Cardiometabolic Disease Is Prevalent in Normal-Weight Chinese Adults

Cardiometabolic diseases, frailty, and healthcare utilization and expenditure in community-dwelling Chinese older adults

This study investigated associations between cardiometabolic diseases, frailty, and healthcare utilization and expenditure among Chinese older adults. The participants were 5204 community-dwelling adults aged at least 60 years from the China Health and Retirement Longitudinal Study. Five cardiometabolic diseases were assessed including hypertension, dyslipidemia, diabetes, cardiac diseases and stroke. Frailty status was based on five criteria: slowness, weakness, exhaustion, inactivity, and shrinking. Participants were deemed frailty if they met at least three criteria. As the number of cardiometabolic diseases increased, so did the prevalence of frailty, and the proportion of healthcare utilization, including outpatient visit and inpatient visit. Moreover, the total healthcare expenditure and the odds of catastrophic health expenditure were increased with the number of cardiometabolic disorders. After adjusting for covariates, cardiometabolic diseases were positively associated with higher odds of frailty, incurring outpatient and inpatient visit. And individuals with 2 or more cardiometabolic diseases had a higher odds of catastrophic health expenditure than persons with non-cardiometabolic disease. Participants who were frailty were more likely to report higher odds of healthcare utilization. These findings suggest that both cardiometabolic diseases and frailty assessment may improve identification of older adults likely to require costly, extensive healthcare.

Novel and traditional anthropometric indices for identifying metabolic syndrome in non-overweight/obese adults

Background

Metabolic syndrome (MetS) in non-overweight/obese people is insidiously associated with cardiovascular disease. Novel anthropometric indices can reflect central obesity better than the traditional anthropometric indices. Therefore, we hypothesize that these newly developed anthropometric indices can better identify MetS in non-overweight/obese people than conventional indices.

Methods

Cross-sectional data of sociodemographic, biochemical and anthropometric indices were collected from 2916 non-overweight/obese Chinese people. A body shape index (ABSI), body roundness index (BRI), waist-to-height ratio (WHtR), weight-adjusted-waist index (WWI) and abdominal volume index (AVI) were calculated. Partial correlation analysis was used to clarify the correlation between anthropometric indices and MetS variables. Binary logistic regression analysis was applied to assess the association between anthropometric indices and MetS and its components. Receiver-operating characteristic curve was used to identify the diagnostic ability of anthropometric indices for MetS and its components. The area under curve (AUC) difference between WHtR and each new anthropometric index was compared in pairs.

Results

After adjusting for covariates, AVI had the optimal ability of identifying MetS (AUC: 0.743 for male, 0.819 for female) and the strongest correlation with high-density lipoprotein cholesterol (HDL-C) (coe: − 0.227 for male, − 0.207 for female) and the highest odds rations (OR) with low HDL-C group (male: OR = 1.37, female: OR = 1.55). The WHtR was comparable to BRI in assessing MetS (AUC: 0.739 for male, 0.817 for female). WHtR or BRI could also well identify hypertension (AUC: 0.602 for male, 0.688 for female) and dysglycemia (AUC: 0.669 for male, 0.713 for female) and female’s high triglyceride level (AUC 0.712). The recognition ability of the two was equivalent. The ability of ABSI and WWI to identify MetS was weak.

Conclusions

AVI is the optimal anthropometric indices to identify MetS in non-overweight/obese Chinese adults. BRI and WHtR can also be considered as discriminators, while ABSI and WWI are weak discriminators. WHtR is easy to measure. So, it is recommended as an early preliminary screening method for the MetS in non-overweight/obese people.

Association of Visceral Adiposity Surrogates with Impaired Fasting Glucose in Nonobese Individuals

Background: Nonobese individuals with disproportionate body fat distribution are also vulnerable to dysglycemia. This study aimed to evaluate the association between three visceral adiposity surrogates and impaired fasting glucose (IFG) in nonobese Chinese individuals. Methods: A total of 70,200 nonobese adults without diabetes were included in this analysis. Two diagnostic criteria (IFG-ADA and IFG-WHO) were used to define IFG. The values of the visceral adiposity index, lipid accumulation product index (LAP), and cardiometabolic index (CMI) were calculated. Multivariable logistic analysis was used to evaluate the association between these surrogates and IFG. Results: Among the three indicators, only LAP and CMI were positively correlated with fasting plasma glucose (all P < 0.001). After fully adjusting for confounders, only LAP and CMI exhibited significant associations with IFG. For women, the odds ratios (ORs) for IFG-ADA in the highest quartile of the LAP and CMI were 1.967 (95% confidence interval [CI]: 1.645-2.353) and 1.594 (95% CI: 1.383-1.836), respectively; and were 2.025 (95% CI: 1.597-2.567) and 2.017 (95% CI: 1.647-2.470), respectively, for IFG-WHO (all P < 0.001). For men, the ORs for IFG-ADA of the LAP and CMI were 1.503 (95% CI: 1.233-1.833) and 2.045 (95% CI: 1.752-2.388), respectively; and were 1.534 (95% CI: 1.174-2.005) and 2.541 (95% CI: 2.025-3.188), respectively, for IFG-WHO (all P < 0.001). Conclusions: The LAP and CMI, cost-effective and simple visceral adiposity surrogates, are strongly associated with IFG in nonobese Chinese individuals. These surrogates might be potential targets to monitor for the recognition and management of excess visceral adiposity in nonobese individuals with prediabetes.

Health behavior practice among understudied Chinese and Filipino Americans with cardiometabolic diseases

Lifestyle modification and health behavior practice among the individuals with cardiometabolic diseases (CMD) are important for secondary prevention and disease control. This study was designed to investigate and compare health behavior practices among Chinese and Filipino Americans with CMD. Three hundred seventy-four Asian Americans (211 Chinese and 163 Filipino) who reside in the greater Philadelphia region and had either CMD or no identified disease were included in the study. Information on smoking, alcohol intake, physical activity, and salt and sweets consumption was collected, as well as demographic and acculturative characteristics. Of the 374 participants, 241 (64.4%) had CMD and 133 (35.6%) had no identified disease. The majority of Chinese and Filipino Americans with CMD failed to meet the dietary and physical activity guidelines, and only a small percentage of them restricted their amount of salt added to food and amount of sweets consumption. Compared to participants with no disease, Chinese participants with CMD were more likely to "never" add salt to food (AOR 4.42 compared to "frequently"). Filipino Americans with CMD were less likely to be those who "never" consume sweets than those who frequently consume sweets (AOR = 0.12). Among the participants with CMD, Chinese participants with CMD were less likely to restrict drinking (AOR 0.11) than Filipinos with CMD. The findings suggest that tailored interventions for Chinese and Filipino Americans with CMD should be developed to enhance their compliance to behavioral guidelines to prevent further disease progression and complications.

Distribution and related factors of cardiometabolic disease stage based on body mass index level in Chinese adults-The National Diabetes and Metabolic Disorders Survey

BACKGROUND

It is important to characterize distribution of cardiometabolic disease (CMD) based on different body mass index (BMI) levels in a population. This information remains scarce in China, so we investigated the proportions and related factors of cardiometabolic disease stages based on different BMI levels in Chinese adults.

METHODS

We included 45 093 participants aged ≥20 years from the National Diabetes and Metabolic Disorders Survey. Cardiometabolic disease (central obesity, elevated triglycerides, elevated blood pressure, elevated plasma glucose, reduced high-density lipoprotein cholesterol, and cardiovascular disease) was classified as stage 0 (no CMD), stage 1 (mild-to-moderate CMD), or stage 2 (severe CMD). Overweight/obesity was defined as BMI ≥25 kg/m² .

RESULTS

The standardized proportions of stage 0, stage 1, and stage 2 were 32.6%, 36.4%, and 30.9% in normal-weight men, 29.9%, 42.5%, and 27.7% in normal-weight women, 4.9%, 31.7%, and 63.4% in overweight/obese men, and 6.9%, 31.4%, and 61.7% in overweight/obese women, respectively. Multinomial regression showed that regardless of gender or region, the probability of severe cardiometabolic disease rapidly increased with increasing BMI. Severe cardiometabolic disease risk was positively associated with ageing, family history of diabetes, hypertension, or cardiovascular disease, but was inversely associated with higher levels of education and increased physical activity.

CONCLUSIONS

Of Chinese men and women with normal weight, more than one third had mild-to-moderate cardiometabolic disease, and less than one third had severe cardiometabolic disease, while of these with overweight or obesity, nearly one third had mild-to-moderate cardiometabolic disease, and nearly two thirds had severe cardiometabolic disease.

Associations between anthropometric parameters and lipid profiles in Chinese individuals with age ≥40 years and BMI <28kg/m2

BACKGROUND

Lipid abnormalities are associated with overweight and obesity. Some simple anthropometric measurements such as body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHpR), and waist-to-height ratio (WHtR), may link to increased risk of dyslipidemia. However, diverse results were found in different population studies. We focused on the associations between these measurements and dyslipidemia in non-obese (BMI <28kg/m2) population aged more than 40 years.

METHODS AND FINDINGS

Cross-sectional study of 4185 non-obese adults aged more than 40 years was conducted in Nanchang, Jiangxi province, China. Questionnaire, anthropometric and laboratory tests were conducted. The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) criteria were used to define high total cholesterol (TC), high low-density lipoprotein cholesterol (LDL-C), low high-density lipoprotein cholesterol (HDL-C), hypertriglyceridemia and dyslipidemia. The overall prevalence of high TC, high LDL-C, low HDL-C, hypercholesterolemia, hypertriglyceridemia and dyslipidemia were 15.68%, 27.98%, 20.12%, 44.01%, 21.98% and 49.06% respectively. Multiple logistic regressions showed only BMI (per quartile increment) increased risks for prevalent high LDL-C, low HDL-C, hypercholesterolemia, hypertriglyceridemia, and dyslipidemia. Regardless of sex, age and prevalent metabolic syndrome, increasing BMI was persistently independent risk factor for having low HDL-C, hypercholesterolemia and dyslipidemia, however was not associated with high TC.

CONCLUSIONS

In non-obese Chinese population aged more than 40 years, increasing BMI may better identify the prevalent dyslipidemia than other anthropometric measurements. However, due to the different meanings, both BMI and WC should be measured and monitored for metabolic risk assessment.

Dietary carbohydrate and fat intakes are differentially associated with lipid abnormalities in Korean adults

BACKGROUND

A high prevalence of metabolic syndrome along with increasing rates of low high-density lipoprotein cholesterol (HDL-C) and elevated triglycerides (TGs) is shown in Korean adults. Little is known about the associations between macronutrient intake and lipid abnormalities in the Asian population, whose major energy source is carbohydrates.

OBJECTIVE

We examined the associations of dietary carbohydrate and fat intakes with lipid abnormalities in Korean adults.

METHODS

A total of 14,301 adults (5715 men and 8586 women) aged ≥30 years with no diagnosis and treatment for diabetes, hypertension, or dyslipidemia were selected from the 2008 to 2012 Korea National Health and Nutrition Examination Survey data. From the 24-hour recall data, dietary carbohydrate and fat intakes were estimated. Multivariate logistic regression was used to estimate odds ratios for lipid abnormalities, that is, elevated total cholesterol (TC), low HDL-C, high TC to HDL-C ratio, elevated non-HDL-C, elevated LDL cholesterol (LDL-C), and elevated TG across quintiles of dietary carbohydrate and fat intakes.

RESULTS

Percentage of energy from carbohydrate was positively associated with elevated TG and low HDL-C but inversely associated with elevated TC and elevated LDL-C in both men and women. Energy-adjusted carbohydrate intake also showed a positive association with low HDL-C. Dietary fat intakes had the opposite associations with lipid abnormalities than results for carbohydrate.

CONCLUSION

High carbohydrate diet is undesirable with regard to increased TG and reduced HDL-C despite the benefit for LDL-C. Dietary strategies emphasizing appropriate macronutrient intakes by the type of lipid abnormalities are recommended for the prevention of cardiovascular disease in Korean adults.