Abdominal adiposity in six populations of West African descent: prevalence and population attributable fraction of hypertension

Spectrum of thyroid function test among type 2 diabetic patients attending a rural health facility, southwest Nigeria: A hospital-based study

Objectives:

The thyroid gland produces hormones that have significant influence on carbohydrate metabolism; its disorders may affect carbohydrate metabolism in type 2 diabetic patients (T2DM) more than the non-diabetic (NDM) patients as reported in various studies. We determined the spectrum of thyroid function tests (TFTs) profile among T2DM in our rural health facility.

Methods:

T2DM patients and NDM patients were recruited for the study. The age, educational level, occupation, marital status, and duration of diabetes were extracted from interviewer’s administered questionnaire. The weight, height, body mass indices (BMIs), and the waist and hip circumferences were measured. Waist-hip ratios (WHR) were calculated for all participants. Venous blood was collected and assayed for free triiodothyronine (fT3), free thyroxine (fT4), and thyroid stimulating hormone (TSH) using a Chemiluminescence Immunoassay (CLIA) 2nd Generation Autoanalyzer. The mean, standard deviation, frequencies, and percentages were calculated for the variables. The student’s t-test and chi-square test were also determined as appropriate.

Results:

Seventy-eight patients made up of 56 T2DM and 22 NDM were evaluated in this study. Fifty-one were males while 27 were females; 67.9% and 59.1% of the female participants were T2DM and NDM, respectively. The WHR was significantly higher in T2DM than NDM (0.92 ± 0.05 versus 0.88 ± 0.06). The TSH was higher in T2DM than the NDM. Forty-four (78.6%) of the T2DM had euthyroid (normal) biochemical pattern; 12 (21.4%) showed abnormal biochemical pattern of euthyroid sick syndrome, subclinical hyperthyroid, and subclinical hypothyroid. Thirty (53.6%) of the T2DM were diagnosed less than five years ago. The value of TSH was increasing with the duration of diabetes but not in a statistically significant way. None of the T2DM showed overt hypothyroid or hyperthyroid test result.

Conclusion:

Thyroid function test may identify diabetics with altered thyroid hormone status that may impact on their metabolic control. Knowledge of the functional state of the thyroid gland can help in achieving a better metabolic control and attenuate the development of complications in T2DM.

Risk factors associated with abdominal obesity in suburban adolescents from a Malaysian district

INTRODUCTION

We aimed to determine the risk factors associated with abdominal obesity (AO) in suburban adolescents.

METHODS

This cross-sectional study included adolescents aged 15-17 years from five randomly selected secondary schools in the Hulu Langat district of Selangor state, Malaysia. Waist circumference (WC) was measured at the midpoint between the lower margin of the last palpable rib and the top of the iliac crest. Information on sociodemographic data, dietary habits, physical activity levels and duration of sleep was obtained via interviewer-administered questionnaires. Participants' habitual food intake was determined using a 73-item Food Frequency Questionnaire.

RESULTS

Among 832 participants, 56.0% were girls; 48.4% were Malay, 40.5% Chinese, 10.2% Indian and 0.8% of other ethnic groups. Median age and WC were 16 (interquartile range [IQR] 15-16) years and 67.9 (IQR 63.0-74.6) cm, respectively. Overall prevalence of AO (> 90th percentile on the WC chart) was 11.3%. A higher proportion (22.4%) of Indian adolescents were found to have AO compared with Malay and Chinese adolescents. Logistic regression analysis showed that female gender (adjusted odds ratio [OR] 7.064, 95% confidence interval [CI] 2.087-23.913; p = 0.002), Indian ethnicity (adjusted OR 10.164, 95% CI 2.182-47.346; p = 0.003), irregular meals (adjusted OR 3.193, 95% CI 1.043-9.774; p = 0.042) and increasing body mass index (BMI) (adjusted OR 2.867, 95% CI 2.216-3.710; p < 0.001) were significantly associated with AO.

CONCLUSION

AO was common among Malaysian adolescents. Female gender, Indian ethnicity, irregular meals and increasing BMI were significant risk factors.

Diabetes mellitus and obesity in the French Caribbean: A special vulnerability for women?

The objective of this study was to analyze the prevalence, awareness, treatment, and control of diabetes and its risk factors among French Caribbean adults. This cross-sectional study included 18-74-year olds (N = 2252; 56.5 percent women) who underwent a heath examination in Guadeloupe during July-December 2014. Diabetes was defined as using antidiabetic treatment, or fasting glucose ≥7 mmol/l, and glycated hemoglobin (HbA1c) ≥6.5 percent; diabetes control was defined as HbA1c < 7 percent. Multilevel logistic regression was used. Diabetes prevalence was 8.2 percent for women and 5 percent for men (age-adjusted odds ratio [aOR] for women = 2.0; 95 percent confidence interval [CI]: 1.4-2.9). The proportion of women with diabetes who were aware of it was 84.5 versus 67.3 percent in men (aOR = 2.7; 95 percent CI: 1.2-6.2). Nearly, all diagnosed participants were being treated. In less than a third of diabetics in both sexes was diabetes control obtained. Most women (55.3 percent) had a waist circumference at or above the National Cholesterol Education Program thresholds versus 14 percent of men (aOR = 9.3; 95 percent CI: 7.5-11.7), which wholly accounted for excess diabetes in women. In women, obesity and diabetes were associated with low education and income. In this French Caribbean sample, abdominal obesity and diabetes affected more women. Diabetes was rarely controlled. A comprehensive women's health policy for the prevention of abdominal obesity and diabetes is needed.

Association of body mass index and abdominal adiposity with atherogenic lipid profile in Nigerians with type 2 diabetes and/or hypertension

Background:

We explored the relationship between anthropometric indices (obesity and abdominal adiposity) and the presence of an atherogenic lipid profile in Nigerians with major cardiovascular risk factors (type 2 diabetes mellitus-T2DM, hypertension-HBP, and concomitant disease).

Materials and Methods:

Using a prospective design, 278 patients with T2DM, HBP, or concomitant disease, attending out-patient diabetes and hypertension clinics at a tertiary institution in Nigeria were evaluated. All patients were cholesterol-lowering oral medication naοve. Demographic and clinical data and anthropometric measurements were documented. Fasting lipid profiles were measured in all cases. The cut-off points for defining dyslipidaemia were: Elevated total cholesterol (TC) (mg/dL) ≥200, elevated low-density lipoprotein cholestrol (LDL-C) (mg/dL) ≥100, low high-density lipoprotein cholesterol (HDL-C) (mg/dL) <40 for men and <50 for women, and high triglycerides (TG) (mg/dL) ≥150 mg/dL.

Results:

We found a significantly higher mean BMI (kg/m²) in the HBP group (30.5 ± 6.0) compared to T2DM (28.1 ± 5.9) and concomitant HBP and T2DM groups (29.4 ± 5.2) (ANOVA; P = 0.02). The most frequent dyslipidaemia was elevated LDL-C in 92 (96.8%) HBP, 73 (85.9%) T2DM and 79 (80.6%) concomitant disease. The frequency of low HDL-C was highest in T2DM (68.2%) compared to the other 2 groups (P = 0.03).

Conclusions:

Only TG levels were found to relate with any anthropometric index (waist circumference (WC) in this case) in Nigerians with major cardiovascular risk factors in this study. Routine anthropometric indices do not appear to be reliable surrogates for atherogenicity measured by abnormalities in TC, LDL-C and HDL-C.

Allostatic load burden and racial disparities in mortality

BACKGROUND

Black-white disparities in mortality persist after adjustment for socioeconomic status and health behaviors. We examined whether allostatic load, the physiological profile influenced by repeated or chronic life stressors, is associated with black-white mortality disparities independent of traditional sociobehavioral risk factors.

METHODS

We studied 4515 blacks and whites aged 35 to 64 years from the third National Health and Nutrition Examination Survey (1988-1994), using the linked mortality file, to ascertain participant deaths through 2006. We estimated unadjusted sex-specific black-white disparities in cardiovascular/diabetes-related mortality and noninjury mortality. We constructed baseline allostatic load scores based on 10 biomarkers and examined attenuation of mortality disparities in 4 sets of sex-stratified multivariate models, sequentially adding risk factors: (1) age/clinical conditions, (2) socioeconomic status (SES) variables, (3) health behaviors, and (4) allostatic load.

RESULTS

Blacks had higher allostatic load scores than whites; for men, 2.5 vs 2.1, p < .01; and women, 2.6 vs 1.9, p < .01. For cardiovascular/diabetes-related mortality among women, the magnitude of the disparity after adjustment for other risk factors (hazard ratio [HR], 1.63; 95% confidence interval [CI], 0.96-2.75) decreased after adjustment for allostatic load (HR, 1.15; 95% CI, 0.70-1.88). For noninjury mortality among women, the magnitude of the disparity after adjustment for other risk factors (HR, 1.43; 95% CI, 1.00-2.04) also decreased after adjustment for allostatic load (HR, 1.26; 95% CI, 0.90-1.78). For men, disparities were attenuated but persisted after adjustment for allostatic load.

CONCLUSIONS

Allostatic load burden partially explains higher mortality among blacks, independent of SES and health behaviors. These findings underscore the importance of chronic physiologic stressors as a negative influence on the health and lifespan of blacks in the United States.

Hypertension in sub-Saharan Africa: cross-sectional surveys in four rural and urban communities

Background

Cardiovascular disease (CVD) is the leading cause of adult mortality in low-income countries but data on the prevalence of cardiovascular risk factors such as hypertension are scarce, especially in sub-Saharan Africa (SSA). This study aims to assess the prevalence of hypertension and determinants of blood pressure in four SSA populations in rural Nigeria and Kenya, and urban Namibia and Tanzania.

Methods and Findings

We performed four cross-sectional household surveys in Kwara State, Nigeria; Nandi district, Kenya; Dar es Salaam, Tanzania and Greater Windhoek, Namibia, between 2009–2011. Representative population-based samples were drawn in Nigeria and Namibia. The Kenya and Tanzania study populations consisted of specific target groups. Within a final sample size of 5,500 households, 9,857 non-pregnant adults were eligible for analysis on hypertension. Of those, 7,568 respondents ≥18 years were included. The primary outcome measure was the prevalence of hypertension in each of the populations under study.

The age-standardized prevalence of hypertension was 19.3% (95%CI:17.3–21.3) in rural Nigeria, 21.4% (19.8–23.0) in rural Kenya, 23.7% (21.3–26.2) in urban Tanzania, and 38.0% (35.9–40.1) in urban Namibia. In individuals with hypertension, the proportion of grade 2 (≥160/100 mmHg) or grade 3 hypertension (≥180/110 mmHg) ranged from 29.2% (Namibia) to 43.3% (Nigeria). Control of hypertension ranged from 2.6% in Kenya to 17.8% in Namibia. Obesity prevalence (BMI ≥30) ranged from 6.1% (Nigeria) to 17.4% (Tanzania) and together with age and gender, BMI independently predicted blood pressure level in all study populations. Diabetes prevalence ranged from 2.1% (Namibia) to 3.7% (Tanzania).

Conclusion

Hypertension was the most frequently observed risk factor for CVD in both urban and rural communities in SSA and will contribute to the growing burden of CVD in SSA. Low levels of control of hypertension are alarming. Strengthening of health care systems in SSA to contain the emerging epidemic of CVD is urgently needed.

Prevalence, associated factors and relationship between prehypertension and hypertension: a study of two ethnic African populations in Northern Nigeria

To determine the prevalence and relationship between prehypertension and hypertension, we studied 782 ethnic Hausa and Fulanis (men, 409; women, 373) aged 38.9±13.9 years recruited by multistage cluster sampling. Demographic, anthropometry, metabolic and JNC VII-based blood pressure categories were obtained and analysed using univariate and multivariate models. The prevalence rates of prehypertension and hypertension were 58.7% (men 59.2%, women 58.2%) and 24.8% (men 25.9%, women 23.6%), respectively. Only 16.5% of the population had JNC VII defined optimum blood pressure. Compared to hypertension, prehypertension had earlier onset (second versus third decade) and peak (fourth versus fifth decade) of life. The peak and trough prevalence of hypertension and prehypertension, respectively were observed in the 5th decade of life. Obesity, abnormalities of glucose metabolism and insulin resistance were the major factors associated with prehypertension and hypertension. Multivariate analysis identified obesity and impaired glucose tolerance as independent predictors of hypertension. Of those with hypertension, 13.9% were aware of their high blood pressure status of which 85.7% were commenced on treatment and 12.5% achieved blood pressure control. Overall, 1.5% of the study population had blood pressure <140/90 mm Hg. It is concluded that less than 20% of people of Hausa and Fulani ethnicities had optimum blood pressure. These are predominantly in their second decade of life suggesting that rise in blood pressure begins early in this population. The fifth decade of life may represent a period of transition from prehypertension to hypertension.

Relationship of anthropometric indicators with blood pressure levels and the risk of hypertension in Nigerian adults

BACKGROUND AND PURPOSE

Studies on cardiovascular risks in relation to anthropometric factors are limited in Sub-Sahara Africa. The aims of this study were to examine the relationship between anthropometric parameters and blood pressure; and to evaluate body mass index (BMI) across the range of underweight and obesity as a primary risk factor of hypertension in adult Nigerians.

MATERIAL AND METHODS

2097 adults aged between 20 and 100 years consented and participated in this door-to-door survey. All participants underwent blood pressure and anthropometric measurements using standard procedures. The population study was separated in normotensive and hypertensive males and females and the possible risk for hypertension were categorized into different classes of value based on BMI definition.

RESULTS

The relative risks (odds ratio [OR] and 95% confidence interval [CI]) of developing hypertension among the obese compared with the underweight, normal weight, and overweight persons were (OR 5.75; CI 5.67-5.83), (OR 1.73; CI 1.65-1.81), and (OR 1.54; CI 1.46-1.62) for all the participants, respectively. Among obese (BMI >/= 30.0 Kg/m(2)) males, the OR for hypertension was three times (OR 2.78; CI 2.76-2.80) that of normal weight (BMI >/= 18.5-24.9 Kg/m(2)) males. Females with obesity had a risk of hypertension three times (OR 3.34; CI 3.33-3.35) that of normal weight females.

CONCLUSION

Our results indicated that the there was a significant positive correlation of obesity indicator with blood pressure. In Nigeria, we found a strong gradient between higher BMI and increased risk of hypertension among all ages. Approaches to reduce the risk of hypertension may include prevention of overweight and obesity.

The relationship of body mass index and waist-hip ratio on the 9-year incidence of diabetes and hypertension in a predominantly African-origin population

PURPOSE

To provide 9-year incidence data for diabetes and hypertension and evaluate the relationship of body mass index (BMI) and waist-hip ratio (WHR) on these comorbidities in an African Caribbean population.

METHODS

This was a longitudinal, population-based cohort study, including 4,631 participants at baseline; 2,793 were reexamined at the 9-year follow-up. Diabetes was defined by self-reported history and/or glycosylated hemoglobin measurement; hypertension was defined as systolic blood pressure (BP) >or=140 mm Hg and/or diastolic BP >or=90 mm Hg and/or use of antihypertensive treatment. Incidence rates were based on persons without such conditions at baseline.

RESULTS

The 9-year incidence of hypertension (95% confidence interval) was higher in women (37.5% [34.0-41.2]) than men (30.6% [26.9-34.6]), whereas the incidence of diabetes was similar for both genders (14%). Body size was related to both conditions; however, the incidence of hypertension was more strongly associated with WHR, whereas diabetes had a stronger association with BMI.

CONCLUSIONS

Incidence rates for diabetes and hypertension were high in this cohort, and the relationship of BMI and WHR on these comorbidities was significant. These findings suggest the need to develop tailored interventions and preventive strategies in this African Caribbean and similar high-risk populations.

[Relative importance of body mass index and waist circumference for hypertension in adults]

OBJECTIVE

To assess the relative importance of Body Mass Index (BMI) and waist circumference for the determination of hypertension in adults.

METHODS

Cross sectional analysis of a sample of employees (N=1,584), aged 18 to 64 years, from a private general hospital in the city of São Paulo, Brazil. Data collection included the application of a structured questionnaire and blood pressure, weight, high, and waist circumference measurements. Hypertension was defined as blood pressure levels >or= 140/90 mmHg or reported use of anti-hypertensive medication. The relative importance of BMI and waist circumference was evaluated by calculating the attributable fraction of hypertension corresponding to each anthropometric indicator, employing both the usual cut-off points as well as cut-off points based on the observed distribution of the indicator in the population. In addition, an indicator combining simultaneously BMI and abdominal circumference values was also developed.

RESULTS

Prevalence of hypertension was 18.9% (26.9% in men and 12.5% in women). In men, the fraction of hypertension attributable to BMI exceeded the fraction attributable to waist circumference based on the usual cut-off points for the indicators (56% vs. 48%, respectively) and also considering the quartiles of the observed distribution for these indicators (73% vs. 69%, respectively). In women, the fraction of hypertension attributable to waist circumference was slightly higher than the fraction attributable to BMI based on the usual cut off points for both indicators (44% vs. 41%), but the reverse was true when quartiles of the observed distribution were used (41% vs. 57%, respectively). In women only, the fraction of hypertension attributable to the indicator combining BMI and waist circumference (64%) was higher that observed using each indicator alone.

CONCLUSIONS

Both BMI and abdominal circumference were positively and independently associated with the occurrence of arterial hypertension, the influence of BMI being higher among men.

Hypertension In Sub-Saharan Africa

Hypertension is an important public health challenge worldwide. Information on the burden of disease from hypertension is essential in developing effective prevention and control strategies. An up-to-date and comprehensive assessment of the evidence concerning hypertension in sub-Saharan Africa is lacking. A literature search of the PUBMED database was conducted and supplemented by a manual search of bibliographies of retrieved articles. The search was restricted to population based studies on hypertension in sub-Saharan Africa published between January 1975 and May 2006. Data were extracted after a standard protocol and using standard data collection forms. Thirty-seven publications met the inclusion criteria. The prevalence of hypertension varied extensively between and within studies. Prevalence of hypertension was higher in urban than rural studies in all studies that covered both types of area, and also increased with increasing age in most studies. In most studies less than 40% of people with blood pressure above the defined normal range had been previously detected as hypertensive. Of people with previously diagnosed hypertension, less than 30% were on drug treatment in most studies, and less than 20% had blood pressure within the defined normal range. Hypertension is of public health importance in sub-Saharan Africa, particularly in urban areas, with evidence of considerable under-diagnosis, treatment, and control. There is an urgent need to develop strategies to prevent, detect, treat, and control hypertension effectively in the African region.

Regional fat localizations and racial/ethnic variations in odds of hypertension in at-risk American adults

The objective of this study was to determine the contribution of regional fat localizations defined as abdominal (AO) or truncal (TO) obesity in racial/ethnic differences to the prevalence odds of hypertension in overweight American adults. Data (n=5,694) from the 1999-2002 US National Health and Nutrition Examination Survey were utilized for this analysis. Abdominal obesity was defined as waist circumference >or=102 and >or=88 cm for men and women, respectively. Truncal obesity was defined using ratio of subscapular to triceps skinfold thickness and were >or=2.24 and >or=1.32, for men and women, respectively. Prevalence odds ratios from gender-specific logistic regression models were used to evaluate the contribution of regional fat localizations to racial/ethnic variation in hypertension. Statistical adjustment was made for age, education, alcohol intake and body mass index. In both men and women, coexistence of AO and TO was associated with much higher prevalence odds of hypertension than association due to each of the regional fat localizations. In men, coexistence of AO and TO was associated with 1.99, 2.47 and 2.10 increased prevalence odds of hypertension in Whites, Blacks and Mexican Americans, respectively. The corresponding values in women were 2.83, 4.07 and 3.61 in Whites, Blacks and Mexican Americans, respectively. The coexistence of AO and TO appears to be the culprit that contributes to high blood pressure on top of body mass index. Weight reduction programs that are targeted toward abdominal and truncal regions in at-risk populations and along racial/ethnic lines may help to alleviate racial/ethnic disparity in risk of hypertension.

Acculturation to Western society as a risk factor for high blood pressure: a meta-analytic review

OBJECTIVE

A number of studies have documented that acculturation to western society is related to an increase in blood pressure (BP). Although there is evidence that higher socioeconomic status appears related to better cardiovascular health, increasing acculturation to western society appears related to worse cardiovascular health. The purpose of this meta-analysis was to investigate the association between acculturation and BP.

METHODS

Literature searches yielded 125 relevant research manuscripts, which were coded by teams of two independent raters. This study was conducted in 2003 and 2004, and research databases such as MEDLINE and PsychINFO were searched through 2004. Measures of association (effect sizes) were extracted for both systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings. Random effects models were used to analyze the resulting data.

RESULTS

The overall effect sizes associated with acculturation were 0.28 for SBP and 0.30 for DBP, with increasing acculturation to western society related to higher BP. More acculturated individuals had an average of 4 mm Hg higher BP than less acculturated individuals, which is similar to the effect sizes of known risk factors for high BP such as diet and physical activity. The effects of acculturation on BP appear to be universal, with similar effect sizes found across all regions of the world. Change in BP due to acculturation was not related to body mass index (BMI) or cholesterol but was related to length of residence in the new culture, with the largest effect sizes seen on initial entry and then decreasing rapidly within the first few years. Sudden cultural changes, such as migration from rural to urban settings, resulted in the largest effect sizes, which finding supports the hypothesis that the stress of cultural change is important role in the acculturation effect.

CONCLUSIONS

Acculturation to western society is associated with higher BP, and the distress associated with cultural change appears to be more influential than changes in diet or physical activity. Future studies would benefit from investigating how cultural change affects health and examining whether some non-Western cultural values and practices are health protective.

Hip girth as a predictor of abdominal adiposity in postmenopausal women

OBJECTIVES

Our primary objective was to determine whether hip girth could accurately predict abdominal fat and total body fat in postmenopausal women. A secondary objective was to investigate the relation between body mass index (BMI) and hip girth in postmenopausal women.

METHODS

Body weight, height, girths, skinfolds, and whole-body dual-energy x-ray absorptiometric scans were obtained in 75 postmenopausal women ages 45 to 76 y. Total body fat, abdominal fat, and the ratio of abdominal fat to lean mass (F:L) were calculated from the dual-energy x-ray absorptiometric scans. Equations predicting total and abdominal fat were developed for 50 subjects by using stepwise multiple regression analysis. These equations were then cross-validated in the remaining 25 subjects.

RESULTS

Hip girth was a strong predictor of total fat (r = 0.86, P < 0.0001, standard error of the estimate = 4.9 kg) and abdominal fat (r = 0.92, P < 0.0001, standard error of estimate = 0.84 kg); with age added, the standard errors of the estimate were 3.8 and 0.8 kg, respectively. Hip girth correlated with BMI (r = 0.89, P < 0.0001). The "healthy" BMI cutoff value lower than 25 kg/m2 equated to a hip girth smaller than 100 cm and an abdominal F:L lower than 1.0. Waist girth (r = 0.83, P < 0.0001) and hip girth (r = 0.76, P < 0.0001) were good predictors of abdominal F:L.

CONCLUSIONS

Hip girth is a practical and useful predictor of abdominal and total adiposity in postmenopausal women. A hip girth of 100 cm or an abdominal F:L of 1.0 can be used as an equivalent cutoff value for the "healthy" BMI value of 25 kg/m2 in this group of women.

Is waist circumference a useful measure in predicting health outcomes in the elderly?

OBJECTIVE

To examine the effect of age on the relationship between body mass index (BMI) and waist circumference (WC), and the usefulness of BMI, WC and waist-hip ratio (WHR) in predicting mortality and cardiovascular risk in the elderly population.

DESIGN

Longitudinal observational study of 36 months duration.

SUBJECTS AND METHOD

A stratified random sample of 2,032 Chinese subjects (990 male, 1,033 female) mean age (s.d.) 80.1 (7.5), interviewed and examined at baseline and after 36 months. Deaths and presence of diabetes mellitus and hypertension were documented. A younger data set of 1,010 subjects (500 male, 510 female), mean age (s.d.) 45.5 (11.6), was used for comparison of the BMI-WC relationship between younger and older subjects. In predicting outcomes using different values of BMI, WC and WHR, receiver operating characteristic curve analysis was used to derive cut-off values with optimal sensitivity and specificity, and the likelihood ratios for mortality, diabetes and hypertension for different anthropometric values were plotted.

RESULTS

The waist circumference values corresponding to BMI values of 25 and 30 kg/m(2) were higher in elderly (92 and 103 cm for men; 88 and 99 cm for women) compared with younger subjects (85 and 97 cm for men; 78 and 88 cm for women). BMI and WC are inversely associated with mortality, in both men and women, positively associated with diabetes in men but not in women. WC was positively associated with hypertension in men and women. WHR was not associated with any outcome measures. The anthropometric measurement at the point of intersection of the likelihood curves for mortality and diabetes may be considered the optimum value, being BMI=21 kg/m(2) for men and 25 kg/m(2) for women, WC between 80 and 85 cm, and WHR 0.88-0.90.

CONCLUSION

Waist measurement values for predicting health outcomes in elderly people aged 70 y and over are different compared with younger subjects, and have similar predictive accuracy compared with body mass index. Waist-hip ratio is not a useful predictor.

Predicting incident diabetes in Jamaica: the role of anthropometry

OBJECTIVE

To evaluate the performance of the body mass index (BMI), waist circumference, waist-to-hip ratio (WHR), and waist-to-height ratio (WHTR) in predicting incident diabetes in Jamaica.

RESEARCH METHODS AND PROCEDURES

A cohort of 728 nondiabetic adults (290 men and 438 women), ages 25 to 74 years and residents of Spanish Town, Jamaica, were followed for a mean of 4 years. Participants had fasting and 2-hour postchallenge glucose concentrations measured at baseline and follow-up.

RESULTS

There were 51 cases of incident diabetes (17 men and 34 women). All indices were independent predictors of diabetes, and none was clearly superior. The area under the receiver operating characteristics curves (95% confidence interval) for BMI was 0.74 (0.59 to 0.88) for men and 0.62 (0.51 to 0.72) for women. For waist circumference, these values were 0.78 (0.65 to 0.91) in men and 0.61 (0.50 to 0.71) in women. Similar results were obtained for WHR and WHTR. "Optimal" cut-off points for BMI were 24.8 kg/m(2) (men) and 29.3 kg/m(2) (women). For waist circumference, these were 88 cm and 84.5 cm for men and women, respectively. Corresponding values for WHR were 0.87 and 0.80 and for WHTR were 0.51 and 0.54, respectively.

DISCUSSION

Cut-off points for waist circumference and WHR were similar to those proposed in developed countries for women but lower in men. Waist circumference could be useful in health promotion as an alternative to BMI.

Large waist circumference and risk of hypertension

OBJECTIVE

To examine the relationship between 24 h ambulatory blood pressure monitoring and three commonest anthropometric measurements for obesity--body mass index (BMI), waist-to-hip ratio (WHR) and waist circumference (W).

DESIGN

Cross-sectional survey among outpatients at the Obesity Research Center.

SUBJECTS AND METHODS

Four-hundred and sixty-one overweight or obese subjects, non-diabetic, otherwise healthy, aged 20-70 y, of either sex, were consecutively recruited. All subjects underwent 24 h ambulatory blood pressure monitoring. The population study was separated in normotensive and hypertensive males and females and the possible risk factors for hypertension (W, WHR, BMI and age) were subdivided into different classes of values.

RESULTS

Logistic regression shows that W is the most important anthropometric factor associated with the hypertensive risk. Among males with W> or =102 cm the odds ratio (OR) for hypertension is three times that of males with W<94 cm using casual BP measure (OR 3.04), nearly four times higher using 24 h BP mean (OR 3.97), and even five times higher using day-time BP mean (OR 5.19). Females with W> or =88 cm have a risk for hypertension twice that of females with W<80 cm, whatever BP measurement was take (casual, 24 h or day-time). Males with WHR> or =0.96 and females with WHR> or =0.86 show significant OR for hypertension only by 24 h BP measurement and by day-time BP measurement. BMI seems to have no significant relationship to hypertensive risk. Age shows a significant relationship to hypertensive risk only considering males aged > or =55 y and females aged > or =50 y.

CONCLUSION

The waist circumference seems to have a strong association with the risk of hypertension, principally by the ambulatory BP monitoring, when compared with casual BP measurement.

Nutritional consequences of the African diaspora

Along with their foods and dietary customs, Africans were carried into diaspora throughout the Americas as a result of the European slave trade. Their descendants represent populations at varying stages of the nutrition transition. West Africans are in the early stage, where undernutrition and nutrient deficiencies are prevalent. Many Caribbean populations represent the middle stages, with undernutrition and obesity coexisting. African-Americans and black populations in the United Kingdom suffer from the consequences of caloric excess and diets high in fat and animal products. Obesity, non-insulin-dependent diabetes mellitus, hypertension, coronary heart disease, and certain cancers all follow an east-to-west gradient of increasing prevalence. Public health efforts must focus not only on eradicating undernutrition in West Africa and the Caribbean but also on preventing obesity, hypercholesterolemia, and their consequences. Fortunately, a coherent and well-supported set of recommendations exists to promote better nutrition. Implementation of it founders primarily as a result of the influence of commercial and political interests.

Overweight, obesity, and blood pressure: the effects of modest weight reduction

Several large epidemiological studies have shown an association between body mass index and blood pressure in normal weight and overweight patients. Weight gain in adult life especially seems to be an important risk factor for the development of hypertension. Weight loss has been recommended for the obese hypertensive patient and has been shown to be the most effective nonpharmacological treatment approach. However, long-term results of weight loss programs are disappointing with people often regaining most of the weight initially lost. In recent years, a modest weight loss, defined as a weight loss of 5% to 10% of baseline weight, has received increasing attention as a new treatment strategy for overweight and obese patients. A more gradual and moderate weight loss is more likely to be maintained over a longer period of time. Several studies have confirmed the blood pressure-lowering effect of a modest weight loss in both hypertensive and nonhypertensive patients. A modest weight loss can normalize blood pressure levels even without reaching ideal weight. In patients taking antihypertensive medication, a modest weight loss has been shown to lower or even discontinue the need for antihypertensive medication. In patients with high normal blood pressure, a modest weight loss can prevent the onset of frank hypertension. The blood pressure-lowering effect of weight loss is most likely a result of an improvement in insulin sensitivity and a decrease in sympathetic nervous system activity and occurs independent of salt restriction. In conclusion, a modest weight loss that can be maintained over a longer period of time is a valuable treatment goal in hypertensive patients.