Polyunsaturated fatty acids in relation to incident mobility disability and decline in gait speed; the Age, Gene/Environment Susceptibility-Reykjavik Study

BACKGROUND/OBJECTIVES

Low intake of long chain polyunsaturated fatty acids (PUFAs) are associated with physical disability; however, prospective studies of circulating PUFAs are scarce. We examined associations between plasma phospholipid n-3 and n-6 PUFAs with risk of incident mobility disability and gait speed decline.

SUBJECTS/METHODS

Data are from a subgroup of the Age, Gene/Environment Susceptibility-Reykjavik Study, a population-based study of risk factors for disease and disability in old age. In this subgroup (n = 556, mean age 75.1 ± 5.0 years, 47.5% men), plasma phospholipid PUFAs were assessed at baseline using gas chromatography. Mobility disability and usual gait speed were assessed at baseline and after 5.2 ± 0.2 years. Mobility disability was defined as the following: having much difficulty, or being unable to walk 500 m or climb up 10 steps; decline in gait speed was defined as change ⩾ 0.10 m/s. Logistic regression analyses were performed to determine associations between sex-specific s.d. increments in PUFAs with risk of incident mobility disability and gait speed decline. Odds ratios (95% confidence intervals) adjusted for demographics, follow-up time, risk factors and serum vitamin D were reported.

RESULTS

In women, but not men, every s.d. increment increase of total n-3 PUFAs and docosahexaenoic acid (DHA) was associated with lower mobility disability risk, odds ratio 0.48 (0.25; 0.93) and odds ratio 0.45 (0.24; 0.83), respectively. There was no association between n-6 PUFAs and the risk of incident mobility disability or gait speed decline.

CONCLUSIONS

Higher concentrations of n-3 PUFAs and, particularly, DHA may protect women from impaired mobility but does not appear to have such an effect in men.

Genome-wide association study of myelosuppression in non-small-cell lung cancer patients with platinum-based chemotherapy

Platinum-induced myelosuppression severely impedes successful chemotherapy in non-small-cell lung cancer (NSCLC) patients. Hence, it is clinically important to identify the patients who are at high risk for severe toxicity to certain chemotherapy. We first carried out a genome-wide scan of 906 703 single-nucleotide polymorphisms (SNPs) to identify genetic variants associated with platinum-induced myelosuppression risk in 333 NSCLC patients with chemotherapy. Then, we replicated 24 SNPs that had P<1 × 10(-4) in another independent cohort of 876 NSCLC patients. With P<0.05 as the criterion of statistical significance, we found that rs13014982 at 2q24.3 and rs9909179 at 17p12 exhibited consistently significant associations with myelosuppression risk in both the genome-wide association studies (GWAS) scan and the replication stage (rs13014982: odds ratio (OR)=0.55, 95% confidence intervals (CIs): 0.41-0.74, P=7.29 × 10(-5) for GWAS scan and OR=0.77, 95% CI: 0.65-0.93, P=0.006 for replication stage; rs9909179: OR=0.51, 95% CI: 0.37-0.70, P=4.60 × 10(-5) for GWAS scan and OR=0.82, 95% CI: 0.68-0.99, P=0.040 for replication stage; both in additive model). In combined samples of genome-wide scan and replication samples, the minor alleles of rs13014982 and rs9909179 remained significant associations with the decreased risk of myelosuppression (rs13014982: OR=0.71, 95% CI: 0.61-0.83, P =1.36 × 10(-5); rs9909179: OR=0.76, 95% CI: 0.65-0.89, P=0.001). Rs13014982 at 2q24.3 and rs9909179 at 17p12 might be independent susceptibility markers for platinum-induced myelosuppression risk in NSCLC patients.

Cardiovascular and all-cause mortality in relation to various anthropometric measures of obesity in Europeans

BACKGROUND AND AIMS

Cardiovascular and all-cause mortality in relation to various anthropometric measures of obesity is still controversial.

METHODS AND RESULTS

Body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), A Body Shape Index (ABSI) and waist-to-hip-to-height ratio (WHHR) were measured at baseline in a cohort of 46,651 European men and women aged 24-99 years. The relationship between anthropometric measures of obesity and mortality was evaluated by the Cox proportional hazards model with age as a time-scale and with threshold detected by a piecewise regression model. Over a median follow-up of 7.9 years, 2381 men and 1055 women died, 1071 men (45.0%) and 339 women (32.1%) from cardiovascular disease (CVD). BMI had a J-shaped relationship with CVD mortality, whereas anthropometric measures of abdominal obesity had positive linear relationships. BMI, WC and WHtR showed J-shaped associations with all-cause mortality, whereas WHR, ABSI and WHHR demonstrated positive linear relationships. Accordingly, a threshold value was detected at 29.29 and 30.98 kg/m(2) for BMI, 96.4 and 93.3 cm for WC, 0.57 and 0.60 for WHtR, 0.0848 and 0.0813 m(11/6) kg(-2/3) for ABSI with CVD mortality in men and women, respectively; 29.88 and 29.50 kg/m(2) for BMI, 104.3 and 105.6 for WC, 0.61 and 0.67 for WHtR, 0.95 and 0.86 for WHR, 0.0807 and 0.0765 for ABSI in men and women, respectively, and 0.52 for WHHR in women with all-cause mortality.

CONCLUSION

All anthropometric measures of abdominal obesity had positive linear associations with CVD mortality, whereas some showed linear and the others J-shaped relationships with all-cause mortality. BMI had a J-shaped relationship with either CVD or all-cause mortality. Thresholds detected based on mortality may help with clinical definition of obesity in relation to mortality.

Comparison of extraction methods of total microbial DNA from freshwater

The demand for molecular analysis of aquatic microbial communities in freshwater has highlighted the need for efficient methods of DNA extraction. The centrifugation method and filtration-membrane method are 2 widely used methods for extracting DNA. The objective of this study was to compare the extraction efficiency of 3 methods, including the centrifugation method, filtration-membrane method, and modified filtration-membrane method, by evaluating the quantity and purity of DNA extracts obtained from water. DNA extraction was analyzed by agarose gel electrophoresis, ultraviolet-spectroscopy, restriction enzyme digestion, and polymerase chain reaction. The results showed that the modified filtration-membrane method was the most efficient for extracting microbial DNA from freshwater with high integrity and purity and is suitable for molecular applications.

An evaluation comparing Californium252 neutron brachytherapy with neoadjuvant intra-arterial embolism chemotherapy assisted surgery effect for treating advanced cervical carcinoma patients

PURPOSE OF INVESTIGATION

To compare the therapeutic and side effects of using Californium252 (252Cf) neutron brachytherapy with neoadjuvant intra-arterial embolism chemotherapy in combination with surgery for treating Stage Ib2-IIb cervical cancers (CCs).

MATERIALS AND METHODS

Thirty-two Stage Ib2-IIb CC patients were enrolled and randomly divided into two groups from January 2007 to April 2010 in the present Hospital. Prior to surgery within four weeks, a total of 17 cases were treated with 252Cf neutron brachytherapy (700-800 cGy doses at point A) once a week (Group A), and 15 cases were treated by neoadjuvant intra-arterial embolism chemotherapy using a combination of bleomycin, carboplatin, and cyclophosphamide twice (Group B). The clinical symptoms and signs, side effects, and relapse condition follow up until July 2013 were compared between the two groups for the perioperation.

RESULTS

Reductions in tumor mass and CR+PR were not significantly different between the groups before the surgery (p > 0.05). Abdominal pain and pelvic adhesions were significantly more severe in Group B (p < 0.05). There were no significant differences in surgical time, blood loss or the other side effects between Groups A and B (p > 0.05). The percentage of pelvic tumor recurrences in Group A was lower than that of the patients in Group B (11.8% vs 20.0%) although with no significant difference at present. No distant metastasis has been found in both two groups.

CONCLUSION

Except for less abdominal pain and pelvic adhesions, 252Cf neutron brachytherapy has perioperative effects similar to those of neoadjuvant intra-arterial embolism chemotherapy.

Role of AMP-activated protein kinase in cross-talk between apoptosis and autophagy in human colon cancer

Unresectable colorectal liver metastases remain a major unresolved issue and more effective novel regimens are urgently needed. While screening synergistic drug combinations for colon cancer therapy, we identified a novel multidrug treatment for colon cancer: chemotherapeutic agent melphalan in combination with proteasome inhibitor bortezomib and mTOR (mammalian target of rapamycin) inhibitor rapamycin. We investigated the mechanisms of synergistic antitumor efficacy during the multidrug treatment. All experiments were performed with highly metastatic human colon cancer CX-1 and HCT116 cells, and selected critical experiments were repeated with human colon cancer stem Tu-22 cells and mouse embryo fibroblast (MEF) cells. We used immunochemical techniques to investigate a cross-talk between apoptosis and autophagy during the multidrug treatment. We observed that melphalan triggered apoptosis, bortezomib induced apoptosis and autophagy, rapamycin caused autophagy and the combinatorial treatment-induced synergistic apoptosis, which was mediated through an increase in caspase activation. We also observed that mitochondrial dysfunction induced by the combination was linked with altered cellular metabolism, which induced adenosine monophosphate-activated protein kinase (AMPK) activation, resulting in Beclin-1 phosphorylated at Ser 93/96. Interestingly, Beclin-1 phosphorylated at Ser 93/96 is sufficient to induce Beclin-1 cleavage by caspase-8, which switches off autophagy to achieve the synergistic induction of apoptosis. Similar results were observed with the essential autophagy gene, autophagy-related protein 7, -deficient MEF cells. The multidrug treatment-induced Beclin-1 cleavage was abolished in Beclin-1 double-mutant (D133A/D146A) knock-in HCT116 cells, restoring the autophagy-promoting function of Beclin-1 and suppressing the apoptosis induced by the combination therapy. These observations identify a novel mechanism for AMPK-induced apoptosis through interplay between autophagy and apoptosis.

Efficient inhibition of intraperitoneal human ovarian cancer growth by short hairpin RNA targeting CD44

CD44 is one member of a big glycoprotein family involved in adhesion of cells or cells and extracellular matrix (ECM). The heavily glycosylated CD44 has been proved to be a major receptor of hyaluronan and a marker of stem cells in ovarian cancer. Here, using short hairpin (shRNA) against CD44, we demonstrate that knockdown CD44 could inhibit cancer growth efficiently compared with controls. Plasmid targeting CD44 gene (pshCD44) or non-relative control sequences (pshHK) was constructed and delivered to ovarian cancer by biodegradable poly D, L-Lactide-co-glycolide acid nanoparticles (PLGANPs). Nude mice were utilized in an intraperitoneal model of ovarian carcinomatosis to assess antitumor efficacy in vivo. Antitumor efficacy was estimated by changes in tumor weights, proliferation (Ki-67), apoptosis (TUNEL) and angiogenesis (CD31 staining and alginate-encapsulated tumor beads assay) in tumor cells. As results, pshCD44 or pshHK could be effectively transfected into SKOV-3 cells by PLGANPs. Tumor weight in pshCD44/PLGANPs group was suppressed by 45% and 50% compared with those in pshHK/PLGANPs and untreated group, respectively (Ps < 0.001). Inhibition of cell proliferation, induction of apoptosis and reduction of angiogenesis in tumor cells of pshCD44/PLGANPs group also show significant difference compared with those in control groups (Ps < 0.05), respectively. These results indicate that pshCD44 delivered by PLGANPs might be a potential approach in ovarian cancer therapy, and point towards a mechanism involving the inhibition of angiogenesis, cellular proliferation and the induction of apoptosis.

Graphene optomechanics realized at microwave frequencies

Cavity optomechanics has served as a platform for studying the interaction between light and micromechanical motion via radiation pressure. Here we observe such phenomena with a graphene mechanical resonator coupled to an electromagnetic mode. We measure thermal motion and backaction cooling in a bilayer graphene resonator coupled to a microwave on-chip cavity. We detect the lowest flexural mode at 24 MHz down to 60 mK, corresponding to 50±6 mechanical quanta, which represents a phonon occupation that is nearly 3 orders of magnitude lower than that which has been recorded to date with graphene resonators.

Rapamycin-enhanced mitomycin C-induced apoptotic death is mediated through the S6K1-Bad-Bak pathway in peritoneal carcinomatosis

Peritoneal carcinomatosis (PC) is the most common secondary cancerous disease, and more effective novel regimens are needed. In this study, we identified a novel combination treatment for PC, chemotherapeutic agent mitomycin C in combination with mTOR (mammalian target of rapamycin) inhibitor rapamycin. We observed that the combination of mitomycin C and rapamycin induced synergistic cytotoxicity and apoptosis, which was mediated through an increase in caspase activation. The combination of mitomycin C and rapamycin inactivated p70 S6 ribosomal kinase (S6K1) and dephosphorylated Bad, leading to dissociation of Bcl-xL from Bak, which resulted in Bak oligomerization, mitochondria dysfunction and cytochrome c release. PF-4708671, a S6K1-specific inhibitor, enhanced the combination treatment-induced apoptosis, whereas S6K1 E389 DeltaCT-HA (S6K1 active form) dramatically decreased the induction of apoptosis. In addition, the combination treatment significantly inhibited LS174T intraperitoneal tumor growth in vivo. This study provides a preclinical rationale for apoptosis induction linked with the mTOR pathway through a combination of chemotherapeutic agents and mTOR inhibitor, and will support this combinatorial strategy to PC patients.

Knockdown of cancerous inhibitor of protein phosphatase 2A may sensitize NSCLC cells to cisplatin

Cancerous inhibitor of protein phosphatase 2A (CIP2A) is a recently identified human oncoprotein that can stabilize some proteins by inhibiting degradation mediated by protein phosphatase 2A (PP2A) and it increases the proliferation of several cancer cells. Recent studies have highlighted a potential role for CIP2A in promoting tumor progression and metastasis. However, whether CIP2A could increase chemoresistance of cancer cells to chemotherapeutic agent cisplatin remains unclear. To determine whether CIP2A serves as a potential therapeutic target of human non-small-cell lung cancer (NSCLC), we utilized small interference RNA (siRNA) to knock down CIP2A expression in human NSCLC cells and analyzed their phenotypic changes. The data demonstrated that CIP2A silencing led to decreased proliferation, impaired clonogenicity and enhanced chemosensitivity and apoptosis to cisplatin in human NSCLC cells, as well as reduced Akt phosphorylation. In addition, overexpression of CIP2A diminished NSCLC cell chemosensitivity to cisplatin by inducing activation of Akt pathway, suggesting critical roles of CIP2A in NSCLC cell chemoresistance to cisplatin and rasing the possibility of CIP2A inhibition as a promising approach for lung cancer therapy.

Resveratrol reduces morphine tolerance by inhibiting microglial activation via AMPK signalling

BACKGROUND

Evidence has accumulated indicating that microglia within the spinal cord play a critical role in morphine tolerance. The present study investigated the effects and possible mechanisms of 5' adenosine monophosphate-activated protein kinase (AMPK) activator resveratrol and AICAR to inhibit microglial activation and to limit the decrease in antinociceptive effects of morphine.

METHODS

The microglial cell line BV-2 was used. Cytokine expression was measured using quantitative polymerase chain reaction. Cell signalling was assayed by Western blot and immunohistochemistry. The antinociception and morphine tolerance were assessed in CD-1 mice using the hot plate and tail-flick tests.

RESULTS

(1) Morphine induces robust BV-2 cell activation, as evidenced by increased p38 mitogen-activated protein kinase phosphorylation, nuclear factor-κB translocation and mRNA expression of pro-inflammatory cytokines [including interleukin-1β (IL-1β), IL-6 and tumour necrosis factor-α], inducible nitric oxide synthase and Toll-like receptor-4, and these changes are inhibited by resveratrol. (2) Resveratrol activates AMPK to suppress morphine-induced BV-2 cell activation. AICAR, another AMPK activator, can mimic the effects of resveratrol, whereas compound C, an AMPK inhibitor, reverses the inhibitory effects of resveratrol treatment. (3) Systemic or spinal administration of resveratrol with morphine significantly blocks microglial activation in the spinal cord and then attenuates the development of acute and chronic morphine tolerance in both male and female mice.

CONCLUSION

Resveratrol directly suppresses morphine-induced microglial activation through activating AMPK, resulting in significant attenuation of morphine antinociceptive tolerance.

Importance of grass-legume choices on cattle grazing behavior, performance, and meat characteristics

We determined if tall fescue in a mixture with either tannin-containing sainfoin or saponin-containing alfalfa affected cattle foraging behavior, performance, meat quality, and consumer acceptance of meat. Foraging behavior, BW, and pasture biomass before and after grazing were monitored when cattle strip-grazed 3 replications of 2 treatments from May through September 2010 (12 calves/replication) and from June through September 2012 (8 calves/replication). Animals were allowed a choice between tall fescue and sainfoin (SAN) or tall fescue and alfalfa (ALF) growing in strips (fescue, legume, and fescue-legume mixture). Incidence of use (scan samples) of legumes increased from the beginning to the end of the trials (P < 0.05), suggesting that cattle learned to mix legumes with tall fescue. Scan samples and assessments of pasture biomass removal revealed greater use of sainfoin than alfalfa when both legumes were abundant in the spring (P < 0.05); that pattern reversed toward the end of the growing season (P < 0.05) as the abundance of sainfoin declined more than that of alfalfa. Intake of forage per kilogram of gain was greater for SAN than for ALF in 2010 (P = 0.0003) and showed a tendency to be greater for SAN than ALF in 2012 (P = 0.19). There were no differences in ADG between SAN and ALF in either year (1 kg/d; P > 0.05). No incidences of bloat were detected. When cattle (3 calves/treatment in 2010 and 8 calves/treatment in 2012) were slaughtered in September to assess meat quality and consumer acceptance, carcasses were lean (4% to 6% fat content of the longissimus muscle), but compared with ALF, SAN had higher marbling scores, quality grades (Select versus Standard), and back fat thicknesses (P < 0.05) in 2012. Steaks from cattle finished on SAN were redder in color than steaks from cattle finished on ALF (P < 0.05; 2012). Meat samples from SAN and ALF showed some differences in unsaturated fatty acid profiles and volatiles concentrations (P < 0.05), but consumer acceptance did not differ between SAN and ALF (P > 0.05). Thus, cattle incorporated a lower-quality grass into their diets even when legumes were available ad libitum during most grazing trials. Choices between tall fescue and legumes differing in the type of secondary compound (tannins vs. saponins) and bloating potential influenced patterns of forage use by cattle and led to differences in meat quality.

Evaluation of common structural brain changes in aging and Alzheimer disease with the use of an MRI-based brain atrophy and lesion index: a comparison between T1WI and T2WI at 1.5T and 3T

BACKGROUND AND PURPOSE

The Brain Atrophy and Lesion Index combines several common, aging-related structural brain changes and has been validated for high-field MR imaging. In this study, we evaluated measurement properties of the Brain Atrophy and Lesion Index by use of T1WI and T2WI at 1.5T and 3T MR imaging to comprehensively assess the usefulness of the lower field-strength testing.

MATERIALS AND METHODS

Data were obtained from the Alzheimer's Disease Neuroimaging Initiative. Images of subjects (n = 127) who had T1WI and T2WI at both 3T and 1.5T on the same day were evaluated, applying the Brain Atrophy and Lesion Index rating. Criterion and construct validity and interrater agreement were tested for each field strength and image type.

RESULTS

Regarding reliability, the intraclass correlation coefficients for the Brain Atrophy and Lesion Index score were consistently high (>0.81) across image type and field strength. Regarding construct validity, the Brain Atrophy and Lesion Index score differed among diagnostic groups, being lowest in people without cognitive impairment and highest in those with Alzheimer disease (F > 5.14; P < .007). Brain Atrophy and Lesion Index scores correlated with age (r > 0.37, P < .001) and cognitive performance (r > 0.38, P < .001) and were associated with positive amyloid-β test (F > 3.96, P < .050). The T1WI and T2WI Brain Atrophy and Lesion Index scores were correlated (r > 0.93, P < .001), with the T2WI scores slightly greater than the T1WI scores (F > 4.25, P < .041). Regarding criterion validation of the 1.5T images, the 1.5T scores were highly correlated with the 3T Brain Atrophy and Lesion Index scores (r > 0.93, P < .001).

CONCLUSIONS

The higher field and T2WI more sensitively detect subtle changes in the deep white matter and perivascular spaces in particular. Even so, 1.5T Brain Atrophy and Lesion Index scores are similar to those obtained by use of 3T images. The Brain Atrophy and Lesion Index may have use in quantifying the impact of dementia on brain structures.

Abstract P6-07-01: Are patient perceptions and expectations about peri-operative imaging for metastatic breast cancer in keeping with current guidelines?

Background: The probability of detecting radiologically evident distant metastatic disease in asymptomatic women with primary operable breast cancer is low. Because of this, evidence-based guidelines have been developed to guide physicians on whom to image. Despite these guidelines, peri-operative staging imaging is frequently over-utilized. Relatively little is known about what patients’ perceptions and expectations are regarding peri-operative imaging and whether or not their views are in concordance with the guidelines. We undertook this study in an attempt to answer this question.

Methods: A questionnaire on peri-operative imaging to look for distant metastatic disease was given to women with early stage breast cancer who had completed their surgery. The survey questions were developed in a collaborative effort amongst oncologists, epidemiologists and knowledge translation experts.

Results: Over a 3 month period, 234 surveys were completed at a large Canadian academic cancer centre. The use of peri-operative imaging to assess the skeleton (e.g. bone scan), thorax (e.g. CT, xray), and abdomen (e.g. CT, MRI or ultrasound) is summarized in Table 1 for the 187 patients (80%) who identified their disease stage.

Patient reported perioperative imaging by disease stage Stage 1Stage 2Stage 3No. of patients (%)82/187 (44%)67/187 (36%)38/187 (20%)Median age (range)59 (29-80)57 (27-77)56 (49-65)Peri-operative imaging done for   Skeleton in (%)41/82 (50%)47/67 (70%)33/38 (87%)Thorax in (%)48/82 (59%)53/67 (79%)30/38 (79%)Abdomen in (%)34/82 (41%)42/67 (63%)27/38 (71%)

The relative proportion of patients undergoing imaging increased with advancing stage. Of the 187 patients, 66% indicated they would want imaging if the chance of finding metastatic disease was ≤10% and half of these patients (i.e. 33%) indicated they would want imaging if the chance was &lt;1%. The most common factors identified as being either extremely (EI) or very important (VI) by patients were: catching the spread of cancer to other parts of the body early (93%), reducing the chance of dying (90%), and providing peace of mind (77%). Avoiding inconvenience, exposure to scans, and extra imaging that will not change length or quality of life, and false alarms were EI or VI in ∼50%. Perceptions of these factors did not differ across disease stage. Although 85% indicated doing whatever their doctor recommended was either EI or VI to them, 72% indicated that they would feel very or somewhat uncomfortable if their physician did not order imaging to look for metastatic disease, even if this was in keeping with the guideline recommendation.

Conclusion: Irrespective of evidence-based guidelines, many patients undergo peri-operative imaging. While guidelines tend to address physician behaviour it is evident that patient perceptions and expectations are divergent from the evidence-based guidelines. If patient expectations are, in part, driving excessive imaging, new strategies targeting patient expectations and knowledge are required.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-07-01.

Comparison of various surrogate obesity indicators as predictors of cardiovascular mortality in four European populations

BACKGROUND/OBJECTIVES

Body mass index (BMI) is the most commonly used surrogate marker for evaluating the risk of cardiovascular disease (CVD) mortality in relation to general obesity, while abdominal obesity indicators have been proposed to be more informative in risk prediction.

SUBJECT/METHODS

A prospective cohort study consisting of 46 651 Europeans aged 24-99 years was conducted to investigate the relationship between CVD mortality and different obesity indicators including BMI, waist circumference (WC), waist-to-hip ratio (WHR), waist-to-stature ratio (WSR), A Body Shape Index (ABSI) and waist-to-hip-to-height ratio (WHHR). Hazard ratio (HR) was estimated by the Cox proportional hazards model using age as timescale, and compared using paired homogeneity test.

RESULTS

During a median follow-up of 7.9 years, 3435 participants died, 1409 from CVD. All obesity indicators were positively associated with increased risk of CVD mortality, with HRs (95% confidence intervals) per standard deviation increase of 1.19 (1.12-1.27) for BMI, 1.29 (1.21-1.37) for WC, 1.28 (1.20-1.36) for WHR, 1.35 (1.27-1.44) for WSR, 1.34 (1.26-1.44) for ABSI and 1.34 (1.25-1.42) for WHHR in men and 1.37 (1.24-1.51), 1.49 (1.34-1.65), 1.45 (1.31-1.60), 1.52 (1.37-1.69), 1.32 (1.18-1.48) and 1.45 (1.31-1.61) in women, respectively. The prediction was stronger with abdominal obesity indicators than with BMI or ABSI (P<0.05 for all paired homogeneity tests). WSR appeared to be the strongest predictor among all the indicators, with a linear relationship with CVD mortality in both men and women.

CONCLUSIONS

Abdominal obesity indicators such as WC, WHR, WSR and WHHR, are stronger predictors for CVD mortality than general obesity indicator of BMI.