issue: 1, 1 - 7, 30.04.2025

Mehtap Balaban , Şeyda Toprak Çelenay , Derya Özer Kaya

Abstract

Objectives: Obesity can lead to structural alterations in the abdominal wall, which are important to assess for effective obesity management. This study aimed to investigate the impact of obesity on abdominal wall morphology and the presence of diastasis recti abdominis (DRA) in women, as well as the correlation between body mass index (BMI) and abdominal wall parameters.
Methods: Women were divided into two groups based on BMI: non-obese (BMI<30 kg/m², n=37) and obese (BMI≥30 kg/m², n=36). Using ultrasound, measurements were taken for umbilical subcutaneous adipose tissue (SCAT) thickness, abdominal muscle thickness, linea alba (LA) distortion (using a distortion index formula) and width (using inter-rectus distance, IRD), and presence of DRA.
Results: The obese group showed significantly greater umbilical SCAT thickness, distortion index scores, and IRD measured 2 cm above the umbilicus compared to the non-obese group (p<0.05). No significant differences were observed in abdominal muscle thickness between the groups (p>0.05). The prevalence of DRA was higher in the obese group (33.3%) than in the non-obese group (10.8%) (p<0.05). Significant positive correlations were found between BMI and umbilical SCAT thickness (p=0.610), distortion index scores (p=0.489), and IRD measured 2 cm above (p=0.359) and below the umbilicus (p=0.304) (p<0.05).
Conclusion: Women with obesity exhibited increased umbilical SCAT thickness, greater linea alba distortion and width, and a higher prevalence of DRA compared to non-obese women. These findings suggest that elevated BMI may negatively influence abdominal wall morphology. Considering these morphological changes may be important in the clinical evaluation and management of obesity.

Keywords

Abdominal muscles , diastasis recti abdominis , obesity , ultrasonography

Ethical Statement

The local ethics committee (Approval number:0061) approved this study.

Supporting Institution

-

Project Number

-

Thanks

-

References

• Bhurosy T, Jeewon R. Overweight and obesity epidemic in developing countries: a problem with diet, physical activity, or socioeconomic
• De Heredia FP, Gómez-Martínez S, Marcos A. Obesity, inflammation and the immune system. Proc Nutr Soc 2012;71:332–8.
• Aune D, Mahamat‐Saleh Y, Norat T, Riboli E. Body mass index, abdominal fatness, weight gain and the risk of urinary incontinence: a systematic review and dose-response meta‐analysis of prospective studies. BJOG 2019;126:1424–33.
• Chowdhury D, Sarkar S, Rashid MH, Rahaman A, Sarkar SK, Roy R. Influence of body mass index on low back pain. Mymensingh Med J 2014;23:125–9.
• Smith AJ, O’Sullivan PB, Beales DJ, de Klerk N, Straker LM. Trajectories of childhood body mass index are associated with adolescent sagittal standing posture. Int J Pediatr Obes 2011;6:e97–106.
• AlAbdulwahab SS, Kachanathu SJ. Effects of body mass index on foot posture alignment and core stability in a healthy adult population. J Exerc Rehabil 2016;12:182–7.
• Saranteas T, Anagnostis G, Lappas T, Christodoulopoulou T, Kostopanagiotou G. Feasibility of ultrasound imaging of the abdominal wall in elderly obese volunteers. Br J Anaesth 2010;105:549–50.
• Flament JB, Avisse C, Delattre JF. Anatomy of the abdominal wall. In: Bendavid R, Abrahamson J, Arregui ME, Flament JB, Phillips EH, editors. Abdominal wall hernias. New York: Springer; 2001. p. 39–63.
• Lee DG, Lee LJ, McLaughlin L. Stability, continence and breathing: the role of fascia following pregnancy and delivery. J Bodyw Mov Ther 2008;12:333–48.
• Springer BA, Mielcarek BJ, Nesfield TK, Teyhen DS. Relationships among lateral abdominal muscles, gender, body mass ındex, and hand dominance. J Orthop Sports Phys Ther 2006;36:289–97.
• Candido G, Lo T, Janssen PA. Risk factors for diastasis of the recti abdominis. Journal of the Association Chartered Physiotherapists in Women’s Health 2005;97:49–54.
• Pachera P, Pavan PG, Todros S, Cavinato C, Fontanella CG, Natali AN. A numerical investigation of the healthy abdominal wall structures. J Biomech 2016;49:1818–23.
• Pirri C, Todros S, Fede C, Pianigiani S, Fan C, Foti C, Stecco C, Pavan P. Inter‐rater reliability and variability of ultrasound measurements of abdominal muscles and fasciae thickness. Clin Anat 2019;32:948–60.
• Teyhen DS. Rehabilitative ultrasound imaging symposium San Antonio, TX, May 8–10, 2006. J Orthop Sport Phys Ther 2006;36:A1–3.
• Mota P, Pascoal AG, Sancho F, Bø K. Test-retest and intrarater reliability of 2-dimensional ultrasound measurements of distance between rectus abdominis in women. J Orthop Sport Phys Ther 2012;42:940–6.
• Lee D, Hodges PW. Behavior of the linea alba during a curl-up task in diastasis rectus abdominis: an observational study. J Orthop Sport Phys Ther 2016;46:580–9.
• Torun BI, Balaban M, Geneci F, Hatipoglu SC. The relationship between the body mass index and the subcutaneous adipose tissue. Anatomy 2022;16:7–12.
• Vecchié A, Dallegri F, Carbone F, Bonaventura A, Liberale L, Portincasa P, Fruhbeck G, Montecucco F. Obesity phenotypes and their paradoxical association with cardiovascular diseases. Eur J Intern Med 2018;48:6–17
• Karakus A, Balaban M, Kaya DO, Celenay ST. Lumbopelvic muscle endurance, morphology, alignment, and mobility in women with primary dysmenorrhea: a case-control study. Clin Biomech (Bristol) 2022;92:105582.
• Mota P, Pascoal AG, Carita AI, Bø K. The ımmediate effects on inter-rectus distance of abdominal crunch and drawing-in exercises during pregnancy and the postpartum period. J Orthop Sport Phys Ther 2015;45:781–8.
• Akoglu H. User’s guide to correlation coefficients. Turk J Emerg Med 2018;18:91–3.
• Busetto L, Baggio MB, Zurlo F, Carraro R, Digito M, Enzi G. Assessment of abdominal fat distribution in obese patients: anthropometry versus computerized tomography. Int J Obes Relat Metab Disord 1992;16:731–6.
• Gradmark AMI, Rydh A, Renström F, De Lucia-Rolfe E, Sleigh A, Nordström P, Brage S, Franks PW. Computed tomography-based validation of abdominal adiposity measurements from ultrasonography, dual-energy X-ray absorptiometry and anthropometry. Br J Nutr 2010;104:582–8.
• Hastuti J, Rahmawati N, Suriyanto R, Wibowo T, Nurani N, Julia M. Patterns of body mass index, percentage body fat, and skinfold thicknesses in 7- to 18-year-old children and adolescents from Indonesia. Int J Prev Med 2020;11:129.
• Kim J, Lim H, Lee SI, Kim YJ. Thickness of rectus abdominis muscle and abdominal subcutaneous fat tissue in adult women: correlation with age, pregnancy, laparotomy, and body mass index. Arch Plast Surg 2012;39:528–33.
• Hildenbrand K, Noble L. Abdominal muscle activity while performing trunk-flexion exercises using the ab roller, abslide, fitball, and conventionally performed trunk curls. J Athl Train 2004;39:37–43.
• Tahan N, Khademi-Kalantari K, Mohseni-Bandpei MA, Mikaili S, Baghban AA, Jaberzadeh S. Measurement of superficial and deep abdominal muscle thickness: an ultrasonography study. J Physiol Anthropol 2016;35:17.
• Khan MA, Qureshi K, Rehman Z. Effect of age and obesity on human male anterior abdominal wall muscles: an ultrasonographic anthropometric analysis. Pakistan Journal of Medical & Health Sciences 2012;6:406–12.
• Linek P. The importance of body mass normalisation for ultrasound measurement of the transversus abdominis muscle: the effect of age, gender and sport practice. Musculoskelet Sci Pract 2017;28:65–70.
• Benjamin DR, Frawley HC, Shields N, van de Water ATM, Taylor NF. Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review. Physiotherapy 2019;105:24–34.
• Fan C, Guidolin D, Ragazzo S, Fede C, Pirri C, Gaudreault N, Porzionato A, Macchi V, De Caro R, Stecco C. Effects of cesarean section and vaginal delivery on abdominal muscles and fasciae. Medicina (Kaunas) 2020;56:260.
• Fredon F, Hardy J, Germain M, Vincent-Viry E, Taïbi A, Monteil J, Mabit C, Valleix D, Durand-Fontanier S. Correlations of the rectus abdominis muscle anatomy with anthropometric measurements. Surg Radiol Anat 2021;43:589–93.
• Grossi JV, Nicola FF, Zepeda IA, Becker M, Trindade EN, Diemen VV, Cavazzola LT, Trindade MR. Linea alba collagen assessment in morbidly obese patients. Arq Bras Cir Dig 2016; 29(suppl 1):8–11.
• Wu L, Gu Y, Gu Y, Wang Y, Lu X, Zhu C, Lu Z, Xu H. Diastasis recti abdominis in adult women based on abdominal computed tomography imaging: prevalence, risk factors and its impact on life. J Clin Nurs 2021;30:518–27.
• Doubkova L, Andel R, Palascakova-Springrova I, Kolar P, Kriz J, Kobesova A. Diastasis of rectus abdominis muscles in low back pain patients. J Back Musculoskelet Rehabil 2018;31:107–12.