Abdominal obesity and peripheral vascular disease in men and women: A comparison of waist-to-thigh ratio and waist circumference as measures of abdominal obesity

Peripheral arterial disease in women

Peripheral arterial disease (PAD) represents one of the most frequent manifestations of atherosclerosis in men and women. In both sexes, PAD is related to classical risk factors of atherosclerosis, which are similarly distributed, but some additional factors determine differences between men and women. More frequent asymptomatic disease in women than in men and less frequent screening in women may result in a false underestimation of the prevalence of PAD in women. All these factors may cause delayed diagnosis and treatment of PAD in women. Estrogen hormones have vasoprotective properties that lower the prevalence of atherosclerosis in women of younger age. However, estrogen probably does not have a protective role against the development of cardiovascular disease in women of an older age. Hormone replacement therapy (HRT) of less than one year does not appear to reduce the odds of developing PAD in postmenopausal women. It may even increase the risk of morbidity from vascular interventions. However, some studies indicated that HRT for more than one year significantly decreases the risk of PAD if administered early after the last menstruation. Also, treatment of PAD in women differs to some extent from men.

The Prevalence Rate of Adult Sarcopenic Obesity and Correlation of Appendicular Skeletal Muscle Mass Index with Body Mass Index, Percent Body Fat, Waist-Hip Ratio, Basal Metabolic Rate, and Visceral Fat Area

Background: This study aimed to investigate the prevalence rate of adult sarcopenic obesity and discuss its predisposing factors. Methods: A total of 14,608 participants including 7521 men and 7087 women aged 18-93 years were enrolled in this study. The definition of sarcopenia was based on appendicular skeletal muscle mass index (ASMI) standards (≤7.0 kg/m² for men and ≤5.7 grams/m² for women). The definition of obesity followed percent body fat (PBF) ≥25% for men and ≥35% for women. Sarcopenic obesity was defined as the combination of sarcopenia and obesity diagnosis. Risk factors for the onset of sarcopenic obesity were analyzed by logistic regression analysis, followed by diagnostic value assessment. Results: There were 496 cases of sarcopenic obesity, including 308 male patients and 188 female patients. The overall prevalence rate was 3.4%, with 4.10% for men and 2.65% for women. Compared with nonsarcogenic obesity group, the subjects with sarcogenic obesity showed shorter height and circumference of limbs, arm muscle, neck, chest, waist and hip, lighter weight, lower body mass index (BMI), bone mineral content (BMC), skeletal muscle mass, basal metabolic rate (BMR), body cell mass, fitness score and ASMI, and higher body fat mass, PBF, waist-hip ratio (WHR), visceral fat area (VFA), extracellular fluid/total body fat, and extracellular water/total body water (ECW/TBW; P < 0.01). Based on logistic regression analysis, BMI, BMC, PBF, WHR, BMR, VFA, fitness score, lean balance trunk, lean balance left leg, ASMI, ECW/TBW and the circumference of left arm, left leg, arm muscle, chest waist and hip were considered as risk factors for sarcogenic obesity (P < 0.05). After receiver operating characteristic (ROC) curve analysis of basic condition, muscle mass, and limb condition, ASMI [area under the curve (AUC) = 0.75] showed relatively high diagnostic value for adult sarcopenic obesity; other indicators (AUC <0.75) showed moderate diagnostic value for adult sarcopenic obesity, except for fitness score. According to joint ROC analysis, combination of BMC, PBF, VFA, and ASMI (AUC = 0.78) showed high diagnostic value for adult sarcopenic obesity. ASMI was correlated with BMI (r = 0.246, P < 0.001), BMC (r = 0.798, P < 0.001), WHR (r = 0.197, P < 0.001), BMR (r = 0.932, P < 0.001), PBF (r = -0.761, P < 0.001), and VFA (r = -0.530, P < 0.001). In adult patients with sarcopenic obesity, a decrease in ASMI indicators may be accompanied by a decrease in BMI, BMC, WHR, and BMR as well as an increase in PBF and VFA. Conclusion: The prevalence rate of adult sarcopenic obesity was 3.40%. ASMI was closely correlated with BMI, BMC, PBF, WHR, BMR, and VFA, which may serve as early indicators in the diagnosis of adult sarcopenic obesity.

Combined Effect of Dynapenia and Abdominal Obesity on the Prevalence of Peripheral Artery Disease in Older Adults Over 75 Years Old in China

The objective is to examine the separate and joint effects of dynapenia and abdominal obesity on the prevalence of peripheral artery disease (PAD) in older adults of different ages (60-74 and over 75 years old). This study comprised 1293 community-dwelling Chinese participants recruited from Shanghai, China, who were aged at least 60 years (753 women; mean age: 72.0 ± 5.9 years). Dynapenia was defined as low-grip strength (<28.0 kg for males and <18.0 kg for females) but normal skeletal muscle index (≥7.0 kg/m² for males and ≥5.7 kg/m² for females). Abdominal obesity was determined according to waist circumference (≥90 cm for males and ≥85 cm for females), and PAD was diagnosed by an ankle-brachial index  ≤ 0.9. Binary logistic regression models were performed to determine associations between dynapenia, abdominal obesity, and the combination of dynapenia and abdominal obesity and PAD. According to dynapenia and abdominal obesity status stratified by age (60-74 or over 75), the patients were divided into 4 groups: normal, dynapenia alone, abdominal obesity alone, and co-occurring groups. A logistic regression showed that the co-occurring groups (odds ratio = 4.63, 95% confidence interval = 1.41-15.21) had a higher prevalence of PAD than the normal group after adjusting for the covariates in older adults over 75 years of age. The combination of dynapenia and abdominal obesity increase the prevalence of PAD in older adults over 75 years. The present findings have important implications for the early identification of older adults with PAD and appropriate interventions should be implemented.

Changes in Nutritional State and Cardiovascular Parameters in Alimentary Obese Children after a Month-Long Stay in Children's Treatment Center

Childhood and adolescent obesity has become an important public health issue, as it leads to higher risk of cardio−metabolic, orthopedic, and psychological comorbidities. The aim of this study was to evaluate the changes in nutritional state and cardiovascular system parameters in obese children. Sixty respondents aged 9−17 years with alimentary obesity participated in this research. Anthropometric parameters (body weight (BWT), body mass index (BMI), percentage of body fat (%), waist and hip circumference (WC and HC), waist−hip ratio (WHR)) and cardiovascular parameters (systolic and diastolic blood pressure (SP and DP), cardio-ankle vascular index (CAVI), ankle-brachial index (ABI), pulse wave velocity and its variability (PWV and PWVV), and parameters of pulse wave analysis) were measured. Every respondent went through two sets of measurements, the first (I.) after their admission to the children’s hospital and the second (II.) at the end of their one-month-long therapeutic stay. Statistically significant differences between measurements I. and II. were observed in the following parameters: BWT (p < 0.01), BMI (p < 0.01), WC (p < 0.01), HC (p < 0.01), DP (p < 0.01), PWV (p < 0.05), and ABI (p < 0.01). The results of this study show that obesity has a mostly negative impact on the cardiovascular health of affected children, with likely negative results in their adulthood.

Assessment of clinical measures of total and regional body composition from a commercial 3-dimensional optical body scanner

BACKGROUND

The accurate assessment of total body and regional body circumferences, volumes, and compositions are critical to monitor physical activity and dietary interventions, as well as accurate disease classifications including obesity, metabolic syndrome, sarcopenia, and lymphedema. We assessed body composition and anthropometry estimates provided by a commercial 3-dimensional optical (3DO) imaging system compared to criterion measures.

METHODS

Participants of the Shape Up! Adults study were recruited for similar sized stratifications by sex, age (18-40, 40-60, >60 years), BMI (under, normal, overweight, obese), and across five ethnicities (non-Hispanic [NH] Black, NH White, Hispanic, Asian, Native Hawaiian/Pacific Islander). All participants received manual anthropometry assessments, duplicate whole-body 3DO (Styku S100), and dual-energy X-ray absorptiometry (DXA) scans. 3DO estimates provided by the manufacturer for anthropometry and body composition were compared to the criterion measures using concordance correlation coefficient (CCC) and Bland-Altman analysis. Test-retest precision was assessed by root mean square error (RMSE) and coefficient of variation.

RESULTS

A total of 188 (102 female) participants were included. The overall fat free mass (FFM) as measured by DXA (54.1 ± 15.2 kg) and 3DO (55.3 ± 15.0 kg) showed a small mean difference of 1.2 ± 3.4 kg (95% limits of agreement -7.0 to +5.6) and the CCC was 0.97 (95% CI: 0.96-0.98). The CCC for FM was 0.95 (95% CI: 0.94-0.97) and the mean difference of 1.3 ± 3.4 kg (95% CI: -5.5 to +8.1) reflected the difference in FFM measures. 3DO anthropometry and body composition measurements showed high test-retest precision for whole body volume (1.1 L), fat mass (0.41 kg), percent fat (0.60%), arm and leg volumes, (0.11 and 0.21 L, respectively), and waist and hip circumferences (all <0.60 cm). No group differences were observed when stratified by body mass index, sex, or race/ethnicity.

CONCLUSIONS

The anthropometric and body composition estimates provided by the 3DO scanner are precise and accurate to criterion methods if offsets are considered. This method offers a rapid, broadly available, and automated method of body composition assessment regardless of body size. Further studies are recommended to examine the relationship between measurements obtained by 3DO scans and metabolic health in healthy and clinical populations.

The abdominal waist circumference and 4-year outcomes following peripheral bypass grafting

BACKGROUND

Current literature evaluating the relationship between obesity, utilizing measures other than the Body Mass Index (BMI), and postoperative outcomes following vascular surgery are sparse. This study aimed to investigate any association between abdominal waist circumference (AWC) and waist-hip ratio (WHR) in relation to postoperative morbidity and mortality following peripheral artery bypass graft (PABG) surgery.

METHODS

AWC and hip circumference (HC) were measured from pre-intervention magnetic resonance (MR) and computed tomography (CT) scans of patients undergoing elective and nonelective PABG. The AWC and WHR were assessed in relation to: the need for higher level care (i.e. level 2/3), the duration of higher level care, postoperative limb ischemia, postoperative hospital stay, graft patency on discharge and 30 day readmission, using logistic and linear regression analysis. Mortality was assessed using cox-regression analysis with calculation of hazard ratios at 30 days and 4 years.

RESULTS

In total, 177 patient images performed between January 2014 to January 2017 were analyzed. There were no significant intra-observer and interobserver differences in measurements of AWC and HC. Pre-intervention AWC was predictive of the need for higher level care following non-elective PABG (adjusted OR 1.1 [95% CI: 1.0-1.1, P=0.026]). An inverse relationship between AWC and mortality at 4 years was also observed (adjusted HR=0.9, 95% CI: 0.9-1.0, P=0.028). However, pre-intervention WHR failed to predict mortality and morbidity.

CONCLUSIONS

AWC may potentially be a suitable risk stratification tool in patients undergoing non-elective PABG. The association of AWC with long-term mortality outcomes require further investigation so that suitable cut-off values may be determined.

Correlation of Waist to Calf Circumference Ratio and Carotid Intima-Media Thickness in Diabetes Mellitus

INTRODUCTION

Diabetes mellitus is a well-known risk factor for cardiovascular disease because of the accelerated process of atherosclerosis. Obesity is an established risk factor and has gained immense importance in recent studies as an important risk factor for clinical cardiovascular disease, yet the fundamental component stays unclear. Calf circumference is another form for lean mass and peripheral subcutaneous fat and is inversely associated with the occurrence of carotid plaques (CP). Multiplicative and opposite effects of both Calf Circumference (CC) and Waist Circumference (WC) in the event of CP suggest that the two measures should be taken into account commonly while assessing vascular risk profile.

AIMS & OBJECTIVES

To ascertain if waist to calf circumference ratio (WCR) is a marker of carotid atherosclerosis in patients with type 2 diabetes mellitus, and the correlation between waist to calf circumference ratio and carotid intima-media thickness (CIMT ) in patients with Type 2 diabetes.

MATERIALS AND METHODS

A cross-sectional study at Hospital affiliated to Kasturba Medical college Mangalore from Sept 2016 to Sept 2018. Patients with type 2 DM as per ADA criteria, age >18years, are recruited for the study.

RESULTS AND DISCUSSION

In our study, with 150 population, 25 patients had carotid atherosclerosis and 20 patients had CIMT>1.1. The waist circumference in patients with CA is in the range of 93.07, and 99.85 & the CC in patients with CA is in the range of 29.49 to 31.25. The WCR in patients with CA is in the range of 3.12 to 3.26. The difference was statistically significant with a p-value of <0.05. In our study, it was found that WC and WCR correlated well with carotid atherosclerosis, and surprisingly, calf circumference also correlated with carotid atherosclerosis but not as significant as both WC and WCR.

CONCLUSION

To conclude, in our population-based study of 150 subjects, we found that carotid atherosclerosis is significantly more in people with increased waist calf circumference ratio. WCR may be a new, useful, and practical anthropometric index that facilitates the early identification of diabetic subjects with high risk for cardiovascular disease. Validation of this finding in individual populations is required. Future studies should test the association of calf circumference with carotid intima-media thickness and carotid plaques using better measures than ultrasound, such as magnetic resonance imaging. Further research focusing on underlying mechanisms in the role of lean mass and peripheral fat mass is required.

Effects of Shift Work on the Eating Behavior of Police Officers on Patrol

Recent studies indicate that the timing of food intake can significantly affect metabolism and weight management. Workers operating at atypical times of the 24-h day are at risk of disturbed feeding patterns. Given the increased risk of weight gain, obesity and metabolic syndrome in shift working populations, further research is required to understand whether their eating behavior could contribute to these increased metabolic risks. The objective of this study was to characterize the dietary patterns of police officers across different types of shifts in their natural environments. Thirty-one police officers (six women; aged 32.1 ± 5.4 years, mean ± SD) from the province of Quebec, Canada, participated in a 28- to 35-day study, comprising 9- to 12-h morning, evening, and night shifts alternating with rest days. Sleep and work patterns were recorded with actigraphy and diaries. For at least 24 h during each type of work day and rest day, participants logged nutrient intake by timestamped photographs on smartphones. Macronutrient composition and caloric content were estimated by registered dieticians using the Nutrition Data System for Research database. Data were analyzed with linear mixed effects models and circular ANOVA. More calories were consumed relative to individual metabolic requirements on rest days than both evening- and night-shift days (p = 0.001), largely sourced from increased fat (p = 0.004) and carbohydrate (trend, p = 0.064) intake. Regardless, the proportions of calories from carbohydrates, fat, and protein did not differ significantly between days. More calories were consumed during the night, between 2300 h and 0600 h, on night-shift days than any other days (p < 0.001). Caloric intake occurred significantly later for night-shift days (2308 h ± 0114 h, circular mean ± SD) than for rest days (1525 h ± 0029 h; p < 0.01) and was dispersed across a longer eating window (13.9 h ± 3.1 h vs. 11.3 h ± 1.8 h, mean ± SD). As macronutrient proportions were similar and caloric intake was lower, the finding of later meals times on night-shift days versus rest days is consistent with emerging hypotheses that implicate the biological timing of food intake—rather than its quantity or composition—as the differentiating dietary factor in shift worker health.

Dyslipidemic profile in healthy women in relation to body fat distribution

Abdominal obesity is associated with particularly adverse lipidemic profile. The aim of this study was to determine the characteristics of the dyslipidemic profile in healthy women with extreme abdominal obesity determined anthropometrically. Lipid profile and atherogenic indexes were determined in 80 healthy women, grouped in 4 groups according to their body mass index (BMI) and grouped in 3 groups according to their body fat distribution (BFD) by means of anthropometric indexes waist/hip ratio (WHR) and waist/thigh ratio circumference (WTR): group M with normal BFD (WHR<0.85 and WTR<1.45), group N with moderate (WHR 0.85-1 and WTR 1.45-1.7) and group O with extremely expressed abdominal BFD. HDL-cholesterol (HDL-C) levels (0.84±0.26mmol/L) were significantly lowest in group O (p<0.002), and significantly lower compared to group N (1.14±0.43mmol/L) (p<0.006). Triglyceride (TG) levels were significantly higher in group O compared to group M (p<0.001) and also higher in group N compared to group M (p<0.044). Atherogenic indexes C/HDL-C, LDL/HDL-C and TG/HDL-C values in group O were significantly higher compared to the corresponding values in group M (p<0.004; p< 0.006; p<0.001), and their values were also higher in group O compared to group N, but with lower significance of the difference (p<0.05) indicating lower increase of the atherogenic indexes in moderate and significant increase in women with extreme abdominal obesity. Dyslipidemic profile and high atherogenic indexes in women with abdominal obesity with significantly highest WHR, WTR and BMI values indicated the need to intervene earlier and more effectively in the prevention and treatment of cardiovascular and metabolic risks. Keywords: abdominal obesity, anthropometric indexes, lipid profile, atherogenic indexes

Novel anthropometric parameters to define obesity and obesity-related disease in adults: a systematic review

Context

Obesity is defined as an abnormal or excessive accumulation of body fat. Traditionally, it has been assessed using a wide range of anthropometric, biochemical, and radiological measurements, with each having its advantages and disadvantages.

Objective

A systematic review of the literature was conducted to identify novel anthropometric measurements of obesity in adults.

Data Sources

Using a combination of MeSH terms, the PubMed database was searched.

Data Extraction

The current systematic review was conducted in accordance with the PRISMA guidelines. The data extracted from each study were (1) details of the study, (2) anthropometric parameter(s) evaluated, (3) study methods, (4) objectives of the study and/or comparisons, and (5) main findings/conclusions of the study.

Data Analysis

The search yielded 2472 articles, of which 66 studies were deemed eligible to be included. The literature search identified 25 novel anthropometric parameters. Data on novel anthropometric parameters were derived from 26 countries. Majority were descriptive cross-sectional studies (n = 43), while 22 were cohort studies. Age range of the study populations was 17–103 years, while sample size varied from 45 to 384 612.

Conclusions

The novel anthropometric parameters identified in the present study showed variable correlation with obesity and/or related metabolic risk factors. Some parameters involved complex calculations, while others were derived from traditional anthropometric measurements. Further research is required in order to determine the accuracy and precision.

Coronary artery stenosis and associations with indicators of anthropometric and diet in patients undergoing coronary angiography

BACKGROUND

Coronary artery diseases (CAD) are one of the major causes of mortality, which is related to the nutritional status and anthropometric indices of individuals. The aim of this study was to determine the relationship between anthropometric indices, the type of protein consumption in meat group and vegetable consumption with coronary artery stenosis.

METHODS

This descriptive and analytical cross-sectional study was conducted in Shariati Hospital in Tehran in 2016. Out of the patients undergoing coronary angiography, 208 cases were assigned to participate in the study of simple random sampling. The required data were collected by Food Frequency questionnaire (FFQ), anthropometric indices and physical activity questionnaire. SPSS software (version #21) was used for statistical analysis.

RESULTS

The number of coronary arteries with more than 50% stenosis was increased by high consumption of red meat (P = 0.014), egg (P = 0.006) and chicken (P = 0.030) and low consumption of legume (P = 0.000), soybean (P = 0.002) and vegetables (P = 0.003). Also, the consumption of garlic and onion was associated with a decrease in the severity of stenosis in left anterior descending (LAD) (P = 0.036), and right coronary artery (RCA) (P = 0.033). There was a significant and positive correlation among waist circumference, wrist circumference and body mass index in patients with coronary artery stenosis and a negative correlation between the height of the patient and the history of previous angiography.

CONCLUSION

High consumption of vegetable proteins, vegetables, maintaining BMI and waist circumference in the normal range, were associated with reduced severity of coronary artery stenosis. In addition high consumption of red meat, chicken and egg is associated with higher severity and number of coronary stenosis.

Peripheral Arterial Disease in Women: an Overview of Risk Factor Profile, Clinical Features, and Outcomes

Purpose of Review

Peripheral arterial disease (PAD) is the third most common manifestation of cardiovascular disease (CVD), following coronary artery disease (CAD) and stroke. PAD remains underdiagnosed and under-treated in women.

Recent Findings

Women with PAD experience more atypical symptoms and poorer overall health status. The prevalence of PAD in women increases with age, such that more women than men have PAD after the age of 40 years. There is under-representation of PAD patients in clinical trials in general and women in particular. In this article, we address the lack of women participants in PAD trials. We then present a comprehensive overview of the epidemiology/risk factor profile, clinical features, treatment, and outcomes.

Summary

PAD is prevalent in women and its global burden is on the rise despite a decline in global age-standardized death rate from CVD. The importance of this issue has been underlined by the American Heart Association’s (AHA) “Call to Action” scientific statement on PAD in women. Large-scale campaigns are needed to increase awareness among physicians and the general public. Furthermore, effective treatment strategies must be implemented.

Risk factors of peripheral arterial disease: a case control study in Sri Lanka

BACKGROUND

Peripheral artery disease (PAD) is an important global health problem and contributes to notable proportion of morbidity and mortality. This particular manifestation of systemic atherosclerosis is largely under diagnosed and undertreated. For sustainable preventive strategies in a country, it is mandatory to identify country-specific risk factors. We intended to assess the risk factors of PAD among adults aged 40-74 years.

METHODS

This case control study was conducted in 2012-2013 in Sri Lanka. Seventy-nine cases and 158 controls in the age group of 40-74 years were selected for the study in order to have case to control ratio 1:2. The criterion for selecting cases and control was based on Ankle brachial pressure index (ABPI). Cases were selected from those who had ABPI 0.85 or less (ABPI ≤0.85) in either lower limb. Controls were selected from those ABPI score between 1.18 and 1.28 in both lower limbs. Only newly identified individuals with PAD were selected as cases. Controls were selected from the same geographical location and within the 5 year age group as cases.

RESULTS

The history of diabetes mellitus more than 10 years (OR 5.8, 95% CI 2.2-14.2), history of dyslipidemia for more than 10 years (OR 4.9, 95% CI 2.1-16.2), history of hypertension for more than 10 years (OR 3.8, 95% CI 1.8-12.7) and smoking (OR 2.9, 95% CI 1.2-6.9), elevated HsCRP (OR 3.7, 95% CI 1.2-12.0) and hyperhomocysteinemia (OR 3.0, 95% CI 1.1-8.1) were revealed as country specific significant risk factor of PAD.

CONCLUSIONS

Diabetes mellitus, hypertension, dyslipidemia, smoking as well as elevated homocysteine and HsCRP found as risk factors of PAD. Longer the duration or higher level exposure to these risk factors has increased the risk of PAD. These findings emphasis the need for routine screening of PAD among patients with the identified risk factors.

Body composition and ankle-brachial index in Ghanaians with asymptomatic peripheral arterial disease in a tertiary hospital

BACKGROUND

Ankle-brachial index (ABI) and indices of obesity are both use to indicate cardiovascular risk. However, association between body composition indices and ABI, a measure of peripheral arterial disease, is inconsistent in various study reports. In this study, we investigated the relationship between ABI and general and central indices of obesity in Ghanaians without history of cardiovascular diseases.

METHOD

In a case-control design, ABI was measured in a total of 623 subjects and categorised into PAD (ABI ≤ 0.9, n = 261) and non-PAD (ABI > 0.9, n = 362) groups. Anthropometric indices, BMI, waist circumference (WC), waist-hip ratio (WHR) and waist-height ratio (WHtR) were also measured.

RESULTS

PAD subjects had higher mean BMI (29.8 ± 8.7 vs. 26.5 ± 7.6 kg/m(2), p = 0.043) and waist circumference (95 ± 15 vs. 92 ± 24 cm, p = 0.034) than non-PAD subjects. In multivariable logistic regression models, having BMI ≥ 30 kg/m(2) increased the odds of both unilateral [OR (95 % CI): 2 (1.14-3.51), p < 0.01] and overall PAD [2 (1.22-3.27), p < 0.01].

CONCLUSION

In indigenous Ghanaians in our study, PAD participants had higher BMI and waist circumference than non-PAD participants. Also, halving BMI ≥ 30 kg/m(2) was associated with twofold increase in the odds of PAD.

Impact of weight loss on ankle-brachial index and interartery blood pressures

OBJECTIVE

To assess whether weight loss improves markers of peripheral artery disease and vascular stenosis.

METHODS

The Action for Health in Diabetes randomized clinical trial compared intensive lifestyle intervention (ILI) for weight loss to a control condition of diabetes support and education (DSE) in overweight or obese adults with type 2 diabetes. Annual ankle and brachial blood pressures over four years were used to compute ankle-brachial indices (ABIs) and to assess interartery blood pressure differences in 5018 participants.

RESULTS

ILI, compared to DSE, produced 7.8% (Year 1) to 3.6% (Year 4) greater weight losses. These did not affect prevalence of low (<0.90) ABI (3.60% in DSE versus 3.14% in ILI; P = 0.20) or elevated (>1.40) ABI (7.52% in DSE versus 7.59% in ILI: P = 0.90), but produced smaller mean (SE) maximum interartery systolic blood pressure differences among ankle sites [19.7 (0.2) mmHg for ILI versus 20.6 (0.2) mmHg for DSE (P < 0.001)] and between arms [5.8 (0.1) mmHg for ILI versus 6.1 (0.1) mmHg for DSE (P = 0.01)].

CONCLUSIONS

Four years of intensive behavioral weight loss intervention did not significantly alter prevalence of abnormal ABI, however, it did reduce differences in systolic blood pressures among arterial sites.

Thigh circumference and diabetes: obesity as a potential effect modifier

Background

Thigh circumference is associated with diabetes risk; however, the role of obesity as a potential effect modifier has not been well studied.

Methods

We examined the association between thigh circumference and diabetes in a cross-sectional study of 384 612 Koreans aged 30 to 79 years. The association between diabetes and thigh circumference in relation to body mass index (BMI) was analyzed among 315 628 participants, using multivariate logistic regression. Thigh circumference was categorized into 9 percentile categories—namely, the 2.5th, 5th, 10th, 25th, 50th, 75th, 90th, 95th, and 97.5th percentiles—and the 50th percentile was used as the reference value for thigh circumference. Separate analyses were performed for men and women.

Results

The association of thigh circumference with diabetes showed contradictory patterns before and after adjustment for BMI and waist circumference. Small thigh circumference was associated with greater risk of diabetes among men and women. This relationship was stronger among participants younger than 50 years, although age was not a significant effect modifier. BMI was a significant effect modifier among men with a BMI of less than 25 kg/m². Among women, diabetes risk increased with smaller thigh circumference.

Conclusions

Small thigh circumference was associated with diabetes, and this association was stronger among participants with a BMI of less than 25 kg/m². Thigh circumference might be a useful diabetes marker in lean populations.

Effect of Lactobacillus gasseri BNR17 on Overweight and Obese Adults: A Randomized, Double-Blind Clinical Trial

Background

Lactobacillus gasseri BNR17 is a type of probiotic strain isolated from human breast milk. A study was reported regarding the fact that BNR17 was an inhibitor of obesity and diabetic activities in the human body through previous animal experiments. This study was furthered to investigate the effect of BNR17, a probiotic strain isolated from human breast milk, on obese and overweight adults.

Methods

Sixty-two obese volunteers aged 19 to 60 with body mass index ≥ 23 kg/m² and fasting blood sugar ≥ 100 mg/dL participated in a placebo controlled, randomized, and double-blind trial. For 12 weeks, 57 participants were given either placebo or BNR17 and were tested by measuring body fat, body weight, various biochemical parameters, vital signs, and computed tomography at the start of the study and at weeks 4, 8, and 12. The subjects assumed usual daily activities without having to make behavioral or dietary modifications during the course of the study.

Results

At the 12th week, a slight reduction in body weight was noted in the BNR17 group, but there were no significant weight changes between groups. Decrease of waist and hip circumferences in the BNR17 group was more pronounced than those in the placebo group. The two groups had no special or severe adverse reactions.

Conclusion

Despite there being no change in behavior or diet, administration of only the supplement of BNR17 reduced weight and waist and hip circumference. However, there were no significant differences between the two groups. These findings warrant a subsequent longer-term prospective clinical investigation with a large population.

Prosthetic graft infections involving the femoral artery

BACKGROUND

Prosthetic graft infection is a major complication of peripheral vascular surgery. We investigated the experience of a single institution over 10 years with bypass grafts involving the femoral artery to determine the incidence and risk factors for prosthetic graft infection.

METHODS

A retrospective cohort single-institution review of prosthetic bypass grafts involving the femoral artery from 2001 to 2010 evaluated patient demographics, body mass index, comorbidities, indications, location of bypass, type of prosthetic material, case urgency, and previous ipsilateral bypass or percutaneous interventions and evaluated the incidence of graft infections, amputations, and mortality.

RESULTS

There were 496 prosthetic grafts identified with a graft infection rate of 3.8% (n = 19) at a mean follow-up of 27 months. Multivariable analysis showed that redo bypass (hazard ratio [HR], 5.8; 95% confidence interval [CI], 2.2-15.0), active infection at the time of bypass (HR, 5.2; 95% CI, 1.9-14.2), female gender (HR, 4.5; 95% CI, 1.6-12.7), and diabetes mellitus (HR, 4.6; 95% CI, 1.5-14.3) were significant predictors of graft infection. Graft infection was predictive of major lower extremity amputation (HR, 9.8; 95% CI, 3.5-27.1), as was preoperative tissue loss (HR, 4.7; 95% CI, 1.8-11.9). Graft infection did not predict long-term mortality; however, chronic renal insufficiency (HR, 2.3; 95% CI, 1.6-3.4), tissue loss (HR, 1.4; 95% CI, 1.0-1.9), and active infection (HR, 2.3; 95% CI, 1.6-3.4) did. Infected grafts were removed 79% of the time. Staphylococcus epidermidis (37%) and methicillin-sensitive Staphylococcus aureus (26%) were the most common pathogens isolated.

CONCLUSIONS

Redo bypass, female gender, diabetes, and active infection at the time of bypass are associated with a higher risk for prosthetic graft infection and major extremity amputation but do not confer an increased risk of mortality. Autologous vein for lower extremity bypass and endovascular interventions should be considered when feasible in high-risk patients.

Prevalence of low ankle brachial index and relationship with cardiovascular risk factors in a Western urban population in Turkey

We determined the prevalence of peripheral arterial disease (PAD) and associated risk factors in an urban population age ≥30 years in Turkey and assessed the impact of incorporating ankle brachial index (ABI) measurement with coronary heart disease risk calculations to the risk reclassification of individuals. The sample was drawn from 4600 participants of Balcova Heart Study. The prevalence of low ABI (<0.9) was 6.3%. Current smoking (odds ratio [OR]: 5.07, 95% confidence interval [CI]: 1.85-13.88), cardiovascular disease history (OR: 6.83, 95% CI: 3.00-15.53), hypertension (OR: 2.58, 95% CI: 1.06-6.33), diabetes (OR: 3.25, 95% CI: 1.51-6.98), and high waist circumference (OR: 2.24, 95% CI: 1.02-4.94) were positively associated with prevalent PAD. When ABI measurement was taken into account, 3.5% of low or intermediate risk patients were reclassified as high risk. Screening individuals who have one of these risk factors with ABI can help reclassifying individuals toward the high-risk category.

Ratio of waist-to-calf circumference and carotid atherosclerosis in Korean patients with type 2 diabetes

OBJECTIVE

To investigate whether waist circumference (WC), calf circumference (CC), and waist-to-calf ratio (WCR) are associated with carotid atherosclerosis in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

This was an observational study performed in 3,694 Korean patients with type 2 diabetes. Anthropometric measures and carotid ultrasound were performed on each subject. Carotid atherosclerosis was defined as having a clearly isolated focal plaque or mean carotid intima-media thickness (CIMT) ≥1.1 mm.

RESULTS

CIMT and the frequency of carotid atherosclerosis were higher with increasing WC quartiles and decreasing CC quartiles. There was an augmentative effect of CC and WC on the frequency of carotid atherosclerosis, which was dramatically higher in both the highest WC quartile and lowest CC quartile. However, except for the relationship between the quartile of CC with the frequency of carotid atherosclerosis in men, those associations disappeared after adjusting for potential confounders. In contrast, WCR was significantly related to CIMT (only in women) and carotid atherosclerosis, even after adjustment (adjusted odds ratio for carotid atherosclerosis for the highest quartile of WCR compared with the lowest quartile being 1.178 [95% CI 1.026-1.353] and 1.276 [1.053-1.545] in men and women, respectively).

CONCLUSIONS

A low CC and high WC seems to be associated with a carotid atherosclerotic burden in Korean diabetic patients. In particular, compared with each circumference, WCR is independently associated with carotid atherosclerosis. However, the cross-sectional nature of the study limits conclusions regarding the direction or causality. Further longitudinal study is warranted in this and other ethnic groups.

Artery remodeling and abdominal adiposity in nonobese postmenopausal women

BACKGROUND/OBJECTIVES

We aimed to assess, in nonobese postmenopausal women, whether markers of central adiposity, especially waist-to-hip ratio (WHR), would be associated with vascular remodeling.

SUBJECT/METHODS

We enrolled 263 postmenopausal nonobese women without metabolic syndrome or diabetes. The strongest anthropometric measure related to brachial artery diameter (BAD) was WHR. Therefore, we divided the population in tertiles according to WHR values. Women in third tertiles were older, with higher body mass index, had worse lipid profile and a higher BAD than women in the first and second tertiles.

RESULTS

An analysis of covariance confirmed that BAD was increased with increasing tertiles after correction for confounding variables.

CONCLUSION

BAD, a surrogate measure of cardiovascular disease, was correlated to WHR in nonobese population; therefore, nonobese women with high WHR should be carefully considered because of a possible worse cardiovascular risk profile.