Waist circumference and the risk of hypertension and prediabetes among Filipino women

Waistline to thigh circumference ratio as a predictor of MAFLD: a health care worker study with 2-year follow-up

BACKGROUND

This study aimed to determine whether the waist-to-thigh ratio (WTTR) is associated with the incidence of metabolic-associated fatty liver disease (MAFLD) in health care workers.

METHODS

There were 4517 health care workers with baseline data and results from 2 follow-up examinations. We divided the subjects into 3 groups according to baseline WTTR and used the Cox hazard regression model to estimate MAFLD risk.

RESULTS

The WTTRs were categorized by tertiles at baseline using the values 1.58 and 1.66. Patients with higher WTTR tended to have significantly greater values for the following factors, body mass index (BMI), fasting blood glucose (FPG), systolic blood pressure, diastolic blood pressure, total cholesterol (TC), triglycerides (TG), low-density lipoprotein-cholesterol (LDL-C) and neck circumference. The incidence of MAFLD significantly increased with increasing WTTR tertiles (5.74%, 12.75% and 22.25% for the first, second and third tertiles, respectively, P < 0.05 for trend). Kaplan-Meier(K-M) survival analysis revealed a significant tendency towards increased MAFLD risk with increasing WTTR tertile. In the fully adjusted model, the hazard ratios (95% CIs) for MAFLD in the second, third WTTR tertiles compared with the first quartile were 2.17(1.58,2.98), 3.63(2.70,4.89), respectively, third neck circumference tertiles compared with the first quartile were 2.84(1.89,4.25), 8.95(6.00,13.35), respectively. Compared with those of individuals with a BMI > 23 kg/m2, the associations between WTTR and MAFLD incidence were more pronounced in subjects with a BMI < 23 kg/m2. Similarly, the difference in neck circumference was more pronounced in these patients with a BMI < 23 kg/m2.

CONCLUSIONS

Our results revealed that the WTTR is an independent risk factor for MAFLD, and there was a dose‒response relationship between the WTTR and MAFLD risk. The neck circumference was significantly different in subjects with a BMI < 23 kg/m2. This approach provides a new way to predict the incidence rate of MAFLD.

Socioeconomic status is negatively associated with immunosenescence but positively associated with inflammation among middle-aged women in Cebu, Philippines

BACKGROUND

Socioeconomic status (SES) gradients in health are well-documented, and while biological pathways are incompletely understood, chronic inflammation and accelerated immune aging (immunosenescence) among lower SES individuals have been implicated. However, previous findings have come from samples in higher income countries, and it is unclear how generalizable they are to lower- and middle-income countries (LMIC) with different infectious exposures and where adiposity-an important contributor to chronic inflammation-might show different SES patterning. To address this gap, we explored associations between SES and inflammation and immunosenescence in a sample of women in Cebu, Philippines.

METHODS

Data came from the mothers of the Cebu Longitudinal Health and Nutrition Survey birth cohort (mean age: 47.7, range: 35-69 years). SES was measured as a combination of annual household income, education level, and assets. Chronic inflammation was measured using C-reactive protein (CRP) in plasma samples from 1,834 women. Immunosenescence was measured by the abundance of exhausted CD8T (CD8 + CD28-CD45RA-) and naïve CD8T and CD4T cells, estimated from DNA methylation in whole blood in a random subsample of 1,028. Possible mediators included waist circumference and a collection of proxy measures of pathogen exposure.

RESULTS

SES was negatively associated with the measures of immunosenescence, with slight evidence for mediation by a proxy measure for pathogen exposure from the household's drinking water source. In contrast, SES was positively associated with CRP, which was explained by the positive association with waist circumference.

CONCLUSIONS

Similar to higher income populations, in Cebu there is an SES-gradient in pathogen exposures and immunosenescence. However, lifestyle changes occurring more rapidly among higher SES individuals is contributing to a positive association between SES and adiposity and inflammation. Our results suggest more studies are needed to clarify the relationship between SES and inflammation and immunosenescence across LMIC.

Association between Arterial Hypertension and Laboratory Markers, Body Composition, Obstructive Sleep Apnea and Autonomic Parameters in Obese Patients

BACKGROUND

Systemic arterial hypertension (SAH) is a multifactorial disease, highly prevalent and associated with health risks.

OBJECTIVE

The purpose of this study was to investigate the association between SAH and laboratory, anthropometric, heart rate variability (HRV), and obstructive sleep apnea markers and, secondarily, to analyze the sensitivity and specificity of the variables that are independent factors in the association.

METHODS

Cross-sectional study with 95 obese patients treated at an obesity referral clinic in Salvador, BA, Brazil. SAH data were obtained from electronic medical records. The sample was stratified in the Normotensive Group (NG) and the Hypertensive Group (HG), and laboratory markers, body composition, polysomnography, and HRV were measured to evaluate the association of SAH with the predictor variables. For the analysis, p<0.05 was adopted.

RESULTS

The average age of the NG was 36.3 ± 10.1 and HG 40.4 ± 10.6 years; 73.7% were women in the NG and 57.9% in HG; 82.4% in HG had insulin resistance. In the multivarious logistics regression model with adjustments in age, sex, height, and oxyhemoglobin saturation, SAH was inversely associated with fasting plasma glucose mg/dL (odds ratio [OR] = 0.96; 95% confidence interval [CI] = 0.92-0.99) and visceral fat area (VFA) cm2(OR = 0.98; 95% CI = 0.97-0.99). The area under the VFA curve was 0.728; CI 95% (0.620-0.836); fasting plasma glucose 0.693;CI 95% (0.582-0.804).

CONCLUSIONS

Lower VFA and fasting plasma glucose concentrations were inversely associated with SAH. In addition, fasting plasma glucose and VFA showed a high sensitivity for SAH screening.

C-Reactive Protein Levels in relation to Incidence of Hypertension in Chinese Adults: Longitudinal Analyses from the China Health and Nutrition Survey

Objective

To explore the association between high sensitivity C-reactive protein (hs-CRP) levels and incident hypertension, as well as the association between hs-CRP levels and related covariates, in a Chinese adult population.

Methods

This study was based on the China Health and Nutrition Survey, a continuing open, large-scale prospective cohort study. Adult participants who were free of hypertension were included at baseline survey in 2009 and were followed up in 2015 (follow-up rate: 77.45%). The hs-CRP was measured using the immunoturbidimetric method and divided into three groups: low-risk group (0 ≤ hs-CRP <1 mg/L), average-risk group (1 ≤ hs-CRP <3 mg/L), and high-risk group (3 ≤ hs-CRP ≤10 mg/L). Definite diagnosis of hypertension in the follow-up survey in 2015 was the endpoint event of this study. The areas under the curve (AUC) of the receiver operating characteristic (ROC) curve analyses were used to evaluate the predictive value of the hs-CRP.

Results

3794 participants were finally included as study sample, of whom 912 developed hypertension during a 6-year follow-up period (incidence: 24.1%). The incidences of hypertension in hs-CRP low-risk, average-risk, and high-risk groups were 17.6% (200/1135), 25.9% (521/2015), and 29.7% (191/644), respectively. Spearman's correlation analyses showed that there was significant positive correlation between hs-CRP levels and waist circumference, total triglycerides, total cholesterol, age, body mass index, and homeostasis model assessment of insulin resistance index. Stepwise regression analyses showed that participants in the hs-CRP high-risk group had a 46.2% higher risk of developing hypertension compared with those in the hs-CRP low-risk group (odds ratio: 1.462, 95% confidence interval: 1.018–2.101). Baseline systolic and diastolic blood pressure levels and waist circumference contributed the most to the development of hypertension with R² of 0.076, 0.052, and 0.039, respectively, while hs-CRP had lower area under the curve (AUC) for hypertension, adding baseline BP and WC to the prediction model increased the AUC to 0.708 (95% CI: 0.681–0.735).

Conclusion

This study revealed a weak positive association between CRP levels and future incidence of hypertension in the Chinese population. The combination of hs-CRP with baseline BP and waist circumference (WC) had a higher predictive value for hypertension (AUC: 0.708), but the predictive value was still limited.

Anthropometry did not approach adequate predictive accuracies for detecting elevated fasting plasma glucose or hemoglobin A1c levels among Chinese children aged 7-9 years

AIMS/INTRODUCTION

Elevated concentrations of fasting plasma glucose (FPG) or hemoglobin A1c (HbA1c) are well-established independent risk factors for progression to diabetes, cardiovascular comorbidities and mortality. Most previous studies on the relationships of anthropometric measures with hyperglycemia were carried out among adults and adolescents, but few data are available for the performance predication of the predictors for diagnosing elevated FPG or HbA1c among young children.

MATERIALS AND METHODS

Involving 5,556 students of aged 7-9 years, a school-based cross-sectional survey was carried out between March and June 2019 in Shenzhen, China. Receiver operating characteristic curve analysis was utilized.

RESULTS

The median was 4.6 (interquartile range [IQR] 4.3-4.8) mmol/L for FPG and 5.3% (IQR 5.1-5.5%) for HbA1c levels for all participants. For detecting elevated FPG, weight (0.651, IQR 0.583-0.719) and waist circumference (0.650, IQR 0.584-0.717) showed the highest area under the curve and 95% confidence interval, followed by body mass index and the z-score of body mass index (both 0.635, IQR 0.567-0.703); other anthropometric measures showed poorer diagnostic efficiencies or no ability. For detecting elevated HbA1c, lower efficiencies for the Conicity Index (0.651, IQR 0.583-0.719), waist-to-height ratio, waist-to-hip ratio and waist-to-chest ratio were shown. The correlations of FPG and HbA1c levels with anthropometric indices were weak (Spearman's r ≤ 0.179).

CONCLUSIONS

None of the evaluated anthropometric indicators approached an adequate predictive accuracy for the detection of elevated FPG or HbA1c levels in Shenzhen children aged 7-9 years. The current study did not recommend anthropometry screening for prediabetes in young children.

Clinical Usefulness of Anthropometric Indices to Predict the Presence of Prediabetes. Data from the ILERVAS Cohort

Prediabetes is closely related to excess body weight and adipose distribution. For this reason, we aimed to assess and compare the diagnostic usefulness of ten anthropometric adiposity indices to predict prediabetes. Cross-sectional study with 8188 overweight subjects free of type 2 diabetes from the ILERVAS project (NCT03228459). Prediabetes was diagnosed by levels of glycated hemoglobin (HbA1c). Total body adiposity indices [BMI, Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE) and Deurenberg's formula] and abdominal adiposity (waist and neck circumferences, conicity index, waist to height ratio, Bonora's equation, A body shape index, and body roundness index) were calculated. The area under the receiver-operating characteristic (ROC) curve, the best cutoff and the prevalence of prediabetes around this value were calculated for every anthropometric index. All anthropometric indices other than the A body adiposity were higher in men and women with prediabetes compared with controls (p < 0.001 for all). In addition, a slightly positive correlation was found between indices and HbA1c in both sexes (r ≤ 0.182 and p ≤ 0.026 for all). None of the measures achieved acceptable levels of discrimination in ROC analysis (area under the ROC ≤ 0.63 for all). Assessing BMI, the prevalence of prediabetes among men increased from 20.4% to 36.2% around the cutoff of 28.2 kg/m², with similar data among women (from 29.3 to 44.8% with a cutoff of 28.6 kg/m²). No lonely obesity index appears to be the perfect biomarker to use in clinical practice to detect individuals with prediabetes.

Prediction of Prehypertenison and Hypertension Based on Anthropometry, Blood Parameters, and Spirometry

Hypertension and prehypertension are risk factors for cardiovascular diseases. However, the associations of both prehypertension and hypertension with anthropometry, blood parameters, and spirometry have not been investigated. The purpose of this study was to identify the risk factors for prehypertension and hypertension in middle-aged Korean adults and to study prediction models of prehypertension and hypertension combined with anthropometry, blood parameters, and spirometry. Binary logistic regression analysis was performed to assess the statistical significance of prehypertension and hypertension, and prediction models were developed using logistic regression, naïve Bayes, and decision trees. Among all risk factors for prehypertension, body mass index (BMI) was identified as the best indicator in both men [odds ratio (OR) = 1.429, 95% confidence interval (CI) = 1.304⁻1.462)] and women (OR = 1.428, 95% CI = 1.204⁻1.453). In contrast, among all risk factors for hypertension, BMI (OR = 1.993, 95% CI = 1.818⁻2.186) was found to be the best indicator in men, whereas the waist-to-height ratio (OR = 2.071, 95% CI = 1.884⁻2.276) was the best indicator in women. In the prehypertension prediction model, men exhibited an area under the receiver operating characteristic curve (AUC) of 0.635, and women exhibited a predictive power with an AUC of 0.777. In the hypertension prediction model, men exhibited an AUC of 0.700, and women exhibited an AUC of 0.845. This study proposes various risk factors for prehypertension and hypertension, and our findings can be used as a large-scale screening tool for controlling and managing hypertension.

Comparison of body mass index, waist circumference, and waist to height ratio in the prediction of hypertension and diabetes mellitus: Filipino-American women cardiovascular study

The relative ability of three obesity indices to predict hypertension (HTN) and diabetes (DM) and the validity of using Asian-specific thresholds of these indices were examined in Filipino-American women (FAW). Filipino-American women (n = 382), 40–65 years of age were screened for hypertension (HTN) and diabetes (DM) in four major US cities. Body mass index (BMI), waist circumference (WC) and waist circumference to height ratio (WHtR) were measured. ROC analyses determined that the three obesity measurements were similar in predicting HTN and DM (AUC: 0.6–0.7). The universal WC threshold of ≥ 35 in. missed 13% of the hypertensive patients and 12% of the diabetic patients. The Asian WC threshold of ≥ 31.5 in. increased detection of HTN and DM but with a high rate of false positives. The traditional BMI ≥ 25 kg/m² threshold missed 35% of those with hypertension and 24% of those with diabetes. The Asian BMI threshold improved detection but resulted in a high rate of false positives. The suggested WHtR cut-off of ≥ 0.5 missed only 1% of those with HTN and 0% of those with DM. The three obesity measurements had similar but modest ability to predict HTN and DM in FAW. Using Asian-specific thresholds increased accuracy but with a high rate of false positives. Whether FAW, especially at older ages, should be encouraged to reach these lower thresholds needs further investigation because of the high false positive rates.

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WC, BMI and WHtR measurements cutoff points were higher in middle aged FAW.

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WC, BMI and WHtR measurements had similar ability to predict HTN and DM in FAW.

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Need to tailor thresholds of obesity measurements for specific Asian subgroups.

Prospective Study of Optimal Obesity Index Cut-Off Values for Predicting Incidence of Hypertension in 18-65-Year-Old Chinese Adults

Background

Overweight and obesity increase the risk of elevated blood pressure; most of the studies that serve as a background for the debates on the optimal obesity index cut-off values used cross-sectional samples. The aim of this study was to determine the cut-off values of anthropometric markers for detecting hypertension in Chinese adults with data from prospective cohort.

Methods

This study determines the best cut-off values for the obesity indices that represent elevated incidence of hypertension in 18–65-year-old Chinese adults using data from the China Health and Nutrition Survey (CHNS) 2006–2011 prospective cohort. Individual body mass index (BMI), waist circumference (WC), waist:hip ratio (WHR) and waist:stature ratio (WSR) were assessed. ROC curves for these obesity indices were plotted to estimate and compare the usefulness of these obesity indices and the corresponding values for the maximum of the Youden indices were considered the optimal cut-off values.

Results

Five-year cumulative incidences of hypertension were 21.5% (95% CI: 19.4–23.6) in men and 16.5% (95% CI: 14.7–18.2) in women, and there was a significant trend of increased incidence of hypertension with an increase in BMI, WC, WHR or WSR (P for trend < 0.001) in both men and women. The Youden index indicated that the optimal BMI, WC, WHR, WSR cut-off values were 23.53 kg/m², 83.7 cm, 0.90, and 0.51 among men. The optimal BMI, WC, WHR, WSR cut-off values were 24.25 kg/m², 79.9 cm, 0.85 and 0.52 among women.

Conclusions

Our study supported the hypothesis that the cut-off values for BMI and WC that were recently developed by the Working Group on Obesity in China (WGOC), the cut-off values for WHR that were developed by the World Health Organization (WHO), and a global WSR cut-off value of 0.50 may be the appropriate upper limits for Chinese adults.

Upper-normal waist circumference is a risk marker for metabolic syndrome in normal-weight subjects

BACKGROUND AND AIMS

To elucidate implication of upper-normal waist circumference (WC), we examined whether the normal range of WC still represents a risk of metabolic syndrome (MetS) or non-adipose MetS components among normal-weight subjects.

METHODS AND RESULTS

A total of 173,510 persons (100,386 men and 73,124 women) with normal WC (<90/80 cm in men/women) and body mass index (BMI) of 18.5-24.9 were included. Subjects were categorized as having low, moderate, and upper-normal WC for those with WC < 80, 80-84, and 85-89 cm in men and <70, 70-74, and 75-79 cm in women, respectively. The prevalence of all the non-adipose MetS components (e.g. prediabetes and borderline dyslipidemia) was significantly higher in subjects with upper-normal WC on comparison with those with low WC. Overall, the prevalence of MetS (having three or more of four non-adipose MetS components) gradually increased with increasing WC (12%, 21%, and 27% in men and 11%, 14%, and 19% in women for low, moderate, and upper-normal WC, respectively). Moreover, the risk of having a greater number of MetS components increased in subjects with upper-normal WC compared with those with low WC (odds ratios for the number of one, two, three, and four MetS components: 1.29, 1.81, 2.53, and 2.47 in men and 1.16, 1.55, 1.49, and 2.20 in women, respectively).

CONCLUSION

Upper-normal WC represents a risk for acquiring a greater number of MetS components and the early stage of MetS components (prediabetes and borderline dyslipidemia), after adjusting for BMI, in a large general population with normal WC and BMI.

Genetic association with lipids in Filipinos: waist circumference modifies an APOA5 effect on triglyceride levels

Blood levels of lipoprotein cholesterol and triglycerides (TGs) are highly heritable and are major risk factors for cardiovascular disease (CVD). Approximately 100 lipid-associated loci have been identified in populations of European ancestry. We performed a genome-wide association study of lipid traits in 1,782 Filipino women from the Cebu Longitudinal Health and Nutrition Survey, and tested for evidence of interactions with waist circumference. We conducted additional association and interaction analyses in 1,719 of their young adult offspring. Genome-wide significant associations (P < 5 × 10⁻⁸) were detected at APOE for low density lipoprotein cholesterol and total cholesterol, and at APOA5 for TGs. Suggestive associations (P < 10⁻⁶) were detected at GCKR for TGs, and at CETP and TOM1 for high density lipoprotein cholesterol. Our data also supported the existence of allelic heterogeneity at APOA5, CETP, LIPC, and APOE. The secondary signal (Gly185Cys) at APOA5 exhibited a single nucleotide polymorphism (SNP)-by-waist circumference interaction affecting TGs (Pinteraction = 1.6 × 10⁻⁴), manifested by stronger SNP effects as waist circumference increased. These findings provide the first evidence that central obesity may accentuate the effect of the TG-increasing allele of the APOA5 signal, emphasizing that CVD risk could be reduced by central obesity control.