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de Almeida RT, Matos SMA, Aquino EML. Individual and Combined Performance of Indicators of Overall and Central Obesity to Estimate Coronary Risk in ELSA-Brasil Participants. Arq Bras Cardiol 2021; 117:701-712. [PMID: 34346941 PMCID: PMC8528349 DOI: 10.36660/abc.20200360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/08/2020] [Accepted: 11/04/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Anthropometric indicators have been used in clinical practice and epidemiological studies for screening of health risk factors. OBJECTIVES To evaluate the individual discriminatory power of body adiposity index (BAI), body mass index (BMI), waist circumference (WC) and waist-hip-ratio (WHR) to identify individuals at risk for coronary heart disease and to evaluate whether combinations of anthropometric indicators of overall obesity with indicators of central obesity improve predictive ability in adults. METHODS A total of 15,092 participants (54.4% women) aged 35-74years were assessed at baseline of the ELSA-Brasil study. Individuals at risk for coronary heart disease were identified using the Framingham risk score and divided into very-high risk (VHR 20%) and high risk (HR10%). Measures of diagnostic accuracy and area under the ROC curves (AUC) were analyzed. Associations were tested using Poisson regression analysis with robust variance, according to age and sex. Statistical significance was set at 5%. RESULTS WHR showed the highest discriminatory power for VHR20% in all groups, with higher predictive ability in women (AUC: 0.802; 95%CI: 0.748-0.856 vs 0.657; 95%CI: 0.630-0.683 in the age range of 35-59 years, and AUC: 0.668; 95%CI: 0.621-0.715 vs 0.611; 95%CI: 0.587-0.635 in the age range of 60-74 years). BAI + WHR and BMI + WHR had the highest predictive power in men and women, respectively. Combinations of indicators of overall obesity with indicators of central obesity were more strongly associated with VHR20% and HR10% in all subgroups. CONCLUSION Combined indicators had greater predictive ability than indicators taken individually. BAI+ WHR and BMI + WHR were the best estimators of coronary risk in men and women, respectively, and WHR had the best individual performance.
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Affiliation(s)
- Rogério Tosta de Almeida
- Universidade Estadual de Feira de SantanaDepartamento de SaúdeFeira de SantanaBABrasilUniversidade Estadual de Feira de Santana - Departamento de Saúde, Feira de Santana, BA – Brasil
- Universidade Federal da BahiaInstituto de Saúde ColetivaSalvadorBABrasilUniversidade Federal da Bahia - Instituto de Saúde Coletiva, Salvador, BA – Brasil
| | - Sheila Maria Alvim Matos
- Universidade Federal da BahiaInstituto de Saúde ColetivaSalvadorBABrasilUniversidade Federal da Bahia - Instituto de Saúde Coletiva, Salvador, BA – Brasil
| | - Estela M. L. Aquino
- Universidade Federal da BahiaInstituto de Saúde ColetivaSalvadorBABrasilUniversidade Federal da Bahia - Instituto de Saúde Coletiva, Salvador, BA – Brasil
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Pazin DC, da Matta SS, Faria-Neto JR, Bloch KV. Association between anthropometric measures and insulin resistance in Brazilian adolescents: data from the national study of cardiovascular risk factors in adolescents - ERICA. J Pediatr Endocrinol Metab 2021; 34:1001-1008. [PMID: 34182615 DOI: 10.1515/jpem-2021-0191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/31/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate anthropometric measures (AM) and insulin resistance (IR) association in adolescents aged 12-17 years and investigates how body mass index (BMI) interrelates with specific indicators of fat distribution in this association. METHODS This analysis is from the Study of Cardiovascular Risks in Adolescents (ERICA) study, a national, cross-sectional study. AM was categorized by quartiles, and their means and 95% confidence intervals (95% CI) were estimated. The prevalence of IR was estimated for each AM according to the quartiles. The associations between AM and homeostatic model assessment of insulin resistance (HOMA-IR) levels were analyzed using Poisson models. RESULTS 37,892 adolescents were included. IR prevalence tended to increase as quartiles increased for each AM. The association of BMI with IR persisted with the adjustment for others AM. The greatest reduction in the association's strength was achieved with the adjustment by the waist circumference (WC) and the waist-to-height ratio (WHtR). Most other AM were also associated with IR. CONCLUSION AM has a positive association with the prevalence of IR, and the joint effect of BMI and central adiposity measures should be considered in cardiometabolic risk evaluation in adolescents.
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Affiliation(s)
- Daiane Cristina Pazin
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brasil
| | - Sandro Silva da Matta
- Institute of Public Health Studies, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - José Rocha Faria-Neto
- Center for Clinical and Epidemiological Research (EpiCenter), School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brasil
| | - Katia Vergetti Bloch
- Institute of Public Health Studies, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Zuo J, Chao H, Tang B, Avolio AP, Schlaich MP, Nolde JM, Adji A, Carnagarin R. Female Gender Is Associated with Higher Susceptibility of Weight Induced Arterial Stiffening and Rise in Blood Pressure. J Clin Med 2021; 10:jcm10163479. [PMID: 34441775 PMCID: PMC8396951 DOI: 10.3390/jcm10163479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 01/13/2023] Open
Abstract
Arterial stiffness is an important predictor of cardiovascular events, independent of traditional risk factors. Stiffening of arteries, though an adaptive process to hemodynamic load, results in substantial increase in the pulsatile hemodynamic forces that detrimentally affects the microcirculation perfusing the vital organs such as the brain, heart and kidneys. Studies have proposed that arterial stiffness precedes and may contribute to the development of hypertension in individuals with obesity. Our study sought to determine the gender-based effects on arterial stiffening in obesity which may predispose to the development of hypertension. We found female sex is associated with higher susceptibility of weight-related arterial stiffening and rise in blood pressure in obesity. Women had significantly higher carotid-femoral pulse wave velocity (CF-PWV) with higher body mass index (BMI) status (normal: 7.9 ± 2 m/s; overweight: 9.1 ± 2 m/s; obese: 9 ± 2 m/s, p < 0.001), whereas it was similar in males across all BMI categories. The linear association between arterial stiffness and BMI following adjustment for age and brachial systolic and diastolic blood pressure (BP), remained significant in females (β = 0.06; 95% CI 0.01 to 0.1; p < 0.05) but not in males (β = 0.04; 95% CI -0.01 to 0.1; p > 0.05). The mean CF-PWV values increased by 0.1 m/s for every 1 kg/m2 increase in BMI in the female subjects in the age adjusted linear model, while such effect was not seen in the male subjects. In line with arterial stiffening, the overweight and obese females demonstrated significantly higher systolic brachial BP. (BP difference: ΔBP 9-11 mmHg, p < 0.01) and central systolic pressure (ΔBP 8-10 mmHg, p < 0.05) compared to their lean counterparts, unlike the male subjects. Our results suggest that female gender is associated with higher susceptibility of weight-related arterial stiffening and rise in blood pressure.
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Affiliation(s)
- Junli Zuo
- Department of Geriatrics and Geriatrics Centre, Ruijin Hospital/Jiaotong University School of Medicine, Shanghai 200240, China; (J.Z.); (H.C.); (B.T.)
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia;
| | - Huijuan Chao
- Department of Geriatrics and Geriatrics Centre, Ruijin Hospital/Jiaotong University School of Medicine, Shanghai 200240, China; (J.Z.); (H.C.); (B.T.)
| | - Biwen Tang
- Department of Geriatrics and Geriatrics Centre, Ruijin Hospital/Jiaotong University School of Medicine, Shanghai 200240, China; (J.Z.); (H.C.); (B.T.)
| | - Alberto P. Avolio
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia;
| | - Markus P. Schlaich
- Dobney Hypertension Centre, School of Medicine—Royal Perth Hospital Research Foundation, University of Western Australia, Perth, WA 6000, Australia; (M.P.S.); (J.M.N.)
- Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, WA 6000, Australia
- Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
| | - Janis Marc Nolde
- Dobney Hypertension Centre, School of Medicine—Royal Perth Hospital Research Foundation, University of Western Australia, Perth, WA 6000, Australia; (M.P.S.); (J.M.N.)
| | - Audrey Adji
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia;
- St Vincent’s Hospital and Clinical School UNSW, Sydney, NSW 2000, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW 2010, Australia
- Correspondence: (A.A.); (R.C.); Tel.: +61-2-8382-1111 (A.A.); +61-8-9224-0316 (R.C.)
| | - Revathy Carnagarin
- Dobney Hypertension Centre, School of Medicine—Royal Perth Hospital Research Foundation, University of Western Australia, Perth, WA 6000, Australia; (M.P.S.); (J.M.N.)
- Correspondence: (A.A.); (R.C.); Tel.: +61-2-8382-1111 (A.A.); +61-8-9224-0316 (R.C.)
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Garg PK, Biggs ML, Kizer JR, Shah SJ, Djousse L, Mukamal KJ. Associations of body size and composition with subclinical cardiac dysfunction in older individuals: the cardiovascular health study. Int J Obes (Lond) 2021; 45:2539-2545. [PMID: 34349227 DOI: 10.1038/s41366-021-00926-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 07/13/2021] [Accepted: 07/23/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Focused studies in younger to middle-aged populations have demonstrated a relationship between obesity and adverse cardiac mechanics. We examined whether measures of overall and central adiposity are associated with cardiac mechanics, assessed by speckle-tracking echocardiography, in an older population without prevalent coronary heart disease or heart failure. METHODS Body composition was measured by anthropometry, bioelectrical impedance, and dual-energy x-ray absorptiometry among participants in the Cardiovascular Health Study, a population-based cohort of adults aged 65 years or older. Systolic and diastolic cardiac mechanics were measured with speckle-tracking analysis of echocardiograms. Multi-variable adjusted linear regression models were used to investigate associations of body composition measures and cardiac mechanics. RESULTS Mean age for the 3525 included participants was 72.6 years, 39% were male, and 10% were black. Mean body-mass index (BMI) was 26.3 ± 4.4 kg/m2, waist circumference (WC) was 93.2 ± 12.9 cm, and waist-to-hip ratio was 0.92 ± 0.09. In fully adjusted analyses, all adiposity measures were associated with worse LV longitudinal strain, LV early diastolic strain rate, and left atrial reservoir strain; however, associations were strongest for WC and BMI (p < 0.001). When both BMI and WC were included in the same model, only WC remained associated with each cardiac strain measure. CONCLUSION In this cross-sectional study of older adults, central obesity was most robustly associated with impaired left ventricular systolic and diastolic strain as well as left atrial strain. The adverse effects of central obesity appear to extend even into older age.
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Affiliation(s)
- Parveen K Garg
- Division of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
| | - Mary L Biggs
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Jorge R Kizer
- Cardiology Section, San Francisco Veterans Affairs Health Care System, and Department of Medicine, University of California San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Sanjiv J Shah
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Luc Djousse
- Division of Aging, Department of Medicine Brigham and Women's Hospital, Boston, MA, USA
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Matić A, Vuković R, Heffer M, Balog M, Ivić V, Gaspar R, Ducza E, Szucs KF, Seres A, Vari SG, Drenjančević I. Sex differences in oxidative stress level and antioxidative enzymes expression and activity in obese pre-diabetic elderly rats treated with metformin or liraglutide. Croat Med J 2021. [PMID: 34212558 PMCID: PMC8275945 DOI: 10.3325/cmj.2021.62.215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Aim To determine the effects of metformin or liraglutide on oxidative stress level and antioxidative enzymes gene transcription and activity in the blood and vessels of pre-diabetic obese elderly Sprague-Dawley (SD) rats of both sexes. Methods Male and female SD rats were assigned to the following groups: a) control group (fed with standard rodent chow); b) high-fat and high-carbohydrate diet (HSHFD) group fed with HSHFD from 20-65 weeks of age; c) HSHFD+metformin treatment (50 mg/kg/d s.c.); and d) HSHFD+liraglutide treatment (0.3 mg/kg/d s.c). Oxidative stress parameters (ferric reducing ability of plasma and thiobarbituric acid reactive substances) and superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) activity and gene transcription were determined from serum, aortas, and surface brain blood vessels (BBV). Results HSHFD increased body weight in both sexes compared with the control group, while liraglutide prevented this increase. Blood glucose level did not change. The liraglutide group had a significantly increased antioxidative capacity compared with the HSHFD group in both sexes. The changes in antioxidative enzymes’ activities in plasma were more pronounced in male groups. The changes in gene expression of antioxidative enzymes were more prominent in microvessels and may be attributed to weight gain prevention. Conclusions Obesity and antidiabetic drugs caused sex-related differences in the level of antioxidative parameters. Liraglutide exhibited stronger antioxidative effects than metformin. These results indicate that weight gain due to HSHFD is crucial for developing oxidative stress and for inhibiting antioxidative protective mechanisms.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Ines Drenjančević
- Ines Drenjančević, Institute and Department of Physiology and Immunology, Faculty of Medicine University Josip Juraj Strossmayer of Osijek, J. Huttlera 4, 31 000 Osijek, Croatia,
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Kang NL. Association Between Obesity and Blood Pressure in Common Korean People. Vasc Health Risk Manag 2021; 17:371-377. [PMID: 34234445 PMCID: PMC8253898 DOI: 10.2147/vhrm.s316108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/14/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose The aim of this study was to investigate the associations of high blood pressure (BP) and wide pulse pressure (PP) with obesity among common Korean people. Materials and Methods This study analyzed data from the Seventh Korean National Health and Nutrition Examination Survey (2017). The associations of BP with body mass index (BMI) and waist-to-height ratio (WHT2R) were investigated using their lump mean values. Results The BPs of males and females increased with BMI, the PP of females increased with BMI and then decreased, and the PP of males is nearly independent of BMI. The BPs of males and females increased to their maximum values with WHT2R and then decreased. The PPs of males and females increased with WHT2R. Conclusion BMI can be used as a useful predictor for high BP, and WHT2R can be used as a useful predictor for wide PP.
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Affiliation(s)
- Nam Lyong Kang
- Department of Nanomechatronics Engineering, Pusan National University, Miryang, 50463, Republic of Korea
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57
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Powell-Wiley TM, Poirier P, Burke LE, Després JP, Gordon-Larsen P, Lavie CJ, Lear SA, Ndumele CE, Neeland IJ, Sanders P, St-Onge MP. Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2021; 143:e984-e1010. [PMID: 33882682 PMCID: PMC8493650 DOI: 10.1161/cir.0000000000000973] [Citation(s) in RCA: 934] [Impact Index Per Article: 311.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The global obesity epidemic is well established, with increases in obesity prevalence for most countries since the 1980s. Obesity contributes directly to incident cardiovascular risk factors, including dyslipidemia, type 2 diabetes, hypertension, and sleep disorders. Obesity also leads to the development of cardiovascular disease and cardiovascular disease mortality independently of other cardiovascular risk factors. More recent data highlight abdominal obesity, as determined by waist circumference, as a cardiovascular disease risk marker that is independent of body mass index. There have also been significant advances in imaging modalities for characterizing body composition, including visceral adiposity. Studies that quantify fat depots, including ectopic fat, support excess visceral adiposity as an independent indicator of poor cardiovascular outcomes. Lifestyle modification and subsequent weight loss improve both metabolic syndrome and associated systemic inflammation and endothelial dysfunction. However, clinical trials of medical weight loss have not demonstrated a reduction in coronary artery disease rates. In contrast, prospective studies comparing patients undergoing bariatric surgery with nonsurgical patients with obesity have shown reduced coronary artery disease risk with surgery. In this statement, we summarize the impact of obesity on the diagnosis, clinical management, and outcomes of atherosclerotic cardiovascular disease, heart failure, and arrhythmias, especially sudden cardiac death and atrial fibrillation. In particular, we examine the influence of obesity on noninvasive and invasive diagnostic procedures for coronary artery disease. Moreover, we review the impact of obesity on cardiac function and outcomes related to heart failure with reduced and preserved ejection fraction. Finally, we describe the effects of lifestyle and surgical weight loss interventions on outcomes related to coronary artery disease, heart failure, and atrial fibrillation.
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Doehner W, Gerstein HC, Ried J, Jung H, Asbrand C, Hess S, Anker SD. Obesity and weight loss are inversely related to mortality and cardiovascular outcome in prediabetes and type 2 diabetes: data from the ORIGIN trial. Eur Heart J 2021; 41:2668-2677. [PMID: 32402060 PMCID: PMC7377581 DOI: 10.1093/eurheartj/ehaa293] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/22/2019] [Accepted: 04/09/2020] [Indexed: 12/15/2022] Open
Abstract
AIMS The association of body weight and weight change with mortality and cardiovascular (CV) outcome in patients with diabetes mellitus (DM) is not clearly established. We assessed the relationship between weight, weight change, and outcomes in patients with established CV risk factors and type 2 DM or pre-diabetes. METHODS AND RESULTS A total of 12 521 participants from the ORIGIN trial were grouped in BMI categories of low body weight [body mass index (BMI) < 22 kg/m2] normal (22-24.9), overweight (25-29.9), obesity Grades 1-3 (30-34.9, 35-39.9, ≥40 kg/m2, respectively). Outcome variables included total and CV mortality and composite outcomes of CV death, non-fatal stroke, or myocardial infarction plus revascularization or heart failure hospitalization. Follow-up was 6.2 years (interquartile range 5.8-6.7 years). After multivariable adjustment, lowest risks were seen in patients with overweight and mild obesity for total mortality [overweight: hazard ratio (HR) 0.80 (95% confidence interval (CI) 0.69-0.91); obesity Grade 1: HR 0.82 (0.71-0.95), both P < 0.01)] and CV mortality [overweight: HR 0.79 (0.66-0.94); obesity Grade 1: 0.79 (0.65-0.95), all compared to patients with normal BMI, P < 0.05]. Obesity of any severity was not associated with higher mortality. Low body weight was related to higher mortality [HR 1.28 (1.02-1.61); CV mortality: HR 1.34 (1.01-1.79), P < 0.05]. A continued 2-year weight loss was associated with higher risk of mortality [HR 1.32 (1.18-1.46), P < 0.0001] and CV mortality [HR 1.18 (1.02-1.35), compared to patients without weight loss, P < 0.05]. In turn, weight gain was not related to any adverse outcome. CONCLUSION Obesity in patients with DM or pre-diabetes and CV risk profile was not associated with higher mortality or adverse CV outcome. The lowest mortality risk was seen in patients with overweight and moderate obesity (BMI 25-35 kg/m2). Weight loss was an independent risk factor for higher mortality compared to no weight loss.
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Affiliation(s)
- Wolfram Doehner
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité Universitätsmedizin Berlin, 13353 Berlin, Germany.,Division of Cardiology and Metabolism, Department of Cardiology (Virchow Hospital), German Centre for Cardiovascular Research (DZHK), Partner Site Berlin and Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Hertzel C Gerstein
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, L8S 4K1 Hamilton, ON, Canada
| | - Janina Ried
- Sanofi-Aventis Deutschland GmbH, Research & Development, 65926 Frankfurt, Germany
| | - Hyejung Jung
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, L8S 4K1 Hamilton, ON, Canada
| | - Christian Asbrand
- Sanofi-Aventis Deutschland GmbH, Research & Development, 65926 Frankfurt, Germany
| | - Sibylle Hess
- Sanofi-Aventis Deutschland GmbH, Research & Development, 65926 Frankfurt, Germany
| | - Stefan D Anker
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité Universitätsmedizin Berlin, 13353 Berlin, Germany.,Division of Cardiology and Metabolism, Department of Cardiology (Virchow Hospital), German Centre for Cardiovascular Research (DZHK), Partner Site Berlin and Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
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Prediction of Insulin Resistance by Modified Triglyceride Glucose Indices in Youth. Life (Basel) 2021; 11:life11040286. [PMID: 33800541 PMCID: PMC8066260 DOI: 10.3390/life11040286] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/19/2021] [Accepted: 03/26/2021] [Indexed: 12/24/2022] Open
Abstract
The triglyceride glucose (TyG) index, derived from a combination of fasting glucose and triglycerides, has been suggested as a useful marker for insulin resistance (IR), in addition to modified TyG indices that combine obesity parameters. This study investigated the association and utility of TyG and modified TyG indices for IR prediction in youth. Based on the Korea National Health and Nutritional Examination Survey, the data of 3728 youth aged 10–19 years were analyzed. Odds ratios (ORs) and 95% confidence intervals (CIs) of tertiles 2 and 3 for each parameter were calculated and compared with tertile 1 as a reference. To compare the parameters for identifying IR, receiver operating characteristic curves were plotted and the area under the curve (AUC) was calculated. The ORs and 95% CIs for insulin resistance (IR) progressively increased across tertiles of each parameter. Overall, all modified TyG indices presented higher ORs and AUC than the TyG index. The TyG-body mass index standard deviation score showed the largest AUC for IR detection in all subjects. In conclusion, TyG and modified TyG indices could be used as valuable markers for the prediction of IR in youth. Moreover, modified TyG indices had better diagnostic accuracy than the TyG index.
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60
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Song WH, Bae EH, Ahn JC, Oh TR, Kim YH, Kim JS, Kim SW, Kim SW, Han KD, Lim SY. Effect of body mass index and abdominal obesity on mortality after percutaneous coronary intervention: a nationwide, population-based study. Korean J Intern Med 2021; 36:S90-S98. [PMID: 32972124 PMCID: PMC8009155 DOI: 10.3904/kjim.2020.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/03/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS We investigated the impact of obesity on the clinical outcomes following percutaneous coronary intervention (PCI). METHODS We included South Koreans aged > 20 years who underwent the Korean National Health Screening assessment between 2009 and 2012. Obesity was defined using the body mass index (BMI), according to the World Health Organization's recommendations. Abdominal obesity was defined using the waist circumference (WC), as defined by the Korean Society for Obesity. The odds and hazard ratios in all-cause mortality were calculated after adjustment for multiple covariates. Patients were followed up to the end of 2017. RESULTS Among 130,490 subjects who underwent PCI, the mean age negatively correlated with BMI. WC, hypertension, diabetes, dyslipidemia, fasting glucose, total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels correlated with the increased BMI. The mortality rates were higher in the lower BMI and WC groups than the higher BMI and WC groups. The non-obese with abdominal obesity group showed a mortality rate of 2.11 per 1,000 person-years. Obese with no abdominal obesity group had the lowest mortality rate (0.88 per 1,000 person-years). The mortality showed U-shaped curve with a cut-off value of 29 in case of BMI and 78 cm of WC. CONCLUSION The mortality showed U-shaped curve and the cut-off value of lowest mortality was 29 in case of BMI and 78 cm of WC. The abdominal obesity may be associated with poor prognosis in Korean patients who underwent PCI.
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Affiliation(s)
- Woo-Hyuk Song
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jeong Cheon Ahn
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Tae Ryom Oh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yong-Hyun Kim
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Jin Seok Kim
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Sun-Won Kim
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Sang Yup Lim
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
- Correspondence to Sang Yup Lim, M.D. Department of Internal Medicine, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan 15355, Korea Tel: +82-31-8099-6352 Fax: +82-31-412-6755 E-mail:
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61
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Hajhashemy Z, Shahdadian F, Ziaei R, Saneei P. Serum vitamin D levels in relation to abdominal obesity: A systematic review and dose-response meta-analysis of epidemiologic studies. Obes Rev 2021; 22:e13134. [PMID: 32881271 DOI: 10.1111/obr.13134] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/08/2020] [Accepted: 08/08/2020] [Indexed: 12/14/2022]
Abstract
Although several observational studies have investigated the relationship between vitamin D deficiency and risk of central obesity, the results were inconsistent. We performed a dose-response meta-analysis on epidemiologic studies that evaluated the association of vitamin D status and abdominal obesity in adults. A systematic search was carried out of all published articles, up to May 2020, in five electronic databases, including MEDLINE (Pubmed), EMBASE, Institute for Scientific Information (ISI) (Web of science), Scopus and Google scholar. Forty-one observational studies reported odds ratios (ORs) or relative risks (RRs) with 95% confidence intervals (CIs) for abdominal obesity in relation to serum vitamin D levels in adults were included in the analysis. Using a random effects model, the overall effect size was calculated. Combining 44 effect sizes from 36 cross-sectional studies with 257,699 participants revealed that the highest versus the lowest serum vitamin D level was significantly associated with a 23% decreased odds of abdominal obesity (OR: 0.77; 95% CI [0.71, 0.83]). This inverse association was significant in almost all subgroups based on different covariates. Dose-response analysis showed that each 25 nmol/L increase in serum vitamin D was related to 8% reduced risk of abdominal obesity (OR: 0.92; 95% CI [0.85, 0.99]). When we confined the analysis to 23 effect sizes from 17 studies with representative population (242,135 participants), the same results were obtained (OR: 0.79; 95% CI [0.71, 0.87]). Dose-response analysis indicated that each 25 nmol/L increase in blood vitamin D levels was linked to 10% decreased central adiposity risk in representative populations (OR: 0.90; 95% CI [0.82, 0.99]). This meta-analysis of epidemiologic studies revealed that serum vitamin D level was inversely associated with risk of abdominal obesity in adults, in a dose-response manner. The same findings were obtained in representative populations. Further prospective studies are required to examine the causal association between serum vitamin D levels and abdominal obesity.
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Affiliation(s)
- Zahra Hajhashemy
- Students' Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farnaz Shahdadian
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rahele Ziaei
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parvane Saneei
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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62
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Bilic-Curcic I, Berkovic MC, Virovic-Jukic L, Mrzljak A. Shifting perspectives – interplay between non-alcoholic fatty liver disease and insulin resistance in lean individuals. World J Hepatol 2021; 13:80-93. [PMID: 33584988 PMCID: PMC7856866 DOI: 10.4254/wjh.v13.i1.80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/22/2020] [Accepted: 11/18/2020] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) has become a significant public health burden affecting not only obese individuals but also people with normal weight. As opposed to previous beliefs, this particular subset of patients has an increased risk of all-cause mortality and worse outcomes than their obese counterparts. The development of NAFLD in lean subjects seems to be interconnected with metabolic phenotype, precisely visceral fat tissue, sarcopenia, and insulin resistance. Here, we summarize available data focusing on the co-dependent relationship between metabolic phenotype, insulin resistance, and development of NAFLD in lean individuals, suggesting more appropriate tools for measuring body fat distribution for the screening of patients at risk.
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Affiliation(s)
- Ines Bilic-Curcic
- Department of Pharmacology, Faculty of Medicine, University of J. J. Strossmayer Osijek, Osijek 31000, Croatia
- Clinical Hospital Center Osijek, Osijek 31000, Croatia
| | - Maja Cigrovski Berkovic
- Department of Kinesiological Anthropology and Methodology, Faculty of Kinesiology, University of Zagreb, Zagreb 10000, Croatia
- Clinical Hospital Dubrava, Zagreb 10000, Croatia
| | - Lucija Virovic-Jukic
- Department of Medicine, Division of Gastroenterology and Hepatology, Sisters of Charity University Hospital, Zagreb 10000, Croatia
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Anna Mrzljak
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
- Department of Medicine, Merkur University Hospital, Zagreb 10000, Croatia
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63
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Hidirova LD, Yakhontov DA, Maksimov VN. [Features of genetic manifestations in patients with abdominal obesity during atrial fibrillation in combination with arterial hypertension]. TERAPEVT ARKH 2021; 93:41-43. [PMID: 33720624 DOI: 10.26442/00403660.2021.01.200591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 11/22/2022]
Abstract
AIM To study the significance of the rs1378942 polymorphisms of the CSK gene and rs2200733 (chromosome 4q25) in the progression of AF in men with AH and AO. MATERIALS AND METHODS In an observational cohort study, 116 men aged 4565 years were followed. Of these, 57 patients with AF, AH and AO and a control group including 59 patients with AF, AH and without AO. Testing of polymorphism rs1378942 of the CSK gene and rs2200733 of chromosome 4q25 using polymerase chain reaction with restriction fragment length polymorphism. All statistical calculations were performed using the Rstudio program (version 0.99.879 20092016 RStudio, Inc., USA). RESULTS The average age of all studied patients was 53.37.1 years. When dividing patients with AF and AH into groups based on the presence/absence of AO, it turned out that in the subgroups of carriers of different genotypes of the rs1378942 polymorphism of the CSK gene there are significant differences in BMI: in the group with BMI, there is an increase in the indicator in the series of CC, AC, AA genotypes. The highest BMI value in carriers of the CC genotype (p0.03) was in the group with AO. In the subgroups of carriers of different rs2200733 genotypes of chromosome 4q25, CC has the highest BMI (p0.05). It was proved that in the group with AO, the progression of AF occurred 2.57 times more often than in the group without AO (p0.003). CONCLUSION In men with AF and AH, single nucleotide polymorphisms rs1378942 of the CSK gene and rs2200733 of chromosome 4q25 are associated with BMI. The heterozygous genotype AC rs1378942 in the CSK gene is significantly more common in patients, regardless of the presence of AO. In the group with AO, the progression of AF occurred 2.57 times more often than in the group without AO.
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Affiliation(s)
| | | | - V N Maksimov
- 2Institute of Internal and Preventive Medicine - branch of the Federal Research Center Institute of Cytology and Genetics
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64
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Quine EJ, Dagan M, William J, Nanayakkara S, Dawson LP, Duffy SJ, Stehli J, Dick RJ, Htun NM, Stub D, Walton AS. Long-Term Outcomes Stratified by Body Mass Index in Patients Undergoing Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 137:77-82. [PMID: 33017578 DOI: 10.1016/j.amjcard.2020.09.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/21/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is emerging as the default strategy for older patients with severe, symptomatic, and trileaflet aortic stenosis. Increased body-mass index (BMI) is associated with a protective effect in patients undergoing percutaneous coronary intervention. We assessed whether elevated BMI was associated with a similar association in TAVI. We evaluated prospectively collected data from 634 patients who underwent TAVI at 2 centers from August 2008 to April 2019. Patients were stratified as normal weight (BMI 18.5 to 24.9 kg/m2, n = 214), overweight (25 to 29.9 kg/m2, n = 234), and obese (>30 kg/m2, n = 185). Outcomes were reported according to VARC-2 criteria. Mortality was assessed using Cox proportional hazards regression analysis (median follow-up 2 years). Kaplan-Meier analysis was used to estimate cumulative mortality. Baseline differences were seen in age (85 vs 84 vs 82, p <0.001), STS-PROM score (4.3 vs 3.4 vs 3.6, p <0.001), sex (50% vs 36% vs 55% female, p <0.001), clinical frailty score (p = 0.02), diabetes (21% vs 29% vs 40%, p <0.001), and presence of chronic obstructive pulmonary disease (COPD) (13% vs 13% vs 23%, p = 0.009). On multivariable analysis there was no mortality difference between normal and obese patients (hazard ratio [HR] 0.70, confidence interval [CI] 0.46 to 1.1 p = 0.11), however overweight patients had significantly lower mortality (HR 0.56 CI 0.38 to 0.85, p = 0.006). Variables independently associated with increased mortality were increasing age, male sex, COPD, previous balloon valvuloplasty, and higher STS-PROM. In conclusion, overweight patients have lower long-term mortality when compared with normal weight and obese patients undergoing TAVI.
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Kim H, Kim K, Shin S. Cardiometabolic Risk Factor in Obese and Normal Weight Individuals in Community Dwelling Men. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8925. [PMID: 33266289 PMCID: PMC7729436 DOI: 10.3390/ijerph17238925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 12/19/2022]
Abstract
The aim of this study was to investigate the cardiometabolic risk factors (CRFs) in community dwelling men based on a combination of body mass index (BMI) and waist circumference (WC). This cross-sectional study was based on 867 males between the ages of 20 and 71 years. Subjects were categorized into 4 groups by BMI and WC (Group 1, BMI < 25 kg/m2 and WC < 90 cm; Group 2, BMI < 25 kg/m2 and WC > 90 cm; Group 3, BMI > 25 kg/m2 and WC < 90 cm; and Group 4 BMI > 25 kg/m2 and WC > 90 cm). The proportion of subjects with a normal weight with high WC was 3.2%. Among normal weight men with the high range of WC, significantly high Odds ratios (ORs) and 95% CI were found for hypertriglyceridemia (3.8, 1.8-8.2) and high blood glucose (3.2, 1.5-6.9). The probability that the general obesity group (Group 3) had one CRF was around twice that of the reference group (Group 1) (1.9 to 2.1 times), but Group 2 had probability more than 4 times higher (4.3 to 4.6 times). In community dwelling adult men, normal weight with high waist circumference was associated with the highest cardiometabolic risk. In conclusion, follow-up screening of those with high WC may be necessary to detect and prevent cardiometabolic diseases, particularly for men with a normal weight.
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Affiliation(s)
- Hyunsoo Kim
- Department of Sports Science, Seoul National University of Science and Technology, 232 Gongneung-ro, Nowon-gu, Seoul 01811, Korea;
| | - Kijeong Kim
- School of Sport and Exercise Science, University of Ulsan, 93 Daehak-ro, Nam-gu, Ulsan 44610, Korea;
| | - Sohee Shin
- School of Sport and Exercise Science, University of Ulsan, 93 Daehak-ro, Nam-gu, Ulsan 44610, Korea;
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Lyu SQ, Yang YM, Zhu J, Wang J, Wu S, Zhang H, Shao XH, Ren JM. Association between body mass index and mortality in atrial fibrillation patients with and without diabetes mellitus: Insights from a multicenter registry study in China. Nutr Metab Cardiovasc Dis 2020; 30:2242-2251. [PMID: 32900569 DOI: 10.1016/j.numecd.2020.07.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/10/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS The aim of this study was to evaluate the association between body mass index (BMI) and mortality in atrial fibrillation (AF) patients with and without diabetes mellitus (DM). METHODS AND RESULTS A total of 1991 AF patients were enrolled and divided into two groups according to whether they have DM at recruitment. Baseline information was collected and a mean follow-up of 1 year was carried out. The primary outcome was defined as all-cause mortality with the secondary outcomes including cardiovascular mortality, stroke and major adverse events (MAEs). Univariable and multivariable Cox regression were performed to estimate the association between BMI and 1-year outcomes in AF patients with and without DM. 309 patients with AF (15.5%) had comorbid DM at baseline. Patients with DM were more likely to have cardiovascular comorbidities, receive relevant medications but carry worse 1-year outcomes. Multivariable Cox regressions indicated that elevated BMI was related with reduced risk of all-cause mortality, cardiovascular mortality and major adverse events. Compared to normal weight, overweight [HR (95% CI): 0.548 (0.405-0.741), p < 0.001] and obesity [HR (95% CI): 0.541 (0.326-0.898), p = 0.018] were significantly related with decreased all-cause mortality for the entire cohort. Remarkably reduced all-cause mortality in the overweight [HR (95% CI): 0.497 (0.347-0.711), p < 0.001] and obesity groups [HR (95% CI): 0.405 (0.205-0.800), p = 0.009] could also be detected in AF patients without DM, but not in those with DM. CONCLUSION Elevated BMI was associated with reduced mortality in patients with AF. This association was modified by DM. The obesity paradox confined to AF patients without DM, but could not be generalized to those with DM.
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Affiliation(s)
- Si-Qi Lyu
- Emergency and Critical Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China.
| | - Yan-Min Yang
- Emergency and Critical Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China.
| | - Jun Zhu
- Emergency and Critical Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China
| | - Juan Wang
- Emergency and Critical Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China
| | - Shuang Wu
- Emergency and Critical Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China
| | - Han Zhang
- Emergency and Critical Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China
| | - Xing-Hui Shao
- Emergency and Critical Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China
| | - Jia-Meng Ren
- Emergency and Critical Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China
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Oh CM, Park JH, Chung HS, Yu JM, Chung W, Kang JG, Moon S. Effect of body shape on the development of cardiovascular disease in individuals with metabolically healthy obesity. Medicine (Baltimore) 2020; 99:e22036. [PMID: 32957321 PMCID: PMC7505363 DOI: 10.1097/md.0000000000022036] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Studies about the effects of metabolically healthy obesity on cardiovascular disease (CVD) have yielded conflicting results. These heterogeneous results could be due to the limited usefulness of BMI in measuring general adiposity, as body mass index (BMI) does not accurately reflect body composition. This study aimed to evaluate the effect of body shape on CVD outcomes across different obesity phenotypes, and to provide an explanation for the heterogeneous effects of metabolically healthy obese (MHO) phenotype on CVD.We analyzed data from the Korean Genome and Epidemiology Study, a population-based cohort study conducted between 2001 and 2012. We divided the participants into 4 groups: metabolically healthy non-obese (MHNO), MHO, metabolically unhealthy non-obese (MUNO), and metabolically unhealthy obese (MUO). To assess body shape, we calculated the z-score of the log-transformed a body shape index (LBSIZ). We computed Pearson correlation coefficients to examine the association of LBSIZ with muscle mass index, percentage of total fat mass (%Total FM), and percentage of abdominal fat mass (%Abdominal FM). We also used Cox proportional hazards regression to evaluate the effect of LBSIZ on CVD events according to the obesity phenotypes.A total of 9460 participants were assessed in this study. The incidence of CVD was 8.53 cases per 1000 person-year. LBSIZ showed strong positive correlation with %Total FM and %Abdominal FM, but negative correlation with muscle mass index. In Cox regression, MHO individuals did not show increased risk of CVD compared with MHNO individuals (hazard ratio [HR], 1.29; 95% confidence interval [CI], 0.96-1.73). However, MHO individuals in the 3rd (HR, 2.40; 95% CI, 1.28-4.51) and 4th (HR, 3.67; 95% CI, 1.99-6.74) quarters of LBSIZ showed significantly higher risk of CVD compared with MHNO individuals in the 1st quarter of LBSIZ. Moreover, LBSIZ showed a linear relationship with CVD among MHO individuals.While the MHO individuals showed similar CVD risk to the MHNO individuals, CVD risk increases with LBSIZ among the MHO individuals. LBSIZ appears to be a useful measure for CVD risk assessment in clinical practice and epidemiologic studies, especially for MHO patients.
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Affiliation(s)
- Chang-Myung Oh
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju
| | - Jung Hwan Park
- Department of Internal Medicine, Hanyang University College of Medicine
| | - Hye Soo Chung
- Division of Endocrinology and Metabolism, Hallym University College of Medicine, Chuncheon
| | - Jae Myung Yu
- Division of Endocrinology and Metabolism, Hallym University College of Medicine, Chuncheon
| | - Wankyo Chung
- Department of Public Health Science, Graduate School of Public Health
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - Jun Goo Kang
- Division of Endocrinology and Metabolism, Hallym University College of Medicine, Chuncheon
| | - Shinje Moon
- Division of Endocrinology and Metabolism, Hallym University College of Medicine, Chuncheon
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Katta N, Loethen T, Lavie CJ, Alpert MA. Obesity and Coronary Heart Disease: Epidemiology, Pathology, and Coronary Artery Imaging. Curr Probl Cardiol 2020; 46:100655. [PMID: 32843206 DOI: 10.1016/j.cpcardiol.2020.100655] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/03/2020] [Indexed: 01/15/2023]
Abstract
Overweight and obesity contribute to the development of cardiovascular disease (CVD) in general and coronary heart disease (CHD) in particular in part by their association with traditional and nontraditional CVD risk factors. Obesity is also considered to be an independent risk factor for CVD. The metabolic syndrome, of which central obesity is an important component, is strongly associated with CVD including CHD. There is abundant epidemiologic evidence of an association between both overweight and obesity and CHD. Evidence from postmortem studies and studies involving coronary artery imaging is less persuasive. Recent studies suggest the presence of an obesity paradox with respect to mortality in persons with established CHD. Physical activity and preserved cardiorespiratory fitness attenuate the adverse effects of obesity on CVD events. Information concerning the effect of intentional weight loss on CVD outcomes in overweight and obese persons is limited.
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Schlottmann F, Dreifuss NH, Patti MG. Obesity and esophageal cancer: GERD, Barrett´s esophagus, and molecular carcinogenic pathways. Expert Rev Gastroenterol Hepatol 2020; 14:425-433. [PMID: 32441160 DOI: 10.1080/17474124.2020.1764348] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Increases in the rates of esophageal adenocarcinoma (EAC) have paralleled rises in the prevalence of overweight and obesity. Despite not being fully understood, obesity-related EAC seems to have different carcinogenic pathways. AREAS COVERED This comprehensive review will thoroughly evaluate the current literature, describing the underlying mechanisms that help understanding the strong association between obesity and esophageal cancer. EXPERT COMMENTARY The risk of esophageal cancer among obese individuals could be partially explained by several factors: high prevalence of GERD; linear association between central adiposity and Barrett´s esophagus development; low levels of adiponectin and high levels of leptin that alter cell proliferation processes; insulin-resistant state that creates a tumorigenesis environment; and changes in the esophageal microbiota due to unhealthy dietary habits that promote carcinogenesis. In addition, a large proportion of obese patients are undergoing sleeve gastrectomy which can worsen GERD or cause de novo reflux, esophagitis, and Barrett´s metaplasia.
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Affiliation(s)
| | - Nicolás H Dreifuss
- Department of Surgery, Hospital Alemán of Buenos Aires , Buenos Aires, Argentina
| | - Marco G Patti
- Department of Medicine and Surgery, University of North Carolina , Chapel Hill, NC, USA
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70
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Zhu Y, Lin Q, Zhang Y, Deng H, Hu X, Yang X, Yao B. Mid-upper arm circumference as a simple tool for identifying central obesity and insulin resistance in type 2 diabetes. PLoS One 2020; 15:e0231308. [PMID: 32437358 PMCID: PMC7241705 DOI: 10.1371/journal.pone.0231308] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 03/20/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Our research aimed to explore the correlation between mid-upper arm circumference (MUAC) and central obesity and insulin resistance (IR) in Chinese subjects with type 2 diabetes. MATERIALS A total of 103 participants (60 men) were recruited in our study. MUAC was measured around the mid-arm between the shoulder and elbow. Waist circumference (WC) was obtained as central obesity parameter, and the IR parameter of Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) was calculated. The subjects were divided into three groups according to the tertiles cut-points of MUAC level. RESULTS Body mass index (BMI), WC, the percentages of central obesity and HOMA-IR were significantly higher in the groups with higher MUAC than those in the group with lower MUAC (all P < 0.05). Pearson analysis showed that MUAC was correlated with BMI, WC, waist-to-hip ratio (WHR), logHOMA-IR, low density lipoprotein cholesterol (LDL-C), uric acid (UA) and high density lipoprotein cholesterol (HDL-C) in all subjects. Multivariate linear regression analysis revealed that MUAC was independently associated with logHOMA-IR (β = 0.036, P<0.001) after adjusting for age, gender, WHR, UA, TG, LDL-C and HDL-C. Binary logistic regression analysis revealed that MUAC was an independent predictor of central obesity (OR: 2.129, 95%CI: 1.311-3.457, P = 0.002). Furthermore, MUAC≥30.9cm for male and ≥30.0cm for female were the optimal cutoff values for identifying central obesity. CONCLUSIONS Our study indicated that among Chinese subjects with type 2 diabetes, MUAC is a simple and effective tool for the determination of central obesity and IR. Additionally, the larger MUAC is proved to be more associated with metabolic risk factors of higher UA and LDL-C and lowever HDL-C.
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Affiliation(s)
- Yanhua Zhu
- Department of Endocrinology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiongyan Lin
- Department of Endocrinology, Jieyang People’s Hospital (Jieyang Affiliated Hospital, Sun Yat-sen University), Jieyang, Guangdong, China
| | - Yao Zhang
- Department of Endocrinology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hongrong Deng
- Department of Endocrinology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiling Hu
- Department of Endocrinology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xubin Yang
- Department of Endocrinology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- * E-mail: (BY); (XY)
| | - Bin Yao
- Department of Endocrinology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- * E-mail: (BY); (XY)
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Miklisanskaya SV, Mazur NA, Solomasova LV, Chigineva VV. [The «obesity paradox» and its degree of proof]. TERAPEVT ARKH 2020; 92:84-90. [PMID: 32598704 DOI: 10.26442/00403660.2020.04.000421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Indexed: 11/22/2022]
Abstract
The article gives a critical assessment of the so-called obesity paradox. Methodological errors that occur in the organization of studies that studied the obesity paradox and the formation of comparison groups are highlighted. There are also examples of the disappearance of the obesity paradox when taking into account additional risk factors. The organization of prospective studies or more careful consideration of all currently known risk factors for cardiovascular diseases (CVD) will significantly improve the results of the study of the effect of overweight and obesity on mortality in patients with CVD. Thus, despite the biological possibility of the existence of a positive effect of adipose tissue in CVD, the presence of a large number of errors identified in the analysis of the work of researchers obesity paradox require to reconsider the existence of this phenomenon, it should be taken into account the possibility that the obesity paradox may be a consequence of improper design studies to investigate this phenomenon.
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Affiliation(s)
| | - N A Mazur
- Russian Medical Academy of Continuous Professional Education
| | - L V Solomasova
- Russian Medical Academy of Continuous Professional Education
| | - V V Chigineva
- Russian Medical Academy of Continuous Professional Education
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Golia N, Krishan K, Kashyap JR. Assessment of Obesity by Using Various Anthropometric Measurements among Patients with Coronary Heart Disease Residing in North India. Cureus 2020; 12:e7948. [PMID: 32509474 PMCID: PMC7270879 DOI: 10.7759/cureus.7948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Obesity is one of the main risk factors of coronary heart disease (CHD). Although a range of anthropometric measures are available to evaluate obesity, which measure is the most precise to predict the risk of CHD is still controversial. Therefore, we assess the prevalence of obesity among patients with CHD by using various anthropometric techniques to find out the most efficient method to predict the risk of CHD. Methods In this cross-sectional study, we included 300 CHD patients and 100 age and sex-matched healthy controls, aged 45-70 years. Various anthropometric measurements (waist and hip circumference, waist-hip ratio, body mass index, and body fat percentage) were taken to assess the prevalence of obesity among the selected population. Results Average waist circumference among male and female patients was significantly higher than the controls; 94.0±13.2 vs. 86.4±4.4 (p < 0.001) and 97.8±12.1 vs. 86.9±5.3 (p < 0.001) respectively. The average waist-hip ratio among patients of both genders was significantly higher than controls 1.0±.06 vs. 0.92±.04 (p < 0.001) among males and 0.96±.07 vs. 0.88±.04 (p < 0.001) among females, respectively. The average body mass index (BMI) was not different among male patients (24.6±4.0) compared to controls (24.3±2.3); however, the frequency distribution of BMI among male patients and controls was significantly different (p < 0.05), whereas female patients had significantly higher BMI compared to controls 27.7±4.9 and 25.1±2.4, (p < 0.001). Similarly, body fat percentage and visceral fat percentage were elevated among female cases vs. female controls, but no significant difference was observed in the body fat percentage of male cases vs. controls 28.0±5.0 vs. 28.1±2.7; (p > 0.05). However, visceral fat percentage was significantly elevated among male cases vs. controls 11.6±5.7 vs. 9.6±2.6 (p < 0.05). Conclusions Central adiposity markers, waist circumference (WC), waist-hip ratio (WHR), and visceral fat percentage were uniformly present in patients of both sexes and are stronger predictors of risk of CHD relative to the BMI.
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Affiliation(s)
- Nisha Golia
- Anthropology, Panjab University, Chandigarh, IND
| | | | - Jeet Ram Kashyap
- Cardiology, Government Medical College and Hospital Sector, Chandigarh, IND
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73
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Lyu SQ, Yang YM, Zhu J, Wang J, Wu S, Zhang H, Shao XH, Ren JM. Gender-specific association between body mass index and all-cause mortality in patients with atrial fibrillation. Clin Cardiol 2020; 43:706-714. [PMID: 32352584 PMCID: PMC7368315 DOI: 10.1002/clc.23371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 12/22/2022] Open
Abstract
Background Elevated body mass index (BMI) is related with reduced mortality in various cardiovascular diseases. Hypothesis Gender‐specific association between BMI and mortality exists in atrial fibrillation (AF). Methods In this multicenter observational study with a mean follow‐up of 1 year, a total of 1991 AF patients were enrolled and divided into two groups based on the gender. The primary endpoint was all‐cause mortality while the secondary endpoints were defined as cardiovascular mortality, stroke, and major adverse events during 1‐year follow‐up. Cox regression was performed to identify the association between BMI and clinical outcomes according to gender. Results Female patients with AF tended to be older (P = .027) and thinner (P < .001) than male patients with AF. They were more likely to have heart failure, hyperthyroidism, and valvular AF (all P < .05), but less likely to have coronary artery disease and prior myocardial infarction (all P < .01). Multivariate analysis revealed that overweight (HR(95%CI): 0.55(0.41‐0.75), P < .001) and obese patients (HR(95%CI): 0.56(0.34‐0.94), P = .028) were associated with significant lower all‐cause mortality compared with normal weight patients for the entire cohort. Similar association between elevated BMI and reduced all‐cause mortality were only identified in female patients with AF (overweight vs normal weight: HR(95%CI): 0.43(0.27‐0.70); obesity vs normal weight: HR(95%CI): 0.46(0.22‐0.97)), but not in male patients with AF. Conclusion This study indicates that overweight and obesity were related with improved survival in patients with AF. The association between elevated BMI and reduced mortality was dependent on gender, which was only significant in female patients, rather than male patients.
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Affiliation(s)
- Si-Qi Lyu
- Emergency and Critical Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yan-Min Yang
- Emergency and Critical Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jun Zhu
- Emergency and Critical Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Juan Wang
- Emergency and Critical Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shuang Wu
- Emergency and Critical Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Han Zhang
- Emergency and Critical Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xing-Hui Shao
- Emergency and Critical Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jia-Meng Ren
- Emergency and Critical Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Abstract
OBJECTIVE This study aimed to investigate the relationship between waist circumference as a measure of abdominal obesity and brain responses to stress among patients with coronary artery disease (CAD). METHODS Patients with CAD (N = 151) underwent acute mental stress tasks in conjunction with high-resolution positron emission tomography and radiolabeled water imaging of the brain. Brain responses to mental stress were correlated with waist circumference. RESULTS Waist circumference was positively correlated with increased activation in the right and left frontal lobes (β values ranging from 2.81 to 3.75 in the paracentral, medial, and superior gyri), left temporal lobe, left hippocampal, left amygdala, left uncus, and left anterior and posterior cingulate gyri (β values ranging from 2.93 to 3.55). Waist circumference was also negatively associated with the left and right parietal lobes, right superior temporal gyrus, and right insula and precuneus (β values ranging from 2.82 to 5.20). CONCLUSION Increased brain activation in the brain regions involved in the stress response and autonomic regulation of the cardiovascular system during psychological stress may underlie stress-induced overeating and abdominal obesity in patients with CAD.
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75
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Wang CH, Chang WT, Huang CH, Tsai MS, Lu TC, Chou E, Wu YW, Chen WJ. Associations between Central Obesity and Outcomes of Adult In-hospital Cardiac Arrest: A Retrospective Cohort Study. Sci Rep 2020; 10:4604. [PMID: 32165678 PMCID: PMC7067829 DOI: 10.1038/s41598-020-61426-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 02/24/2020] [Indexed: 01/15/2023] Open
Abstract
To investigate the association between central obesity and outcomes following in-hospital cardiac arrest (IHCA). A single-centred retrospective study was conducted. Adult patients that experienced IHCA during 2006-2015 were screened. Body mass index (BMI) was calculated at hospital admission. Central obesity-related anthropometric parameters were measured by analysing computed tomography images. A total of 648 patients were included, with mean BMI of 23.0 kg/m2. The proportions of BMI-defined obesity in this cohort were underweight (13.1%), normal weight (41.4%), overweight (31.5%) and obesity (14.0%). The mean waist circumference was 85.9 cm with mean waist-to-height ratio (WHtR) of 0.53. The mean sagittal abdominal diameter was 21.2 cm with mean anterior and posterior abdominal subcutaneous adipose tissue (SAT) depths of 1.6 and 2.0 cm, respectively. Multivariate logistic regression analyses indicated BMI of 11.7-23.3 kg/m2 (odds ratio [OR]: 2.53, 95% confidence interval [CI]: 1.10-5.85; p-value = 0.03), WHtR of 0.49-0.59 (OR: 3.45, 95% CI: 1.56-7.65; p-value = 0.002) and anterior abdominal SAT depth <1.9 cm (OR: 2.84, 95% CI: 1.05-7.74; p-value = 0.04) were positively associated with the favourable neurological outcome. Central obesity was associated with poor IHCA outcomes, after adjusting for the effects of BMI.
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Affiliation(s)
- Chih-Hung Wang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Tien Chang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Min-Shan Tsai
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tsung-Chien Lu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Eric Chou
- Department of Emergency Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, Texas, USA
| | - Yen-Wen Wu
- Departments of Internal Medicine and Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Nuclear Medicine and Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Wen-Jone Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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76
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Agrimi J, Baroni C, Anakor E, Lionetti V. Perioperative Heart-Brain Axis Protection in Obese Surgical Patients: The Nutrigenomic Approach. Curr Med Chem 2020; 27:258-281. [PMID: 30324875 DOI: 10.2174/0929867325666181015145225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/01/2018] [Accepted: 09/25/2018] [Indexed: 02/06/2023]
Abstract
The number of obese patients undergoing cardiac and noncardiac surgery is rapidly increasing because they are more prone to concomitant diseases, such as diabetes, thrombosis, sleep-disordered breathing, cardiovascular and cerebrovascular disorders. Even if guidelines are already available to manage anesthesia and surgery of obese patients, the assessment of the perioperative morbidity and mortality from heart and brain disorders in morbidly obese surgical patients will be challenging in the next years. The present review will recapitulate the new mechanisms underlying the Heart-brain Axis (HBA) vulnerability during the perioperative period in healthy and morbidly obese patients. Finally, we will describe the nutrigenomics approach, an emerging noninvasive dietary tool, to maintain a healthy body weight and to minimize the HBA propensity to injury in obese individuals undergoing all types of surgery by personalized intake of plant compounds that may regulate the switch from health to disease in an epigenetic manner. Our review provides current insights into the mechanisms underlying HBA response in obese surgical patients and how they are modulated by epigenetically active food constituents.
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Affiliation(s)
- Jacopo Agrimi
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Carlotta Baroni
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Ekene Anakor
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Vincenzo Lionetti
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,UOS Anesthesiology, Fondazione Toscana G. Monasterio, Pisa, Italy
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77
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Damaskos C, Litos A, Dimitroulis D, Antoniou EA, Mantas D, Kontzoglou K, Garmpis N. Cardiovascular Effects of Metabolic Surgery on Type 2 Diabetes. Curr Cardiol Rev 2020; 16:275-284. [PMID: 32077829 PMCID: PMC7903510 DOI: 10.2174/1573403x16666200220120226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 11/29/2019] [Accepted: 12/18/2019] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Cardiovascular, together with renal disease, claims a significant proportion of morbidity and mortality in association with type 2 diabetes mellitus (T2DM) and obesity. To improve the long-term renal and cardiovascular outcome, there is the incorporation of bariatric surgery (BS), which seems to be a pivotal intervention. Areas Explored: Cohort studies and randomized controlled trial (RCT) research of BS among patients with T2DM, were conducted by screening, and then information on renal effects and the cardiovascular outcome was gathered. Metabolic surgery (MS) and BS reduce both mortality and the risk of cardiovascular disorder, chronic kidney diseases and albuminuria. MS refers to a surgical approach, the primary intent of which is the control of metabolic alterations/hyperglycemia in contrast to BS which is a mere weight-reduction therapy. Patients suffering from poor glycaemic control and other macro and micro-vascular diseases will benefit from a surgical approach. The approach implicates hypertension glomerular remission, gut microbiota shift, reduced renal inflammation and fewer instances of chronic cardiac remodelling. CONCLUSION MS is beneficial where the main aim is to attain significant and long-lasting weight loss results. The RCTs have depicted the superiority which surgical mechanisms hold over medically- based therapy, for enhancing glycaemic control, and achieving remission of diabetes. This type of surgery improves life quality, reduces incidences of other obesity and diabetes related diseases like microvascular disases, sleep apnea, fatal disorder, and fatty liver disease.
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Affiliation(s)
- Christos Damaskos
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Litos
- Psychiatric Department, General Hospital of Athens G. Gennimatas, Athens, Greece
| | - Dimitrios Dimitroulis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios A Antoniou
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Mantas
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Kontzoglou
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Garmpis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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78
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Qu Y, Yang J, Zhang F, Li C, Dai Y, Yang H, Gao Y, Pan Y, Yao K, Huang D, Lu H, Ma J, Qian J, Ge J. Relationship between body mass index and outcomes of coronary artery disease in Asian population: Insight from the FOCUS registry. Int J Cardiol 2020; 300:262-267. [PMID: 31685245 DOI: 10.1016/j.ijcard.2019.10.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 09/22/2019] [Accepted: 10/14/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Obesity is often considered as a risk factor of cardiovascular events, but recent researches showed conflicting results regarding to the effect of body weight on prognosis of coronary artery disease (CAD). This study aimed to evaluate the relationship between body mass index (BMI) and clinical outcomes of CAD in Asian population. METHODS A total of 4315 patients from the FOCUS registry were enrolled into this analysis. Patients were divided into 4 groups according to BMI: lean group (BMI<18.5 kg/m2), normal group (BMI 18.5-24.9 kg/m2), overweight group (BMI 25-30 kg/m2) and obesity group (BMI>30 kg/m2). Follow-up was continued to 3 years to evaluate clinical outcomes, and the primary endpoint was a composite of all-cause death and myocardial infarction (MI). RESULTS Patients with higher BMI were more likely to be associated with cardiovascular risk factors like hypertension, hypercholesterolemia and diabetes, but not smoking. At the end of the follow-up period, however, the incidence of a composite endpoint of all-cause death and MI was significantly lower in the higher BMI (overweight and obese) subsets, as compared with the lower BMI group (5.2% vs. 8.0%, p < 0.001). So did the cumulative rates of all-cause death (p < 0.001), cardiovascular death (p < 0.001), and a combined endpoint of cardiovascular death and MI (p = 0.001). CONCLUSIONS In Asian patients with CAD, an inverse association between BMI and long-term prognosis was observed. Although overweight or obese patients were associated with more metabolism-associated comorbidities, they had significantly lower adverse events at 3-year follow up after percutaneous coronary intervention.
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Affiliation(s)
- Ya'nan Qu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China
| | - Ji'e Yang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China
| | - Feng Zhang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China.
| | - Chenguang Li
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China
| | - Yuxiang Dai
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China
| | - Hongbo Yang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China
| | - Yang Gao
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China
| | - Yueyi Pan
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China
| | - Kang Yao
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China
| | - Dong Huang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China
| | - Hao Lu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China
| | - Jianying Ma
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, China.
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79
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Kamon T, Kaneko H, Itoh H, Kiriyama H, Mizuno Y, Morita H, Yamamichi N, Komuro I. Association Between Waist Circumference and Carotid Intima-Media Thickness in the General Population. Int Heart J 2020; 61:103-108. [DOI: 10.1536/ihj.19-470] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Tatsuya Kamon
- Department of Cardiovascular Medicine Graduate School of Medicine, The University of Tokyo
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine Graduate School of Medicine, The University of Tokyo
- Department of Advanced Cardiology, Graduate School of Medicine, The University of Tokyo
| | - Hidetaka Itoh
- Department of Cardiovascular Medicine Graduate School of Medicine, The University of Tokyo
| | - Hiroyuki Kiriyama
- Department of Cardiovascular Medicine Graduate School of Medicine, The University of Tokyo
| | - Yoshiko Mizuno
- Department of Cardiovascular Medicine Graduate School of Medicine, The University of Tokyo
- Center for Epidemiology and Preventive Medicine, The University of Tokyo Hospital
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine Graduate School of Medicine, The University of Tokyo
| | - Nobutake Yamamichi
- Center for Epidemiology and Preventive Medicine, The University of Tokyo Hospital
| | - Issei Komuro
- Department of Cardiovascular Medicine Graduate School of Medicine, The University of Tokyo
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80
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Mohammadi H, Ohm J, Discacciati A, Sundstrom J, Hambraeus K, Jernberg T, Svensson P. Abdominal obesity and the risk of recurrent atherosclerotic cardiovascular disease after myocardial infarction. Eur J Prev Cardiol 2020; 27:1944-1952. [PMID: 31958380 DOI: 10.1177/2047487319898019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The association between abdominal obesity and recurrent atherosclerotic cardiovascular disease after myocardial infarction remains unknown. OBJECTIVE The purpose of this study was to investigate the prevalence of abdominal obesity and its association with recurrent atherosclerotic cardiovascular disease in patients after a first myocardial infarction. DESIGN AND METHODS In this register-based observational cohort, 22,882 patients were identified from the national Swedish Web-system for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) registry at a clinical revisit 4-10 weeks after their first myocardial infarction 2005-2014. Patients were followed for recurrent atherosclerotic cardiovascular disease defined as non-fatal myocardial infarction, coronary heart disease death, non-fatal or fatal ischaemic stroke. Univariate and multivariable-adjusted Cox regression models were used to calculate hazard ratios and 95% confidence intervals in quintiles of waist circumference as well as three categories of body mass index including normal weight, overweight and obesity. RESULTS The majority of patients had abdominal obesity. During a median follow-up time of 3.8 years, 1232 men (7.3%) and 469 women (7.9%) experienced a recurrent atherosclerotic cardiovascular disease event. In the univariate analysis, risk was elevated in the fifth quintile (hazard ratio 1.22, 95% confidence interval 1.07-1.39) compared with the first. In the multivariable-adjusted analysis, risk was elevated in the fourth and fifth quintiles (hazard ratio 1.21, confidence interval 1.03-1.43 and hazard ratio 1.25, confidence interval 1.04-1.50), respectively. Gender-stratified analyses showed similar associations in men, while U-shaped associations were observed in women and the body mass index analyses. CONCLUSIONS Abdominal obesity was common in post-myocardial infarction patients and larger waist circumference was independently associated with recurrent atherosclerotic cardiovascular disease, particularly in men. We recommend utilising waist circumference to identify patients at increased risk of recurrent atherosclerotic cardiovascular disease after myocardial infarction.
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Affiliation(s)
- Hanieh Mohammadi
- Department of Clinical Sciences and Education, Karolinska Institute-Södersjukhuset, Sweden
| | - Joel Ohm
- Department of Medicine-Solna, Karolinska Institute, Sweden.,Function of Emergency Medicine, Karolinska University Hospital, Sweden
| | | | | | | | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital-Karolinska Institute, Sweden
| | - Per Svensson
- Department of Clinical Sciences and Education, Karolinska Institute-Södersjukhuset, Sweden.,Department of Cardiology, Södersjukhuset, Sweden
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81
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Kim HY, Kim JK, Shin GG, Han JA, Kim JW. Association between Abdominal Obesity and Cardiovascular Risk Factors in Adults with Normal Body Mass Index: Based on the Sixth Korea National Health and Nutrition Examination Survey. J Obes Metab Syndr 2019; 28:262-270. [PMID: 31909369 PMCID: PMC6939698 DOI: 10.7570/jomes.2019.28.4.262] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/07/2019] [Accepted: 10/25/2019] [Indexed: 12/28/2022] Open
Abstract
Background Abdominal obesity predisposes individuals to cardiovascular disease, but the data in adults with normal body mass index (BMI) are relatively rare. This study aimed to evaluate the characteristics of subjects with normal BMI and abdominal obesity and to identify the relationship between central obesity and cardiovascular risk factors in normal BMI adults in Korea. Methods Ten thousands six hundred thirty-four adults with BMI between 18.5 to 24.9 kg/m2 who participated in the sixth Korea National Health and Nutrition Examination Survey were included. Abdominal obesity was defined as a waist circumference of ≥90 cm in males and ≥85 cm in females. Through logistic regression, we analyzed the factors influencing abdominal obesity and the relationship between abdominal obesity and cardiovascular risk factors. Results The prevalence of abdominal obesity in adults with normal BMI was 6.9% for males and 7.7% for females, and this prevalence tended to increase with age. When adjusted for age and BMI, daily excessive alcohol consumption increased the risk of abdominal obesity in adults of normal weight. Women with lower socioeconomic status and men in need of walking exercise also had a higher risk of abdominal obesity. In the model adjusted for age and BMI, abdominal obesity was associated with fasting glucose intolerance and diabetes in men and hypertriglyceridemia and low high-density lipoprotein cholesterol in women. Conclusion Cardiovascular risk factors were associated with abdominal obesity in Korean adults with normal BMI. These results suggest that more careful management of abdominal obesity in those with normal weight is necessary.
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Affiliation(s)
- Hye Yun Kim
- Department of Family Medicine, Obesity and Metabolic Disease Center, Seongnam Central Hospital, Seongnam, Korea
| | - Jae Kyung Kim
- Department of Family Medicine, Obesity and Metabolic Disease Center, Seongnam Central Hospital, Seongnam, Korea
| | - Gook Gyeon Shin
- Department of Family Medicine, Obesity and Metabolic Disease Center, Seongnam Central Hospital, Seongnam, Korea
| | - Jin Ah Han
- Department of Family Medicine, Obesity and Metabolic Disease Center, Seongnam Central Hospital, Seongnam, Korea
| | - Jin Wook Kim
- Department of Family Medicine, Obesity and Metabolic Disease Center, Seongnam Central Hospital, Seongnam, Korea.,Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
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Shirasawa T, Ochiai H, Yoshimoto T, Nagahama S, Kobayashi M, Ohtsu I, Sunaga Y, Kokaze A. Associations between normal weight central obesity and cardiovascular disease risk factors in Japanese middle-aged adults: a cross-sectional study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2019; 38:46. [PMID: 31849344 PMCID: PMC6918653 DOI: 10.1186/s41043-019-0201-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 11/05/2019] [Indexed: 05/22/2023]
Abstract
BACKGROUND Several studies have shown that normal weight central obesity (NWCO) is associated with cardiovascular disease (CVD) risk factors. However, studies conducted in the Japanese population have been very limited. Thus, the relationships between normal weight central obesity, classified using body mass index (BMI), the waist-to-height ratio (WHtR), and CVD risk factors in middle-aged Japanese adults were investigated. METHODS The participants were Japanese adults aged 40-64 years who had undergone periodic health examinations in Japan during the period from April 2013 to March 2014. The participants were categorized into the following four groups: normal weight (BMI 18.5-24.9 kg/m2) and no central obesity (WHtR < 0.5) (NW); normal weight and central obesity (WHtR ≥ 0.5) (NWCO); obesity (BMI ≥ 25 kg/m2) and no central obesity (OB); and obesity and central obesity (OBCO). Hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or taking medication for hypertension. Dyslipidemia was defined as LDL-C ≥ 140 mg/dl, HDL-C < 40 mg/dl, triglyceride ≥ 150 mg/dl, or taking medication for dyslipidemia. Diabetes was defined as fasting plasma glucose ≥ 126 mg/dl, random plasma glucose ≥ 200 mg/dl, HbA1c ≥ 6.5%, or receiving medical treatment for diabetes mellitus. A logistic regression model was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for hypertension, dyslipidemia, and diabetes. RESULTS A total of 117,163 participants (82,487 men and 34,676 women) were analyzed. The prevalence of NWCO was 15.6% in men and 30.2% in women. With reference to NW, the ORs for hypertension (adjusted OR 1.22, 95% CI 1.17-1.27 in men, 1.23, 1.16-1.31 in women), dyslipidemia (1.81, 1.74-1.89 in men, 1.60, 1.52-1.69 in women), and diabetes (1.35, 1.25-1.46 in men, 1.60, 1.35-1.90 in women) were significantly higher in NWCO. CONCLUSIONS Normal weight with central obesity was associated with CVD risk factors, such as hypertension, dyslipidemia, and diabetes, compared with normal weight without central obesity, regardless of sex. It is important to focus on normal weight with central obesity for the prevention of CVD in Japanese middle-aged adults.
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Affiliation(s)
- Takako Shirasawa
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan
| | - Hirotaka Ochiai
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan
| | - Takahiko Yoshimoto
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan
| | - Satsue Nagahama
- All Japan Labor Welfare Foundation, 6-16-11 Hatanodai, Shinagawa-ku, Tokyo, 142-0064 Japan
| | - Mariko Kobayashi
- All Japan Labor Welfare Foundation, 6-16-11 Hatanodai, Shinagawa-ku, Tokyo, 142-0064 Japan
| | - Iichiro Ohtsu
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan
| | - Yuma Sunaga
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan
| | - Akatsuki Kokaze
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan
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A simple cut-off for waist-to-height ratio (0·5) can act as an indicator for cardiometabolic risk: recent data from adults in the Health Survey for England. Br J Nutr 2019; 123:681-690. [DOI: 10.1017/s0007114519003301] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AbstractThe National Institute for Health and Care Excellence (NICE) has acknowledged the value of waist-to-height ratio (WHtR) as an indicator for ‘early health risk’. We used recent UK data to explore whether classification based on WHtR identifies more adults at cardiometabolic risk than the ‘matrix’ based on BMI and waist circumference, currently used for screening. Data from the Health Survey for England (4112 adults aged 18+ years) were used to identify cardiometabolic risk, indicated by raised glycated Hb, dyslipidaemia and hypertension. HbA1c, total/HDL-cholesterol and systolic blood pressure (BP) were more strongly associated with WHtR than the ‘matrix’. In logistic regression models for HbA1c ≥ 48 mmol/mol, total/HDL-cholesterol > 4 and hypertension (BP > 140/90 mmHg or on medication), WHtR had a higher predictive value than the ‘matrix’. AUC was significantly greater for WHtR than the ‘matrix’ for raised HbA1c and hypertension. Of adults with raised HbA1c, 15 % would be judged as ‘no increased risk’ using the ‘matrix’ in contrast to 3 % using WHtR < 0·5. For hypertension, comparative values were 23 and 9 %, and for total/HDL-cholesterol > 4, 26 and 13 %. Nearly one-third of the ‘no increased risk’ group in the ‘matrix’ had WHtR ≥ 0·5 and hence could be underdiagnosed for cardiometabolic risk. WHtR has the potential to be a better indicator of cardiometabolic risks associated with central obesity than the current NICE ‘matrix’. The cut-off WHtR 0·5 in early screening translates to a simple message, ‘your waist should be less than half your height’, that allows individuals to be aware of their health risks.
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Bonikowske AR, Barillas Lara MI, Koepp KE, Medina Inojosa JR, Squires RW, Lopez-Jimenez F, Olson TP. Fat Mass Index Better Identifies Metabolic Syndrome: Insights from Patients in Early Outpatient Cardiac Rehabilitation. J Clin Med 2019; 8:jcm8122147. [PMID: 31817309 PMCID: PMC6947316 DOI: 10.3390/jcm8122147] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/22/2019] [Accepted: 12/02/2019] [Indexed: 12/29/2022] Open
Abstract
Body mass index (BMI) does not differentiate fat and lean mass or the distribution of adipose tissue. The purpose of this study was to examine the prevalence of metabolic syndrome (MetS) among patients entering outpatient cardiac rehabilitation (CR) across fat mass index (FMI) categories compared with BMI. This retrospective cross-sectional study evaluated dual-energy x-ray absorptiometry in 483 CR patients from 1 January 2014, through 31 December 2017. Clinical data were extracted from the electronic health record. Patients were grouped by FMI and BMI categories. Mean (SD) age of patients was 64.3 (14) years. The normal FMI category had 15 patients; excess fat, 74; and obese, 384. In contrast, 93, 174, and 216 were in the normal, overweight, and obese BMI categories, respectively. Prevalence of MetS was 0 (0%) in normal, 5 (1%) in excess fat, and 167 (54%) in obese FMI, with 97% in the obese category. MetS prevalence was 4 patients (0.8%) in normal, 39 (8%) in overweight, and 129 (27%) in obese BMI categories, with 75% of MetS in the obese category. FMI more accurately classified CR patients with metabolically abnormal fat (p < 0.001). FMI is a more sensitive index than BMI for metabolically abnormal fat of outpatient CR patients.
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85
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Lumish HS, O'Reilly M, Reilly MP. Sex Differences in Genomic Drivers of Adipose Distribution and Related Cardiometabolic Disorders: Opportunities for Precision Medicine. Arterioscler Thromb Vasc Biol 2019; 40:45-60. [PMID: 31747800 DOI: 10.1161/atvbaha.119.313154] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This review focuses on the human genetics, epidemiology, and molecular pathophysiology of sex differences in central obesity, adipose distribution, and related cardiometabolic disorders. Distribution of fat is important for cardiometabolic health, with peripheral fat depots having a protective effect and central visceral fat depots conferring a detrimental effect on health. There are important sex differences in fat distribution that are masked when studying body mass index as a measure of obesity. From epidemiological, murine, and in vitro studies, several mechanisms have been proposed to explain the sex differences in adipose distribution, including sex hormonal effects, cell-intrinsic properties, and the microenvironment in fat depots. More recently, human genetics have revealed hundreds of loci for central obesity providing disruptive opportunities for mechanistic discoveries and clinical translation. A striking feature is that over one-third of these loci have reproducible but poorly understood sexual dimorphic associations with central obesity, most having stronger effects in women. Understanding the genetic and molecular mechanisms of adipose distribution and its sexual dimorphism in humans provides a unique opportunity to promote the use of precision medicine for early identification of at-risk individuals, and the development of novel therapeutic strategies for central obesity and related cardiometabolic disorders.
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Affiliation(s)
- Heidi S Lumish
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY (H.S.L., M.O., M.P.R.)
| | - Marcella O'Reilly
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY (H.S.L., M.O., M.P.R.)
| | - Muredach P Reilly
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY (H.S.L., M.O., M.P.R.).,Irving Institute for Clinical and Translational Research, Columbia University, New York, NY (M.P.R.)
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Abstract
OBJECTIVES Although one third or more of critically ill patients in the United States are obese, obesity is not incorporated as a contributing factor in any of the commonly used severity of illness scores. We hypothesize that selected severity of illness scores would perform differently if body mass index categorization was incorporated and that the performance of these score models would improve after consideration of body mass index as an additional model feature. DESIGN Retrospective cohort analysis from a multicenter ICU database which contains deidentified data for more than 200,000 ICU admissions from 208 distinct ICUs across the United States between 2014 and 2015. SETTING First ICU admission of patients with documented height and weight. PATIENTS One-hundred eight-thousand four-hundred two patients from 189 different ICUs across United States were included in the analyses, of whom 4,661 (4%) were classified as underweight, 32,134 (30%) as normal weight, 32,278 (30%) as overweight, 30,259 (28%) as obese, and 9,070 (8%) as morbidly obese. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS To assess the effect of adding body mass index as a risk adjustment element to the Acute Physiology and Chronic Health Evaluation IV and Oxford Acute Severity of Illness scoring systems, we examined the impact of this addition on both discrimination and calibration. We performed three assessments based upon 1) the original scoring systems, 2) a recalibrated version of the systems, and 3) a recalibrated version incorporating body mass index as a covariate. We also performed a subgroup analysis in groups defined using World Health Organization guidelines for obesity. Incorporating body mass index into the models provided a minor improvement in both discrimination and calibration. In a subgroup analysis, model discrimination was higher in groups with higher body mass index, but calibration worsened. CONCLUSIONS The performance of ICU prognostic models utilizing body mass index category as a scoring element was inconsistent across body mass index categories. Overall, adding body mass index as a risk adjustment variable led only to a minor improvement in scoring system performance.
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Abstract
PURPOSE OF REVIEW Obesity in the older adult is a burgeoning health epidemic that leads to increased morbidity, disability, and institutionalization. This review presents a brief overview of geriatric-specific consequences of obesity by highlighting the risks and benefits of intentional weight loss. RECENT FINDINGS Intentional weight loss reduces the extent of adiposity-related illnesses, yet the approach in older adults is fraught with challenges. Interventions combining caloric restriction and physical exercise (aerobic and resistance) maximize fat loss and minimize loss of muscle and bone. Interventions are also effective at improving physical function, reducing medication burden, and improving symptomatic osteoarthritis in this population. Approaches can mitigate the risks of isolated caloric restriction on muscle and bone in a safe and effective manner. Effective weight loss strategies should be considered in older adults. While there are potential risks, practical clinical approaches can minimize the potential harms while maximizing their benefits.
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Affiliation(s)
- Peter R DiMilia
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH, USA
- Collaboratory for Implementation Science at Dartmouth, Lebanon, NH, USA
| | - Alexander C Mittman
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - John A Batsis
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH, USA.
- Collaboratory for Implementation Science at Dartmouth, Lebanon, NH, USA.
- Health Promotion Research Center at Dartmouth, Lebanon, NH, USA.
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
- Section of Weight & Wellness, Department of Medicine, Dartmouth-Hitchcock, Lebanon, NH, USA.
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Januszek R, Ruzsa Z, Nyerges A, Óriás V, Kleczyński P, Wojtasik-Bakalarz J, Pawlik A, Arif S, Dudek D, Bartuś S. Body mass index and long-term outcomes in patients with chronic total occlusions undergoing retrograde endovascular revascularization of the infra-inguinal lower limb arteries. Cardiol J 2019; 28:509-518. [PMID: 31642053 DOI: 10.5603/cj.a2019.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 08/27/2019] [Accepted: 09/29/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of the present study is to assess the relationship between body mass index (BMI) and long-term clinical outcomes in retrograde endovascular recanalization (ER) regarding chronic total occlusions (CTOs) of the infra-inguinal lower limb arteries. METHODS The study included patients who underwent retrograde ER of CTOs localized in superficial, popliteal or below-the-knee arteries. During follow-up, major adverse cardiac and cerebrovascular and major adverse lower limb events (MALE) were evaluated. MALE was defined as amputation, target lesion re-intervention, target vessel re-intervention and surgical treatment. RESULTS The study included 405 patients at the mean age of 67.2 ± 10.4. The authors divided the overall group of patients according to BMI into < 25 (n = 156, 38.5%) and ≥ 25 kg/m2 (n = 249, 61.5%), and then into < 30 (n = 302, 75.8%) and ≥ 30 kg/m2 (n = 103, 24.2%). During the average follow-up 1,144.9 ± 664.3 days, the mortality rate was higher in the group of patients with BMI < 25 kg/m2 (10.5% vs. 5.3%, p = 0.051), and in the group of patients with BMI < 30 kg/m2 (8.7% vs. 2.9%, p = 0.048). The comparison of Kaplan-Meier curves revealed borderline differences when assessing months to death for the BMI < 25 kg/m2 (p = 0.057) and BMI < 30 kg/m2 (p = 0.056) grouping variables. CONCLUSIONS Obese and overweight patients undergoing CTO ER of the lower limb arteries from retrograde access are related to lower death rates during long-term follow-up.
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Affiliation(s)
- Rafał Januszek
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland. .,Department of Clinical Rehabilitation, University of Physical Education, Krakow, Poland.
| | - Zoltan Ruzsa
- Semmelweis University, Heart and Vascular Center, Cardiology Department, Budapest, Hungary.,Bács-Kiskun County Hospital, Invasive Cardiology Department, Teaching Hospital of Szent-Györgyi Albert Medical University, Kecskemét, Hungary
| | - Andras Nyerges
- Bács-Kiskun County Hospital, Invasive Cardiology Department, Teaching Hospital of Szent-Györgyi Albert Medical University, Kecskemét, Hungary
| | - Victor Óriás
- Semmelweis University, Heart and Vascular Center, Cardiology Department, Budapest, Hungary
| | - Paweł Kleczyński
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Joanna Wojtasik-Bakalarz
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Artur Pawlik
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Salech Arif
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Dariusz Dudek
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.,2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Stanisław Bartuś
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.,2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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Pedersen LR, Olsen RH, Anholm C, Astrup A, Eugen-Olsen J, Fenger M, Simonsen L, Walzem RL, Haugaard SB, Prescott E. Effects of 1 year of exercise training versus combined exercise training and weight loss on body composition, low-grade inflammation and lipids in overweight patients with coronary artery disease: a randomized trial. Cardiovasc Diabetol 2019; 18:127. [PMID: 31575375 PMCID: PMC6774219 DOI: 10.1186/s12933-019-0934-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 09/21/2019] [Indexed: 12/18/2022] Open
Abstract
Background Dyslipidaemia and low-grade inflammation are central in atherogenesis and linked to overweight and physical inactivity. Lifestyle changes are important in secondary prevention of coronary artery disease (CAD). We compared the effects of combined weight loss and interval training with interval training alone on physical fitness, body composition, dyslipidaemia and low-grade inflammation in overweight, sedentary participants with CAD. Methods Seventy CAD patients, BMI 28–40 kg/m2 and age 45–75 years were randomised to (1) 12 weeks’ aerobic interval training (AIT) at 90% of peak heart rate three times/week followed by 40 weeks’ AIT twice weekly or (2) a low energy diet (LED) (800–1000 kcal/day) for 8–10 weeks followed by 40 weeks’ weight maintenance including AIT twice weekly and a high-protein/low-glycaemic load diet. Effects of the intervention were evaluated by physical fitness, body weight and composition. Dyslipidaemia was described using both biochemical analysis of lipid concentrations and lipoprotein particle subclass distribution determined by density profiling. Low-grade inflammation was determined by C-reactive protein, soluble urokinase-type plasminogen activator receptor and tumour necrosis factor α. Effects on continuous outcomes were tested by mixed-models analysis. Results Twenty-six (74%) AIT and 29 (83%) LED + AIT participants completed the study. At baseline subject included 43 (78%) men; subjects averages were: age 63 years (6.2), body weight 95.9 kg (12.2) and VO2peak 20.7 mL O2/kg/min (4.9). Forty-six (84%) had pre-diabetes (i.e. impaired fasting glucose and/or impaired glucose tolerance). LED + AIT reduced body weight by 7.2 kg (− 8.4; − 6.1) and waist circumference by 6.6 cm (− 7.7; − 5.5) compared to 1.7 kg (− 0.7; − 2.6) and 3.3 cm (− 5.1; − 1.5) after AIT (within-group p < 0.001, between-group p < 0.001 and p = 0.018, respectively). Treatments caused similar changes in VO2peak and lowering of total cholesterol, triglycerides, non-HDL cholesterol and low-grade inflammation. A shift toward larger HDL particles was seen following LED + AIT while AIT elicited no change. Conclusions Both interventions were feasible. Both groups obtained improvements in VO2peak, serum-lipids and inflammation with superior weight loss and greater central fat loss following LED + AIT. Combined LED induced weight loss and exercise can be recommended to CAD patients. Trial registration NCT01724567, November 12, 2012, retrospectively registered (enrolment ended in April 2013).
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Affiliation(s)
- Lene Rørholm Pedersen
- Department of Cardiology, Bispebjerg University Hospital, University of Copenhagen, Building 67, 1st, Bispebjerg Bakke 23, 2400, Copenhagen, NW, Denmark. .,Department of Cardiology, University Hospital of Zealand, Roskilde, University of Copenhagen, Copenhagen, Denmark.
| | - Rasmus Huan Olsen
- Department of Cardiology, Bispebjerg University Hospital, University of Copenhagen, Building 67, 1st, Bispebjerg Bakke 23, 2400, Copenhagen, NW, Denmark
| | - Christian Anholm
- Department of Internal Medicine, Glostrup University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Arne Astrup
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Eugen-Olsen
- Clinical Research Centre, Hvidovre University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mogens Fenger
- Department of Medical Biochemistry, Genetics and Molecular Biochemistry, Hvidovre University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lene Simonsen
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Rosemary L Walzem
- Faculty of Nutrition, Texas A & M University, College Station, TX, USA
| | - Steen Bendix Haugaard
- Department of Internal Medicine, Amager and Hvidovre University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, University of Copenhagen, Building 67, 1st, Bispebjerg Bakke 23, 2400, Copenhagen, NW, Denmark
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90
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Chung W, Park JH, Chung HS, Yu JM, Moon S, Kim DS. The Association between Z-Score of Log-Transformed A Body Shape Index and Cardiovascular Disease in Korea. Diabetes Metab J 2019; 43:675-682. [PMID: 31237130 PMCID: PMC6834836 DOI: 10.4093/dmj.2018.0169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 01/15/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND In order to overcome the limitations of body mass index (BMI) and waist circumference (WC), the z-score of the log-transformed A Body Shape Index (LBSIZ) has recently been introduced. In this study, we analyzed the relationship between the LBSIZ and cardiovascular disease (CVD) in a Korean representative sample. METHODS Data were collected from the Korea National Health and Nutrition Examination VI to V. The association between CVD and obesity indices was analyzed using a receiver operating characteristic curve. The cut-off value for the LBSIZ was estimated using the Youden index, and the odds ratio (OR) for CVD was determined via multivariate logistic regression analysis. ORs according to the LBSIZ value were analyzed using restricted cubic spline regression plots. RESULTS A total of 31,227 Korean healthy adults were analyzed. Area under the curve (AUC) of LBSIZ against CVD was 0.686 (95% confidence interval [CI], 0.671 to 0.702), which was significantly higher than the AUC of BMI (0.583; 95% CI, 0.567 to 0.599) or WC (0.646; 95% CI, 0.631 to 0.661) (P<0.001). Similar results were observed for stroke and coronary artery diseases. The cut-off value for the LBSIZ was 0.35 (sensitivity, 64.5%; specificity, 64%; OR, 1.29, 95% CI, 1.12 to 1.49). Under restricted cubic spline regression, LBSIZ demonstrated that OR started to increase past the median value. CONCLUSION The findings of this study suggest that the LBSIZ might be more strongly associated with CVD risks compared to BMI or WC. These outcomes would be helpful for CVD risk assessment in clinical settings, especially the cut-off value of the LBSIZ suggested in this study.
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Affiliation(s)
- Wankyo Chung
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Korea
- Institute of Health and Environment, Seoul National University, Seoul, Korea
| | - Jung Hwan Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hye Soo Chung
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jae Myung Yu
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Shinje Moon
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
- Department of Internal Medicine, Graduate School, Hanyang University, Seoul, Korea
| | - Dong Sun Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
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Joint association of body mass index and central obesity with cardiovascular events and all-cause mortality in prediabetic population: A prospective cohort study. Obes Res Clin Pract 2019; 13:453-461. [DOI: 10.1016/j.orcp.2019.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/26/2019] [Accepted: 08/26/2019] [Indexed: 01/19/2023]
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Relationship between BMI and aortic stiffness: influence of anthropometric indices in hypertensive men and women. J Hypertens 2019; 38:249-256. [PMID: 31460994 DOI: 10.1097/hjh.0000000000002228] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Increased aortic stiffness could be one of the mechanisms by which obesity increases cardiovascular risk independently of traditional risk factors. Studies have suggested that anthropometric indices may be predictors of cardiovascular risk but few studies have investigated their relations with aortic stiffness in high cardiovascular risk population. We investigated the strength of correlation between different anthropometric indices with aortic stiffness in hypertensive and diabetic patients. METHODS A cross-sectional study was performed in 474 hypertensive patients. Anthropometric indices were calculated: BMI, waist circumference, waist-hip ratio, and waist-height ratio (WHtR). Aortic stiffness was assessed by measurement of carotid-femoral pulse wave velocity (PWV). Correlations between indices and PWV were investigated by linear regression analyses and hierarchical analyses after adjusting for cardiovascular risk factors. RESULTS Regional anthropometric indices were more strongly correlated with PWV than BMI in both sexes. In linear regression analyses, WHtR presented the highest correlation with PWV than other indices in our study population. In adjusted hierarchical regression used, WHtR had the highest additive value on top of BMI while there no additive value of BMI on top of WHtR. These differences remained after adjustment on cardiovascular events. In men WHtR was more closely correlated with PWV than others. In women, waist-hip ratio and WHtR were equally correlated with PWV compared with BMI. CONCLUSION Regional anthropometric indices are more closely correlated with PWV than BMI in hypertensive patients. WHtR presents the highest correlation with PWV beyond BMI. REGISTRATION The study was registered in the French National Agency for Medicines and Health Products Safety (No. 2013-A00227-38) and was approved by the Advisory Committee for Protection of Persons in Biomedical Research.
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Hajian-Tilaki K, Heidari B. Variations in the pattern and distribution of non-obese components of metabolic syndrome across different obesity phenotypes among Iranian adults' population. Diabetes Metab Syndr 2019; 13:2419-2424. [PMID: 31405653 DOI: 10.1016/j.dsx.2019.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 06/07/2019] [Indexed: 11/22/2022]
Abstract
AIMS To investigate the association of obesity phenotypes with non-obese components of metabolic syndrome (MetS) by considering the presence of general adiposity and central obesity. METHODS We analyzed the data of population-based cross-sectional study of 981 adults' individuals who were community dwelling in urban population of Babol, the north of Iran. The demographic characteristics and anthropometric measures and hypertension were collected with standard method by trained nurses. The fasting blood sugar, CHL, TG, HDL-C and LDL-C were measured by enzymatic method. The presence of cardiometabolic risk factors were analyzed according to the combination of obesity phenotypes either overweight/obese or central obese. The logistic regression model was used to calculate the adjusted odds ratio (OR) of obesity phenotypes in compared with normal weight not central obese in association of presence of metabolic abnormality. RESULTS The 394 (40.6%) individuals were both overweight/obese and central obese and 295 (30.1%) persons were "normal weight not central obese" and the minority 28(2.9%) were normal weight but central obese and the remainder 260 (26.5%) were "overweight/obese not central obese". Overweight/obese not central obese increased significantly the odds of presence of ≥2 non-obese components of metabolic abnormality by 2.17 times (95%CI OR: 1.51, 3.13) but the OR was elevated for the joint phenotypes of overweight/obese and central obese (OR = 4.16 (95%CI: 2.85, 6.06) as compare with normal weight not central obese. CONCLUSIONS Overweight/obese alone increased the risk of cardiometabolic abnormality but being overweight/obese and central obese a further elevated the risk compared with "normal weight not central obese".
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Affiliation(s)
| | - Behzad Heidari
- Dept of Internal Medicine, Ayatollah Rohani Hospital, Babol University of Medical Sciences, Iran
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94
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Utility of the Z-score of log-transformed A Body Shape Index (LBSIZ) in the assessment for sarcopenic obesity and cardiovascular disease risk in the United States. Sci Rep 2019; 9:9292. [PMID: 31243316 PMCID: PMC6594943 DOI: 10.1038/s41598-019-45717-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 06/11/2019] [Indexed: 12/14/2022] Open
Abstract
Body mass index (BMI) has limited accuracy for predicting cardiovascular diseases (CVD) and is not capable of identifying sarcopenic obesity, the combination of sarcopenia (an age-associated decline in muscle mass and physical function) and obesity. To overcome this, the z-score of the log-transformed A Body Shape Index (LBSIZ) was recently introduced as a measure of obesity using waist circumference, height, and weight. We aimed to investigate the association of LBSIZ with sarcopenic obesity and CVD, and propose appropriate cut-off values using the National Health and Nutrition Examination Survey 1999–2016 data. Of 92,062 participants, 40,468 adults (≥20 years) were included. Overall area under curve (AUC) of LBSIZ was 0.735 (95% confidence interval [CI]: 0.716–0.754) for sarcopenic obesity, and 0.695 (95% CI: 0.687–0.703) for CVD. The subgroup analysis of ethnicity/race showed similar results. Waist circumference (WC), BMI, conicity index, body roundness index (BRI), Clinica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE), new BMI, and waist to height ratio (WHtR) showed a negative association with sarcopenic obesity, while LBSIZ and conicity index showed a positive association. The AUC of LBSIZ was significantly higher for sarcopenic obesity than that of conicity index (p < 0.001). The AUC of LBSIZ was significantly higher for CVD than those of parameters including WC, BMI, BRI, CUN-BAE, new BMI, and WHtR (p < 0.001). The AUC for conicity index alone was comparable to that of LBSIZ for CVD. Overall LBSIZ cut-off was 0.35 for both sarcopenic obesity (sensitivity, 65.3%; specificity, 71.5%) and CVD (sensitivity, 63.3%; specificity, 66.6%). These results may be useful not only to identify sarcopenic obesity, but also to conduct CVD risk assessment in the clinical setting.
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95
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Ortega-Loubon C, Fernández-Molina M, Singh G, Correa R. Obesity and its cardiovascular effects. Diabetes Metab Res Rev 2019; 35:e3135. [PMID: 30715772 DOI: 10.1002/dmrr.3135] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 12/21/2022]
Abstract
Obesity is described in terms of body fat percentage or body mass index (BMI), despite the fact that these measures do not give full insight about the body fat distribution. It is presently a consistently growing universal challenge since it has tripled in the last 10 years, killing approximately 28 million people each year. In this review, we aim to clarify the different results of obesity on the working and physiology of the cardiovascular system and to reveal changes in the obesity "paradox"-a variety of cardiovascular outcomes in typical/overweight people. Central fat build-up in ordinary/overweight populaces has been related to expanded occurrences of myocardial infarction, heart failure, or all-cause mortality when contrasted with the obese populace. These discoveries are additionally clarified as the abundance and prolonged vulnerability to free fatty acids (FFAs) in obesity. This has been believed to cause the myocardial substrate to move from glucose to FFAs digestion, which causes lipid gathering in cardiomyocytes, spilling over to other lean tissues, and prompting a general atherogenic impact. This cardiomyocyte lipid aggregation has been demonstrated to cause insulin resistance and cardiovascular hypertrophy, and to lessen the heart functions in general. There is a proof backing the fact that fat tissue is not only an energy reservoir, it also coordinates hormones and proinflammatory cytokines and deals with the energy transition of the body by putting away abundant lipids in diverse tissues.
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Affiliation(s)
- Christian Ortega-Loubon
- Department of Pediatric Cardiac Surgery, Universidad Autonoma de Barcelona, Barcelona, Spain
| | | | - Gauri Singh
- Department of Medicine, University of Miami, Miller School of Medicine, Miami, Florida
| | - Ricardo Correa
- Department of Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
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96
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Mean BMI, visit-to-visit BMI variability and BMI changes during follow-up in patients with acute myocardial infarction with systolic dysfunction and/or heart failure: insights from the High-Risk Myocardial Infarction Initiative. Clin Res Cardiol 2019; 108:1215-1225. [PMID: 30953180 DOI: 10.1007/s00392-019-01453-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 03/13/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND In patients with acute myocardial infarction (MI), BMI < 18.5 kg/m2 and a decrease in BMI during follow-up have been associated with poor prognosis. For BMI ≥ 25 kg/m2, an "obesity paradox" has been suggested. Recently, high visit-to-visit BMI variability has also been associated with poor prognosis in patients with coronary artery disease. AIMS To simultaneously evaluate several BMI measurements and study their association with cardiovascular (CV) outcomes in a large cohort of patients with acute myocardial infarction (MI) and left ventricular (LV) systolic dysfunction, heart failure (HF) or both. METHODS The high-risk MI dataset is pooled from four trials: CAPRICORN, EPHESUS, OPTIMAAL and VALIANT. Mean BMI, change from baseline, and variability were assessed during follow-up. The primary outcome was CV death. Cox-proportional hazard models were performed to study the association between the various BMI parameters and outcomes (median follow-up = 1.8 years). RESULTS A total of 12,719 patients were included (72% male, mean age 65 ± 11 years). Mean, change and visit-to-visit variability in BMI had a non-linear association with CV death (P < 0.001). Mean BMI < 26 kg/m2 (vs. ≥ 26-35 kg/m2) and BMI decrease during follow-up were independently associated with CV death (adjusted HR 1.32, 95% CI 1.16-1.51, P < 0.001 and adjusted HR 1.57, 95% CI 1.40-1.76, P < 0.001, respectively). Low and high BMI variability (< 2% and > 4%) were associated with increased event-rates, but lost statistical significance in sensitivity analysis including patients with ≥ 5 measurements or excluding patients with HF hospitalization, suggesting that BMI variability may be particularly associated with HF hospitalizations. CONCLUSION Mean BMI < 26 kg/m2 and a BMI decrease during follow-up were independently associated with CV death in patients with MI and LV systolic dysfunction, HF or both. These associations likely reflect poorer patient status and causality cannot be inferred.
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97
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Song P, Li X, Bu Y, Ding S, Zhai D, Wang E, Yu Z. Temporal trends in normal weight central obesity and its associations with cardiometabolic risk among Chinese adults. Sci Rep 2019; 9:5411. [PMID: 30931996 PMCID: PMC6443661 DOI: 10.1038/s41598-019-41986-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 03/18/2019] [Indexed: 02/08/2023] Open
Abstract
Normal weight central obesity (NWCO), a distinct phenotype of obesity that is associated with a higher risk of cardiometabolic dysregulation, has received growing attention in the scientific literature. In this study, we aimed to report the prevalence of NWCO in the general Chinese adults and its secular trend from 1993 to 2011. The comorbid cardiometabolic risk of NWCO was also explored. Data from the China Health and Nutrition Survey (CHNS) 1993-2011 were obtained. NWCO was defined as the combination of a BMI of 18.5-23.9 kg/m2 and 1) a waist circumference (WC) of >85 cm in males or >80 cm in females (NWCO by WC); 2) a waist to height ratio (WHtR) of ≥0.5 (NWCO by WHtR); 3) a waist to hip ratio (WHR) of ≥0.9 in males or ≥0.85 in females (NWCO by WHR). We assessed the trend of NWCO prevalence with the generalized estimating equation method. The demographic, socioeconomic, geographic, behavioural and cardiometabolic predictors of NWCO were explored with multivariable logistic regression. From 1993 to 2011, the age-standardized prevalence of NWCO by WC increased from 6.65% (95% CI: 6.09-7.26) to 13.24% (95% CI: 12.58-13.93), and that of NWCO by WHtR and NWCO by WHR rose from 13.18% (95% CI: 12.41-13.98) to 17.06% (95% CI: 16.35-17.79) and from 16.14% (95% CI: 15.3-17.01) to 19.04% (95% CI: 18.25-19.85) respectively. The associated cardiometabolic factors of NWCO (by WC, WHtR and WHR) were hypertension, diabetes, insulin resistance, decreased insulin sensitivity, low high-density lipoprotein and elevated triglyceride. Moreover, NWCO by WC and NWCO by WHtR were associated with a decreased risk of impaired insulin secretion, and NWCO by WC was additionally linked to elevated total cholesterol. The prevalence of NWCO in the general Chinese adults increased significantly from 1993 to 2011. Effective strategies are needed to combat this epidemic and reduce its deleterious health outcomes.
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Affiliation(s)
- Peige Song
- School of Public Health, Xinxiang Medical University, Xinxiang, China
- Centre for Global Health Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Xue Li
- School of Public Health, Xinxiang Medical University, Xinxiang, China
- Centre for Global Health Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Yongjun Bu
- School of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Shibin Ding
- School of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Desheng Zhai
- School of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Erhui Wang
- School of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Zengli Yu
- School of Public Health, Xinxiang Medical University, Xinxiang, China.
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98
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Wan J, Zhou P, Wang D, Liu S, Yang Y, Hou J, Li W, Wang P. Impact of Normal Weight Central Obesity on Clinical Outcomes in Male Patients With Premature Acute Coronary Syndrome. Angiology 2019; 70:960-968. [PMID: 30871333 DOI: 10.1177/0003319719835637] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is a lack of studies that evaluate the association between normal weight central obesity and subsequent outcomes in patients with premature acute coronary syndrome (ACS). We evaluated 338 consecutive male patients (aged ≤ 55 years) with premature ACS. The primary outcomes were all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE). We compared the hazard ratios (HRs) in patients with and without normal weight central obesity using multivariable Cox proportional hazard models. All-cause mortality (16.8%) of patients with normal weight central obesity was much higher than those (7.1%) without normal weight central obesity (P = .008). The incidence of MACCE in patients with and without normal weight central obesity were 40.7 and 23.6% (P = .001), respectively. After multivariable adjustment, the risks of all-cause mortality and MACCE were significantly higher in patients with normal weight central obesity than those without normal weight central obesity (adjusted HR: 1.83; 95% confidence interval [CI]: 1.04-3.31; P = .004 and adjusted HR: 1.62; 95% CI: 1.18-2.27; P = .017, respectively). In conclusion, the risks of all-cause mortality and MACCE were significantly higher in male patients with premature ACS with normal weight central obesity than in those without normal weight central obesity.
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Affiliation(s)
- Jindong Wan
- 1 Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, People's Republic of China.,2 Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan, People's Republic of China
| | - Peng Zhou
- 1 Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, People's Republic of China.,2 Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan, People's Republic of China
| | - Dan Wang
- 1 Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, People's Republic of China.,2 Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan, People's Republic of China
| | - Sen Liu
- 1 Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, People's Republic of China.,2 Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan, People's Republic of China
| | - Yi Yang
- 1 Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, People's Republic of China.,2 Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan, People's Republic of China
| | - Jixin Hou
- 1 Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, People's Republic of China.,2 Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan, People's Republic of China
| | - Wenzhang Li
- 1 Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, People's Republic of China.,2 Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan, People's Republic of China
| | - Peijian Wang
- 1 Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, People's Republic of China.,2 Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan, People's Republic of China
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99
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Kang J, Smith S, Pavitt S, Wu J. Association between central obesity and tooth loss in the non‐obese people: Results from the continuous National Health and Nutrition Examination Survey (
NHANES
) 1999–2012. J Clin Periodontol 2019; 46:430-437. [DOI: 10.1111/jcpe.13091] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 02/14/2019] [Accepted: 02/16/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Jing Kang
- Division of Oral BiologySchool of DentistryUniversity of Leeds Leeds UK
| | - Scott Smith
- Division of Applied Health and Clinical TranslationSchool of DentistryUniversity of Leeds Leeds UK
| | - Susan Pavitt
- Division of Applied Health and Clinical TranslationSchool of DentistryUniversity of Leeds Leeds UK
| | - Jianhua Wu
- Division of Applied Health and Clinical TranslationSchool of DentistryUniversity of Leeds Leeds UK
- Leeds Institute for Data AnalyticsUniversity of Leeds Leeds UK
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100
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Mohamed SF, Haregu TN, Khayeka-Wandabwa C, Muthuri SK, Kyobutungi C. Magnitude and predictors of normal-weight central obesity- the AWI-Gen study findings. Glob Health Action 2019; 12:1685809. [PMID: 31694493 PMCID: PMC6844381 DOI: 10.1080/16549716.2019.1685809] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 10/23/2019] [Indexed: 11/24/2022] Open
Abstract
Background: Normal-weight central obesity is associated with higher mortality than general obesity as defined by body mass index, particularly in the absence of central fat distribution.Objective: The aim of this study was to examine the magnitude and predictors of normal-weight central obesity in an urban informal settlement setting in Kenya.Methods: We used data from the AWI-Gen study, a cross-sectional survey targeting randomly selected consenting adults between the ages of 40-60 in two urban informal settlements of Nairobi between 2014 and 2016. Central obesity was determined using waist circumference, waist to hip ratio, visceral fat thickness, and subcutaneous fat thickness. General obesity was determined using body mass index (BMI).Results: About 20.0% of participants in the study had general obesity. The prevalence of central obesity as measured by waist circumference was 52.0%, by waist-to-hip ratio was 53.5%, by visceral fat thickness was 32.4% and by subcutaneous fat thickness was 49.2%. The prevalence of normal-weight central obesity in the study population was highest when measured by waist to hip ratio (38.1%) and lowest when measured by visceral fat thickness (18.1%). Factors associated with normal-weight central obesity as assesses by waist circumference were being female, of older age, and in full-time employment. Older age was associated with normal-weight central obesity as assessed by waist to hip ratio.Conclusion: The findings highlight a significant prevalence of normal-weight central obesity among adults in a poor urban setting in Kenya, pointing to women as a key target group for focused interventions. Longitudinal studies are needed to establish whether there is a link between normal-weight central obesity and mortality in such settings as has been found in other settings.
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Affiliation(s)
- Shukri F. Mohamed
- Health and Systems for Health Unit (HSH), African Population and Health Research Center (APHRC), Nairobi, Kenya
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Tilahun Nigatu Haregu
- Health and Systems for Health Unit (HSH), African Population and Health Research Center (APHRC), Nairobi, Kenya
- Non-Communicable Disease Unit, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Christopher Khayeka-Wandabwa
- School of Pharmaceutical Science and Technology (SPST), Health Science Platform, Tianjin University, Tianjin, China
| | - Stella Kagwiria Muthuri
- Health and Systems for Health Unit (HSH), African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Catherine Kyobutungi
- Health and Systems for Health Unit (HSH), African Population and Health Research Center (APHRC), Nairobi, Kenya
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