Association of wrist circumference with cardio-metabolic risk factors: a systematic review and meta-analysis

Wrist Circumference Cutoff Points for Determining Excess Weight Levels and Predicting Cardiometabolic Risk in Adults

(1) Background: An elevated wrist circumference may indicate excess weight and cardiometabolic risk. The present study aims to identify wrist circumference cutoff points (WrC) to determine excess weight levels and predict cardiometabolic risk in adults. (2) Methods: A cross-sectional study was conducted with adults aged 20 to 59 years old, attending the outpatient clinic at University Hospital/Federal University of Sergipe HU/UFS-EBSERH. Demographic, anthropometric, biochemical, and blood pressure (BP) data were collected. Cardiometabolic risk was assessed, according to the global risk score (ERG) and Framingham score criteria. The descriptive analysis included calculating medians and frequencies of anthropometric, demographic, biochemical, and blood pressure variables. The gender and age of adult groups were compared using the Mann-Whitney test. Spearman's correlation coefficient and multiple regression analysis were used to assess the association between wrist circumference (WrC) and the variables mentioned above. The predictive validity of WrC in identifying excess weight levels and cardiometabolic risk was analyzed using the ROC curve. The sample consisted of 1487 adults aged 20 to 59 years, 55.7% of whom were female; (3) Results: WrC correlated positively with other adiposity indicators such as waist circumference and Body Mass Index. WrC was the anthropometric indicator most significantly associated with cardiometabolic risk factors. WrC cutoff points identified by the study for determining excess weight were categorized by gender and age group. For males aged 20 to 40 years and >40 years, respectively, the cutoff points for overweight were 17.1 cm and 17.3 cm, and for obesity, 17.9 cm and 17.5 cm. For females aged 20 to 40 years and >40 years, respectively, the cutoff points for overweight were 15.6 cm and 15.4 cm, and for obesity, 16.1 cm and 16 cm (4). Conclusions: Wrist circumference showed a significant correlation with other adiposity indicators and can be used to identify adults with excess weight and predict cardiometabolic risk.

Associations between Neck Circumference, Mid-Upper Arm Circumference, Wrist Circumference, and High Blood Pressure among Lithuanian Children and Adolescents: A Cross-Sectional Study

(1) Background: High blood pressure (HBP) and obesity are significant and growing public health issues worldwide. Our study aimed to evaluate the associations of neck circumference (NC), mid-upper arm circumference (MUAC), and wrist circumference (WrC) with HBP among Lithuanian children and adolescents aged 7-17 years. (2) Methods: In this cross-sectional study, data on BP and anthropometric measurements were analysed in 3688 children and adolescents aged 7-17 years. Multivariate logistic regression analysis was used to estimate the associations between anthropometric indices and HBP. (3) Results: Overall, the prevalence rates of elevated BP and hypertension were 13.7% and 12.9%, respectively. After adjustment for age, BMI, and WC, statistically significant elevated aORs were observed for associations between greater NC, MUAC, WrC, and HBP in boys (aORs: 2.13, 2.46, and 2.48, respectively) and in girls (aORs: 2.01, 2.36, and 2.09, respectively). Moreover, per-unit increase in NC, MUAC, and WrC was also associated with greater odds of HBP in boys (aORs: 1.20, 1.21, and 1.37, respectively) and in girls (aORs: 1.10, 1.10, and 1.21, respectively). The analysed anthropometric indices presented higher area under the curve values for predicting HBP in boys than in girls. (4) Conclusions: This study suggests that higher NC, MUAC, and WrC are associated with increased odds of HBP in Lithuanian children and adolescents.

The Association between Mid-Upper Arm Circumference and Blood Pressure in an Italian Population of School-Aged Children and Adolescents with Lipid Disorders

Background: Many anthropometric measurements have been investigated concerning their association with blood pressure (BP) in paediatric age groups. This study aims to find a relationship between mid-upper arm circumference (MUAC) and BP in a population of children and adolescents aged 1-18 years. Methods: 5853 subjects (2977 females and 2876 males) were studied. MUAC, body mass index (BMI), and BP were measured. The individuals in the study were subdivided and grouped by gender and type of school attended in Italy: 1-5 years (pre-school), 6-10 years (primary school), 11-13 years (secondary school), 14-18 years (high school). Results: In the age range of 6-13 years, all the subjects with MUAC > 50th percentile had systolic and diastolic BP significantly higher than children with MUAC below 50th percentile (p < 0.0001). In the age range 14-18 years, the relationship persisted only in females (p < 0.001 and p < 0.05 for diastolic and systolic BP, respectively). A linear relationship was found between MUAC and BMI. Conclusions: In Italian children of both genders aged 6-13, arm distribution of body fat is strongly associated with increased systolic and diastolic BP. As such, a simple anthropometric measurement like MUAC might represent a tool to identify young subjects who are at risk for HTN.

Evaluation of subclinical atherosclerosis and cardiac functions in children of mothers with gestational diabetes and maternal obesity

BACKGROUND AND AIMS

We aimed to evaluate the effects of maternal obesity or gestational diabetes on body composition, lipid, and glucose metabolism, arterial morphology, and functions in children, and to investigate these effects in terms of cardiometabolic diseases.

METHODS

The study group was composed of 48 children who had a history of gestational diabetes or maternal obesity, and the control group was composed of 33 children. Echocardiographic assessments were performed. Socio-economic status and education level of mothers were obtained.

RESULTS

In the study group, carotid intima-media thickness, epicardial adipose tissue thickness, and arterial stiffness values were found to be significantly higher compared to the control group (p < 0.001, p < 0.001, p = 0.003, respectively), while arterial distensibility and arterial strain values were found to be significantly lower (p = 0.003, p = 0.008, respectively). Among the children who had similar body mass index in both groups, children in the study group had higher carotid intima-media thickness and epicardial adipose tissue thickness values. Arterial stiffness values were significantly reduced (p = 0.028) and arterial distensibility and strain values were significantly increased (p = 0.039, p = 0.033, respectively) in the children whose mothers had gestational diabetes and high socio-economic status. Left ventricular mass and left ventricular end-diastolic internal thickness were found to be significantly increased in the children who had obese and unemployed mothers (p = 0.04, p = 0.03, respectively).

CONCLUSION

Low socio-economic status was found to be associated with increased maternal obesity and gestational diabetes. Poor socio-economic status, poor glycaemic control and being overweight during pregnancy indicate negative cardiometabolic outcomes for children in the long term.

Association between Wrist Circumference and Risk of Any Fracture in Adults: Findings from 15 Years of Follow-Up in the Tehran Lipid and Glucose Study

We evaluated whether wrist circumference (WrC), as a novel anthropometric measure, is associated with incidences of any fractures. The study population included 8288 adults (45.3% men) aged ≥30 years, who were followed for incidences of any fractures from 31 January 1999 to 16 March 2016. We used Cox proportional hazard models adjusted for well-known risk factors to evaluate the association of WrC, both as continuous and categorical variables (bottom tertile as reference), with incidences of any fractures and major osteoporotic fractures (MOF). Over 15 years of follow-ups, 348 fractures occurred (men = 162). For a 1 cm increase in WrC, hazard ratios (HRs) were 1.18 (95% CI: 1.03-1.35) for incident any fractures and 1.22 (1.01-1.49) for incident MOF. In addition to WrC, age, female sex, lower BMI, higher WC, current smoking, and usage of steroidal medications were significantly associated with the incidences of any fractures. Moreover, participants in the middle and top tertiles of WrC had a higher risk of incidence for any fractures [HR = 1.62 (1.19-2.20) and 1.70 (1.14-2.55), respectively, p-value for trend = 0.012]. We presented WrC as a strong and independent risk factor for incidences of any fractures that might be considered in the risk prediction of bone fracture in Iranian adults.

The effect of calcineurin inhibitors on anthropometric measurements in kidney transplant recipients

Background

This study was designed to investigate the effect of calcineurin inhibitors (CNIs), cyclosporine (CsA), and tacrolimus (Tac) on anthropometrics in kidney transplant recipients.

Methods

111 of 128 adult kidney transplant recipients who received post-transplant CNIs were included in this retrospective study. Anthropometrics were recorded in the pre-transplant and post-transplant 4-year follow-up periods (1st, 3rd, 6th, 12th, 24th, 36th and 48th months).

Results

Compared to pre-transplant values, significant increases in body weight and body mass index (between 3rd and 48th months), waist and hip circumferences (between 1st and 48th months), waist-to-hip ratio (between 1st and 3rd or 6th months) and neck circumference (between 1st and 12th or 24th months) were observed in both CsA and Tac groups. A significant increase was noted in post-transplant body fat percentage values for the 3rd to 24th months in the CsA group, whereas for the 24th to 48th months in both CsA and Tac groups. Hip circumferences percentage changes from the pre-transplant period to the 1st, 12th and 24th months were significantly higher in CsA than in the Tac group. At each time point, there was no significant difference in percentage changes for other anthropometric parameters between the CsA and Tac groups. De novo diabetes mellitus developed in 8.3% of the CsA group and 19.1% of the Tac group.

Conclusions

After a successful kidney transplant, anthropometric measurements increase in most recipients. Although the effect of calcineurin inhibitor type on weight gain is unclear, a regression analysis showed that CNI type was not a risk factor for the development of obesity in the 48th month. However, it is helpful to be cautious about its dyslipidemic effect in patients using CsA and the potential hazards of using Tac in patients with a diabetic predisposition.

Utility of wrist circumference in recognition of metabolic syndrome in overweight and obese South Indian children and adolescents

OBJECTIVE

To describe the utility of wrist circumference in the identification of cardiometabolic risk in overweight and obese children.

METHODS

A cross-sectional study was conducted in the obesity clinic of a tertiary care referral hospital over a two year period. All children and adolescents aged 5-17 years with nutritional overweight and obesity were recruited. Data pertaining to chronological age, sex, risk factors and family history were collected. Clinical assessment of anthropometry: Weight, height, body mass index (BMI), Tanner's stage, wrist circumference, blood pressure, waist circumference and triceps skinfold thickness done as per standard criteria. Biochemical assessment of blood glucose, serum insulin, lipid profile, and Homeostatic Model for Insulin Resistance performed after 12 h of fasting.

RESULTS

We recruited 118 subjects (mean age 10.9 years, 71.1% males, 87.3% obese and 12.7% overweight); 30 (25.4%) had metabolic syndrome. The mean z scores of wrist circumference of children who presented with and without metabolic syndrome was 2.7 ± 0.8 and 2.1 ± 0.7, respectively (p<0.05). We observed a fair positive correlation between wrist circumference z score and BMI z score, (r=0.5; p<0.05). On receiver operating characteristic curve analysis, 97th percentile of wrist circumference predicted metabolic syndrome among overweight and obese children with a sensitivity of 86.7% and specificity of 37.5% (AUC=0.675).

CONCLUSIONS

Wrist circumference with 97th percentile as a cut-off is a useful tool to identify metabolic syndrome amongst overweight and obese children and adolescents.

Wrist circumference as a novel predictor of transition from metabolically healthy to unhealthy phenotype in overweight/obese adults: a gender-stratified 15.5-year follow-up

BACKGROUND

Individuals with transition from metabolically healthy overweight/obese (MHO) to metabolically unhealthy overweight/obese (MUO) phenotype are significantly predisposed to greater risks of cardiovascular events compared to those with a persistent MHO phenotype. The aim of this study was to evaluate the predictive performance of wrist circumference for this transition in adults over a 15.5-year follow-up.

METHODS

We included 309 males and 821 females with the age of ≥18 years old, body mass index ≥25 kg/m², and metabolically healthy status according to the criteria of the Joint Interim Statement. The incidence of MUO phenotype was evaluated for each gender, across tertiles wrist circumference, using Cox-proportional hazard models.

RESULTS

The overall rate of transition from MHO to MUO phenotype was 87.1% in males and 77.5% in females. The hazard ratios (HRs) with 95% CI across second and third tertiles of wrist circumference were 0.89 (0.64-1.24) and 1.31 (0.99-1.73) in men (P for trend =0.027); and 1.34 (1.09-1.66) and 1.61 (1.30-2.00) in women (P for trend <0.001), respectively. After multivariable adjustment, HRs across second and third tertiles of wrist circumference were 0.92 (0.64-1.32) and 1.18 (0.83-1.67) in males (p for trend =0.352), and 1.32 (1.05-1.65) and 1.34 (1.06-1.96) in females (p for trend =0.025), respectively.

CONCLUSIONS

Wrist circumference significantly predicts the transition from MHO to MUO phenotype in adults of both genders. However, it is an independent predictor of the transition only in females. Future studies are warranted to clarify the role of wrist circumference mechanisms on metabolic risk deterioration.

Associations between Anthropometrics, Cardiorespiratory Fitness, and Metabolic Syndrome Components in Brazilian Adolescents with Obesity

Purpose: To describe the presence of metabolic syndrome (MS) in Brazilian adolescents with obesity, and to compare anthropometric and cardiorespiratory fitness measurements in relation to the presence of MS. Methods: Sixty-seven adolescents (13-18 years, 36 girls) with obesity (body mass index z-score ≥2.0) were enrolled. The following were assessed for each participant: anthropometrics, body composition, lipid profile, glucose, serum insulin, insulin resistance, blood pressure (BP), and cardiorespiratory fitness. Results: The presence of MS was found in 47.76% of the sample. The following abnormal measurements were most frequently reported: waist circumference (WC) (100.0%), BP (85.07%), and triglycerides (TG) (50.75%). Boys with obesity were more likely to meet MS criteria when compared to girls (P = 0.040; odds ratio = 2.80 [1.04-7.56]). Conclusion: The presence of MS in Brazilian adolescents with obesity in this study was 47.76%. Among this sample, the most frequently reported MS variables above the established cutoffs were WC (100%), followed by altered BP (85%) and TG (50%). These data further support previously published studies that low levels of cardiorespiratory fitness may increase the risk of MS among adolescents with obesity.

Association of a body shape index and hip index with cardiometabolic risk factors in children and adolescents: the CASPIAN-V study

OBJECTIVE

This study designed to discover the link between a body shape index (ABSI) and hip index (HI) with cardiometabolic risk factors (CMRFs) in Iranian children and adolescents.

SUBJECTS AND METHODS

In a nationwide cross-sectional survey, 4200 students who were 7-18 years old were chosen via a multistage cluster sampling method in 30 provinces of Iran in 2015. Metabolic syndrome (MetS) was defined in line with the Adult Treatment Panel III criteria. ABSI and HI were defined as waist circumference (m)/ [body mass index 2/3 * height (m)1/2] and hip circumference (cm) *(height/ 166 cm)0.310 *(weight / 73 kg)-0.482 respectively. Association between ABSI and HI with CMRFs as categorical and continuous variables were evaluated using multivariable logistic and linear regression analysis respectively.

RESULTS

Totally, information of 14,002 students and findings of blood samples of 3483 of them were involved in the current study. In the multivariable logistic regression, an association of HI with high triglyceride (TG) (OR: 0.99, 95 % CI: 0.98-0.99) and ABSI with MetS (OR: 11.41, 2.61-49.88) was statistically significant (P < 0.05). Also, both indices were significantly associated with overweight, generalized, and abdominal obesity. In the multivariable linear regression analysis, increasing HI (per one unit) was associated with body mass index z-score (z-BMI) (β: -0.01), waist circumference (WC) (β: 0.15), TG (β: -0.16), and systolic blood pressure (SBP) (β: -0.02). Moreover, in the multivariable linear models, ABSI was significantly associated with z-BMI, WC, SBP, and diastolic blood pressure (P < 0.001).

CONCLUSIONS

ABSI and HI as novel body shape indices were significantly associated with some CMRFs. Therefore, these indices can be used as some useful anthropometric risk indices for predicting MetS.

Relative Children's Lipid Accumulation Product Is a Novel Indicator for Metabolic Syndrome

BACKGROUND

The children's lipid accumulation product (CLAP) is associated with MS in Chinese children and adolescents. The aim of this study was to develop a more effective indicator, the relative children's lipid accumulation product (RCLAP) was evaluated for correlation with MS and the density of lipid accumulation.

METHODS

A stratified cluster sampling method was used to recruit 683 students aged 8-15 years in this study. The presence of MS was defined according to the NCEP-ATP III criteria. The participants' guardians signed informed consent before the medical examination. This study was approved by the Medical Ethics Committee of the Bengbu Medical College [(2015) No.003] and was conducted in accordance with the Declaration of Helsinki.

RESULTS

The overall prevalence of MS was 4.8% (male 6.6%, female 2.8%). After adjusting for sedentary activity time, relative children's lipid accumulation product per height (RCLAP-H) and relative children's lipid accumulation product per sitting height (RCLAP-SH) significantly increased the risk of MS in girls [OR (95% CI): 96.13 (11.11-831.97) and 96.13 (11.11-831.97), respectively]. After adjusting for ages and moderate-to-vigorous physical activity time, RCLAP-H, and RCLAP-SH significantly increased the risk of MS in boys [OR (95% CI): 171.75 (33.60-878.00) and 133.18 (27.65-641.39), respectively]. The AUCs of RCLAP-H and RCLAP-SH for predicting MS were 0.950, 0.948 in girls, and 0.952, 0.952 in boys, which were higher than BMI, WHtR, Tg/HDL-C, CLAP, and CLAP combining height, sitting height.

CONCLUSIONS

The RCLAP-H and RCLAP-SH were more effective indicators for predicting MS than BMI, WHtR, Tg/HDL-C, and CLAP in children and adolescents.

Association between junk food consumption and cardiometabolic risk factors in a national sample of Iranian children and adolescents population: the CASPIAN-V study

AIMS

Only a few studies have attempted to assess the relationship between junk food consumption and cardiometabolic risk factors in Iranian children and adolescents; therefore, the aim of our study was to determine the association between junk food intake and cardiometabolic risk factors in this population.

STUDY DESIGN

This is a cross-sectional study.

METHODS

A total of 14,400 students were selected from 30 provinces of Iran using multistage, stratified cluster sampling method. Information about student's lifestyle, health behaviors and health status was obtained through a validated questionnaire. Blood pressure was measured and anthropometric indices were calculated. Blood samples were drawn from 3,303 students for biochemical tests. In our study, sugar-sweetened beverages, salty snacks, sweets and fast foods were considered as junk foods.

RESULTS

The mean age of participants was 12.42 ± 2.97 years. Those with metabolic syndrome were more likely to live in urban areas (P = 0.004) and have higher BMI (P < 0.0001). Junk food intake was not related to metabolic syndrome; however, it was associated with increased odds of high BP (OR 1.23, 95% CI 1.09, 1.39), high SBP (OR 1.38, 95% CI 1.09, 1.75), and high DBP (OR 1.18, 95% CI 1.04, 1.35), overweight (OR 1.22, 95% CI 1.08, 1.39) and excess weight (OR 1.14, 95% CI 1.04, 1.25).

CONCLUSIONS

Junk food consumption plays an important role in childhood overweight and is related to high blood pressure in this population.

LEVEL OF EVIDENCE

Level III, case-control analytic studies.

Cardiovascular Implications in Idiopathic and Syndromic Obesity in Childhood: An Update

Childhood obesity is a modern worldwide epidemic with significant burden for health. It is a chronic metabolic disorder associated with multiple cardiovascular risk factors such as dyslipidemia, hypertension, stroke, and insulin resistance. Many obese adolescents remain obese into adulthood, with increased morbidity and mortality. As childhood obesity is a risk factor for adult obesity, the childhood obesity-related disorders account for an increased risk of cardiovascular consequences in adults, in addition to the effects already exerted by the fat mass in adulthood. Several papers have already described the cardiovascular implications of idiopathic obesity, while few data are available about syndromic obesity, due to the small sample size, not homogeneous phenotypes, and younger age at death. The aim of this mini-review is to give a comprehensive overview on knowledge about cardiovascular implications of idiopathic and syndromic obesity to allow the reader a quick comparison between them. The similarities and differences will be highlighted.

Wrist circumference is a biomarker of adipose tissue dysfunction and cardiovascular risk in children with obesity

PURPOSE

To evaluate the relationship between wrist circumference, markers of adipose dysfunction, and cardiovascular risk in youths with obesity.

METHODS

In this cross-sectional study, we measured body mass composition by dual-energy X-ray absorptiometry, wrist circumference, waist-to-height ratio, fasting blood insulin, glucose, lipid profile, adiponectin, and leptin in 280 children with overweight/obesity and without diabetes (age: 7-18 years). Cardiovascular risk was estimated by "metabolic syndrome score" (MetS score).

RESULTS

Study participants had median [25th-75th percentile] wrist circumference of 17.5 [16.7-18.5] cm and waist-to-height ratio of 0.62 [0.59-0.67]. Lower adiponectin-leptin ratio was found among subjects in the upper 50th percentiles of wrist circumference [0.17 (0.09-0.36) vs. 0.38 (0.16-0.79); p < 0.001]. Wrist circumference was independently associated with MetS score (r = 0.5 p < 0.001). Among MetS score components, an independent association between wrist circumference HDLc, triglycerides, and systolic blood pressure was found (r = - 0.253 p < 0.001; r =+ 0.204 p < 0.001; r = + 0.403 p = < 0.001, respectively). The coefficient of determination for MetS score was nominally higher when considering wrist circumference as independent variable (Adj-R² = 0.30) then when considering body mass index SD (Adj-R² = 0.28), waist-to-height ratio (Adj-R² = 0.26) or truncal fat percentage (Adj-R² = 0.01). The addition of wrist circumference in age and gender adjusted models, accounting to any other anthropometric parameters, resulted in a significant improvement of the Adj-R² (p < 0.001 for all).

CONCLUSIONS

Our study shows that wrist circumference independently relates to adiponectin-leptin ratio and to the prediction of cardiovascular risk, suggesting it as an efficient and adjunctive anthropometric marker of cardiometabolic risk in children with obesity.

Anthropometric measures and the risk of coronary artery disease

BACKGROUND

Nowadays, obesity and overweight are projected to become main risk factors for coronary artery disease (CAD). We aimed to determine the association of anthropometric measures with presence of significant (sig.) CAD as evaluated by coronary angiography, among an adult Iranian population.

METHODS

The present study included 441 patients (men=275) aged > 30 years with suspected CAD, who had undergone coronary angiography between January 2019 and November 2019. All demographic data and patients' medical history as well as clinical examinations were recorded by a trained physician. Coronary angiography was performed using standard techniques to determine the presence of sig. coronary artery lesions. Logistic regression analyses were conducted to assess the odds ratio (OR) of each anthropometric measure for the presence of sig. CAD.

RESULTS

The mean age of participants was 51.2±8.7 years and sig. CAD was detected in 185 patients. Univariate analyses showed that body mass index (BMI), waist circumference (WC), and waist to hip ratio (WHR) were significantly associated with increased risk of CAD. On multivariable logistic regression model, BMI and WHR correlated independently with increased risk of CAD; while higher WC and wrist circumference (WrC) could not predict the CAD risk. The corresponding ORs (95% confidence interval) were 1.36 (1.04-1.74), 1.17 (0.95-1.63), 1.29 (1.12-1.41), and 1.24 (0.76-1.92) for BMI, WC, WHR, and WrC, respectively. Considering the receiver operating characteristic analysis, no superiority was observed for each of the measures for discriminating sig. CAD from non-sig. CAD status.

CONCLUSION

BMI and WHR are independently associated with the presence of CAD among Iranian population. These results emphasize the value of anthropometric assessment among those with suspected CAD.

The association of wrist circumference with hypertension in northeastern Chinese residents in comparison with other anthropometric obesity indices

Background

Wrist circumference (WrC) is an easily obtained measure in estimating the body frame and regional fat distribution, and has increasingly used as an obesity index. The aim of our study is to estimate the association of WrC with elevated blood pressure (BP) among northeastern Chinese community-dwelling residents, and compare the strength of this association to other anthropometric obesity indices.

Methods

A total of 2,331 adult participants (761 male participants, and 1,570 female participants) were included. WrC and other five generally used obesity indices, including body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and neck circumference (NC) were measured. Hypertension was defined as systolic blood pressure (SBP)/diastolic blood pressure (DBP) ≥140/90 mmHg or anti-hypertensive medication use. Multivariable linear and logistic regression models were performed to identify associations of BP and hypertension with per standard deviation (SD) increase of obesity indices. Areas under receiver operative characteristic curves (AUC) were calculated to compare the predicting capacity of WrC and other obesity indices on hypertension.

Results

All of the six obesity indices were positively associated with both SBP and DBP after adjustment for age and gender (P-values of associations of SBP with obesity indices were 0.043 for WrC, and <0.001 for other five indices; P-values of associations of DBP with obesity indices were 0.011 for WrC, 0.031 for WHR, and <0.001 for other four indices), while the association between SBP and WrC showed no statistically significant after further adjusted for life-style and metabolic risk factors (P-value was 0.062). The increases of both SBP and DBP per SD increase of BMI were the largest. The positive associations of five obesity indices but WHR with hypertension were observed after adjustment for all risk factors (P-values were 0.024 for WrC, 0.064 for WHR and <0.001 for other four indices). However, the odd ratios (OR) of WrC was the smallest, while BMI was the largest. Consistently, the AUC of BMI was the largest and statistically larger than that observed for WrC (P-value <0.001).

Conclusions

WrC was associated with hypertension among northeastern Chinese populations. However, the association was not stronger than the other generally used indices, particularly BMI.

Risk factors and predictive biomarkers of early cardiovascular disease in obese youth

Obesity in childhood and adolescence continues to be a major health issue due to significant health implications and to the economic burden that arise from treating this disease and its complications. Current data show that childhood obesity is no longer just a concern for developed countries, but more significantly affecting developing countries. In adult population, cardiovascular disease is the main cause of mortality and morbidity among obese patients. It is therefore believed that risk factors found in adult patients could also be observed in obese youth. These risk factors will then persist and become progressively worse if obese youth remain obese as they reach adulthood. However, risk reduction is achievable through various prevention and management strategies of obesity and obese children who become nonobese in adulthood have a significant reduction in their risk of developing cardiovascular disease. New biomarkers to improve risk assessment in obese youth are an open research field, which will eventually lead to a more targeted approach in prevention and treatment. Nevertheless, there is still a need for continuous research in understanding the roles of these biomarkers and their potential in risk prediction. Cardiovascular risk modification of childhood obesity depends on a more concerted effort among the various parties involved and particularly a global collaboration to stop the rising prevalence of the epidemic in developing countries.

Association of Anthropometric Indices With Metabolic Phenotypes of Obesity in Children and Adolescents: The CASPIAN-V Study

Background: Obesity, particularly in the upper part of the body, is a major health problem. Measuring the neck circumference (NC) and wrist circumference (WrC) is a relatively new method of differentiating between normal and abnormal fat distributions. This study aimed to evaluate the association of NC, hip circumference (HC), and WrC with different phenotypes of obesity and their metabolic status. Methods: In this multi-centric cross-sectional study, 4,200 students aged 7-18 years were selected from 30 provinces in Iran in 2014 by using a multistage cluster random sampling method. Metabolic syndrome (MetS) was defined based on the ATP III criteria modified for the pediatric age group. The subjects were classified into four groups according to their weight and metabolic status: metabolically healthy obese (MHO), metabolically non-healthy non-obese (MNHNO), metabolically non-healthy obese (MNHO), and metabolically healthy non-obese (MHNO). Results: Significant but different associations of NC, HC, and WrC with obesity phenotypes were documented in the entire population. Significant but different associations of NC, HC, and WrC with metabolic phenotypes were also found in the entire population. In the multinomial logistic regression, the association of the different obesity phenotypes with the study anthropometric indices increased significantly with increasing NC, WrC, and HC. Also, per one unit increment in NC, HC, and WrC, the odds of MHO, MNHNO, and MNHO increased compared to that of the MHNO phenotype. Conclusion: In children and adolescents, HC, NC, and WrC are significantly associated with obesity phenotypes and their metabolic status, and these metrics are suggested to be innovative, low-cost, and alternative tools for assessing them in different age and sex pediatric age groups.