Wrist circumference as a novel predictor of hypertension and cardiovascular disease: results of a decade follow up in a West Asian cohort

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

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

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

Background

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

Methods

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

Results

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

Conclusions

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

Evaluating Sex Differences in the Effect of Increased Systolic Blood Pressure on the Risk of Cardiovascular Disease in Asian Populations: A Systematic Review and Meta-Analysis

Background

Cardiovascular disease (CVD) is a serious health concern worldwide, and half of the cases of CVD occur in Asia. Because hypertension or high blood pressure has been confirmed to be an important risk factor for CVD, controlling blood pressure is helpful for CVD prevention. Although many studies have shown a sex difference in the impact of blood pressure on the risk of CVD, the risk threshold of blood pressure remained the same for both sexes in the latest global guidelines.

Objective

The study aimed to evaluate sex differences in the effect of increased blood pressure on the risk of CVD in Asian populations.

Methods

In this study, we performed a systematic review via PubMed, Embase, and MEDLINE to select studies conducted with Asian populations published before 30 June 2021.

Results

Six female and eleven male effect sizes for CVD risk from six articles were identified. The unadjusted pooled effect size for CVD risk per 10-mmHg increase in systolic blood pressure was estimated to be 1.20 for females (95% confidence interval: [1.10, 1.32]) and 1.19 for males (95% confidence interval: [1.11, 1.27]). Furthermore, using meta-regression to adjust for the significant effect of smoking, we showed that the impact of a 10-mmHg systolic blood pressure increase on CVD risk among females was 1.232 times that among males, corresponding to a significant sex difference (95% confidence interval: [1.065, 1.426]; P = 0.02). In summary, the effect of an increased systolic blood pressure on the risk of CVD in females was significantly higher than that in males in the Asian population.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Sleep duration and anthropometric indices in an Iranian population: the Fasa PERSIAN cohort study

Recent decades have seen a dramatic rise in the prevalence of obesity. While genetic factors can influence obesity, environmental factors and lifestyle may play important roles as well. Sleep can be regarded as one of these factors. This study aimed to examine sleep duration, as a potential risk factor for obesity in an Iranian population. In this cross-sectional study, the Fasa PERSIAN cohort study data was used and 10,136 subjects aged 35-70 were entered. Anthropometrics indices have been measured and the total body fat percentage (BFP) was obtained by Bio-Impedance Analysis. Also, physical activity and dietary intake have been recorded. Sleep duration was obtained and individuals categorized into two groups of "< 8" and "≥ 8" h of sleep. The mean age and sleep duration of the participants were 48.63 ± 9.57 years and 6.92 ± 1.62 h in the total population, respectively. All of the anthropometric indices were significantly higher in the "< 8 h of sleep" group than in the "≥ 8 h of sleep" group. Regarding BFP and fat mass index (FMI) the same results was seen (p-value < 0.05). Body mass index (BMI), Waist and hip circumferences (WC, HC), and waist-to-height ratio (WHtR) were in a significant negative association with night time sleep (p-value < 0.001), while these associations with daytime napping were positive (p-value < 0.001). After multi-variable adjusting, BMI, WC, HC, WHtR, and wrist circumference showed significant negative associations with 24-h sleep duration (p-value < 0.05). This study established the association between nocturnal, daytime napping, 24-h sleep duration and obesity parameters. Daytime napping was positively associated with obesity parameters and short 24-h sleep duration was associated with higher risk of overweight/obesity. These results indicate that insufficient sleep can be a screening indicator for an unhealthy lifestyle and poor health outcomes.

Neck and Wrist Circumferences as Indicators of Metabolic Alterations in the Pediatric Population: A Scoping Review

Neck circumference (NC) and wrist circumference (WrC) have been proposed as practical and inexpensive tools with the capacity to indicate metabolic alterations to some extent. Nevertheless, their application in the pediatric population is relatively recent. Thus, the aim of this scoping review was to review and analyze the reported evidence regarding the correlation of NC and WrC with metabolic alterations in the pediatric stage. The literature search was performed in January 2021 in seven indexes and databases. A total of 26 articles published between 2011 and 2020 were included. Most significant results were grouped into three categories: serum lipid profile, glucose homeostasis, and blood pressure. The parameter that showed the most significant results regardless of the anthropometric indicator analyzed for association was blood pressure. In contrast, total cholesterol and LDL-cholesterol showed non-significant associations along with conflicting results. We conclude that the use of NC and WrC, in addition to other well-established indicators, could facilitate the identification of metabolic alterations, specifically in plasma insulin and blood pressure. In fact, further studies are required to address the potential use of NC and WrC as predictors of early metabolic alterations, especially in countries with a fast-growing prevalence in obesity.

Wrist circumference: A new marker for insulin resistance in African women with polycystic ovary syndrome

BACKGROUND

Insulin resistance (IR) is the main complication found in 35%-80% of women with polycystic ovary syndrome (PCOS). However, there is no definite consensus regarding which marker to use for its assessment in PCOS women. Research has shown that hyperinsulinemia is correlated with increased bone mass. Given that most women with PCOS are insulin resistant, which is independent from body fat and characterized by hyperinsulinemia, it could be hypothesized that there would be an increased bone mass in the patient as a result. Subsequently, increased bone mass could be measured using the wrist circumference method.

AIM

To assess the wrist circumference as an easy-to-detect marker of IR in Congolese women with PCOS.

METHODS

Seventy-two Congolese women with PCOS and seventy-one controls from the same ethnic group, were enrolled in the study (mean age 24.33 ± 5.36 years). Fasting biochemical parameters, and the Homeostasis Model Assessment of insulin resistance (HOMA-IR) and body composition were evaluated. The non-dominant wrist circumference was measured manually, as was the waist circumference (WC), hip circumference, height and weight. Calculated measures included evaluation of body mass index (BMI), Waist-to-Height (WHtR) and Waist-to-hip ratio (WHR). In addition, body composition was assessed by Bioelectrical Impedance Analysis using a body fat analyzer.

RESULTS

The non-dominant wrist circumference was more closely correlated with HOMA-IR (r = 0.346; P = 0.003) and was the best anthropometrical marker correlated with IR (P = 0.011 ) compared with other anthropometrical markers in women with PCOS: Dominant Wrist Circumference (r = 0.315; P = 0.007), Waist Circumference (WC) (r = 0.259; P = 0.028), BMI (r = 0.285; P = 0.016), WHR (r = 0.216; P = 0,068) and WHtR (r = 0.263; P = 0.027). The diagnostic accuracy of the non-dominant wrist circumference for the presence or absence of IR using Receiver-operating characteristic (ROC) curve analysis showed that the area under the ROC curve was 0.72. A cutoff value for the non-dominant wrist circumference of 16.3 cm was found to be the best predictor of IR in Congolese women with PCOS.

CONCLUSION

Non-dominant wrist circumference is, to date, the best anthropometrical marker of IR in Sub-Saharan African women with PCOS. It could be suggested as an easy-to-detect marker for assessing IR.

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

BACKGROUND AND AIMS

The association of Wrist Circumference (WrC) with cardio-metabolic risk factors is still contradictory. We aimed to systematically review the association of WrC with cardio-metabolic diseases among the general populations.

METHODS

We systematically searched electronic databases such as PubMed/Medline, Web of Sciences, and Scopus without language restriction until March 2017. Observational studies that examined the association of WrC with any cardio-metabolic risk factors were included. Pooled association of WrC with metabolic syndrome (MetS) was estimated using a random-effect model, and heterogeneity among studies was assessed by I² index and Q test.

RESULTS

A total of 14 papers including cohort study (n = 9), cross-sectional study (n = 4), and case-control study (n = 1) met the criteria and included. The eligible papers have been examined the association of WrC with any cardiovascular disorders (n = 8), metabolic syndrome (n = 4), insulin resistance (IR) (n = 5), diabetes mellitus (n = 2), impaired glucose tolerance (n = 1), cardio-metabolic risk factors (n = 2) and obesity/overweight (n = 1). In the whole population (both adults and pediatric population), high WrC increased the risk of MetS by 33% (Pooled OR = 1.33; 95% CI 1.20, 1.48; I² = 60.2%, p = 0.04), while the pooled OR in adult populations was 1.27 (95% CI 1.15-1.41; I²: 32.8%, p = 0.21). Qualitative synthesis showed that associations of WrC with other cardio-metabolic risk factors are conflicting.

CONCLUSION

High WrC increased the risk of MetS and other cardio-metabolic risk factors. However, due to limited studies, particularly in children, results should be declared with great caution. Further cohort studies are needed to clarify whether WrC is a suitable anthropometric index to predict cardio-metabolic disorders in adult and children populations in different societies.

LEVEL OF EVIDENCE

Level 1, systematic review and meta-analysis.

Anthropometric measures and the risk of coronary artery disease

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

Background

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

Methods

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

Results

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

Conclusions

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

Wrist circumference as a novel predictor of obesity in children and adolescents: the CASPIAN-IV study

Background Recent studies have discussed the application of wrist circumference as an easy-to-use predictor of general and abdominal obesity. The aim of the current study is to evaluate the association of wrist circumference with generalized and abdominal obesity and to determine its sex- and age-specific optimal cutoff points in association with generalized and abdominal obesity in a national sample of pediatric population. Methods This nationwide survey was conducted among 14,880 students, aged 6-18 years, selected through a multistage, random cluster sampling method from rural and urban areas of 30 provinces in Iran from 2011 to 2012. Anthropometric indices (weight, height, wrist circumference, waist circumference [WC], hip circumference [HC]) were measured by standard protocols using calibrated instruments. Body mass index (BMI) and waist-to-height ratio (WHtR) were calculated. By considering the area under the curve (AUC) of the receiver operator characteristic (ROC) curves, we evaluated the association of wrist circumference with obesity indices and determined its sex- and age-specific optimal cutoff points in association with obesity. AUC: 0.5, AUC: 0.5-0.65 and AUC: 0.65-1.0 were interpreted as equal to chance, moderately and highly accurate tests, respectively. Results Overall, 13,486 children and adolescents with a mean age of 12.47±3.36 years completed the study (participation rate of 90.6%). In both genders, wrist circumference had a significant correlation with anthropometric measures including weight, height, BMI, WC, HC and WHtR. In all age groups and both genders, wrist circumference performed relatively well in classifying individuals into overweight (AUC: 0.67-0.75, p<0.001), generalized obesity (AUC: 0.81-0.85, p<0.001) and abdominal obesity (AUC: 0.82-0.87, p<0.001). Conclusions Wrist circumference is suggested to be a useful index for assessing excess weight in the pediatric age group. Its easy measurement without the need of calculation ratios might make it as a routine measurement in daily clinical practice and in large epidemiological studies.

Wrist circumference is associated with increased systolic blood pressure in children with overweight/obesity

Wrist circumference is a clinical marker for insulin-resistance in overweight/obese children and adolescents. Insulin resistance is considered a major determinant of increased vascular resistance and hypertension. The aim of the study was to investigate the association between wrist circumference and systolic (S) and diastolic (D) blood pressure (BP) in a population of overweight/obese children and adolescents. A population of 1133 overweight/obese children and adolescents (n = 1133) were consecutively enrolled. Multivariate regression analyses were used to investigate the influence of independent variables on the variance of BP. The prevalence of hypertension was 21.74% in males and 28.95% in females (p = 0.048). The results showed that SBP was significantly associated with wrist circumference in both genders (p < 0.0001 for both comparisons). We found no association between DBP and wrist circumference in either gender. Wrist circumference accounted for 17% of the total variance of SBP in males and 14% in females. Wrist circumference, a marker of insulin resistance, is associated with increased SBP in overweight/obese children and adolescents, suggesting a role of insulin resistance in the pathogenesis and development of hypertension.

Association of Wrist Circumference and Waist-to-Height Ratio with Cardiometabolic Risk Factors among Type II Diabetics in a Ghanaian Population

The study determined the association of wrist circumference (WrC) and waist-to-height ratio (WHtR) with cardiometabolic risk factors among diabetics in a Ghanaian population. This cross-sectional study involved 384 diabetic patients at Begoro District Hospital, Ghana. Blood pressure, anthropometrics, and biochemical indices were measured. The overall prevalence of dyslipidaemia, metabolic syndrome (MetS), and hypertension was 42.4%, 76.3%, and 39.8%, respectively. The optimum cut-off range of WrC to identify individuals at increased cardiometabolic risk was 17.5 to -17.8 cm for men and 16.0 to 16.7 cm for women while that of WHtR was 0.52 to 0.61 for men and 0.53 to 0.59 for women. WrC for women was a significant independent predictor for MetS [aOR = 3.0 (1.39-6.72), p = 0.005] and systolic blood pressure [aOR = 2.08 (1.17-3.68), p = 0.012]. WHtR was a significant positive predictor for triglycerides [aOR = 3.23 (0.10-3.82), p = 0.001] for women. Using Framingham risk scores, 61% of the subjects had elevated 10-year risk of developing cardiovascular diseases (CVDs), with no significant difference in gender prevalence. WrC [aOR = 6.13 (0.34-111.4), p = 0.107] and WHtR [aOR = 2.52 (0.42-15.02), p = 0.309] were associated with statistically insignificant increased odds of moderate-to-high risk of developing CVDs in 10 years. The use of gender-specific cut-offs for WrC and WHtR may offer putative markers for early identification of CRFs.

Predictors of early adulthood hypertension during adolescence: a population-based cohort study

Background

Some longitudinal studies have shown that blood pressure tracks from adolescence to adulthood, yet there is limited evidence regarding the predictive factors of adulthood hypertension during adolescence. This study was conducted within the framework of the Tehran Lipid and Glucose Study (TLGS) to investigate the role of some factors in adolescence, measured in the first examination (1999–2001), to predict adulthood hypertension in the 4th examination (2009–2011).

Methods

Overall, 1579 subjects, aged 10–19 years, were used for the analysis of the current study. Mean age (SD) of participants at the baseline was 14.2 (2.5) years and 55% of them were female. A forward stepwise approach (p-value <0.2 for enter and >0.05 for removal) was considered to keep significant covariates among common variables including gender, body mass index, waist circumference, wrist and hip circumferences, fasting blood sugar, triglycerides, high density lipoprotein cholesterol, total cholesterol (TC), systolic (SBP) and diastolic blood pressure (DBP). Variance inflation factor (VIF) showed some multicollinearity for anthropometric variables (VIFs between 3.5 and 10). Multivariable logistic regression revealed that gender, blood pressure, wrist circumference and total cholesterol in adolescents are important predictors for adulthood hypertension.

Results

The risk increased by 4% and 39% per each 10 mmHg and 1 mmol/L increase in SBP/DBP and TC, respectively; additionally, females had a 70% lower risk. Among anthropometric variables, wrist circumference remained in the model, with 50% per centimeter increase in the risk of hypertension.

Conclusions

Wrist circumferences and TC had significant roles in predicting hypertension through adolescence to adulthood.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4922-3) contains supplementary material, which is available to authorized users.

Exploring risk patterns for incident ischemic stroke during more than a decade of follow-up: A survival tree analysis

BACKGROUND AND PURPOSE

The burden of stroke is increasing in low to middle income countries. Identifying risk patterns for ischemic stroke (IS) can help develop individualized preventive measures for at risk populations.

METHODS

The study population included 3088 Iranian subjects (1426 men) aged ≥50 years, free of cardiovascular diseases at baseline. The risk factors for ischemic stroke were identified by multivariate Cox analysis. A survival tree model was used to explore interactions between risk factors.

RESULTS

During 12years of follow-up, 106 cases of IS occurred. Age (hazard ratio (HR): 1.08), male gender (HR: 1.69), diastolic blood pressure (DBP) (HR: 1.04), fasting plasma glucose (HR: 1.10), waist circumference (WC) (HR: 1.03) and smoking (HR: 1.96), were associated with increased risk and estimated glomerular filtration rate (eGFR) (HR: 0.97) and wrist circumference (HR: 0.68) decreased the risk of IS (all P-values <0.05). The survival tree identified six risk patterns. The highest and lowest risks were related to subjects ≥60.5years with DBP ≥100mmHg and subjects <60.5years with DBP<97mmHg, respectively. In subjects ≥60.5years with DBP <100mmHg, risk of ischemic stroke was determined by WC ≥96.5cm or (eGFR) <60.87ml/min/1.73m².

CONCLUSION

By applying survival tree as a complementary method to the conventional Cox-analysis, for the first time, we identified risk patterns of ischemic stroke and explored the interactions between risk factors of the disease. DBP was the most important predictor of ischemic stroke in middle-aged and old subjects. In elderly subjects with DBP <100mmHg, abdominal obesity was associated with high risk; however, among non-obese subjects, kidney dysfunction increased the risk of ischemic stroke. Wrist circumference was reported as a novel predictor.

Association between neck and wrist circumferences and cardiometabolic risk in children and adolescents: The CASPIAN-V study

OBJECTIVE

The predictive potentials of neck and wrist circumferences for cardiometabolic risks in children and adolescents remain to be determined. The aim of this study was to evaluate the association of neck and wrist circumferences with some cardiometabolic risk factors in children and adolescents.

METHODS

This multicenter study was conducted during the 2014 to 2015 school year with 4200 children and adolescents ages 7 to 18 y. The children were selected by multistage cluster sampling from 30 provinces of Iran. Anthropometric indices (neck, wrist and waist circumference, and body mass index), biochemical and clinical parameters were measured. Metabolic syndrome was defined based on the Adult Treatment Panel III criteria modified for the pediatric age group. High total cholesterol, high low-density lipoprotein cholesterol, and obesity were included as other cardiometabolic risk factors.

RESULTS

The participation rate for blood sampling was 91.5% (n = 3843). The mean (standard deviation) age of participants was 12.3 y (3.2 y). In a multivariate model, neck and wrist circumferences had significant association with elevated blood pressure, low high-density lipoprotein cholesterol, increased body mass index (overweight, excess weight, and generalized obesity), abdominal obesity, and metabolic syndrome. Additionally, obesity had the strongest associations with neck (odds ratio, 1.48; 95% confidence interval, 1.45-1.51) and wrist circumference (odds ratio, 2.25; 95% confidence interval, 2.15-2.36).

CONCLUSION

Neck and wrist circumferences are associated with some cardiometabolic risk factors. They could be used as alternative clinical tools and easy-to-use indicators of cardiometabolic risk in children and adolescents.

The value of wrist circumference for predicting the presence of coronary artery disease and metabolic syndrome

Background

Recently, the value of various structural body components have been proposed for predicting cardio-metabolic risk. The present study aimed to assess the wrist circumference (WrC) as an alternative measure for differentiating patients with CAD and METs from those without CAD and METs.

Methods

We studied 228 consecutive subjects who underwent coronary angiography. Those with and without evidence of coronary artery involvement at angiography were considered as the coronary artery disease (CAD) group (n = 139) and the non-CAD group (n = 89), respectively. WrC was measured; and metabolic syndrome (METs) was defined according to the modified National Cholesterol Education Program Adult Treatment Panel III criteria.

Results

WrC was significantly higher in CAD compared to non-CAD patients (17.85 ± 1.29 mm vs 17.43 ± 1.29 mm, P = 0.017). The overall prevalence of METs was significantly different between the CAD and non-CAD subjects (74.3% vs 58.8%, P = 0.016). Although there was a tendency for association, no statistically significant association between the mean of the WrC and the severity of CAD was found (P = 0.065). WrC had a weak positive correlation with triglyceride (r = 0.172, P = 0.011) and cholesterol (r = 0.141, P = 0.038) level and a weak negative association with high-density lipoprotein level (r = −0.279, P < 0.001). In multivariate logistic regression models, WrC could predict neither presence of CAD nor METs.

Conclusion

Although correlated with METs-type lipid profile, WrC may not be a valuable index for predicting the presence of CAD or METs.

Percentiles for anthropometric measures in Iranian children and adolescents: the CASPIAN-IV study

BACKGROUND

The aim of the study was to provide the age- and sex-specific percentile values of anthropometric measures for Iranian children and adolescents.

METHODS

This cross-sectional nationwide survey was conducted on a representative sample of 14,880 school students, selected by multistage random cluster sampling from urban and rural areas of 30 provinces in Iran. Anthropometric measures including body mass index (BMI), waist circumference (WC), hip circumference (HC), and wrist circumference were measured under standard protocols by using calibrated instruments. Age- and gender-specific reference values were developed for anthropometric measures by the maximum penalized likelihood approach [Cole's least mean square (LMS) method].

RESULTS

In the present study, 13,486 out of the 14,880 invited subjects completed all the required data of the study (participation rate: 90.6%). Participants consisted of 6640 girls (49.2%) and 75.6% urban residents; their mean and standard deviation (SD) age was 12.47±3.36 years. The BMI percentile curves of girls had a sharp increase from 14 to 18 years, and then began to plateau, but among boys, these curves had a consistent increase until the age of 18 years. In addition, the higher percentiles were higher in adolescent boys than girls. The HC percentile curves of both sexes had a persistent increase and the percentiles for HC were higher in adolescent girls than in boys. WC had a sharp increase from 7 to 18 years of age for boys, whereas for girls, these curves had a less sharp increase with age. In all ages, the percentiles for wrist circumference were higher in adolescent boys than girls.

CONCLUSIONS

The findings of this study highlight the necessity of paying special attention to developing age- and gender-specific percentiles of anthropometric measures in children and adolescents.

Classification-based data mining for identification of risk patterns associated with hypertension in Middle Eastern population: A 12-year longitudinal study

Hypertension is a critical public health concern worldwide. Identification of risk factors using traditional multivariable models has been a field of active research. The present study was undertaken to identify risk patterns associated with hypertension incidence using data mining methods in a cohort of Iranian adult population.Data on 6205 participants (44% men) age > 20 years, free from hypertension at baseline with no history of cardiovascular disease, were used to develop a series of prediction models by 3 types of decision tree (DT) algorithms. The performances of all classifiers were evaluated on the testing data set.The Quick Unbiased Efficient Statistical Tree algorithm among men and women and Classification and Regression Tree among the total population had the best performance. The C-statistic and sensitivity for the prediction models were (0.70 and 71%) in men, (0.79 and 71%) in women, and (0.78 and 72%) in total population, respectively. In DT models, systolic blood pressure (SBP), diastolic blood pressure, age, and waist circumference significantly contributed to the risk of incident hypertension in both genders and total population, wrist circumference and 2-h postchallenge plasma glucose among women and fasting plasma glucose among men. In men, the highest hypertension risk was seen in those with SBP > 115 mm Hg and age > 30 years. In women those with SBP > 114 mm Hg and age > 33 years had the highest risk for hypertension. For the total population, higher risk was observed in those with SBP > 114 mm Hg and age > 38 years.Our study emphasizes the utility of DTs for prediction of hypertension and exploring interaction between predictors. DT models used the easily available variables to identify homogeneous subgroups with different risk pattern for the hypertension.