Cigarette smoking, adiposity, non-insulin-dependent diabetes, and coronary heart disease in Japanese-American men

Body Mass, Smoking, and Overall and Cause-Specific Mortality Among Older U.S. Adults

The authors examine the relationships between body mass, smoking, and overall and cause-specific mortality among U.S. adults aged 60 and older, using data from the National Health Interview Survey linked to the Multiple Cause of Death file and Cox proportional hazard models. The authors find that, compared to those who are normal weight, obese individuals have higher risks of overall, circulatory disease, and diabetes mortality. Furthermore, smoking status suppresses the relationships between obesity and overall, circulatory disease, and cancer mortality, and interacts with lowbody weight to increase mortality risks. Finally, underweight individuals initially face increased risks of death over the follow-up period, although over time their mortality risks diminish to those of normal-weight individuals, likely due to the presence of unobserved illness. Researchers and health practitioners must account for smoking status, body mass, and specific causes of death to understand and improve the health of our increasingly obese elderly population.

Reduction in adiposity, β-cell function, insulin sensitivity, and cardiovascular risk factors: a prospective study among Japanese with obesity

Background

A reduction in adiposity may be associated with an improvement in insulin sensitivity and β-cell function as well as cardiovascular disease (CVD) risk factors; however, few studies have investigated these associations in a longitudinal setting.

Methods

To investigate these associations over a 1-year period, we conducted an observational analysis of 196 Japanese subjects with obesity in the Saku Control Obesity Program. We investigated the relations between changes in adiposity (body mass index [BMI], waist circumference, subcutaneous fat area [SFAT], and visceral fat area [VFAT]) and changes in HbA1c, fasting plasma glucose (FPG), insulin sensitivity index (ISI), the homeostasis model assessment β cell function (HOMA-β), lipids, and blood pressure.

Results

All adiposity changes were positively associated with HbA1c and FPG changes. Reductions in BMI and VFAT were associated with HOMA-β reduction. Reductions in all adiposity measures were associated with an improvement in the ISI. Changes in most adiposity measures were positively associated with changes in blood pressure and lipid levels, except for LDL.

Conclusion

The present findings provide additional supportive evidence indicating that a reduction in adiposity may lead to an improvement in insulin sensitivity and the reduction of CVD risk factors in obese individuals.

Behavioral risk factors in relation to visceral adipose tissue deposition in adolescent females

OBJECTIVE

To characterize visceral adipose tissue (VAT) and subcutaneous abdominal adipose tissue (SAAT) deposition in girls over the pubertal period and to assess the influence of behavioral risk factors on their deposition.

PARTICIPANTS

In total, 41 subjects of mean age of 13.5 years (standard deviation, SD=0.9) were assessed at menarche. At 4 years after menarche, follow-up data were available for 24 of these subjects.

METHODS

VAT and SAAT were measured by magnetic resonance imaging (MRI) and total body fat by isotopic dilution of (18)O water at menarche and 4 years after menarche in a subset of subjects enrolled in a larger study of growth and development. Smoking, alcohol use, and physical activity were assessed by self-report at both time points. Smoking, alcohol use, and physical activity at 4 years after menarche were assessed in relation to concurrent VAT and SAAT, and to the 4-year change in VAT and SAAT.

RESULTS

Smoking and alcohol use at 4 years after menarche was associated with the change in VAT over the 4-year period, before (p<0.03 and p<0.02, respectively), and after adjustment for total body fat (p<0.01 and p<0.02, respectively).

CONCLUSIONS

In addition to the established health risks, smoking and drinking, even at low levels, appear to be associated with increased VAT deposition in adolescent females.

Smoking cessation and glycaemic control in type 2 diabetic patients

AIM

To elucidate the relationship between glycaemic control, blood pressure and body-weight change after smoking cessation in type 2 diabetic patients.

METHODS

We examined HbA(1c), blood pressure and body weight in 15 type 2 diabetic patients before, 6 and 12 months after quitting smoking. Sixteen type 2 diabetic patients who did not quit smoking served as control.

RESULTS

Body weight slightly increased after quitting smoking. Although HbA(1c) levels showed no change in the control group, those in patients who quit smoking significantly increased (6.8 +/- 0.3% before quitting smoking; 7.4 +/- 0.3% 6 months after quitting smoking, p < 0.05; 7.8 +/- 0.4% 12 months after quitting smoking, p < 0.001). Fasting blood glucose also increased in patients who quit smoking. The increase in body weight after quitting smoking did not correlate with the deterioration of glycaemic control. Diastolic blood pressure showed no change in control, whereas that in patients who quit smoking increased at month 12 (69 +/- 3 vs. 76 +/- 3 mmHg, p < 0.01). The increase in HbA(1c) at month 12 after quitting smoking correlated with body mass index before quitting smoking (r = 0.72, p < 0.005) and serum triglyceride before quitting smoking (r = 0.68, p < 0.01).

CONCLUSIONS

Glycaemic control and diastolic blood pressure deteriorated in type 2 diabetic patients after quitting smoking. Type 2 diabetic patients who want to stop smoking need a caution to prevent deterioration of glycaemic control and blood pressure after quitting smoking.

Association of multiple risk factors and insulin resistance with increased prevalence of asymptomatic coronary artery disease by an electron-beam computed tomographic study

The insulin resistance syndrome, consisting of resistance to insulin and several metabolic abnormalities, is associated with an increased risk of symptomatic coronary artery disease. Asymptomatic persons with increased coronary calcification have increased coronary plaque and an increased likelihood of future cardiovascular events. Electron-beam computed tomography-derived coronary artery calcium scores, metabolic and anthropometric parameters, and fasting and stimulated concentrations of glucose and insulin were measured in 1160 asymptomatic men and women. Coronary artery calcium scores were positively correlated with glucose, insulin, and homeostasis model assessment (HOMA) insulin resistance. Calcium scores were positively correlated with intra-abdominal adiposity, age, total cholesterol/high density lipoprotein (HDL) ratio, low density lipoprotein, triglycerides, blood pressure, and HOMA beta cell function and inversely correlated with HDL and peripheral fat. These correlations, except for 2-hour glucose, remained significant for all subjects with fasting serum glucose <126 mg/dL or all subjects with fasting serum glucose 110 mg/dL. In a multivariate analysis, age, sex, family history of premature coronary artery disease, intra-abdominal adiposity, low density lipoprotein, and smoking independently predicted calcium scores. Blood pressure, HDL, triglycerides, glucose, insulin, and HOMA insulin resistance or beta cell function were not independently correlated with coronary artery calcium scores. Asymptomatic individuals with insulin resistance have elevated coronary calcium scores. The association between insulin resistance and coronary calcification persists with impaired glucose tolerance and normal fasting serum glucose. Central/visceral adiposity may be a determinant of insulin resistance and atherosclerosis even in asymptomatic nondiabetic persons.

Waist to hip ratio, body mass index, and glucose intolerance from Funagata population-based diabetes survey in Japan

To examine the association of body mass index (BMI) and waist-to-hip ratio (WHR) with glucose intolerance among adults age 45 and over, we conducted a population-based study using an oral glucose tolerance test as a primary examination in two areas of Funagata, Japan, in 1990 and 1992. The number of eligible subjects was 1673. The participation rate was 84% (1408/1673). Glucose tolerance was assessed by the 1985 World Health Organization criteria as having diabetes (DM), impaired glucose tolerance (IGT), or normal glucose tolerance (NGT). Analyses by the generalized linear model revealed that both BMI and WHR were higher in the subjects with DM and IGT than those with NGT in both men and women after controlling for age. Analyses employing multiple logistic regression indicated that BMI and WHR were independently associated with IGT and DM in both men and women, except for BMI with IGT for men. The odds ratios for IGT associated with BMI were 1.06 (p=0.19) for men and 1.11 (p<0.01) for women. Those associated with WHR were 2.14 (p<0.01) for men and 1.35 (p<0.01) for women. These results imply that WHR plays an important role for developing DM independent of BMI.

Fat distribution, physical activity, and cardiovascular risk factors

The purpose of this study was to report the relationship between fat distribution, physical activity (PA), and cardiovascular disease (CVD) risk factors. Percent fat, computed tomography intra-abdominal adipose tissue (IAF), anthropometrics, Baecke activity questionnaire, and CVD risk (blood pressure, cholesterol, HDL, HDL2, HDL3, IDL, LDL, VLDL, and triglycerides) were evaluated in 137 men 30-71 yr old. IAF was consistently more highly related to CVD risk than other fat distribution variables including percent fat and waist:hip ratio (r = 0.3-0.45). IAF was significantly related to CVD risk after adjusting for other fat distribution variables. With the exception of the sum of biceps, triceps, thigh, and calf skinfolds (peripheral skinfolds), which was negatively related to CVD risk, no other fat distribution variable had consistent significant partial correlations with CVD risk. PA was related to IAF after adjusting for peripheral skinfolds, but PA was not related to peripheral skinfolds after adjusting for IAF, indicating more active men have relatively low IAF. IAF was related to CVD risk after adjusting for PA, but PA was not related to CVD risk after adjusting for IAF. These results indicate that IAF is directly related to CVD risk while the lower CVD risk found with more active men is more directly related to the low IAF found in more active men.

A review of the association between abdominal fat distribution, health outcome measures, and modifiable risk factors

PURPOSE OF THE REVIEW. This review of the literature examines the relationship between abdominal fat distribution and specific health outcome measures, modifiable risk factors, the impact of intervention efforts, and the significance of measurement methods. SEARCH METHODS USED. The research material that was received was found through several on-line data bases, including MEDLINE and CINAHL, an examination of references from selected articles, a manual review of recent relevant journals, and interviews with several physicians and epidemiologists who are experts in this field of inquiry. Forty-three research articles were reviewed for the section on health risk outcomes and abdominal fat distribution. Twenty studies were reviewed in the section on modifiable variables associated with fat distribution. Finally, 10 studies which examined the effect of behavior change on fat distribution were included in this review. SUMMARY OF IMPORTANT FINDINGS. Recent research indicates that people whose body fat is deposited more in the central or abdominal area, especially the intra-abdominal area, than it is in the gluteofemoral area are at increased risk for cardiovascular disease. This risk is independent of, but exacerbated by, the degree of obesity. Several nonmodifiable factors such as age, gender, and menopause as well as some modifiable factors such as obesity, smoking, physical inactivity, and alcohol intake are positively associated with abdominal fat deposition. MAJOR CONCLUSIONS. Intervention results indicate that it is possible to decrease abdominal fat with total weight loss or smoking cessation.

Adipose tissue and muscle volume determination by computed tomography in acromegaly, before and 1 year after adenomectomy

The adipose tissue volume, skeletal muscle and skin volume and visceral organ volume were determined using the multiscan CT (computed tomography) technique in 15 patients with acromegaly. The examinations were performed before treatment and 1 year after transsphenoidal adenectomy. The mean body weight did not change significantly after treatment; 91.3 kg and 92.3 kg pre and postoperatively in men and 66.7 kg and 65.9 kg in women respectively. The total adipose tissue volume increased by 7.11 (59.2%, P < 0.01) in the male group and 3.9 1 (20.3%, P < 0.05) in the female group. Muscle and skin mass and visceral organ mass decreased significantly after treatment. The muscle and skin mass decreased by 3.6 1 (-7.4%, P < 0.01) in males and by 3.2 1 in females (-11.5%, P < 0.02). The corresponding decrease in visceral organ mass was 1.5 1 (-17.0%, P < 0.01) in males and 1.0 1 (15.4%, P < 0.05) in females respectively. On average, the fractions of adipose tissue in the subcutaneous trunk and the intra-abdominal depots increased after treatment, while the fractions of adipose tissue in the limbs and the head and neck region decreased. The change in adipose tissue distribution pattern reached significance (P < 0.005) in men only.