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Associations between Body Mass Index, Waist Circumference, and Myocardial Infarction in Older Adults Aged over 75 Years: A Population-Based Cohort Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121768. [PMID: 36556970 PMCID: PMC9783624 DOI: 10.3390/medicina58121768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/17/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022]
Abstract
Background and Objectives: Body mass index (BMI) is widely used as a standard screening method for obesity and an indicator of related diseases. However, its inability to distinguish between lean body mass and body fat limits its utility. This limitation may be more prominent in older populations, wherein age-related sarcopenia and increased visceral fat due to the redistribution of adipose tissue may preclude a precise estimation of obesity. Many studies suggest that waist circumference (WC) is more strongly related to obesity-related diseases. There are also different opinions on whether the obesity paradox is real or a result of confusing interpretations. This study seeks to determine the association between myocardial infarction (MI), BMI, and WC in older adults and to determine if BMI and WC can reliably predict the risk of cardiovascular disease. Materials and Methods: We conducted a cohort study of older Korean adults aged over 75 years registered in the National Health Insurance System Senior database. Results: The results from the analysis using model 5, which was adjusted for each study variable, showed that the lower the BMI, the higher the hazard ratio (HR) of MI and vice versa. On the other hand, groups with lower than normal WC showed lower HR; even if it was higher, the difference was not statistically significant. Those with abdominal obesity tended to have an increased HR of MI. Conclusions: This study found that HR for MI has a negative relationship with BMI, whereas it has a positive relationship with WC. Furthermore, WC is a more appropriate indicator for predicting the risk of MI in the older population.
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Rogers LR, Ostrom QT, Schroer J, Vengoechea J, Li L, Gerson S, Nock CJ, Machtay M, Selman W, Lo S, Sloan AE, Barnholtz-Sloan JS. Association of metabolic syndrome with glioblastoma: a retrospective cohort study and review. Neurooncol Pract 2020; 7:541-548. [PMID: 33014395 DOI: 10.1093/nop/npaa011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Metabolic syndrome is identified as a risk factor for the development of several systemic cancers, but its frequency among patients with glioblastoma and its association with clinical outcomes have yet to be determined. The aim of this study was to investigate metabolic syndrome as a risk factor for and affecting survival in glioblastoma patients. Methods A retrospective cohort study, consisting of patients with diagnoses at a single institution between 2007 and 2013, was conducted. Clinical records were reviewed, and clinical and laboratory data pertaining to 5 metabolic criteria were extrapolated. Overall survival was determined by time from initial surgical diagnosis to date of death or last follow-up. Results The frequency of metabolic syndrome among patients diagnosed with glioblastoma was slightly greater than the frequency of metabolic syndrome among the general population. Within a subset of patients (n = 91) receiving the full schedule of concurrent radiation and temozolomide and adjuvant temozolomide, median overall survival was significantly shorter for patients with metabolic syndrome compared with those without. In addition, the presence of all 5 elements of the metabolic syndrome resulted in significantly decreased median survival in these patients. Conclusions We identified the metabolic syndrome at a slightly higher frequency in patients with diagnosed glioblastoma compared with the general population. In addition, metabolic syndrome with each of its individual components is associated with an overall worse prognosis in patients receiving the standard schedule of radiation and temozolomide after adjustment for age.
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Affiliation(s)
- Lisa R Rogers
- Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Quinn T Ostrom
- Department of Medicine, Section of Epidemiology and Population Health, Baylor College of Medicine, Houston, Texas
| | - Julia Schroer
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jaime Vengoechea
- Division of Medical Genetics, Emory University School of Medicine, Atlanta, Georgia
| | - Li Li
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Stanton Gerson
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Charles J Nock
- Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Hematology and Oncology, University Hospitals, Cleveland, Ohio
| | - Mitchell Machtay
- Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Radiation Oncology, University Hospitals, Cleveland, Ohio
| | - Warren Selman
- Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Simon Lo
- Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington
| | - Andrew E Sloan
- Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Case Western Reserve University School of Medicine, Cleveland, Ohio.,Case Comprehensive Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jill S Barnholtz-Sloan
- Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
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The Effects of a Low Calorie Ketogenic Diet on Glycaemic Control Variables in Hyperinsulinemic Overweight/Obese Females. Nutrients 2020; 12:nu12061854. [PMID: 32580282 PMCID: PMC7353458 DOI: 10.3390/nu12061854] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/12/2020] [Accepted: 06/17/2020] [Indexed: 12/12/2022] Open
Abstract
Diet is a factor which can influence both glycaemic variables and body mass. The aim of this study was to compare the influence of a 12-week, well-planned, low-calorie ketogenic diet (LCKD) on hyperglycaemic, hyperinsulinemic and lipid profile in adult, overweight or obese females. Ninety-one females who participated in the study were divided into two groups: a LCKD group who followed a hypocaloric ketogenic diet (8% of carbohydrate, 72% of fat and 20% of proteins) (n = 46), and a control group (CG) (n = 45) who continued their typical diet (50% of carbohydrates, 32% of fat and 18% of proteins). Methods: Baseline and post-intervention glucose (Gl), insulin (I), glycated haemoglobin (HbA1c), Homeostatic model assessment HOMA-IR, triglycerides (TG) and high-density cholesterol (HDL-C) were evaluated. Also, body mass (BM), waist circumference (WC), hip circumference (HC) and thigh circumference (TC) were measured. Results: Compared with the CG, there were significant changes observed in the LCKD group regarding all biochemical variables. Also, BM, TC, WC and AC changed significantly in the LCKD group compared with the CG. Conclusions: The 12-week LCKD intervention changed the glucose control variables, body mass, as well as waist, hip and thigh circumferences. A low-calorie ketogenic diet may be recommended for adult females with glucose control variables disturbance and excess body mass.
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Grundy SM, Williams C, Vega GL. Upper body fat predicts metabolic syndrome similarly in men and women. Eur J Clin Invest 2018; 48:e12941. [PMID: 29682733 PMCID: PMC6099361 DOI: 10.1111/eci.12941] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 04/17/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND The metabolic syndrome is a constellation of risk factors including dyslipidemia, dysglycemia, hypertension, a pro-inflammatory state, and a prothrombotic state. All of these factors are accentuated by obesity. However, obesity can be defined by body mass index (BMI), percent body fat, or by body fat distribution. The latter consists of upper body fat (subcutaneous and visceral fat) and lower body fat (gluteofemoral fat). Waist circumference is a common surrogate marker for upper body fat. METHODS Data from the National Health and Nutrition Examination Survey (NHANES) for the years 1999-2006 was examined for associations of metabolic risk factors with percent body fat, waist circumference, and BMI. RESULTS Associations between absolute measures of waist circumference and risk factors were similiar for men and women. The similarities of associations between waist circumference and risk factors suggests that greater visceral fat in men does not accentuate the influence of upper body fat on risk factors. CONCLUSIONS Different waist concumference values should not be used to define abdominal obesity in men and women.
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Affiliation(s)
- Scott M. Grundy
- Center for Human NutritionUniversity of Texas Southwestern Medical CenterDallasTXUSA
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Corbin Williams
- Center for Human NutritionUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Gloria L. Vega
- Center for Human NutritionUniversity of Texas Southwestern Medical CenterDallasTXUSA
- Department of Clinical NutritionUniversity of Texas Southwestern Medical CenterDallasTXUSA
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5
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Looijmans A, Stiekema APM, Bruggeman R, van der Meer L, Stolk RP, Schoevers RA, Jörg F, Corpeleijn E. Changing the obesogenic environment to improve cardiometabolic health in residential patients with a severe mental illness: cluster randomised controlled trial. Br J Psychiatry 2017; 211:296-303. [PMID: 28982656 DOI: 10.1192/bjp.bp.117.199315] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/17/2017] [Accepted: 07/22/2017] [Indexed: 11/23/2022]
Abstract
BackgroundFor patients with severe mental illness (SMI) in residential facilities, adopting a healthy lifestyle is hampered by the obesity promoting (obesogenic) environment.AimsTo determine the effectiveness of a 12-month lifestyle intervention addressing the obesogenic environment with respect to diet and physical activity to improve waist circumference and cardiometabolic risk factors v. care as usual (Dutch Trial Registry: NTR2720).MethodIn a multisite cluster randomised controlled pragmatic trial, 29 care teams were randomised into 15 intervention (365 patients) and 14 control teams (371 patients). Intervention staff were trained to improve the obesogenic environment.ResultsWaist circumference decreased 1.51 cm (95% CI -2.99 to -0.04) in the intervention v. control group after 3 months and metabolic syndrome z-score decreased 0.22 s.d. (95% CI -0.38 to -0.06). After 12 months, the decrease in waist circumference was no longer statistically significantly different (-1.28 cm, 95% CI -2.79 to 0.23, P=0.097).ConclusionsTargeting the obesogenic environment of residential patients with SMI has the potential to facilitate reduction of abdominal adiposity and cardiometabolic risk, but maintaining initial reductions over the longer term remains challenging.
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Affiliation(s)
- Anne Looijmans
- Anne Looijmans, MSc, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Annemarie P. M. Stiekema, PhD, Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Richard Bruggeman, MD, PhD, Department of Psychiatry and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Lisette van der Meer, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Ronald P. Stolk, MD, PhD, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen; Robert A. Schoevers, MD, PhD, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen; Frederike Jörg, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Research Department, Friesland Mental Health Services, Leeuwarden; Eva Corpeleijn, PhD, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Annemarie P M Stiekema
- Anne Looijmans, MSc, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Annemarie P. M. Stiekema, PhD, Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Richard Bruggeman, MD, PhD, Department of Psychiatry and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Lisette van der Meer, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Ronald P. Stolk, MD, PhD, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen; Robert A. Schoevers, MD, PhD, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen; Frederike Jörg, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Research Department, Friesland Mental Health Services, Leeuwarden; Eva Corpeleijn, PhD, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- Anne Looijmans, MSc, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Annemarie P. M. Stiekema, PhD, Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Richard Bruggeman, MD, PhD, Department of Psychiatry and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Lisette van der Meer, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Ronald P. Stolk, MD, PhD, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen; Robert A. Schoevers, MD, PhD, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen; Frederike Jörg, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Research Department, Friesland Mental Health Services, Leeuwarden; Eva Corpeleijn, PhD, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lisette van der Meer
- Anne Looijmans, MSc, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Annemarie P. M. Stiekema, PhD, Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Richard Bruggeman, MD, PhD, Department of Psychiatry and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Lisette van der Meer, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Ronald P. Stolk, MD, PhD, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen; Robert A. Schoevers, MD, PhD, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen; Frederike Jörg, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Research Department, Friesland Mental Health Services, Leeuwarden; Eva Corpeleijn, PhD, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ronald P Stolk
- Anne Looijmans, MSc, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Annemarie P. M. Stiekema, PhD, Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Richard Bruggeman, MD, PhD, Department of Psychiatry and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Lisette van der Meer, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Ronald P. Stolk, MD, PhD, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen; Robert A. Schoevers, MD, PhD, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen; Frederike Jörg, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Research Department, Friesland Mental Health Services, Leeuwarden; Eva Corpeleijn, PhD, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert A Schoevers
- Anne Looijmans, MSc, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Annemarie P. M. Stiekema, PhD, Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Richard Bruggeman, MD, PhD, Department of Psychiatry and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Lisette van der Meer, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Ronald P. Stolk, MD, PhD, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen; Robert A. Schoevers, MD, PhD, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen; Frederike Jörg, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Research Department, Friesland Mental Health Services, Leeuwarden; Eva Corpeleijn, PhD, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Frederike Jörg
- Anne Looijmans, MSc, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Annemarie P. M. Stiekema, PhD, Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Richard Bruggeman, MD, PhD, Department of Psychiatry and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Lisette van der Meer, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Ronald P. Stolk, MD, PhD, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen; Robert A. Schoevers, MD, PhD, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen; Frederike Jörg, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Research Department, Friesland Mental Health Services, Leeuwarden; Eva Corpeleijn, PhD, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eva Corpeleijn
- Anne Looijmans, MSc, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Annemarie P. M. Stiekema, PhD, Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Richard Bruggeman, MD, PhD, Department of Psychiatry and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Lisette van der Meer, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Ronald P. Stolk, MD, PhD, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen; Robert A. Schoevers, MD, PhD, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen; Frederike Jörg, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Research Department, Friesland Mental Health Services, Leeuwarden; Eva Corpeleijn, PhD, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Pirani N, Khiavi FF. Population Attributable Fraction for Cardiovascular Diseases Risk Factors in Selected Countries: A comparative study. Mater Sociomed 2017; 29:35-39. [PMID: 28484352 PMCID: PMC5402361 DOI: 10.5455/msm.2017.29.35-39] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 02/28/2017] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Cardiovascular diseases are the most common cause of death. The prevalence of cardiovascular diseases was reported to be 3,500 per 100,000. And it is predicted that these numbers will increase in the near future. By removing the main factors responsible for non-communicable diseases, cardiovascular disease can be prevented by 80%. AIM The aim of this study was to compare the population attributable fraction for cardiovascular diseases' risk factors in Iran, USA and Spain. METHODS This study was a comparative study and the population consisted of Iran, USA and Spain. The required information was collected from printed and electronic documentations and articles published in reliable databases, in the period 2007-2015. RESULTS The cardiovascular diseases' Population Attributable Risk or Fraction for blood pressure was calculated to be 11.37%, 54% and 60%, diabetes 7.32%, 13% and 18%, and high cholesterol 6.85%, 13% and 20%, for Iran, USA and Spain respectively. Among risk factors, blood pressure was the most relevant factor to cardiovascular disease. CONCLUSIONS The risk factor for high blood pressure had a more population attributable fraction than other physiological factors in the development of cardiovascular disease. Hence, by implementing comprehensive health policies, educating healthy lifestyle, screening and finding related cases as well as conducting health promotion programs, these diseases can be prevented.
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Affiliation(s)
- Narges Pirani
- School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Farzad Faraji Khiavi
- Social Determinants of Health Research Center (SDHRC), School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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7
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Abbasi F, Mathur A, Reaven GM, Molina CR. Cardiometabolic Risk in South Asian Inhabitants of California: Hypertriglyceridemic Waist vs Hypertriglyceridemic Body Mass Index. Ethn Dis 2016; 26:191-6. [PMID: 27103769 DOI: 10.18865/ed.26.2.191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Hypertriglyceridemic waist (HTG-waist), an increased waist circumference (WC) with an elevated triglyceride (TG) concentration, can identify increased cardiometabolic risk in apparently healthy individuals. Since WC and BMI are highly correlated, we examined whether an HTG-BMI would be as effective as an HTG-waist in identifying cardiometabolic risk in apparently healthy South Asians. DESIGN SETTING AND PARTICIPANTS In this cross-sectional study, we classified South Asian women (n=1156) and men (n=1842) without diabetes mellitus as having an HTG-waist (TG ≥150 mg/dL and a WC ≥80 cm in women or ≥ 90 cm in men) and an HTG-BMI (TG ≥150 mg/dL and a BMI ≥23 kg/m²). OUTCOME MEASURES We measured cardiometabolic risk factors, including blood pressure and fasting lipid profile, glucose, insulin, fibrinogen, and high-sensitivity C-reactive protein. RESULTS An HTG-waist was present in 670 individuals, of whom 648 (97%) had an HTG-BMI. The cardiometabolic profile was significantly more adverse in those in whom an HTG-waist was present vs absent; and the same was true when individuals with an HTG-BMI were compared with those without. CONCLUSIONS Essentially every individual with an HTG-waist also had an HTG-BMI. An HTG-BMI identified cardiometabolic risk as effectively as an HTG-waist in a population composed entirely of South Asians.
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Affiliation(s)
- Fahim Abbasi
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Ashish Mathur
- South Asian Heart Center, El Camino Hospital, Mountain View, California
| | - Gerald M Reaven
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - César R Molina
- South Asian Heart Center, El Camino Hospital, Mountain View, California
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Abdelmawgoud A, Brown CJ, Sui X, Fonarow GC, Kokkinos PF, Bittner V, Aronow WS, Kheirbek RE, Fletcher RD, Blair SN, Ahmed A. Relationship of Physical Activity and Healthy Eating with Mortality and Incident Heart Failure among Community-Dwelling Older Adults with Normal Body Mass Index. ESC Heart Fail 2015; 2:20-24. [PMID: 27499885 PMCID: PMC4973627 DOI: 10.1002/ehf2.12028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIMS Normal body mass index (BMI) is associated with lower mortality and may be achieved by physical activity (PA), healthy eating (HE), or both. We examined the association of PA and HE with mortality and incident heart failure (HF) among 2040 community-dwelling older adults aged ≥ 65 years with baseline BMI 18.5 to 24.99 kg/m2 during 13 years of follow-up in Cardiovascular Health Study. METHODS AND RESULTS Baseline PA was defined as ≥500 weekly metabolic equivalent task-minutes (MET-minutes) and HE as ≥5 daily servings of vegetable and fruit intake. Participants were categorized into 4 groups: (1) PA-/HE- (n=384); (2) PA+/HE- (n=992); (3) PA-/HE+ (n=162); and (4) PA+/HE+ (n=502). Participants had a mean age of 74 (±6) years, mean BMI of 22.6 (±1.5) kg/m2, 61% were women, and 4% African American. Compared with PA-/HE-, age-sex-race-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality for PA-/HE+, PA+/HE-, and PA+/HE+ groups were 0.96 (0.76-1.21), 0.61 (0.52-0.71) and 0.62 (0.52-0.75), respectively. These associations remained unchanged after multivariable adjustment and were similar for cardiovascular and non-cardiovascular mortalities. Respective demographic-adjusted HRs (95% Cis) for incident HF among 1954 participants without baseline HF were 1.21 (0.81-1.81), 0.71 (0.54-0.94) and 0.71 (0.51-0.98). These later associations lost significance after multivariable-adjustment. CONCLUSION Among community-dwelling older adults with normal BMI, physical activity, regardless of healthy eating, was associated with lower risk of mortality and incident HF, but healthy eating had no similar protective association in this cohort.
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Affiliation(s)
| | - Cynthia J Brown
- University of Alabama at Birmingham, Birmingham, AL; Veterans Affairs Medical Center, Birmingham, AL
| | - Xuemei Sui
- University of South Carolina, Columbia, SC 29208
| | | | | | - Vera Bittner
- University of Alabama at Birmingham, Birmingham, AL
| | | | - Raya E Kheirbek
- Veterans Affairs Medical Center, Washington, DC, USA; George Washington University, Washington, DC, USA
| | | | | | - Ali Ahmed
- Veterans Affairs Medical Center, Washington, DC; University of Alabama at Birmingham, Birmingham, AL
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Raimi TH, Fasanmade O, Odusan O, Ohwovoriole AE. The Best Central Adiposity Index in the Prediction of Cardiovascular Risk Factors in South-Western Nigeria. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojemd.2015.512023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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10
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Salazar MR, Carbajal HA, Espeche WG, Balbín E, Aizpurúa M, Marillet AG, Reaven GM. Do differences in waist circumference modify the relationships among body mass index, insulin resistance, and related cardiometabolic risk factors in apparently healthy women? J Am Coll Nutr 2014; 33:32-8. [PMID: 24533606 DOI: 10.1080/07315724.2014.869982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aims of the study were to (1) compare the cardiometabolic risk profile between insulin-resistant and non-insulin-resistant women within similar body mass indexes (BMIs) and waist circumference (WC) groupings and (2) test the hypothesis that measurements of BMI are not inferior to WC in identifying insulin resistance. METHODS The sample consisted of 899 women without known cardiovascular disease or diabetes. BMI was used to divide participants in normal (<25.0 kg/m(2)), overweight (≥25-29.9 kg/m(2)), and obese (≥30.0 kg/m(2)) subgroups, and waist circumference ≥88 cm was used to identify women with or without abdominal obesity. The 25% of the population with highest fasting insulin concentrations was classified as insulin resistant. BMI, WC, blood pressure, and fasting plasma glucose, insulin, triglyceride, and high-density lipoprotein cholesterol concentrations were compared using analysis of covariance (ANCOVA). The relationships between obesity and insulin resistance were analyzed using univariate, multivariate, and logistic regression. RESULTS Triglyceride and glucose concentrations were higher and high-density lipoprotein cholesterol concentrations lower in the insulin-resistant group in each BMI category, as was the case when comparing by abdominal obesity. In the univariate analysis, correlations between obesity and the individual cardiometabolic risk factor were significant but weak. In multivariate analysis including both indices, only body mass independently predicted insulin resistance. CONCLUSION Insulin-resistant women were at greater cardiometabolic risk, irrespective of adiposity category. Obesity contributed to a modest variability in insulin resistance, and abdominal obesity does not add to the ability of BMI to predict insulin resistance.
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Affiliation(s)
- Martin R Salazar
- a Hospital Universitario San Martín , La Plata , Buenos Aires , ARGENTINA
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Efficacy and Safety of Weight-based Insulin Glargine Dose Titration Regimen Compared With Glucose Level- and Current Dose-based Regimens in Hospitalized Patients With Type 2 Diabetes: A Randomized, Controlled Study. Clin Ther 2014; 36:1269-75. [DOI: 10.1016/j.clinthera.2014.06.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/03/2014] [Accepted: 06/27/2014] [Indexed: 11/23/2022]
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Wu X, Huang Z, Han H, Zhong Z, Gan Z, Guo X, Diao F, Han Z, Zhao J. The comparison of glucose and lipid metabolism parameters in drug-naïve, antipsychotic-treated, and antipsychotic discontinuation patients with schizophrenia. Neuropsychiatr Dis Treat 2014; 10:1361-8. [PMID: 25092981 PMCID: PMC4114900 DOI: 10.2147/ndt.s63140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Although many studies have reported that glucose and lipid metabolism disorders are a significant side effect associated with the use of antipsychotic drugs, the characteristics of glucose and lipid metabolism disorders in patients with schizophrenia who are taking antipsychotic drugs remain poorly understood, and the possible effects that antipsychotic discontinuation may have on glucose and lipid metabolism remain unclear. METHODS The sample consisted of 131 Chinese patients with schizophrenia, including 70 first-episode, drug-naïve patients; 33 patients who had received continuous antipsychotic drug treatment for ≥1 year prior to the beginning of the study; and 28 patients who had discontinued antipsychotic drug treatment for ≥3 months prior to the beginning of study. We compared the glucose and lipid metabolic parameter levels among the three groups of patients with schizophrenia. All assessments were performed upon hospital admission. RESULTS The characteristics of glucose and lipid metabolism disorders in Chinese patients with schizophrenia who are taking antipsychotic drugs included significant augmentation of the body mass index and waist circumference, significantly higher levels of fasting plasma insulin and insulin resistance, and significantly lower plasma high-density lipoprotein cholesterol levels. Antipsychotic discontinuation appeared to not significantly improve any plasma glucose and lipid metabolic parameter levels. CONCLUSION The results suggest that antipsychotic drugs aggravate glucose and lipid metabolism disorders and that antipsychotic discontinuation is generally not associated with improvements in the parameters that indicate glucose and lipid metabolism disorders in Chinese patients with schizophrenia.
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Affiliation(s)
- Xiaoli Wu
- Mental Health Institute of the Second Xiangya Hospital, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan, People's Republic of China ; Psychiatry Department, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Zeping Huang
- Ultrasound Department, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Hongying Han
- Psychiatry Department, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Zhiyong Zhong
- Psychiatry Department, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Zhaoyu Gan
- Psychiatry Department, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Xiaofeng Guo
- Mental Health Institute of the Second Xiangya Hospital, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan, People's Republic of China
| | - Feici Diao
- Psychiatry Department, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Zili Han
- Psychiatry Department, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Jingping Zhao
- Mental Health Institute of the Second Xiangya Hospital, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan, People's Republic of China
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Abbasi F, Blasey C, Reaven GM. Cardiometabolic risk factors and obesity: does it matter whether BMI or waist circumference is the index of obesity? Am J Clin Nutr 2013; 98:637-40. [PMID: 23885045 PMCID: PMC3743728 DOI: 10.3945/ajcn.112.047506] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND It has been suggested that the cardiometabolic risk associated with excess adiposity is particularly related to central obesity. OBJECTIVE The objective was to compare the associations between cardiometabolic risk of apparently healthy individuals and measures of central obesity [waist circumference (WC)] and overall obesity [body mass index (BMI)]. DESIGN In this cross-sectional, observational study, 492 subjects (306 women and 303 non-Hispanic whites) were classified by BMI (in kg/m²) as normal weight (BMI <25) or overweight/obese (BMI = 25.0-34.9) and as having an abnormal WC (≥80 cm in women and ≥94 cm in men) or a normal WC (<80 cm in women and <94 cm in men). Measurements were also made of the cardiometabolic risk factors age, systolic blood pressure (SBP), and fasting plasma glucose (FPG), triglyceride, and high-density lipoprotein (HDL)-cholesterol concentrations. Associations among cardiometabolic risk factors and BMI and WC were evaluated with Pearson correlations. RESULTS There was a considerable overlap in the normal and abnormal categories of BMI and WC, and ~81% of the subjects had both an abnormal BMI and WC. In women, BMI and WC correlated with SBP (r = 0.30 and 0.19, respectively), FPG (r = 0.25 and 0.22, respectively), triglycerides (r = 0.17 and 0.20, respectively), and HDL cholesterol (r = -0.23 and -0.20, respectively) (P < 0.01 for all). In men, BMI and WC also correlated with SBP (r = 0.22 and 0.22, respectively), FPG (r = 0.22 and 0.25, respectively), triglycerides (r = 0.21 and 0.18, respectively), and HDL cholesterol (r = -0.20 and -0.13, respectively) [P < 0.05 for all, except for the association of WC with HDL cholesterol (P = 0.08)]. CONCLUSIONS Most individuals with an abnormal BMI also have an abnormal WC. Both indexes of excess adiposity are positively associated with SBP, FPG, and triglycerides and inversely associated with HDL cholesterol.
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Affiliation(s)
- Fahim Abbasi
- Division of Cardiovascular Medicine, Department of Medicine and the Department of Psychiatry, Stanford University School of Medicine, Stanford, CA 94305, USA.
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14
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Laclaustra M, Ordoñez B, Leon M, Andres EM, Cordero A, Pascual-Calleja I, Grima A, Luengo E, Alegria E, Pocovi M, Civeira F, Casasnovas-Lenguas JA. Metabolic syndrome and coronary heart disease among Spanish male workers: a case-control study of MESYAS. Nutr Metab Cardiovasc Dis 2012; 22:510-516. [PMID: 21186101 DOI: 10.1016/j.numecd.2010.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Revised: 08/16/2010] [Accepted: 09/23/2010] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND AIMS In Spain, the incidence of coronary heart disease is below that expected based on the burden of classic cardiovascular risk factors present in the population. Whether the risk associated with metabolic syndrome is lower in Spain deserves to be investigated. This study evaluates the association of incident clinical coronary heart disease with metabolic syndrome and each of its individual defining components in a sample of Spanish working males. METHODS AND RESULTS Among the workers of a factory (MESYAS registry), 208 incident cases of coronary heart disease (between 1981 and 2005) were age-matched with 2080 healthy workers visited in 2004-2005. Metabolic syndrome was characterized using modified criteria of the joint consensus definition (2009). Metabolic syndrome was strongly associated with coronary heart disease (OR = 4.03; 95% CI: 2.98, 5.45) and the risk seemed to be fully explained by metabolic syndrome components (OR = 0.84, p = 0.54 after adjustment). Odds ratios for the independent effects of the diagnostic criteria were: hypertriglyceridemia (OR = 3.39, p < 0.001), hyperglycemia (OR = 2.70, p < 0.001), low HDL cholesterol (OR = 2.35, p < 0.001), hypertension (OR = 1.49, p = 0.016) and overweight (OR = 1.07, p = 0.678). Young workers showed a higher risk associated with metabolic syndrome. CONCLUSION The risk associated with metabolic syndrome is fully explained by its components considered independently. The risk of coronary heart disease in a Spanish male working population is considerably increased among those with metabolic syndrome, by a factor similar to that described for other countries. Public health measures to prevent a rise in the prevalence of metabolic syndrome are advisable to minimize cardiovascular disease rate in Spain.
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Affiliation(s)
- M Laclaustra
- Department of Cardiovascular Epidemiology and Population Genetics, National Center for Cardiovascular Research (CNIC), Melchor Fernandez Almagro, 3, E-28029, Madrid, Spain.
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Liu A, Abbasi F, Reaven GM. Adiposity indices in the prediction of metabolic abnormalities associated with cardiovascular disease in non-diabetic adults. Nutr Metab Cardiovasc Dis 2011; 21:553-560. [PMID: 20304617 PMCID: PMC2895680 DOI: 10.1016/j.numecd.2009.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 12/10/2009] [Accepted: 12/22/2009] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND AIMS The prevalence of insulin resistance and cardiovascular disease (CVD) increases with degree of obesity. Whether measurements of generalized and abdominal obesity differ in the ability to predict changes associated with increased CVD risk is widely debated. We compared the prevalence of metabolic abnormalities in 275 women and 204 men stratified by categories of body mass index (BMI) and waist circumference (WC), and assessed the ability of these adiposity indices in combination with metabolic risk variables to predict insulin resistance. METHODS AND RESULTS Healthy, non-diabetic volunteers underwent measurements of BMI, WC, blood pressure, fasting plasma glucose (FPG), lipoprotein concentrations, and direct quantification of insulin-mediated glucose uptake. Insulin resistance was defined as the top tertile of steady-state plasma glucose (SSPG) concentrations. BMI and WC were highly correlated (P < 0.001) in both women and men. Abnormal SSPG and triglyceride concentrations were associated with increasing adiposity by either index in both genders. Among women, abnormal FPG and high density lipoprotein cholesterol (HDL-C) concentrations were associated with increasing BMI and WC. In men, abnormal HDL-C was associated with increasing BMI only. Elevated systolic blood pressure (SBP) was associated with increasing BMI in both genders. The odds of insulin resistance were greatest in women with elevated FPG and triglycerides (4.5-fold). In men, the best predictors were BMI and SBP, and WC and HDL-C (3-fold). CONCLUSION BMI is at least comparable to WC in stratifying individuals for prevalence of metabolic abnormalities associated with increased CVD risk and predicting insulin resistance.
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Affiliation(s)
- A Liu
- Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
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Jover A, Corbella E, Muñoz A, Millán J, Pintó X, Mangas A, Zúñiga M, Pedro-Botet J, Hernández-Mijares A. Prevalence of Metabolic Syndrome and its Components in Patients With Acute Coronary Syndrome. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.rec.2011.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Jover A, Corbella E, Muñoz A, Millán J, Pintó X, Mangas A, Zúñiga M, Pedro-Botet J, Hernández-Mijares A. [Prevalence of metabolic syndrome and its components in patients with acute coronary syndrome]. Rev Esp Cardiol 2011; 64:579-86. [PMID: 21640461 DOI: 10.1016/j.recesp.2011.03.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 03/02/2011] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES A large proportion of patients with coronary disease have metabolic syndrome, although the frequency and association of its different components are not well understood. The aim of this study was to determine the prevalence of metabolic syndrome and the combination of its components in a Spanish cohort of patients with acute coronary syndrome. METHODS Clinical histories of 574 inpatients with acute coronary syndrome in 6 tertiary hospitals were reviewed and the presence of metabolic syndrome and its components determined by applying Adult Treatment Panel III criteria. In a second step, the components of the metabolic syndrome were analyzed, excluding those patients with diabetes mellitus. RESULTS The metabolic syndrome was present in 50.9% of patients and was more frequent in women than in men (66.3% vs. 47.3%; P<.001). The most prevalent component was carbohydrate metabolism disorder (85.3%), followed by low high-density lipoprotein cholesterol (HDLc) levels (80.5%). In nondiabetic patients, 34.6% had metabolic syndrome and the most prevalent component was low HDLc levels (86%), followed by high blood pressure and hypertriglyceridemia and, in fourth place, impaired fasting serum glucose levels. CONCLUSIONS The metabolic syndrome has a high prevalence in patients with an acute coronary syndrome, especially in women. The most frequent components are hyperglycemia and low HDLc levels. After excluding diabetic patients, the most prevalent diagnostic criterion of metabolic syndrome was low HDLc levels. Full English text available from: www.revespcardiol.org.
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Affiliation(s)
- Ana Jover
- Servicio de Endocrinología, Hospital Universitario Dr. Peset y Fundación para la Investigación Hospital Universitario Dr. Peset, Valencia, Spain
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Barzin M, Hosseinpanah F, Fekri S, Azizi F. Predictive value of body mass index and waist circumference for metabolic syndrome in 6-12-year-olds. Acta Paediatr 2011; 100:722-7. [PMID: 21244485 DOI: 10.1111/j.1651-2227.2011.02162.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To determine the predictive value of body mass index (BMI) and waist circumference (WC) and their optimal cut-off points for metabolic syndrome (MetS), and also the incidence of MetS. METHODS This study included 888 children, aged 6-12 years, who were followed for a mean of 6.6 years. BMI, WC and their optimal cut-off points to predict MetS were investigated. RESULTS The cumulative incidence of MetS was 10.7%. The adjusted ORs for age, sex and family history to predict MetS for BMI and WC z-scores were 2.6 (95% CI, 2.0-3.5) and 2.6 (95% CI, 1.9-3.5), respectively. In their correspondent models, area under the receiver operating characteristic (ROC) curve was 0.73 (95% CI, 0.68-0.79) for BMI z-scores and 0.72 (95% CI, 0.67-0.78) for WC z-scores with no statistically significant difference. The optimal cut-off values for BMI were 16.5 kg/m(2) for boys and 16.3 kg/m(2) for girls and those for WC were 57.5 cm for boys and 56.5 cm for girls. CONCLUSIONS Our findings suggest that both BMI and WC have the same power to predict MetS and also children with higher BMI or WC are more susceptible to MetS. Moreover, a high incidence of MetS in children highlights the importance of interventional strategies during early childhood.
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Affiliation(s)
- Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Science, Tehran, Iran
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Gallagher EJ, Leroith D, Karnieli E. Insulin resistance in obesity as the underlying cause for the metabolic syndrome. ACTA ACUST UNITED AC 2011; 77:511-23. [PMID: 20960553 DOI: 10.1002/msj.20212] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The metabolic syndrome affects more than a third of the US population, predisposing to the development of type 2 diabetes and cardiovascular disease. The 2009 consensus statement from the International Diabetes Federation, American Heart Association, World Heart Federation, International Atherosclerosis Society, International Association for the Study of Obesity, and the National Heart, Lung, and Blood Institute defines the metabolic syndrome as 3 of the following elements: abdominal obesity, elevated blood pressure, elevated triglycerides, low high-density lipoprotein cholesterol, and hyperglycemia. Many factors contribute to this syndrome, including decreased physical activity, genetic predisposition, chronic inflammation, free fatty acids, and mitochondrial dysfunction. Insulin resistance appears to be the common link between these elements, obesity and the metabolic syndrome. In normal circumstances, insulin stimulates glucose uptake into skeletal muscle, inhibits hepatic gluconeogenesis, and decreases adipose-tissue lipolysis and hepatic production of very-low-density lipoproteins. Insulin signaling in the brain decreases appetite and prevents glucose production by the liver through neuronal signals from the hypothalamus. Insulin resistance, in contrast, leads to the release of free fatty acids from adipose tissue, increased hepatic production of very-low-density lipoproteins and decreased high-density lipoproteins. Increased production of free fatty acids, inflammatory cytokines, and adipokines and mitochondrial dysfunction contribute to impaired insulin signaling, decreased skeletal muscle glucose uptake, increased hepatic gluconeogenesis, and β cell dysfunction, leading to hyperglycemia. In addition, insulin resistance leads to the development of hypertension by impairing vasodilation induced by nitric oxide. In this review, we discuss normal insulin signaling and the mechanisms by which insulin resistance contributes to the development of the metabolic syndrome.
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Risk factors for metabolic syndrome in stable Italian renal transplant patients. Clin Exp Nephrol 2011; 15:560-6. [PMID: 21360023 DOI: 10.1007/s10157-011-0422-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 01/31/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND The prevalence of metabolic syndrome (MS) in renal transplant recipients (RTR) is still under investigation. METHODS We performed a cross-sectional study of 107 stable RTR who were diagnosed as having MS defined by the Adult Treatment Panel III of the National Cholesterol Education Program (NCEP-ATP III) criteria. Anthropometric, clinical and biochemical data were collected. RESULTS Mean age of the patients studied was 55 ± 11 years (72 male, 35 female), dialysis duration before transplantation 30 ± 31 months, time since transplantation 42 ± 13 months. Mean serum creatinine was 1.68 ± 0.64 mg/dl; creatinine clearance by Cockcroft-Gault formula 53 ± 20 ml/min, glomerular filtration rate by 4-variable MDRD formula 48 ± 18 ml/min/1.73 m(2). Thirty-seven patients (34.5%) had MS. The MS patients had higher weight (76 ± 13 vs. 68 ± 12 kg, p = 0.0033), body mass index (BMI) (26 ± 4 vs. 24 ± 3 kg/m(2), p = 0.0025), waist circumference (101 ± 11 vs. 90 ± 11 cm, p < 0.0001), prevalence of BMI >25 k/m(2) (57 vs. 34%, p = 0.0254), prevalence of diabetes mellitus before transplantation (8 vs. 0%, p = 0.0157), glycaemia (104 ± 31 vs. 87 ± 11 mg/dl, p = 0.0002), and triglyceridaemia (225 ± 105 vs. 112 ± 35 mg/dl, p < 0.0001). They also showed lower levels of high-density lipoprotein cholesterol (48 ± 15 vs. 68 ± 17 mg/dl, p < 0.0001). Multiple logistic regression analysis showed that only BMI was independently associated with MS (OR 1.21, 95% CI 1.06-1.37, p = 0.0037). CONCLUSIONS MS according to NCEP-ATP III criteria appears to be present in about one-third of RTR, and even small increases in BMI above 25 kg/m(2) may determine the presence of MS in these patients. Therefore the preventive value of lifestyle modifications is very important for such patients, in order to strictly maintain body fat accumulation within the normal range.
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Abstract
The diagnostic category of the metabolic syndrome (MetS) has received considerable attention over the last decade, and prestigious organizations continue to strive for its incorporation into medical practice. This review has three goals: (i) summarize the history of the several attempts to define a diagnostic category designated as the MetS; (ii) question the aetiological role of abdominal obesity in the development of the other components of the MetS; and (iii) evaluate a diagnosis of the MetS as an effective way to identify apparently healthy individuals at increased risk to develop cardiovascular disease (CVD) or type 2 diabetes (2DM). The most important conclusion is that the MetS seems to be less effective in this population than the Framingham Risk Score in predicting CVD, and no better, if not worse, than fasting plasma glucose concentrations in predicting 2DM.
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Affiliation(s)
- G M Reaven
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
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Is Job-Related Stress the Link Between Cardiovascular Disease and the Law Enforcement Profession? J Occup Environ Med 2010; 52:561-5. [DOI: 10.1097/jom.0b013e3181dd086b] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Owens CD, Kim JM, Hevelone ND, Hamdan A, Raffetto JD, Creager MA, Conte MS. Novel adipokines, high molecular weight adiponectin and resistin, are associated with outcomes following lower extremity revascularization with autogenous vein. J Vasc Surg 2010; 51:1152-9. [PMID: 20223619 DOI: 10.1016/j.jvs.2009.12.051] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 12/16/2009] [Accepted: 12/16/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE A significant portion of patients undergoing lower extremity bypass surgery (LEB) for peripheral arterial disease (PAD) will have cardiovascular or graft-related events. It has been previously demonstrated that systemic inflammation is associated with PAD and its clinical outcomes. We hypothesized that serum biomarkers of insulin resistance and inflammation would identify a subgroup at elevated risk for graft failure, limb loss, and mortality. METHODS This was a prospective longitudinal study of patients (n = 225) undergoing LEB using autogenous vein. Baseline blood samples were obtained prior to surgery in the fasting state. High-sensitivity C-reactive protein (hsCRP) and the adipokines resistin and high-molecular weight adiponectin (HMWA) were measured by enzyme-linked immunosorbent assay (ELISA). Median follow-up was 893 days. The major endpoints of primary patency (PP) and amputation-free survival (AFS) were examined using multivariable methods. Endpoints were screened against biomarkers and patient characteristics for univariate associations. Promising explanatory variables (P < .1) were included in multivariable Cox proportional hazard models. RESULTS The mean age of subjects was 67.6 years; 71.6% were male and 87.1% were Caucasian. One hundred thirty-three (59.1%) subjects underwent bypass for critical limb ischemia (CLI) and 73 (32.4%) had tissue loss. Patients with CLI and diabetes demonstrated elevated resistin and hsCRP levels. HMWA levels correlated with CLI and with a measure of insulin resistance (HOMA-IR) but not with clinical diabetes. Baseline biomarkers were higher in those presenting with tissue loss and in patients with postoperative events (mortality, limb loss). After multivariable analysis (including CLI, diabetes, age, estimated glomerular filtration rate [eGFR], adiponectin, resistin, and CRP), resistin (hazard ratio [HR] 1.75, 95% confidence interval [CI], 1.07-2.85; P = .025) and CRP (HR 2.39, 95% CI, 1.30-4.39; P = .005) were independently predictive of reduced AFS. However, only resistin maintained its significance when restricted to the diabetic cohort (HR 2.10, 95% CI, 1.10-3.99; P = .025). Higher levels of HMWA were found to be associated with primary graft patency (HR 0.73 for graft failure; 95% CI, 0.55 to 0.97; P = .031) in a multivariable model adjusting for diabetes, CRP, African-American race, CLI, high-risk conduits, and redo bypass procedures. CONCLUSION These findings suggest that serum biomarkers of insulin resistance and inflammation may be predictive of clinical outcomes following LEB. Improving the systemic milieu of insulin resistance and inflammation in these high-risk patients may lead to reduced morbidity and mortality.
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Affiliation(s)
- Christopher D Owens
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, Calif, USA.
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Satoh H, Kishi R, Tsutsui H. Body mass index can similarly predict the presence of multiple cardiovascular risk factors in middle-aged Japanese subjects as waist circumference. Intern Med 2010; 49:977-82. [PMID: 20519812 DOI: 10.2169/internalmedicine.49.3006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Adiposity is closely associated with the clustering of metabolic risk factors such as high blood pressure, dyslipidemia, and glucose intolerance. Waist circumference and body mass index (BMI) are the established markers of abdominal adiposity and general adiposity, respectively. However, it has not been examined whether these two markers can detect the clustering of metabolic risk factors in Japanese subjects. METHODS AND RESULTS We studied 5,796 Japanese middle-aged subjects aged 40-60 years (4,344 males and 1,452 females). Metabolic risk factors including high blood pressure, dyslipidemia, and glucose intolerance were identified according to the diagnostic criteria for metabolic syndrome in Japan. The number of metabolic risk factors was significantly associated with the BMI values in both male and female subjects. The prevalence of subjects with multiple (two or more) metabolic risk factors was 29.4% and 7.6% in males and females, respectively. According to receiver operating characteristic (ROC) analysis, the area under curve values of BMI and waist circumference did not differ in male (0.658 vs. 0.671, p=n.s.) and female (0.776 vs. 0.790, p=n.s.) subjects, indicating that the waist circumference as well as the BMI could be useful in detecting the occurrence of multiple metabolic risk factors. The appropriate cut-off values of BMI to predict the presence of multiple metabolic risk factors were 24.7 and 23.4 kg/m(2) in males and females, respectively. The sensitivity and specificity using these cut-off values were 58 and 65% in males and 65 and 77% in females, respectively. CONCLUSION The BMI values can similarly predict the presence of multiple metabolic risk factors just as the waist circumference in Japanese middle-aged subjects.
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Affiliation(s)
- Hiroki Satoh
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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Keane J, Meier JL, Noth RH, Swislocki AL. Computer-Based Screening of Veterans for Metabolic Syndrome. Metab Syndr Relat Disord 2009; 7:557-61. [DOI: 10.1089/met.2009.0021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Jessica Keane
- Medicine Service, Veteran Affairs Northern California Health Care System (VANCHCS), Martinez, California
- Department of Internal Medicine, University of California Davis School of Medicine, Davis, California
| | - Joy L. Meier
- Pharmacy Service, Veteran Affairs Northern California Health Care System (VANCHCS), Martinez, California
| | - Robert H. Noth
- Medicine Service, Veteran Affairs Northern California Health Care System (VANCHCS), Martinez, California
- Department of Internal Medicine, University of California Davis School of Medicine, Davis, California
| | - Arthur L.M. Swislocki
- Medicine Service, Veteran Affairs Northern California Health Care System (VANCHCS), Martinez, California
- Department of Internal Medicine, University of California Davis School of Medicine, Davis, California
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Bobbioni-Harsch E, Pataky Z, Makoundou V, Kozakova M, Dekker J, Golay A. Fat distribution influences the cardio-metabolic profile in a clinically healthy European population. Eur J Clin Invest 2009; 39:1055-64. [PMID: 19807784 DOI: 10.1111/j.1365-2362.2009.02211.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Waist and hip circumferences are largely influenced by Fat Mass and several other determinants. To evaluate the specific effects of a preferential fat distribution, we corrected the waist and hip circumferences for all their determinants. We then examined the association between fat distribution and several cardio-metabolic parameters in a clinically healthy population. SUBJECTS AND METHODS In a subgroup of 625 females (F) and 490 males (M) from the RISC (Relationship between Insulin Sensitivity and Cardiovascular Disease) study, we evaluated insulin sensitivity by hyperinsulinaemic euglycaemic clamp and intima-media thickness (IMT) of the common (CCA) and internal (ICA) carotid artery by ultrasound imaging. Waist and hip circumferences were adjusted for age, height, fat and fat-free mass; in males, waist was also adjusted by hip and vice versa. RESULTS Both F and M with enlarged waist showed significantly increased plasma insulin, C-peptide, total cholesterol, non-high density lipoprotein-cholesterol, low density lipoprotein cholesterol and triglycerides, when compared with subjects with a smaller waist circumference. Males also showed lower glucose uptake and higher heart rate and ICA-IMT. A larger hip in both females and males was linked to a significantly greater inhibition of free fatty acids during the clamp test. CONCLUSION Adjustment of waist circumference for its determinants permits the detection of early impairment of cardiovascular function and of glucose and lipid metabolism in a clinically healthy population, in particular in normal body weight subjects. Enlarged hip adjusted values are associated with greater insulin sensitivity.
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Affiliation(s)
- E Bobbioni-Harsch
- Service of Therapeutic Education for Chronic Diseases, Geneva University Hospital, Gabrielle-Perret-Gentil 4, CH-1211 Geneva 14, Switzerland.
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Waist circumference is the best anthropometric predictor for insulin resistance in nondiabetic patients with schizophrenia treated with clozapine but not olanzapine. J Psychiatr Pract 2009; 15:251-61. [PMID: 19625881 PMCID: PMC2918660 DOI: 10.1097/01.pra.0000358312.99233.ef] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The goal of this study was to evaluate which anthropometric measure (human body measurement) best predicts insulin resistance measured by the insulin sensitivity index (SI) and the homeostasis model of assessment of insulin resistance (HOMA-IR) in nondiabetic patients with schizophrenia treated with clozapine or olanzapine. METHODS We conducted a cross-sectional study of nondiabetic subjects with schizophrenia being treated with olanzapine or clozapine using a frequently sampled intravenous glucose tolerance test, nutritional assessment, and anthropometric measures, to assess the relationship between anthropometric measures and insulin resistance. RESULTS No difference was found between the groups treated with clozapine and olanzapine in age, gender, race, body mass index (BMI), waist circumference (WC), lipid levels, HOMA-IR, or SI. The disposition index (SI x the acute insulin response to glucose), which measures how the body compensates for insulin resistance to maintain a normal glucose level, was significantly lower in the group treated with clozapine than in the group treated with olanzapine (1067+/-1390 vs. 2521+/-2805; P=0.013), suggesting that the subjects treated with clozapine had a reduced compensatory response to IR compared with the subjects treated with olanzapine. In the clozapine group, both higher WC and BMI were significantly associated with elevated HOMA-IR and lower SI; however, WC was a stronger correlate of IR than BMI, as measured by SI (-0.50 vs. -0.40). In the olanzapine group, neither WC nor BMI was significantly associated with any measure of glucose metabolism. CONCLUSIONS In this study, WC was the single best anthropometric surrogate for predicting IR in patients treated with clozapine but not olanzapine. The results suggest that WC may be a valuable screening tool for predicting IR in patients with schizophrenia being treated with clozapine who are at relatively higher risk of developing the metabolic syndrome, type 2 diabetes mellitus, and associated cardiovascular disease.
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Palmer IM, Schutte AE, Huisman HW. Ethnic and gender differences regarding the insulin-blood pressure relationship. Diabetes Res Clin Pract 2009; 85:102-10. [PMID: 19443068 DOI: 10.1016/j.diabres.2009.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 03/22/2009] [Accepted: 04/09/2009] [Indexed: 11/18/2022]
Abstract
Ageing is associated with increased insulin and C-peptide levels. Due to a lack of data, our first aim was to establish whether this also holds true for Africans from South Africa. Our second aim was to determine whether an association between insulin/C-peptide levels and blood pressure exist within an African and Caucasian population with increasing age, as well as to establish gender differences. African men and women (N=260) and Caucasian men and women (N=369) were recruited and stratified into age groups (18-35 years, 36-45 years and >45 years). ANCOVAs and partial correlations were performed. Results showed opposing changes in insulin/C-peptide levels of African and Caucasian men with increasing age. Insulin/C-peptide tended to decrease in African men, whereas insulin tended to increase and C-peptide increased significantly (p=0.03) in Caucasian men. Despite similar obesity levels, the oldest African women had significantly lower insulin (p<0.01) and C-peptide (p<0.01) levels compared to their Caucasian counterparts. In conclusion, insulin/C-peptide levels tended to decrease in the African population with increasing age. Despite significantly lower levels of insulin, blood pressure levels of African men seems to be affected more detrimentally compared to their Caucasian counterparts, leaving them more vulnerable for the development of cardiovascular diseases.
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Affiliation(s)
- I M Palmer
- Hypertension in Africa Research Team, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa.
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Klausen KP, Parving HH, Scharling H, Jensen JS. Microalbuminuria and obesity: impact on cardiovascular disease and mortality. Clin Endocrinol (Oxf) 2009; 71:40-5. [PMID: 18803675 DOI: 10.1111/j.1365-2265.2008.03427.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Microalbuminuria and obesity are both associated with cardiovascular disease (CVD). The aim of this study was to determine the association between obesity (measured by body mass index, waist-to-hip ratio, waist circumference) and different levels of microalbuminuria. We also aimed to determine the risk of death and CVD at different levels of microalbuminuria and obesity. DESIGN Population-based observational study based on 2696 men and women, 30-70 years of age. Urinary albumin excretion (UAE), body mass index, waist-to-hip ratio, waist circumference and other cardiovascular risk factors were measured during the years 1992-1994 at the Copenhagen City Heart Study. End-points were registered until 1999-2000 with respect to CVD and until 2004 with respect to death. RESULTS There was a strong association between microalbuminuria and obesity. Microalbuminuria and obesity had additive effects on the relative risk of death independently of other risk factors. In contrast there was no statistically significant association between microalbuminuria and risk of CVD when stratified by obesity. CONCLUSIONS Microalbuminuria (UAE > 5 microg/min) confers increased risk of death and to a similar extent as obesity. This effect is independent of concomitant obesity. We suggest microalbuminuria to be included in health examinations besides measurements of obesity.
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Affiliation(s)
- Klaus Peder Klausen
- The Copenhagen City Heart Study, Epidemiological Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark.
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30
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Persistently increased HDL-cholesterolemia and reduced triglyceridemia in a large lipid clinic population treated with fenofibrate for 15 years or longer. Int J Cardiol 2009; 133:412-4. [DOI: 10.1016/j.ijcard.2007.11.090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Accepted: 11/18/2007] [Indexed: 11/19/2022]
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Grundy SM, Adams-Huet B, Vega GL. Variable contributions of fat content and distribution to metabolic syndrome risk factors. Metab Syndr Relat Disord 2009; 6:281-8. [PMID: 18759660 DOI: 10.1089/met.2008.0026] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Previous reports indicate that both distribution and amount of body fat confers susceptibility to metabolic syndrome. However, the relative contributions of these two different parameters of body fat to the various components of the metabolic syndrome have not been well defined. METHODS Dual-energy X-ray absorptiometry (DXA) was used to measure and compare the relative amounts of total body fat, truncal fat, and lower body fat in a representative sample of 2587 black, white, and Hispanic men and women from the Dallas Heart Study (DHS). The relationships among these variables and fasting plasma levels of lipids, glucose, insulin, C-reactive protein (CRP), and leptin as well as blood pressure were analyzed. RESULTS Beyond total body fat, fat distribution had the greatest impact on plasma triglycerides in all subjects and on high-density lipoprotein cholesterol (HDL-C) levels in women only. An intermediate effect of fat distribution was observed for homeostasis model assessment of insulin resistance (HOMA-IR) and for blood pressure. Plasma CRP levels were much more sensitive to body fat content than to body fat distribution and leptin levels were determined almost exclusively by body fat content. Although there were minor differences among the different ethnic groups, the major relationship patterns between these variables were similar. CONCLUSION For most metabolic risk factors, both body fat content and distribution independently contributed to levels, although significant differences were seen between the relative contributions of each variable to individual risk factors.
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Affiliation(s)
- Scott M Grundy
- Donald W. Reynolds Cardiovascular Clinical Research Center, Department of Internal Medicine, Center for Human Nutrition, Dallas, Texas 75390-9052, USA.
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Kim YJ, Park JW, Kyung SY, An CH, Lee SP, Park HY, Chung MP, Jeong SH. Association of Diabetes Mellitus and Metabolic Syndrome with Idiopathic Pulmonary Fibrosis. Tuberc Respir Dis (Seoul) 2009. [DOI: 10.4046/trd.2009.67.2.113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Yu Jin Kim
- Division of Pulmonology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Jeong-Woong Park
- Division of Pulmonology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Sun Young Kyung
- Division of Pulmonology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Chang Hyeok An
- Division of Pulmonology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Sang Pyo Lee
- Division of Pulmonology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Hye Yun Park
- Division of Pulmonology, Department of Internal Medicine, Sungkyunkwan University Samsung Medical Center, College of Medicine, Seoul, Korea
| | - Man Pyo Chung
- Division of Pulmonology, Department of Internal Medicine, Sungkyunkwan University Samsung Medical Center, College of Medicine, Seoul, Korea
| | - Sung Hwan Jeong
- Division of Pulmonology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
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Chang SL, Tuan TC, Tai CT, Lin YJ, Lo LW, Hu YF, Tsao HM, Chang CJ, Tsai WC, Chen SA. Comparison of outcome in catheter ablation of atrial fibrillation in patients with versus without the metabolic syndrome. Am J Cardiol 2009; 103:67-72. [PMID: 19101232 DOI: 10.1016/j.amjcard.2008.08.042] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Revised: 08/19/2008] [Accepted: 08/19/2008] [Indexed: 01/16/2023]
Abstract
Previous studies have reported that metabolic syndrome (MS) is associated with the development of atrial fibrillation (AF). However, its impact on the atrial substrate properties and catheter ablation in patients with AF is still unclear. This study consisted of 282 patients with AF (216 with paroxysmal AF and 66 with nonparoxysmal AF) who underwent catheter ablation using a 3-dimensional mapping system (NavX). Detailed AF mapping (frequency analysis and complex fractionated electrographic mapping) was performed in 59 patients. The patients were classified on the basis of MS, which was defined according to the guidelines of the National Cholesterol Education Program Adult Treatment Panel III. Patients with MS had larger left atrial sizes, shorter fractionated intervals, and higher dominant frequencies compared with those without it. Higher incidences of complex fractionated atrial electrographic sites located in the left atrial appendage base, coronary sinus, and crista terminalis regions were found in patients with MS. Patients with MS had a higher incidence of recurrent AF compared with those without MS (55% vs 24%, p <0.001). A higher incidence of recurrent AF from non-pulmonary vein origins was observed in patients with MS compared with those without it (45% vs 20%, p = 0.037). In conclusion, MS is associated with larger left atrial size and an arrhythmogenic substrate, which may increase the risk for recurrence after the ablation of AF. Close follow-up with good control of any metabolic disturbances may be needed in patients with MS to improve their outcomes after AF ablation.
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Paniagua L, Lohsoonthorn V, Lertmaharit S, Jiamjarasrangsi W, Williams MA. Comparison of Waist Circumference, Body Mass Index, Percent Body Fat and Other Measure of Adiposity in Identifying Cardiovascular Disease Risks among Thai Adults. Obes Res Clin Pract 2008; 2:I-II. [PMID: 24351779 DOI: 10.1016/j.orcp.2008.05.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Revised: 11/30/2007] [Accepted: 05/24/2008] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the abilities of body mass index (BMI), percent body fat (%BF), waist circumference (WC), waist-hip ratio (WHR) and waist-height ratio (WHtR) to identify cardiovascular disease risk factors. METHODS This cross-sectional study is comprised of 1,391 Thai participants (451 men and 940 women) receiving annual health check-ups. Spearman's rank correlation was used to determine the association of the five anthropometric indices with metabolic parameters including fasting plasma glucose, triglyceride, high density lipoprotein and blood pressure. The prevalence of cardiovascular disease risk factors was determined according to tertile of each anthropometric measure. Receiver operating characteristic (ROC) curves were plotted to compare anthropometric measure as predictors of the prevalence of cardiovascular risk factors. RESULTS Metabolic parameters were more strongly associated with %BF and WHR and least correlated with BMI in men. Among women, BMI was most strongly correlated with metabolic parameters. In both genders, the prevalence of cardiovascular disease risk factors increased across successive tertiles for each anthropometric measure. Review of ROC curves indicated that %BF and WHR performed slightly better than other measures in identifying differences in CVD risk factors among men. BMI performed at least as well or better than other measures of adiposity among women. CONCLUSIONS These findings confirm high correlations between anthropometric measures and metabolic parameters. BMI, WC and other measures were not materially different in identifying cardiovascular disease risk factors. Although small differences were observed, the magnitudes of those differences are not likely to be of public health or clinical significance.
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Affiliation(s)
- Linda Paniagua
- Department of Epidemiology, Multidisciplinary International Research Training Program, University of Washington School of Public Health and Community Medicine, Seattle, WA, USA
| | - Vitool Lohsoonthorn
- Department of Epidemiology, Multidisciplinary International Research Training Program, University of Washington School of Public Health and Community Medicine, Seattle, WA, USA.
| | - Somrat Lertmaharit
- Department of Epidemiology, Multidisciplinary International Research Training Program, University of Washington School of Public Health and Community Medicine, Seattle, WA, USA
| | - Wiroj Jiamjarasrangsi
- Department of Epidemiology, Multidisciplinary International Research Training Program, University of Washington School of Public Health and Community Medicine, Seattle, WA, USA
| | - Michelle A Williams
- Department of Epidemiology, Multidisciplinary International Research Training Program, University of Washington School of Public Health and Community Medicine, Seattle, WA, USA
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Bays HE, González-Campoy JM, Bray GA, Kitabchi AE, Bergman DA, Schorr AB, Rodbard HW, Henry RR. Pathogenic potential of adipose tissue and metabolic consequences of adipocyte hypertrophy and increased visceral adiposity. Expert Rev Cardiovasc Ther 2008; 6:343-68. [PMID: 18327995 DOI: 10.1586/14779072.6.3.343] [Citation(s) in RCA: 334] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
When caloric intake exceeds caloric expenditure, the positive caloric balance and storage of energy in adipose tissue often causes adipocyte hypertrophy and visceral adipose tissue accumulation. These pathogenic anatomic abnormalities may incite metabolic and immune responses that promote Type 2 diabetes mellitus, hypertension and dyslipidemia. These are the most common metabolic diseases managed by clinicians and are all major cardiovascular disease risk factors. 'Disease' is traditionally characterized as anatomic and physiologic abnormalities of an organ or organ system that contributes to adverse health consequences. Using this definition, pathogenic adipose tissue is no less a disease than diseases of other body organs. This review describes the consequences of pathogenic fat cell hypertrophy and visceral adiposity, emphasizing the mechanistic contributions of genetic and environmental predispositions, adipogenesis, fat storage, free fatty acid metabolism, adipocyte factors and inflammation. Appreciating the full pathogenic potential of adipose tissue requires an integrated perspective, recognizing the importance of 'cross-talk' and interactions between adipose tissue and other body systems. Thus, the adverse metabolic consequences that accompany fat cell hypertrophy and visceral adiposity are best viewed as a pathologic partnership between the pathogenic potential adipose tissue and the inherited or acquired limitations and/or impairments of other body organs. A better understanding of the physiological and pathological interplay of pathogenic adipose tissue with other organs and organ systems may assist in developing better strategies in treating metabolic disease and reducing cardiovascular disease risk.
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Affiliation(s)
- Harold E Bays
- L-MARC Research Center, 3288 Illinois Avenue, Louisville, KY 40213, USA.
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Wang Y, Jacobs EJ, Patel AV, Rodríguez C, McCullough ML, Thun MJ, Calle EE. A prospective study of waist circumference and body mass index in relation to colorectal cancer incidence. Cancer Causes Control 2008; 19:783-92. [PMID: 18322811 DOI: 10.1007/s10552-008-9141-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 02/20/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To study the association between waist circumference and colorectal cancer, and whether it is independent of body mass index (BMI). METHODS Between 1997 and 2005, 953 incident colorectal cancer cases (546 men and 407 women) were identified among 95,151 participants (44,068 men and 51,083 women) from the Cancer Prevention Study-II Nutrition Cohort. RESULTS Waist circumference was associated with increased colorectal cancer incidence in both men (multivariable adjusted rate ratio (RR) 1.68, 95% confidence interval (CI) 1.12-2.53 for waist circumference > or =120 cm compared to <95 cm, p trend = 0.006) and women (RR 1.75, 95% CI 1.20-2.54 for > or =110 compared to <85 cm, p trend = 0.003). High levels of BMI were also associated with increased risk. After adjustment for BMI, waist circumference remained associated with a nonstatistically significant increase in colorectal cancer incidence in both men (RR 1.41, 95% CI 0.81-2.45 for > or =120 compared to <95 cm, p trend = 0.10) and women (RR 1.48, 95% CI 0.89-2.48 for > or =110 compared to <85 cm, p trend = 0.13). CONCLUSIONS Our results confirm that waist circumference is associated with increased colorectal cancer incidence, possibly partially independent of BMI.
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Affiliation(s)
- Yiting Wang
- Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA 30303-1002, USA
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Delaney JAC, Daskalopoulou SS, Brophy JM, Steele RJ, Opatrny L, Suissa S. Lifestyle variables and the risk of myocardial infarction in the general practice research database. BMC Cardiovasc Disord 2007; 7:38. [PMID: 18088433 PMCID: PMC2241637 DOI: 10.1186/1471-2261-7-38] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Accepted: 12/18/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The primary objective of this study is to estimate the association between body mass index (BMI) and the risk of first acute myocardial infarction (AMI). As a secondary objective, we considered the association between other lifestyle variables, smoking and heavy alcohol use, and AMI risk. METHODS This study was conducted in the general practice research database (GPRD) which is a database based on general practitioner records and is a representative sample of the United Kingdom population. We matched cases of first AMI as identified by diagnostic codes with up to 10 controls between January 1st, 2001 and December 31st, 2005 using incidence density sampling. We used multiple imputation to account for missing data. RESULTS We identified 19,353 cases of first AMI which were matched on index date, GPRD practice and age to 192,821 controls. There was a modest amount of missing data in the database, and the patients with missing data had different risks than those with recorded values. We adjusted our analysis for each lifestyle variable jointly and also for age, sex, and number of hospitalizations in the past year. Although a record of underweight (BMI <18.0 kg/m2) did not alter the risk for AMI (adjusted odds ratio (OR): 1.00; 95% confidence interval (CI): 0.87-1.11) when compared with normal BMI (18.0-24.9 kg/m2), obesity (BMI > or =30 kg/m2) predicted an increased risk (adjusted OR: 1.41; 95% CI: 1.35-1.47). A history of smoking also predicted an increased risk of AMI (adjusted OR: 1.81; 95% CI: 1.75-1.87) as did heavy alcohol use (adjusted OR: 1.15; 95% CI: 1.06-1.26). CONCLUSION This study illustrates that obesity, smoking and heavy alcohol use, as recorded during routine care by a general practitioner, are important predictors of an increased risk of a first AMI. In contrast, low BMI does not increase the risk of a first AMI.
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Affiliation(s)
- Joseph A C Delaney
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
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Kotani K, Saiga K, Kurozawa Y, Sakane N, Tsuzaki K, Hamada T. Adiponectin I164T gene polymorphism and the obesity-related effects on the Japanese female population. Clin Chim Acta 2007; 384:182-3. [PMID: 17604011 DOI: 10.1016/j.cca.2007.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2007] [Revised: 06/06/2007] [Accepted: 06/07/2007] [Indexed: 11/18/2022]
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Lim SC, Morgenthaler NG, Subramaniam T, Wu YS, Goh SK, Sum CF. The relationship between adrenomedullin, metabolic factors, and vascular function in individuals with type 2 diabetes. Diabetes Care 2007; 30:1513-9. [PMID: 17384335 DOI: 10.2337/dc06-1899] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Subjects with type 2 diabetes are at risk for vascular injury. Several vasoactive factors (e.g., angiotensin) have been implicated. We hypothesize that adrenomedullin, a novel vascoactive factor, is deranged in subjects with type 2 diabetes. RESEARCH DESIGN AND METHODS Using a new immunoluminometric method, plasma midregional proadrenomedullin (MR-proADM) was measured in four groups of Chinese subjects: healthy (n = 100, fasting plasma glucose [FPG] <5.6 mmol/l), impaired fasting glucose (IFG) (n = 60, FPG 5.6-6.9 mmol/l), and diabetic subjects with (n = 100) and without (n = 100) nephropathy. Resting forearm cutaneous microcirculatory perfusion (RCMP) was quantified in vivo using 2-dimensional laser Doppler flowmetry. We investigated the relationship between plasma MR-proADM concentrations, multiple metabolic factors, and vascular function. RESULTS We observed a stepwise increase in MR-proADM among the groups: healthy group mean +/- SD 0.27 +/- 0.09, IFG group 0.29 +/- 0.13, diabetic group 0.42 +/- 0.13, and diabetic nephropathy group 0.81 +/- 0.54 nmol/l (diabetic vs. healthy and IFG groups, P = 0.04; and diabetic nephropathy group vs. all, P < 0.01). Statistical adjustment for sex, age, BMI, and blood pressure did not affect the conclusions. Multiple linear regression analysis revealed that highly sensitive C-reactive protein (beta = 0.11; P = 0.01), insulin resistance index (beta = 0.20; P = 0.001), LDL cholesterol (beta = 0.31; P < 0.001), and adiponectin (beta = 0.33; P < 0.001) were significant predictors of plasma MR-proADM concentrations among nondiabetic individuals. Among subjects with diabetes, plasma MR-proADM concentrations correlated significantly with RCMP (r = 0.43, P = 0.002). CONCLUSIONS Plasma MR-proADM concentration was elevated in subjects with type 2 diabetes. This was further accentuated when nephropathy set in. MR-proADM was related to multiple metabolic factors and basal microcirculatory perfusion. Adrenomedullin might play a role in the pathogenesis of diabetic vasculopathy.
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Affiliation(s)
- Su Chi Lim
- Department of Medicine, Alexandra Hospital, Singapore, Republic of Singapore.
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Affiliation(s)
- Gerald M Reaven
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Falk Cardiovascular Research Center, 300 Pasteur Drive, Stanford, CA 94305, USA.
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