Index of central obesity - A novel parameter

Probiotics combined with atorvastatin administration in the treatment of hyperlipidemia: A randomized, double-blind, placebo-controlled clinical trial

BACKGROUND

Hyperlipidemia is a common feature of chronic diseases. The aim of this work was designed to assess the role of probiotics (Lactobacillus casei Zhang, Bifidobactetium animalis subsp. lactis V9, and Lactobacillus plantarum P-8) in the treatment of hyperlipidemia.

METHODS

Thirty three patients with hyperlipidemia were randomly divided into a probiotic group (n = 18) and a control group (n = 15). The probiotic group was administered probiotics (2 g once daily) and atorvastatin 20 mg (once daily), and the control group was administered a placebo (2 g once daily) and atorvastatin 20 mg (once daily). Serum and fecal samples were gathered for subsequent analyses.

RESULTS

Time had a significant effect on the total cholesterol (TC), triglycerides (TG), and low-density lipoprotein-cholesterol (LDL-C) levels in the probiotic and control groups (P < .05). The gut microbial abundance in the probiotic group was markedly higher than that in the control group following 3-month probiotic treatment (P < .05). At the phylum level, probiotics exerted no notable effects on the relative abundance of Firmicutes, Bacteroidetes, and Actinobacteria but elevated that of Tenericutes and reduced Proteobacteria. At the genus level, probiotics increased the relative abundance of Bifidobacterium, Lactobacillus, and Akkermansia, and decreased that of Escherichia, Eggerthella, and Sutterella relative to the control group in months 1, 2, and 3 (P < .05).

CONCLUSIONS

Probiotics optimize the gut microbiota structure and decrease the amount of harmful bacteria in patients with hyperlipidemia. Probiotics can influence the composition of gut microorganisms and increase their diversity and abundance in vivo. It is recommended to use probiotics combined with atorvastatin to treat patients with hyperlipidemia.

The Effect of Dietary Supplementation with Plant Sterols on Total and LDL-Cholesterol in Plasma Is Affected by Adherence to Mediterranean Diet: Insights from the DESCO Randomized Clinical Study

Plant sterols are well-known natural lipid-lowering agents. The DESCO (Diet and plant sterols in the control of cholesterolemia) study was a single-center, randomized, double-blind, placebo-controlled, two-way crossover clinical trial designed to investigate the effect of a once-a-day ready-to-drink dietary supplement containing 2.5 g of phytosterols on the lipid profile, also in relation to the quality of the diet, in a cohort of 50 Italian individuals with polygenic hypercholesterolemia and low global cardiovascular risk. Eligible individuals were enrolled in a run-in period of 2 weeks. Then, participants who qualified for continuation in the study were randomly allocated (1:1) to a 3-week treatment with either phytosterols or placebo. After a 2-week washout period, enrolled individuals were crossed over to receive the alternative treatment. Dietary supplementation with phytosterols was associated with significant improvement in plasma levels of total cholesterol (TC; -11.8 ± 4.0 mg/dL, p = 0.016), low-density lipoprotein cholesterol (LDL-C; -7.8 ± 7.7 mg/dL, p = 0.021), and apolipoprotein B-100 (Apo B-100, -3.7 ± 4.1 mg/dL, p = 0.048) compared to baseline. The changes in TC and LDL-C were also significant compared to placebo, and greater adherence to the Mediterranean diet was significantly associated with greater reductions in LDL-C. Dietary supplementation with phytosterols was well tolerated and adherence to treatment was high. According to the findings of DESCO, the once-a-day ready-to-drink dietary supplement we tested is able to quickly and significantly decrease plasma levels of TC, LDL-C, and Apo B-100, with a greater effect in individuals more adhering to the Mediterranean dietary pattern.

Sources and severity of bias in estimates of the BMI-mortality association

Estimates of mortality differences by body mass index (BMI) are likely biased by: (1) confounding bias from heterogeneity in body shape; (2) positive survival bias in high-BMI samples due to recent weight gain; and (3) negative survival bias in low-BMI samples due to recent weight loss. I investigate these sources of bias in the National Health and Nutrition Examination Survey (NHANES) 1988-94 and 1999-2006 linked to mortality up to 2015 (17,784 cases; 4,468 deaths). I use Cox survival models to estimate BMI differences in all-cause mortality risks among adults aged [45-85) in the United States. I test for age-based differences in BMI-mortality associations and estimate functional forms of the association using nine BMI levels. Estimates of the BMI-mortality association in NHANES data are significantly affected by all three biases, and obesity-mortality associations adjusted for bias are substantively strong at all ages. The mortality consequences of overweight and obesity have likely been underestimated, especially at older ages.

Physical Activity, Sleep Patterns and Diet Habits as Well as the Prevalence of Obesity among Adolescents: A Cross Sectional Study from Ha'il City in Saudi Arabia

Obesity is expected to increase in the Kingdom of Saudi Arabia (KSA). Therefore, the objective of this study was to determine the physical activity, sleep patterns and diet habits as well as the prevalence of obesity among adolescents from Ha’il City. A cross-sectional study was conducted with 1598 adolescent students (663 males and 935 females) aged 12−15 years who were randomly selected from different schools in Ha’il. Body mass index (BMI) was used to classify participants as underweight, normal weight, overweight and obese (class and class II). Moreover, physical activity, sleep patterns and diet habits were recorded. The prevalence of obesity was 52.1%. Obesity is significantly more prevalent in females compared to males (62.9% vs. 36.59%, p < 0.001). Moreover, students in the third grade are the most obese in comparison with the first and the second educational level (p < 0.001). Additionally, students aged 15 years old are the most obese compared to 12 years, 13 years and 14 years (p < 0.001). Additionally, the results showed that students who suffer from obesity eat food when they feel higher stress and tension scores and that they do not eat their meals regularly. Additionally, 79% of those who eat fried food daily are obese. It was reported that 61.1% of students in this study were physically inactive. Furthermore, 58.4% of students have a higher proportion of insufficient sleeping duration (>7 h per night) (p < 0.001). This increased rate of obesity is higher in females compared to males and it was related to inactivity as well as perturbed sleep and eating habits. Therefore, we recommend an obesity prevention program including health education in Ha’il City, KSA.

Perceived urban environment attributes and obesity indices in adults: an 8-Nation study from Latin America

This study examines the associations between perceived urban environment attributes and obesity indices by country using data from an eight-nation study from Latin America. The data were collected from 8185 adults. The Neighbourhood Environment Walkability-abbreviated scale was used to assess perceived urban environment attributes. Obesity indices considered were body mass index, waist circumference, neck circumference, a body shape index and waist-to-height ratio. The perception of a more and better land use mix-diversity (β - 0.44; 95% CI - 0.59, - 0.28), traffic safety (- 0.39; - 0.66, - 0.12), and safety from crime (- 0.36; - 0.57, - 0.15) was associated with lower body mass index across the entire sample. Land use mix-diversity (- 1.21; - 1.60, - 0.82), street connectivity (- 0.26; - 0.37, - 0.15), and traffic safety (- 0.79; - 1.47, - 0.12) were negatively associated with waist circumference. Land use mix-diversity (- 0.11; - 0.20, - 0.03), land use mix-access (- 0.23; - 0.34, 0.12), walking/cycling facilities (- 0.22; - 0.37, - 0.08), and safety from crime (- 0.27; - 0.42, - 0.12) were negatively associated with neck circumference. No associations between perceived urban environment attributes and a body shape index were found. Land use mix-diversity (- 0.01; - 0.02, - 0.01), aesthetics (- 0.02; - 0.03, - 0.01), and safety from crime (- 0.02; - 0.04, - 0.01) were associated with waist-to-height ratio. Environmental interventions involving urban environment attributes are associated with obesity indices and, therefore, may help decrease the prevalence of overweight and obesity.

An N-Shaped Association between Population Density and Abdominal Obesity

Abdominal obesity is a threat to public health and healthy cities. Densification may reduce abdominal obesity, but current evidence of the relationship between population density and abdominal obesity is not conclusive. The aim of this study was to disentangle the nonlinear association between population density and abdominal obesity. Data came from the 2004-2015 China Health and Nutrition Survey, which included 36,422 adults aged between 18 and 65 years. Generalized additive models (GAMs) were applied to explore how population density was associated with objectively measured waist circumference (WC) and waist-to-height ratio (WHtR), after controlling for other built environmental attributes, socioeconomic characteristics, and regional and year fixed effects. We found that population density had N-shaped associations with both WC and WHtR, and the two turning points were 12,000 and 50,000 people/km2. In particular, population density was positively correlated with abdominal obesity when it was below 12,000 people/km2. Population density was negatively associated with abdominal obesity when it was between 12,000 and 50,000 people/km2. Population density was also positively related to abdominal obesity when it was greater than 50,000 people/km2. Therefore, densification is not always useful to reduce abdominal obesity. Policy-makers need to pay more attention to local density contexts before adopting densification strategies.

Exergaming During Ramadan Intermittent Fasting Improve Body Composition as Well as Physiological and Psychological Responses to Physical Exercise in Adolescents With Obesity

The effects of exergaming on biochemical responses has been investigated; however, no data is available for this effect during Ramadan intermittent fasting (RIF). RIF is a daily fasting characterized by abstaining from eating and drinking from sunrise to sunset for 29-30 days. The purpose of this study was to investigate the effect of exergaming during RIF on body composition, physical performance and hematological parameters in overweight and adolescents with obesity. Twenty-four adolescents with obesity were divided into two groups [control group (CG), n = 12, or cooperative sport exergaming group (EG), n = 12: 45 min per session during five days per week)]. Participants completed a 6-min walking test (6MWT), a squat jump test and a 10 and a 30m sprint tests in four different occasions: before Ramadan (T0), the second week of Ramadan (T1), the fourth week of Ramadan (T2), and after Ramadan (T3). Blood pressure, rating of perceived exertion (RPE), body composition, central obesity index, dietary intake and profile of mood states (POMS) were, also, assessed over the four periods. The results showed that body weight, body mass index and body fat percentage were significantly lower at T2 compared to T0 and T1 in the EG. After RIF, body composition returned to the values recorded before RIF. The POMS score was significantly lower during T2 compared to T0, T1 and T3 in the EG. The vertical jump and the 6MWT distance were significantly higher (i) at T2 compared to T0, T1 and T3 in the EG and (ii) in EG compared to CG at T2. RPE was significantly lower (i) at T2 compared to T0, T1 and T3 in the EG and (ii) in EG compared to CG at T2. Blood pressure was lower during T2 compared to the other periods in EG. The EG experienced significant decreases in total cholesterol and triglycerides during T2. However, no significant changes between groups and periods was reported for all the other parameters. In conclusion, exergaming during RIF has a positive effect on body composition and physiological and psychological responses in adolescents with obesity.

Obesity: The Fat Tissue Disease Version of Cancer

Obesity is a disease with high potential for fatality. It perfectly fits the disease definition, as cancer does. This is because it damages body structure and functions, both mechanically and biologically, and alters physical, mental, and social health. In addition, it shares many common morbid characteristics with the most feared disease, cancer. For example, it is influenced by a sophisticated interaction between a person’s genetics, the environment, and an increasing number of other backgrounds. Furthermore, it displays abnormal cell growth and proliferation events, only limited to white fat, resulting in adipose tissue taking up an increasing amount of space within the body. This occurs through fat “metastases” and via altered signaling that further aggravates the pathology of obesity by inducing ubiquitous dishomeostasis. These metastases can be made graver by angiogenesis, which might boost diseased tissue growth. More common features with cancer include its progressive escalation through different levels of severity and its possibility of re-onset after recovery. Despite all these similarities with cancer, obesity is substantially less agitating for most people. Thus, the ideas proposed herein could have utility to sensitize the public opinion about the hard reality of obesity. This is increasingly needed, as the obesity pandemic has waged a fierce war against our bodies and society in general, while there is still doubt about whether it is a real disease or not. Hence, raising public consciousness to properly face health issues is crucial to improving our health instead of gaining weight unhealthily. It is obviously illogical to fight cancer extremely seriously on the one hand and to consider dying with obesity as self-inflicted on the other. In fact, obesity merits a top position among the most lethal diseases besides cancer.

Benchmarking the driver acceleration impact on vehicle energy consumption and CO2 emissions

The study proposes a methodology for quantifying the impact of real-world heterogeneous driving behavior on vehicle energy consumption, linking instantaneous acceleration heterogeneity and CO₂ emissions. Data recorded from 20 different drivers under real driving are benchmarked against the Worldwide Harmonized Light Vehicle Test Cycle (WLTC), first by correlating the speed cycle with individual driver behavior and then by quantifying the CO₂ emissions and consumption. The vehicle-Independent Driving Style metric (IDS) is used to quantify acceleration dynamicity, introducing driving style stochasticity by means of probability distribution functions. Results show that the WLTC cycle assumes a relatively smooth acceleration style compared to the observed ones. The method successfully associates acceleration dynamicity to CO₂ emissions. We observe a 5% difference in the CO₂ emissions between the most favourable and the least favourable case. The intra-driver variance reached 3%, while the inter-driver variance is below 2%. The approach can be used for quantifying the driving style induced emissions divergence.

Exploring the association between measures of obesity and measures of trip-induced fall risk among older adults

OBJECTIVE

Explore the association between measures of obesity and measures of trip-induced fall risk among community-dwelling older adults.

DESIGN

Case-control SETTING: Gait laboratory PARTICIPANTS: Voluntary sample of 55 community-dwelling older adults (≥65 years of age) with body mass index (BMI) of 18.84-44.68 kg/m².

INTERVENTIONS

Not applicable MAIN OUTCOMES MEASURES: Measures of obesity included six anthropometry-based measures (BMI; thigh, hip and waist circumferences; ratio of waist-to-hip circumference; and index of central obesity) and four DEXA-based measures (percent trunk, leg and total fat; and fat mass index). Measures of risk of tripping during overground walking included median and interquartile range of toe clearance, and area under the swing phase toe trajectory. Measures of trip recovery after a laboratory-induced trip included trunk angle and angular velocity at ground contact of the first recovery step, anteroposterior distance from stepping foot to center of mass at the same instant, and step time of the first recovery step.

RESULTS

Risk of tripping was associated with waist-to-hip ratio and thigh circumference. After grouping participants by waist-to-hip ratio, those with high ratios (≥0.9 cm for males and ≥0.85 cm for females) exhibited significantly greater variability in toe clearance. Trip recovery was associated with hip circumference, thigh circumference, fat mass index, and total fat. After grouping participants by fat mass index, those with high indices (>9 kg/m² for males and >13 kg/m² for females) exhibited less favorable trunk kinematics following a laboratory-induced trip (Cohen's d=0.84).

CONCLUSION

Waist-to-hip ratio and fat mass index may more closely relate to trip-induced fall risk than BMI among community-dwelling older adults.

The effect of obesity on periodontitis progression: the 10-year retrospective cohort study

OBJECTIVE

Due to inconsistent findings in limited previous cohort studies, the aim of this study was to estimate the obesity effect on periodontitis progression in Thai adults.

MATERIALS AND METHODS

This 10-year retrospective cohort study comprised 2216 employees of the Electric Generation Authority of Thailand (EGAT). Their demographic, medical, and periodontal status was collected. Subjects with periodontitis progression were defined as having ≥ 2 teeth with progression. Additional proximal clinical attachment loss ≥ 3 mm or tooth loss with severe periodontitis at baseline were used to identify disease progression at the tooth level. Central obesity was classified using the waist-hip ratio. Multi-level Poisson regression was used to determine the effect of obesity on periodontitis progression by adjusting for age, sex, education, income, smoking, alcohol drinking, exercise, diabetes mellitus, and hypertension.

RESULTS

The cumulative incidence of periodontitis progression during the 10-year period was 59.6 cases per 100 persons (95% CI: 57.5, 61.6). The univariate analysis indicated that obese subjects had 15% higher risk of progression than that of healthy subjects. However, when confounders were analyzed simultaneously, the effect of obesity was not significant with a risk ratio of 0.98 (95% CI: 0.88, 1.08).

CONCLUSIONS

Despite the higher incidence of disease progression in the obese, obesity is not an independent risk factor for periodontitis progression.

CLINICAL RELEVANCE

Obesity and periodontitis progression share many common risk factors. Using the obesity as a preliminary screening for periodontitis progression may be an alternative prevention protocol.

The Value of Morphometric Measurements in Risk Assessment for Donor-Site Complications after Microsurgical Breast Reconstruction

Microsurgical abdominally-based reconstruction is considered the gold standard in autologous breast reconstruction. Despite refined surgical procedures, donor-site complications still occur, reducing patient satisfaction and quality of life. Recent work has outlined the potential of morphometric measurements in risk assessment for postoperative hernia development. With rising demand for personalised treatment, the goal of this study was to investigate their potential in risk assessment for any donor site complication. In this retrospective cohort study, 90 patients were included who each received microsurgical breast reconstruction at the hands of one surgeon between January 2015 and May 2017. Donor-site complications formed the primary outcome and were classified according to Clavien-Dindo. Morphometric measurements were taken on a routinely performed computed tomographic angiogram. Complications occurred in 13 of the 90 (14.4%) cases studied. All patients who developed any type of postoperative donor site complication had a history of abdominal surgery. The risk of postoperative complications increased by 3% with every square centimetre of omental fat tissue (OR 1.03, 95% CI 1.00-1.06, and p-value = 0.022). Morphometric measurements provide valuable information in risk assessment for donor-site complications in abdominally-based breast reconstruction. They may help identify personalised reconstructive options for maximal postoperative patient satisfaction and quality of life.

Metformin Attenuates Liver Fat Content: Finding from Schizophrenia Patients with Olanzapine-induced Weight Gain

Objective

This study was performed to evaluate the efficacy of metformin on liver fat content (LFC) in first episode schizophrenia patients with olanzapine-induced weight gain, and the relationship between the change of LFC and the other metabolic indices.

Methods

In a double-blind study, the clinically stable inpatients with first-episode schizophrenia under olanzapine monotherapy who gained more than 7% of their baseline weight were randomly assigned to two groups; one with olanzapine plus metformin (1,000 mg/day) (metformin group) and the other with olanzapine plus placebo (placebo group) for 16 weeks. All patients continued to maintain the original olanzapine dosage. LFC was measured by magnetic resonance imaging at baseline and at the end of 16 weeks, respectively. At the same time, glucose and lipid metabolism, homeostasis model assessment of insulin resistance index (HOMA-IR) were measured respectively, analyzing the correlation between the change value of LFC and other indicators.

Results

Over the 16-week study period, LFC value in metformin group decreased compared with baseline. LFC change across the 16-week treatment period was −2.91% for the metformin group and 0.59% for the placebo group, with a between-group difference of −3.5% (95% confidence interval, −6.08 to −0.93; p = 0.009). Compared to baseline, in the metformin group, triglyceride and HOMA-IR reduced significantly, while high density lipoprotein cholesterol increased significantly at weeks 16. There was positive correlation between LFC changes and triglycerides, HOMA-IR changes significantly.

Conclusion

Metformin can significantly attenuate LFC in schizophrenia patients with olanzapine-induced weight gain. It may be related to the improvement of the part of the glucolipid metabolic indices.

Comparison of the associations between non-traditional and traditional indices of adiposity and cardiovascular mortality: an observational study of one million person-years of follow-up

BACKGROUND/OBJECTIVE

The most widely used adiposity index, body mass index (BMI), is not optimal to evaluate cardiovascular (CV) risk associated with overweight and obesity. We aimed to explore the association between traditional and non-traditional adiposity indices and CV mortality, and compare their discriminative ability for CV death.

METHODS

We studied participants (age 19-79 years, BMI ≥18.5 kg/m²) from the population-based Norwegian Nord-Trøndelag Health Study 2 (HUNT 2). Traditional indices explored were BMI, waist circumference (WC) and waist- to-hip ratio, whereas non-traditional were estimated total body fat (eTBF), which is a sex-specific fat%-index, index of central obesity (WC/height) and a body shape index (ABSI) [WC/(BMI^2/3 × √height)]. Associations between the traditional and non-traditional indices and CV death, obtained from the Norwegian Cause of Death Registry, were explored by Cox proportional hazard regression, and the indices' discriminative ability by Harrell's C statistics.

RESULTS

Baseline assessments were done from 1995 to 1997 and the population (n = 61,016, 52% women) was observed for 17.7 ± 4.2 years (until 2016), yielding 1,080,473.6 person-years of follow-up. Thirteen thousand one hundred and ninety five (21.6%) subjects died, of whom 4908 (37.2%) died from CV causes. Across genders, eTBF had the strongest association to CV death (unadjusted hazard ratios [HRs] 4th vs. 1st quartile in women and men 13.38 [95% confidence interval (CI): 11.05-16.22] and 9.32 [8.03-10.81], respectively), together with index of central obesity in women and ABSI in men. The other indices showed weaker associations, in particular BMI in men: 1.73 [1.56-1.93]. Age adjustment attenuated the associations, but the pattern remained. In concordance with this, C-statistics was C = 0.725 [0.713-0.737] in women and 0.711 [0.701-0.721] in men for eTBF, and C = 0.622 [0.610-0.634] in women and 0.551 [0.541-0.562] in men for BMI.

CONCLUSION

eTBF, a sex-specific total body fat index, was more strongly associated with CV death than other adiposity indices and may be a suitable clinical tool for assessment of obesity-associated CV risk.

Assessment of the validity of multiple obesity indices compared with obesity-related co-morbidities

Objective

The aim of the present study was to compare selected obesity indicators with comprehensive health status.

Design

The study employed a pooled cross-sectional design.

Setting

BMI, waist circumference, waist-to-height ratio (WHtR) and body fat percentage were considered as indirect obesity indicators. The Edmonton Obesity Staging System (EOSS) was used as a composite indicator to comprehensively reflect obesity-related co-morbidities. Cohen’s κ coefficient was used to evaluate inter-measurement agreement for obesity. Conformity of indirect obesity indicators to the EOSS was assessed based on percentage agreement (proportion classified as obese and severely unhealthy as a result of obesity among the total sample), sensitivity (proportion classified as obese among individuals severely unhealthy as a result of obesity) and specificity (proportion classified as non-obese among fairly healthy individuals). Logistic regression analysis was used to identify the sociodemographic factors most strongly associated with conformity.

Participants

The study included 17338 adults from the Korea National Health and Nutrition Examination survey conducted between July 2008 and May 2011.

Results

Level of conformity to the EOSS was highest for WHtR (60·77 %) and lowest for BMI (35·96 %). WHtR and BMI had the highest sensitivity (53·7 %) and specificity (98·4 %), respectively. Predictability of conformity was lower among men for all indirect obesity indicators.

Conclusions

WHtR has the greatest potential to identify individuals at risk of health problems due to obesity. Individual demographic factors must be considered in selecting the most appropriate obesity measurement.

Salivary alpha-amylase and hormones levels of young adults with different body composition

The aim of this study was to assess the differences in salivary biomarker levels of young adults classified according to body fat accumulation. One hundred and thirty-four volunteers were evaluated (mean age 21 ± 2 years). Body composition was calculated through skinfold thickness: supra-iliac, biceps, and triceps, sub-scapular. Body fat percentage (BF%) was used to classify subjects according to fat tissue accumulation: normal-weight (n = 37, 19 females, 18 males), overweight (n = 42, 30 females, 12 males), and obese (n = 55, 42 females, 13 males). Saliva samples were collected 30 min after awakening to determine salivary levels of 17-beta-estradiol. For salivary cortisol and alpha-amylase activity (sAA) three samples were obtained, just after awakening, 30 min after awakening and at bedtime. Oral contraceptive intake was considered for the female group. The results showed that overweight and obese females using oral contraceptive presented lower levels of 17-β-estradiol than normal-weight females. In overweight and obese males, sAA levels were higher 30 min post-awakening when compared with the normal-weight group. The comparison of sAA levels within time showed no difference for males; obese females showed significant higher values at bedtime than 30 min post-awakening. The salivary cortisol concentration showed higher values at morning decreasing significantly at bedtime for all groups. Concluding, differences in 17-β-estradiol and sAA levels were found in females and males, respectively, according to body fat accumulation, showing the usefulness of salivary biomarkers in the study of systemic conditions. PRACTICAL APPLICATIONS: Saliva is an advantageous biological fluid in innovative methods for diagnosis. Besides being a noninvasive method, salivary steroid measurements have the potential to provide a convenient assessment of serum free steroid concentrations.

Longitudinal association between obesity and periodontal diseases among secondary school students in Hong Kong: a prospective cohort study

Background

There is no consensus opinion regarding the association between obesity and periodontal diseases among children and adolescents in the literature.

Methods

A prospective observational cohort study was conducted in a Hong Kong cohort at age 12, 15 and 18. CPI and various obesity indices including BMI, WC, WHR, WHtR, and TRSKF were recorded during each wave of data collection. Information on socioeconomic status and oral health behaviors were collected through self-completed questionnaires.

Results

Two hundred and eighty-two (male: 122 and female: 160) participants completed all three rounds of data collection. Prevalence of overweight/obesity was 27.0, 19.1, and 14.2% at 12, 15, and 18 years, respectively. 19.9% participants had healthy periodontal conditions at age 12. While the percentage dropped to 10.3% at 15 years and 5.7% at 18 years. The proportion of 15-year-old adolescents who brushed teeth more than twice a day was significantly higher among participants belonging to the lower BMI, WC, WHR, and WHtR category (P < 0.05). The fully adjusted model revealed that participants with lower BMI at age 15 had higher probability of having more than 50% index teeth free from periodontal diseases at age 18 (OR: 2.78; 95% CI: 1.16, 6.64; P = 0.022).

Conclusions

Although higher BMI at 15 years was associated with more extensive periodontal inflammation at age 18, this was believed to be an indirect association confounded by the poor oral health care among overweight/obese individuals. Oral health promotions should be directed to improve periodontal conditions of overweight/obese secondary school students.

Relationships between self-reported asthma and pulmonary function and various measures of obesity

OBJECTIVE

We explore the association with self-reported asthma and pulmonary function based on spirometry measurements using different measures to determine obesity because body mass index (BMI) is limited in not differentiating fat and muscle mass.

METHODS

A multi-year cross-sectional study using Korean National Health and Nutrition Examination Survey data was conducted between July 2008 and May 2011. A total of 9409 subjects were included in the final analysis.

RESULTS

Obesity was associated with self-reported asthma and pulmonary function limitations mainly in adult women aged between 40 and 65 years and elderly men aged 65 or older. The association was stronger when the measurement of obesity was based on body fat percentage or waist-to-height ratio (WHtR), compared to BMI. There was a higher self-reported asthma risk among obese women according to the WHtR [odds ratio (OR) = 1.817, 95% CI: (1.208, 2.735)]. There was an increased risk of pulmonary function limitation with abdominal obesity [OR 1.418, 95% CI (1.020, 1.972)], weight-to-height ratio [OR 1.467, 95% CI (1.058, 2.034)], and obesity with regard to body fat percentage [OR 1.753, 95% CI (1.251, 2.457)] in adult women. In elderly men, obesity based on body fat percentage was associated with an increased risk of pulmonary function limitation [OR 1.93, 95% CI (1.098, 3.388)].

CONCLUSIONS

Measures other than BMI should be examined when investigating the effect of obesity on self-reported asthma and pulmonary function limitation.

Influence of the Resected Gastric Volume on the Weight Loss After Laparoscopic Sleeve Gastrectomy

BACKGROUND

The relation between the resected gastric volume and the weight loss after laparoscopic sleeve gastrectomy appears conflicting in the literature. Both the residual and the resected volumes represent the total gastric volume, and if the weight loss is related to one of the two volumes, it should be related to the other. While some reports indicate that the weight loss is related to the resected gastric volume, others state that the weight loss is not related to the residual volume. The aim is to investigate the influence of the resected gastric volume on the weight loss after surgery.

METHODS

The study included 287 consecutive patients. Gastrectomy was performed encroaching over a 38-Fr calibrating tube all the way to the angle of His. Filling volume of the resected stomach, with tap water, was measured. Patients were analyzed into group 1 with BMI ≤50 kg/m(2) and group 2 >50 kg/m(2).

RESULTS

Females represented 74 % of cases. Mean age was 32.9 ± 9.5 years; preoperative BMI = 48.7 ± 7.9 kg/m(2). The mean resected gastric volume was 1525 ± 408 ml, and it was significantly lower in females compared to that in males (1443 ± 311 vs 1824 ± 502 ml, p < 0.001). Data were analyzed in two groups: group 1 with BMI ≤5050 kg/m(2) and group 2 >50 kg/m(2). Both groups were similar in preoperative BMI (p = 0.399) and excess weight percent (EW%) (p = 0.33). Group 2 had a resected gastric volume (1663 ± 424.7 ml) greater than that of group 1 (1440 ± 347 ml; p < 0.001). The percentage of excess weight loss (EWL%) was 57.9 ± 14.5 % at 6 months (62.7 ± 13.5 % vs 48.34 ± 11.29 %, p < 0.001), 77 ± 19 % at 12 months (84 ± 19.6 % vs 68 ± 14.2 %, p = 0.001), 76.6 ± 7.4 % at 18 months (79.7 ± 4.8 vs 74.7 ± 8.2 %, p = 0.5), and 75.8 ± 11.5 % at 24 months (81.7 ± 11.17 vs 70 ± 11 %, p = 0.8) (group 1 vs group 2, respectively). At 12 months, 86 % patients achieved more than 50 % EWL% (100 % of group 1 vs 60 % of group 2). Preoperative BMI correlated with resected gastric volume (r = 0.239, p = 0.004). In multiple regression, the initial BMI was a predictor of EWL% at 6 and 12 months (r partial = -0.65, p < 0.0001) while the resected gastric volume was not.

CONCLUSIONS

The resected gastric volume is related to the total gastric volume when the technique is standardized and the residual volume is calibrated using a consistent technique. It is not in itself a predictor of weight loss, but it is related to the initial BMI which predicts the weight loss.

Women with Polycystic Ovary Syndrome and Risk of Cardiovascular Disease

BACKGROUND

Polycystic ovary syndrome (PCOS) is associated with reproductive and metabolic abnormalities. The aim of this study was to analyse risk of cardiovascular disease (CVD) in PCOS, to define individual risk factors and assess their ability to predict risk.

METHODS

Fifty-four young women with PCOS (22 obese and 32 normal weight) were compared to 46 respective controls (17 obese and 29 normal weight). Anthropometric parameters, lipid status parameters, inflammation markers, concentrations of glucose, transaminases, sex and anterior pituitary hormones, sex hormone binding globulin (SHBG) and androgens were measured. Cardiovascular Risk Score (CVRS), indices for identifying Non-Alcoholic Fatty Liver Disease (NAFLD) and the Index of Central Obesity (ICO) were calculated.

RESULTS

Significantly higher CVRS values (p<0.05) were found in obese PCOS women compared to normal weight control and normal weight PCOS groups. Anthropometric parameters, lipid status parameters and fibrinogen (p<0.001, p<0.01) were higher in women with higher CVRS. The most significant CVRS predictors in all PCOS women were SHBG, androstenedione, follicle-stimulating hormone (FSH) and dehydroepiandrosterone sulphate (DHEAS). ICO and all NAFLD indices exhibited significant positive correlation with CVRS and a model consisting of these indices provided good diagnostic accuracy (AUC>0.8) in identifying patients with increased cardiovascular risk (CVR).

CONCLUSIONS

Obesity is a higher risk for developing CVD than PCOS alone. Anthropometric parameters, lipid parameters, fibrinogen, NAFLD indices and ICO increase CVR in PCOS women. For the prediction of CVR in PCOS, we suggest a combination of NAFLD indices and ICO.

Dynamic Relation of Changes in Weight and Indices of Fat Distribution With Cardiac Structure and Function: The Dallas Heart Study

BACKGROUND

Obesity may increase heart failure risk through cardiac remodeling. Cross-sectional associations between adiposity and cardiac structure and function have been elucidated, but the impact of longitudinal changes in adiposity on cardiac remodeling is less well understood.

METHODS AND RESULTS

Participants in the Dallas Heart Study without cardiovascular disease or left ventricular dysfunction underwent assessment of body weight, anthropometrics, and cardiac magnetic resonance imaging at baseline and 7 years later. Associations between changes in indices of generalized and central adiposity with changes in left ventricular mass, volume, mass/volume ratio (concentricity), wall thickness, and ejection fraction were assessed using multivariable linear regression. The study cohort (n=1262) mean age was 44 years with 57% women, 44% black, and 36% obese participants. At follow-up, 41% had ≥5% weight gain, and 15% had ≥5% weight loss. Greater weight gain was associated with younger age, lower risk factor burden, and lower body mass index at baseline. In multivariable models adjusting for age, sex, race, comorbid conditions at baseline and follow-up, baseline adiposity, and cardiac measurement, increasing weight was associated with increases in left ventricular mass (β=0.10, P<0.0001), wall thickness (β=0.10, P<0.0001), and concentricity (β=0.06, P=0.002), with modest effects on end-diastolic volume (β=0.04, P=0.044) and ejection fraction (β=0.05, P=0.046). Similar results were seen with other adiposity indices.

CONCLUSIONS

Concentric left ventricular remodeling is the predominant phenotype linked to increasing adiposity in middle age. Our findings support the importance of weight management to prevent secular changes in adiposity, concentric remodeling, and eventual heart failure over time.

Dietary Profiles of First-Generation South Asian Indian Adolescents in the United States

This study aimed to describe the dietary profile and health characteristics of first-generation South Asian Indian (SAI) adolescents in the United States because SAIs have a high prevalence of cardiovascular disease and diabetes, and dietary risk factors for those diseases begin in youth. A descriptive cross-sectional design was used to examine age, gender, usual dietary intake, body composition, blood pressure, blood glucose, and length of residency among 56 first-generation, urban SAI adolescents. Intake of saturated fat exceeded recommendations for all participants, and potassium, magnesium, calcium, vitamin D, and fiber intakes were insufficient in nearly all. Sodium intake exceeded recommendations for most males. Cholesterol intake and sweets consumption was lower among those who lived in the U.S. longer. There were no associations of dietary patterns with health characteristics. Dietary patterns that may increase future disease risk included high saturated fats and low potassium, magnesium, calcium, vitamin D, and fiber.

Association of a gain-of-function variant in LGR4 with central obesity

OBJECTIVE

To determine the relationship of the gain-of-function variant A750T in leucine-rich repeat containing G protein-coupled receptor 4 (LGR4) with central obesity and related metabolic phenotypes.

METHODS

The LGR4 A750T (c.2248 G > A) variant was detected by Sanger sequencing in a discovery young population and a validation community-based population with obesity from eastern China. Fat indices determined by anthropometry and computed tomography scans and clinical biochemical measurements were collected for association analysis.

RESULTS

LGR4 A750T was significantly correlated with waist circumference (P = 0.030) and waist-to-height ratio (P < 0.001) in the young cohort (N = 594) and with waist-to-hip ratio (P = 0.013) in the community population (N = 1067). Combined analysis showed a significant correlation of the variant with waist circumference (P < 0.001) and waist-to-hip ratio (P = 0.021). Moreover, the variant had a remarkable correlation with abdominal visceral fat area (P = 0.004) and was associated with 2-h plasma insulin (P = 0.009) and the Matsuda index (P = 0.027) after an oral glucose tolerance test in young subjects with obesity.

CONCLUSIONS

The LGR4 A750T variant may contribute to central obesity characterized by abdominal visceral fat accumulation.

Empagliflozin reduces body weight and indices of adipose distribution in patients with type 2 diabetes mellitus

AIMS

To determine the effects of empagliflozin on adiposity indices among patients with type 2 diabetes mellitus.

METHODS

Changes in weight, waist circumference, estimated total body fat, index of central obesity and visceral adiposity index were assessed using analysis of covariance and testing of treatment by strata for age, sex and baseline waist circumference in patients with type 2 diabetes mellitus randomized to blinded treatment with empagliflozin versus placebo in clinical trials of 12 weeks (cohort 1) or 24 weeks (cohort 2) duration.

RESULTS

This study comprised 3300 patients (cohort 1, N = 823; cohort 2, N = 2477). Empagliflozin reduced weight, waist circumference and adiposity indices versus placebo in both cohorts. Adjusted mean (95% confidence interval) change from baseline in empagliflozin versus placebo was -1.7 kg (-2.1 to -1.4 kg) and -1.9 kg (-2.1 to -1.7 kg) for body weight (p < 0.001); -1.3 cm (-1.8 to -0.7 cm) and -1.3 cm (-1.7 to -1.0 cm) for waist circumference (p < 0.001); -0.2% (-0.7% to 0.3%; p = 0.45) and -0.3% (-0.7% to 0.0%; p = 0.08) for estimated total body fat; -0.007 (-0.011 to -0.004) and -0.008 (-0.010 to -0.006) for index of central obesity (p < 0.001); and -0.3 (-0.5 to 0.0; p = 0.07) and -0.4 (-0.7 to -0.1; p = 0.003) for visceral adiposity index in cohorts 1 and 2, respectively. Adipose reductions were seen across most age, sex and waist circumference subgroups.

CONCLUSION

Empagliflozin significantly reduced weight and adiposity indices with the potential to improve cardiometabolic risk among patients with type 2 diabetes mellitus.

Correlation between the percentage of body fat and surrogate indices of obesity among adult population in rural block of Haryana

INTRODUCTION

The increasing prevalence of overweight and obesity has raised concerns regarding the importance of different techniques, which are used to assess body growth composition that can be used at the level of primary health care settings with minimal knowledge. The purpose of this study was to evaluate the relationship between different surrogate indices of fatness (body mass index [BMI], waist circumference [WC], waist-to-hip ratio [WHR], waist-to-height ratio [WHtR], and body fat percentage [BF%]) with the percentage of body fat and their usefulness as a predictor of obesity among adult population.

MATERIALS AND METHODS

The community-based cross-sectional study done over a period of 1-year involved 1080 adult participants from a rural area in Haryana. Anthropometry, along with BF% (using hand held analyzer) were recorded using standard procedures.

RESULTS

The prevalence of overweight and obesity as per the modified criteria of BMI for the Asian Indians was found to be 15.0% and 34.6%, respectively. Positive correlation was seen among all the indices except between the WHR and body adiposity index (BAI) using Pearson's correlation analysis. Maximum correlation was seen between WHtR and WC (r = 0.923), whereas WHtR depicted maximum correlation (r = 0.810) with BF%. Receiver operating characteristic curve analysis revealed that the WHtR was the most sensitive and specific indicator for the study population to predict overweight and obesity comparable to that calculated by body fat analyser followed by BAI, BMI, and WHR.

CONCLUSION

A single value of WHtR irrespective of gender and the area of residence can be used as a universal screening tool for the identification of individuals at high risk of development of metabolic complications.

Index of central obesity as a parameter to replace waist circumference for the definition of metabolic syndrome in predicting cardiovascular disease

OBJECTIVE

To compare the suitability of metabolic syndrome definitions in predicting cardiovascular disease (CVD) risk.

METHODS

We analyzed data from a population-based prospective cohort of 3598 participants from Jiangsu, China. Waist circumference was replaced with central obesity [index of central obesity (ICO), a ratio of waist circumference and height] in Cholesterol Education Program Adult Treatment Panel III (ICO-replaced ATPIII) and International Diabetes Federation (ICO-replaced IDF), respectively. Cox proportional-hazards regression model and the receiver operating characteristic curve (ROC curve) was used to evaluate the suitability of ATPIII, IDF, ICO-replaced IDF and ICO-replaced ATPIII in predicting CVD risk.

RESULTS

ICO was a better parameter in predicting CVD risk by ROC curve analysis. The ROC curve analysis also showed that although ICO-replaced IDF and IDF had the higher degree of specificity, lower sensitivity, longer ROC curve distance, less area under the curve to identify CVD than ATPIII and ICO-replaced ATPIII, therefore ICO-replaced IDF and IDF seemed to be undesirable. However, there was no significant difference in area under the curve between ATPIII and ICO-replaced ATPIII in predicting CVD risk. But it seems that odds ratios for abnormal triglyceride and high-density lipoprotein levels increase slightly when using ICO, but decrease for hyperglycemia and hypertension when using ICO.

CONCLUSION

ICO was a better predictor of abnormal triglyceride and high-density lipoprotein levels than waist circumference, but waist circumference was a better predictor of hyperglycemia and hypertension than ICO. However, we failed to support ICO as a better parameter for metabolic syndrome definition in predicting CVD risk compared with waist circumference.

If not dieting, how to lose weight? Tips and tricks for a better global and cardiovascular health

Weight loss is a popular topic and may be of serious concern for many patients. Even with the abundant literature on obesity and cardiometabolic risk, it is always challenging to demystify and reinforce the determinants of safe approaches to lose weight. Measures of central obesity are essential to characterize the patient's adiposity distribution and should be part of the routine medical examination. Beyond this, screening for fasting lipids and glucose are important for the assessment of the cardiometabolic risk which may lead to increased cardiovascular morbidity and mortality. Differences in adiposity as well as in weight loss exist between sexes and should be taken into consideration. Rather than avoiding some food or following certain type of diet, any planned weight loss interventions should promote lifestyle and environmental modifications with healthy eating and appropriate physical activity. With clear objectives, this appears to be the best way in order to achieve weight loss goals permanently.

Auricular or body acupuncture: which one is more effective in reducing abdominal fat mass in Iranian men with obesity: a randomized clinical trial

BACKGROUND

The prevalence of abdominal obesity is on the rise worldwide. Previous studies have indicated the higher diagnostic value of body fat distribution pattern compared with general body in abdominal obesity assessments. Several non-pharmacological methods have been suggested for obesity management, of which acupuncture has gained a great deal of research interest with promising results. This study aimed to comparatively evaluate the effects of conventional auricular and body electroacupuncture on abdominal fat mass in obese men.

METHODS

The volunteers were randomly divided into four groups, including 2 interventions and 2 controls. This study was conducted on 80 obese volunteer men with Body Mass Index (BMI) range of 30-40 kg/m2.The intervention groups including real body electroacupuncture (A), real auricular acupuncture (C) and the control groups containing sham body electroacupuncture (B), and sham auricular acupuncture (D). All groups were in combination with a low-calorie diet for 6 weeks. BMI, Trunk Fat Mass (TFM), Waist Circumference (WC), and Hip Circumference (HC) were measured pre- and post-intervention.

RESULTS

In group A, respectively a significant reduction was shown in BMI (P < 0.005), TFM (P < 0.005), WC (P < 0.05, P < 0.005) and HC (P < 0.005) when compared with controls (Groups B and D). Interestingly, group C had significant decreases in BMI (P < 0.005), TFM (P < 0.01, P < 0.005), WC (P < 0.005) and HC (P < 0.001) after comparison with the sham. Likewise, WC (P < 0.05) and HC (P < 0.05) were significantly reduced post- intervention when compared with two treatment groups.

CONCLUSIONS

In our study, acupuncture treatment (body or auricular) seemed to have an effect on reducing BMI, TFM, WC and HC. Comparison of the two types of treatment (body and auricular acupuncture) suggests that the two types of acupuncture had similar effects on reducing BMI and TFM, but body electroacupuncture is more effective in reducing WC and auricular in HC. It seems that both auricular and body electro-acupuncture combined with a low-calorie diet are efficient, simple and painless methods to reduce respectively the HC and WC fat in obese men, compared with conventional techniques.

TRIAL REGISTRATION

IRCT201201127117N2.

The four-compartment model of body composition in obese Chilean schoolchildren, by pubertal stage: comparison with simpler models

OBJECTIVES

We assessed the agreement of body fat and fat-free mass measured by simpler methods against the four-compartment model (4C).

METHODS

In 60 obese schoolchildren (body mass index ≥95th percentile) between the ages of 8 and 13 y who were recruited from one school in Chile, multicompartmental body composition was estimated with the use of isotopic dilution, plethysmography (BodPod), radiographic absorptiometry (DEXA), and anthropometric equations. These results were compared to those of the 4C model, which is considered the gold standard.

RESULTS

For body fat, the 4C model showed the best agreement with DEXA for boys in Tanner stages I and II (r = 0.971) and with isotopic dilution for boys in Tanner stages III and IV (r = 0.984). The best agreement in girls occurred with isotopic dilution, regardless of pubertal stage (r = 0.948 for Tanner stages I and II; r = 0.978 for Tanner stages III and IV). Both isotopic dilution and the Huang, Ellis, and Deurenberg anthropometric equations underestimated body fat in boys; by contrast, DEXA, BodPod, and the Slaughter equation overestimated body fat in boys. All of the equations underestimated body fat in girls. For fat-free mass in both boys and girls, the 4C model showed the best agreement with isotopic dilution, regardless of pubertal stage. The Huang equation showed the best agreement for boys (r = 0.730 for Tanner stages I and II; r = 0.695 for Tanner stages III and IV) and for girls in Tanner stages I and II (r = 0.884). The Ellis equation had the best agreement for girls in Tanner stages III and IV (r = 0.917).

CONCLUSIONS

For obese Chilean children of both sexes, isotopic dilution and DEXA were the two-compartment methods that had the best agreement with the gold-standard 4C model for both body fat and fat-free mass; these were followed by the Huang and Ellis anthropometric equations.

Waist height ratio: A universal screening tool for prediction of metabolic syndrome in urban and rural population of Haryana

AIMS

To compare waist circumference (WC), body mass index (BMI), waist hip ratio (WHR), and waist-to-height ratio (WHtR) and define an appropriate cut-off, which is most closely predictive of the non-adipose components of the IDF metabolic syndrome (MetS) definition.

METHODS AND RESULTS

A total of 3,042 adults (1,693 in rural area and 1,349 in urban area) were screened for the presence of MetS according to the IDF definition. Among 3,042 adults selected as subjects, 1,518 were male and 1,524 were female. The receiver operating curve (ROC) analysis was done to determine the optimal cut-off value and the best discriminatory value of each of these anthropometric parameters to predict two or more non-obese components of metabolic syndrome. The area under ROC (AURC) for WC was superior to that for other anthropometric variables. The optimal cut-off value of WC in urban and rural males was >89 cm, which is higher than that in urban and rural females at 83 cm and 79 cm, respectively; the optimal cut-off for WHtR was >0.51 in rural females, 0.52 in rural males, and 0.53 in both urban males and females. Both parameters were found to be better than BMI and WHR. ROC and AURC values for WC were better than those for WHtR in men and women in both urban and rural areas (P = 0.0054); however, when the entire study cohort was analyzed together, irrespective of gender and place of residence, then at a value of 0.52, WHtR scored over WC as a predictor of metabolic syndrome (P = 0.001).

CONCLUSION

Although the predictive value of different gender-specific WC values is clearly superior to other anthropometric measures for predicting two or more non-adipose components of MetS, a single value of WHtR irrespective of gender and the area of residence can be used as a universal screening tool for the identification of individuals at high risk of development of metabolic complications.

Predictive equations for central obesity via anthropometrics, stereovision imaging and MRI in adults

OBJECTIVE

Abdominal visceral adiposity is related to risks for insulin resistance and metabolic perturbations. Magnetic resonance imaging (MRI) and computed tomography are advanced instruments that quantify abdominal adiposity; yet field use is constrained by their bulkiness and costliness. The purpose of this study is to develop prediction equations for total abdominal, subcutaneous, and visceral adiposity via anthropometrics, stereovision body imaging (SBI), and MRI.

METHODS

Participants (67 men and 55 women) were measured for anthropometrics and abdominal adiposity volumes evaluated by MRI umbilicus scans. Body circumferences and central obesity were obtained via SBI. Prediction models were developed via multiple linear regression analysis, utilizing body measurements and demographics as independent predictors, and abdominal adiposity as a dependent variable. Cross-validation was performed by the data-splitting method.

RESULTS

The final total abdominal adiposity prediction equation was -470.28 + 7.10 waist circumference - 91.01 gender + 5.74 sagittal diameter (R2 = 89.9%), subcutaneous adiposity was -172.37 + 8.57 waist circumference - 62.65 gender - 450.16 stereovision waist-to-hip ratio (R2 =90.4%), and visceral adiposity was -96.76 + 11.48 central obesity depth - 5.09 central obesity width + 204.74 stereovision waist-to-hip ratio - 18.59 gender (R2 = 71.7%). R2 significantly improved for predicting visceral fat when SBI variables were included, but not for total abdominal or subcutaneous adiposity.

CONCLUSIONS

SBI is effective for predicting visceral adiposity and the prediction equations derived from SBI measurements can assess obesity.

The influence of different metabolic syndrome definitions in predicting vasculogenic erectile dysfunction: is there a role for the index of central obesity?

AIMS

Analyze the capacity of ICO, the ratio of waist circumference (WC) and height, in predicting hemodynamic impairment in Erectile Dysfunction (ED) patients, independently and integrated in Metabolic Syndrome (MetS) definitions.

METHODS

Four hundred and eighty-five ED patients followed in Urology consult from January 2008 until March 2012 were evaluated by a standardized protocol: health questionnaire, anthropometric measurements (AM), blood pressure and analysis, and Penile Duplex Doppler Ultrasound (PDDU) exam. Associations between AM and MetS definitions, including ATPIII, IDF and a new definition replacing WC by ICO in ATPIII MetS definition (ModATPIII), and PDDU were calculated.

RESULTS

ICO was the measure of obesity more strongly correlated with diminished mean Peak Systolic Velocity (mPSV) (r = -0.189, p < 0.001). A positive association remained when replacing WC by ICO ≥ 0.60 (a nationally obtained ratio) in ATPIII MetS definition (ModATPIII). Patients with ModATPIII had lower mPSV when compared to non-MetS patients (30.8 versus 37.1, p < 0.001). Only the IDF definition had a significant association with AD (OR = 1853; 95%CI, 1.202-2.857).

CONCLUSIONS

ICO revealed potential value to predict PDDU changes in a MetS context. However, IDF definition presented a stronger correlation with arteriogenic ED. Although longitudinal studies are necessary to confirm this hypothesis, our study highlights the importance of different MetS definitions for ED assessment.

Sagittal abdominal diameter to triceps skinfold thickness ratio: a novel anthropometric index to predict premature coronary atherosclerosis

OBJECTIVE

We aimed to compare the accuracy of a novel index defined by us, as a ratio of Sagittal abdominal diameter (SAD) and triceps skinfold thickness (TSF) with other indices of adiposity for prediction of presence, severity and extension of premature coronary artery disease (CAD).

METHODS

A cross-sectional study was conducted on 238 younger patients (females <55 years; males <45 years) who underwent coronary angiography. Anthropometric indices including TSF, SAD, waist circumference, and hip circumference were measured before catheterization and body mass index, waist-to-hip ratio, abdominal diameter index, index of central obesity as well as our proposed index, SAD-to-TSF ratio, were calculated accordingly. Evaluation of severity and extension of coronary stenosis was by Gensini score and extent score, respectively.

RESULTS

After adjustment for age and sex in multivariate regression models, the SAD-to-TSF ratio was the best predictor for the presence (OR = 2.49, 95% CI = 1.44-4.30; p = 0.001) and extension (β = 1.10, p = 0.004) of premature CAD. TSF and the SAD-to-TSF ratio were the only indices that significantly predicted the Gensini score and the correlation remained significant even after adjustment for age and sex (β = -7.28, p < 0.0001 and β = 3.76, p < 0.0001, respectively).

CONCLUSION

We showed that our proposed index, SAD-to-TSF ratio, has a substantially better accuracy than do the known indices of obesity like body mass index, waist circumference, and waist-to-hip ratio for the prediction of premature CAD. Furthermore, our index was the only index that positively correlated with the severity of premature CAD.

Can weight-related health risk be more accurately assessed by BMI, or by gender specific calculations of Percentage Body Fatness?

The problem of obesity over the last 10 years has consistently been referred to as a 'global epidemic'. The Body Mass Index (BMI) is the currently accepted measure for classifying weight-related risk, but is a crude measure that has not changed in 150 years. It is recognised as having significant limitations, largely due to its lack of distinction between fat and muscle tissue. As the health risks of obesity are linked to the fat content of the body, a more accurate method of classifying would be Percentage Body Fatness (PBF). Although skinfold thickness analysis is recognised as a valid and accurate estimate of PBF in field studies, this method is not routinely used in clinical practice. Using data collected from young adults in the United Kingdom, we compared classifications (underweight, normal weight, overweight and obese) using BMI, with classifications using estimated PBF (from skinfold thickness analysis). We identified disparity between these two methods in approximately 1/3 of participants. BMI correctly classified 66.5% of females and 62.7% of males, with different gender profiles of incorrect classification. Regression analysis was conducted using estimated PBF (by skinfold thickness analysis) as the dependent variable, with explanatory variables of age, height, weight, systolic blood pressure, frequency of vigorous exercise and grip strength. The resulting gender-specific formulae derived from this regression analysis provides a regression R(2) of around 65%, and improved correct classifications to 74% for females and 76% for males. This represents an average improvement of roughly ten percentage points over BMI (male: 7.2% points; female: 13.4% points). We hypothesise that the presented formulae provide gender-specific calculations of PBF, which result in a more accurate indicator of weight-related health risk, compared with BMI in this population. This provides a new approach to an increasingly important clinical issue. These formulae use data that can be easily, quickly and cost-effectively measured in a practice setting. If shown to be repeatable with larger and more diverse populations, the PBF formulae could provide an alternative to the BMI as the major indicator of body-composition related health risk. This would ensure resources are targeted more appropriately and efficiently.

Selection signature analysis implicates the PC1/PCSK1 region for chicken abdominal fat content

We conducted a selection signature analysis using the chicken 60k SNP chip in two chicken lines that had been divergently selected for abdominal fat content (AFC) for 11 generations. The selection signature analysis used multiple signals of selection, including long-range allele frequency differences between the lean and fat lines, long-range heterozygosity changes, linkage disequilibrium, haplotype frequencies, and extended haplotype homozygosity. Multiple signals of selection identified ten signatures on chromosomes 1, 2, 4, 5, 11, 15, 20, 26 and Z. The 0.73 Mb PC1/PCSK1 region of the Z chromosome at 55.43-56.16 Mb was the most heavily selected region. This region had 26 SNP markers and seven genes, Mar-03, SLC12A2, FBN2, ERAP1, CAST, PC1/PCSK1 and ELL2, where PC1/PCSK1 are the chicken/human names for the same gene. The lean and fat lines had two main haplotypes with completely opposite SNP alleles for the 26 SNP markers and were virtually line-specific, and had a recombinant haplotype with nearly equal frequency (0.193 and 0.196) in both lines. Other haplotypes in this region had negligible frequencies. Nine other regions with selection signatures were PAH-IGF1, TRPC4, GJD4-CCNY, NDST4, NOVA1, GALNT9, the ESRP2-GALR1 region with five genes, the SYCP2-CADH4 with six genes, and the TULP1-KIF21B with 14 genes. Genome-wide association analysis showed that nearly all regions with evidence of selection signature had SNP effects with genome-wide significance (P<10(-6)) on abdominal fat weight and percentage. The results of this study provide specific gene targets for the control of chicken AFC and a potential model of AFC in human obesity.

Sex-specific association of anthropometric measures of body composition with arterial stiffness in a healthy population

Background

Anthropometric measures of body composition and arterial stiffness are commonly used as indicators of cardiovascular risk. Little is known, however, about the association of the anthropometric measures with arterial stiffness, especially in a healthy, generally non-obese population.

Material/Methods

In a sample of 352 healthy subjects (200 premenopausal women), 3 arterial stiffness indices were analyzed (pulse wave velocity, augmentation index and central systolic blood pressure) in relation to 5 anthropometric measures of body composition (body mass index – BMI, body fat percentage by skinfold measurements –%BF, waist circumference – WC, waist-hip ratio – WHpR, and waist-height ratio – WHtR). Data were analyzed using correlation and regression analyses, with adjustment for the following confounders: age, blood pressures, height, heart rate, blood lipids and smoking.

Results

Most correlations between anthropometric measures and arterial stiffness indices were significant and positive in both sex groups (r=0.14–0.40, P<0.05). After adjustment for confounding effects, BMI, WC and WHtR remained significant (but inverse) predictors of arterial stiffness (β from −0.06 to −0.16; P<0.05) in the females, while in the males BMI was the only measure inversely predicting arterial stiffness (β from −0.09 to −0.13; P<0.05).

Conclusions

Measures of body composition are weak and inverse predictors of arterial stiffness and their influence is sex-dependent. BMI, WC and WHtR were key predictors of arterial stiffness in the females, while BMI was the principal predictor in the males. The associations of anthropometric measures with arterial stiffness are strongly and differently confounded by various factors that have to be taken into account when explaining results of similar studies.

Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis

Our aim was to differentiate the screening potential of waist-to-height ratio (WHtR) and waist circumference (WC) for adult cardiometabolic risk in people of different nationalities and to compare both with body mass index (BMI). We undertook a systematic review and meta-analysis of studies that used receiver operating characteristics (ROC) curves for assessing the discriminatory power of anthropometric indices in distinguishing adults with hypertension, type-2 diabetes, dyslipidaemia, metabolic syndrome and general cardiovascular outcomes (CVD). Thirty one papers met the inclusion criteria. Using data on all outcomes, averaged within study group, WHtR had significantly greater discriminatory power compared with BMI. Compared with BMI, WC improved discrimination of adverse outcomes by 3% (P < 0.05) and WHtR improved discrimination by 4-5% over BMI (P < 0.01). Most importantly, statistical analysis of the within-study difference in AUC showed WHtR to be significantly better than WC for diabetes, hypertension, CVD and all outcomes (P < 0.005) in men and women. For the first time, robust statistical evidence from studies involving more than 300 000 adults in several ethnic groups, shows the superiority of WHtR over WC and BMI for detecting cardiometabolic risk factors in both sexes. Waist-to-height ratio should therefore be considered as a screening tool.

Role of Retinol-Binding Protein 4 in Obese Asian Indians with Metabolic Syndrome

Retinol-binding protein 4 is an adipocytokine separately implicated in the development of obesity-related insulin resistance and proatherogenic lipid profile, however, its role in humans is unclear. This study was carried out to assess the role of retinol-binding protein 4 as a potential marker of metabolic syndrome in obese Asian Indians (a high-risk population for diabetes). 52 obese (BMI >23 kg/m2) Asian Indians were grouped into those with and without metabolic syndrome based on IDF criteria and compared with healthy controls. The anthropometric and biochemical parameters (fasting blood sugar, lipid profile, serum insulin, high-sensitivity C-reactive protein, and retinol-binding protein 4) were estimated. The obese groups had significantly altered adiposity indices, insulin resistance parameters (fasting blood sugar (only in the metabolic syndrome group), serum insulin, HOMA-IR and QUICKI), index of inflammation (C-reactive protein) and proatherogenic dyslipidemic profile (serum triglycerides, VLDL-cholesterol, and triglyceride/HDL-cholesterol ratio). Retinol-binding protein 4 levels were elevated in the obese groups, but were not significant. Retinol-binding protein 4 levels were correlated with anthro-pometric parameters and atherogenic lipids, while C-reactive protein was correlated with anthropometric and insulin resistance parameters in the entire group of subjects. Although these correlations were not observed in the obese groups, in the control group, retinol-binding protein 4 was correlated to the lipid parameters and C-reactive protein to adiposity indices. Thus, the role of retinol-binding protein 4 as a potential marker of metabolic syndrome is limited to the prediction of proatherogenic risk among Asian Indians.

Changing definitions of metabolic syndrome

The first description of patients with clustering of various metabolic abnormalities was as early as 1923 but it was more than five decades later, in 1988, that Reaven coined the term 'syndrome X' for this entity. The last two decades have brought forth a number of definitions and criteria to identify this condition. Various studies have demonstrated disparities in these definitions and a few researchers have questioned the utility of these criteria and even the existence of such a syndrome. A few important definitions are reviewed in this paper and, at the end, a simplified clinical definition is given and a simple parameter - lipid accumulation product - is been described that can be used to identify this condition.

Should waist circumference be replaced by index of central obesity (ICO) in definition of metabolic syndrome?

Waist circumference has been widely used as the parameter of central obesity in defining metabolic syndrome. Global consensus definition of metabolic syndrome has suggested various race- and gender-specific cutoffs of waist circumference for quantifying central obesity. We have earlier proposed that using index of central obesity (ICO), the need for race- and gender-specific cutoffs may be obviated. We propose that waist circumference be supplanted with index of central obesity in all definitions of metabolic syndrome. Using index of central obesity a common cutoff of 0.5 applicable across races and genders might be obtained. Moreover, it will enhance the sensitivity of definition by diagnosing subjects who are shorter than general population. Among 258 male and 242 female diabetic patients, subjects with metabolic syndrome (defined as per gender-specific waist circumference cutoffs), were found to have a common lower range of index of central obesity suggesting that a common cutoff of waist circumference may be obtained. In another study from National Health and Nutrition Examination Survey database, replacing index of central obesity with waist circumference was found to enhance the specificity and sensitivity of definition of metabolic syndrome.

Comparison of several anthropometric indices with insulin resistance proxy measures among European adolescents: The Helena Study

The aim of the current study was to compare the association of several anthropometric indices, with insulin resistance (IR) proxy measures in European adolescents. The present study comprises 1,097 adolescents aged 12.5-17.5 from ten European cities participating in the HELENA study. Weight, height, waist circumference (WC) and hip circumference, skinfolds thickness, fat mass (FM), fasting plasma glucose (G(F)) and serum insulin (I(F)) levels were measured. HOMA (as indicator of IR body mass index (BMI), waist to hip ratio (WHR) and waist to height ratio (WHtR) were calculated. I(F) and HOMA were statistically significantly related to BMI, WC, skinfold sum, WHtR, WHR and FM. BMI, WC, WHtR, skinfold sum and FM displayed similar correlation with I(F) and HOMA as opposed to WHR where lower correlation with IR indices was detected in the overall sample. Similar results were found for boys, girls and underweight/normal weight adolescents. On the other hand, WC and WHtR were found to be more strongly associated with IR proxy measures compared to the rest of anthropometric indices among overweight/obese subjects. Based on the current findings, WC and WHtR could be used, alternatively, to identify the overweight/obese adolescent at risk for developing IR. In addition, all aforementioned anthropometric indices, except WHR, could be used among the underweight/normal weight adolescents.

Oxidative Stress in Obesity and Metabolic Syndrome in Asian Indians

Oxidative stress is associated with the individual components of metabolic syndrome and has been implicated in the development of complications of these metabolic disorders. In this study oxidative stress levels have been compared in obese Indians (a high-risk population for diabetes and cardiovascular disorders) with and without metabolic syndrome. 30 adult normotensive, normoglycemic obese subjects and 35 adults with metabolic syndrome of either sex with BMI >23 kg/m2were compared with 30 adult, healthy volunteers with BMI <23 kg/m2. Anthropometric parameters, blood pressure, biochemical parameters, hydroperoxides levels and total antioxidant capacity were estimated. The obese groups with and without metabolic syndrome had significantly increased anthropometric parameters like waist circumference and index of central obesity and aqueous phase hydroperoxides when compared with normal controls. The metabolic syndrome group also had significantly increased blood sugar levels, lipid profile and hydroperoxide levels when compared to obese or control groups. There was no alteration in the total antioxidant capacity in any of the groups. The Triglyceride/HDL-Cholesterol ratio (>3), a surrogate marker of insulin resistance, indicates insulin resistance in the metabolic syndrome group. The anthropometric profile, insulin resistance and oxidative stress seen in obesity are further elaborated in metabolic syndrome. Thus, the early identification of high-risk individuals based on anthropometric parameters, lipid profile, insulin resistance and indices of oxidative stress may help to prevent the development of complications of metabolic syndrome.

Waist-to-height ratio, an optimal predictor for obesity and metabolic syndrome in Chinese adults

OBJECTIVE

Anthropometric indices to obesity were evaluated as predictors of metabolic syndrome risk factors. Our purpose was to explore an optimal or more reliable anthropometric indicator and optimal cut-off points for obesity on metabolic syndrome in Chinese adults.

PARTICIPANTS AND METHODS

The survey was conducted involving 2947 participants, aged 20 or above with cross-sectional study of population. The predictive validity and optimal cut-off values were analyzed by receiver operating characteristic (ROC) curves, area under curve (AUC) and the largest Youden's index (sensitivity + specificity - 1) by gender group, respectively. Kappa value showed diagnostic consistency.

RESULTS

According to the criteria of CDS 2004, IDF 2005 and AHA/NHLBI 2005, the prevalence of metabolic syndrome was 10.32%, 9.64% and 16.12% respectively, which indicated that the prevalence was higher in men than in women and increased with age (P < 0.05). The BMI, WC, WHR and WHtR in metabolic syndrome patients were greater than those in healthy volunteers and the indices in men were higher than those in women. With adjusted age and gender, the partial correlation coefficient for BMI-WC, BMI-WHR and BMI-WHtR was 0.7991, 0.5278 and 0.8196, respectively (P < 0.05). The area under curves (AUCs) of receiver operating characteristic (ROC) curves for WHtR was larger (P < 0.05) than that for WC and WHR. The cut-point of WHtR was approximately 0.5 in both genders with a satisfactory balance between sensitivity and specificity, where the Kappa (k) value for WHtR-BMI was higher than that for WHtR-WHR, and WHtR-WC.

CONCLUSIONS

The results indicated that WHtR might be an optimal anthropometric predictor of metabolic syndrome risk factors and the cut-point of WHtR was approximately 0.50 in both genders of Chinese adults.

Index of central obesity is better than waist circumference in defining metabolic syndrome

OBJECTIVE

The International Diabetes Federation (IDF) global definition of metabolic syndrome suggests using race- and gender-specific waist circumference (WC) cutoffs. Previously, we have hypothesized that need for gender- and race-specific cutoffs could be obviated by supplanting WC with index of central obesity (ICO). The aim of this study was to test the utility of ICO in defining metabolic syndrome.

MATERIALS AND METHODOLOGY

Data were collected from National Health and Nutrition Examination Survey (NHANES) database for year 2005-2006. Subjects were analyzed for presence of metabolic syndrome using National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. The IDF definition was modified by replacing WC with ICO. Sensitivity and specificity of the IDF definition and modified definition were compared against the NCEP ATP III definition.

RESULTS

Using a modified IDF definition, a common cutoff of 0.53 could be obtained for both males and females. The modified IDF definition improved sensitivity from 0.85 to 0.98 and 0.98 to 0.99 among males and females, respectively. This was at the cost of compromised specificity, which reduced from 1.0 to 0.89 and 0.98 for males and females, respectively.

CONCLUSIONS

ICO appears better than WC in defining metabolic syndrome in terms of better sensitivity and potential to be used with single cutoff for both genders.