Relationship between obesity and several cardiovascular disease risk factors in apparently healthy Korean individuals: comparison of body mass index and waist circumference

Loss of Anthropometry-Lipids Relationship in Obese Adults: A Cross-Sectional Study in Southern China

Background

Emerging data suggest that the interpretation of the association between obesity and lipids appears to be oversimplified. This study aimed to quantify the complex relationships between anthropometric indices and lipid profile.

Methods

This is a cross-sectional study including 9620 participants in Southern China. Anthropometric indices included the indices of general obesity (ie, body mass index (BMI)) and central obesity (ie, waist circumference (WC) and waist-to-hip ratio (WHR)). Lipids included low-density lipoprotein cholesterol (LDLc) and atherogenic lipids (ie, high-density lipoprotein cholesterol (HDLc), triglycerides (TG) and TG/HDLc ratio). LOESS regression and general linear model were the main statistical methods.

Results

Almost all associations between anthropometric indices and lipids were lost in obese adults. The loss of association occurred quicker with LDLc than that with atherogenic lipids; the break point for the association loss was at BMI of 24 kg/m² with LDLc (Slope _{Below break-point} = 1.81, P<0.001; Slope _{Above break-point} = 0.29, P=0.121), while at 28 kg/m² with HDLC (Slope _{Below break-point} = -1.41, P<0.001; Slope _{Above break-point} = 0.07, P=0.666) or TG (Slope _{Below break-point} = 4.96, P<0.001; Slope _{Above break-point} = 2.93, P=0.01), and at 30 kg/m² with TG/HDLc ratio (Slope _{Below break-point} = 0.15, P<0.001; Slope _{Above break-point}= 0.01, P=0.936), respectively. Similar relationships were found for WC and WHR. Besides, the presence of other metabolic disorders contributed to the loss of anthropometry-lipids relationships, for example, the BMI-LDLc association attenuated to null in both obese adults and non-obese population but with more than one other metabolic disorders.

Conclusion

The relationships were lost between anthropometric indices and lipids in obese adults with different break points across different lipids, which appeared to be dependent on metabolic status.

Dynamic behavior of metabolic syndrome progression: a comprehensive systematic review on recent discoveries

BACKGROUND

The assessment of the natural history of metabolic syndrome (MetS) has an important role in clarifying the pathways of this disorder.

OBJECTIVE

This study purposed to provide a rational statistical view of MetS progression pathway.

METHODS

We performed a systematic review in accordance with the PRISMA Statement until September 2019 in the Medline/PubMed, Scopus, Embase, Web of Science and Google Scholar databases. From the 68 found studies, 12 studies were eligible for review finally.

RESULTS

The selected studies were divided in 2 groups with Markovian and non-Markovian approach. With the Markov approach, the most important trigger for the MetS chain was dyslipidemia with overweight/obesity in the under-50 and with hypertension in the over-50 age group, where overweight/obesity was more important in women and hypertension in men. In non-Markov approach, the most common trigger was hypertension. Transition probability (TP) from no component to MetS were higher in all Markovian studies in men than in women. In the Markovians the combination of dyslipidemia with overweight/obesity and in non-Markovians, hyperglycemia with overweight/obesity were the most common combinations. Finally, the most important components, which predict the MetS, were 2-component states and hyperglycemia in Markovian approach and overweight/obesity in non-Markovians.

CONCLUSIONS

Among the components of the MetS, dyslipidemia and hypertension seems to be the main developer components in natural history of the MetS. Also, in this chain, the most likely combination over time that determines the future status of people seems to be the combination of dyslipidemia with obesity or hyperglycemia. However, more research is needed.

Synergistic Effects and Sex Differences in Anthropometric Measures of Obesity and Elevated High-Sensitivity C-Reactive Protein Levels

Background: It remains unclear which anthropometric measure best predicts elevated high-sensitivity C-reactive protein (hs-CRP) levels. This study investigated the association and synergistic interaction of two obesity indices with elevated hs-CRP levels in a national sample of Korean adults, stratified by sex. Methods: The present cross-sectional study used data from the 2015–2018 Korea National Health and Nutrition Examination Survey of 18,610 subjects aged ≥20 years after excluding those with missing variables. Multiple logistic regression analyses and chi-squared tests were performed to investigate the association between body mass index (BMI) and waist circumference (WC) with elevated hs-CRP levels. Interaction analysis was used to examine the synergistic effect between BMI and WC on the risk of having elevated hs-CRP levels. Results: Elevated hs-CRP levels exceeding 3 mg/L were present in 9.3% and 7.5% of men and women, respectively. The relationship between each obesity index and elevated hs-CRP levels was significant in women (high WC (odds ratio [OR] = 1.77, 95% confidence interval [CI] = 1.24–2.54), high BMI (OR = 2.08, 95% CI = 1.58–2.74)) but not in men (high WC (OR = 1.19, 95% CI = 0.86–1.64), high BMI (OR = 0.99, 95% CI = 0.77–1.29)). Furthermore, combined measures of the two obesity indices and interaction analysis results revealed a synergistic association in men (OR = 1.57, 95% CI = 1.33–1.85; relative excess risk due to interaction (RERI) = 0.39, 95% CI = −0.09–0.86), and women (OR = 3.70, 95% CI = 3.09–4.43; RERI = 0.85, 95% CI = −0.06–1.75). Conclusion: BMI and WC were significantly associated with a risk of elevated hs-CRP levels in women but not in men. Nevertheless, significant synergistic interactions were seen in combined measures of BMI and WC, regardless of sex. These findings emphasize the need to use both measures of adiposity concurrently in the assessment of obesity and when identifying cardiovascular risk.

Myths about Insulin Resistance: Tribute to Gerald Reaven

Gerald Reaven was often called the "father of insulin resistance." On the 1-year anniversary of his death in 2018, we challenge three myths associated with insulin resistance: metformin improves insulin resistance; measurement of waist circumference predicts insulin resistance better than body mass index; and insulin resistance causes weight gain. In this review, we highlight Reaven's relevant research that helped to dispel these myths associated with insulin resistance.

Including selective metabolic components in current diagnostic criteria does not improve discriminative validity for metabolic syndrome: a risk score approach

Objective

To examine whether including additional metabolic components to the current five-marker system can improve the discriminative validity for diagnosing metabolic syndrome (MetS).

Methods

This longitudinal cohort study included data from subjects that had completed at least three health examinations during a 5-year period. The study outcome was the onset of MetS. Sociodemographic and biochemical variables were recorded for all subjects so that the adjusted relative risks (ARRs) could be calculated for 11 metabolic components. Risk scores for the development of MetS based on the ARR values were determined. The sums of the risk scores of different component combinations were used to conduct a receiver operating characteristic (ROC) curve analysis of MetS diagnosis.

Results

A total of 3368 individuals with complete data was analysed. The ARRs of the 11 metabolic components were all statistically significant. According to ROC analysis, although good discriminative validity (area under the curve [AUC] range, 0.954–0.976) could be achieved for MetS diagnosis by using either all 11 or combinations of six metabolic components (the five current components plus one extra component), the current five metabolic components used for diagnosis had the best discriminative validity (AUC = 0.977).

Conclusion

The current five metabolic components used for the diagnosis of MetS still represent the best combination with the highest discriminative validity.

INDICADORES ANTROPOMÉTRICOS E FATORES DE RISCO CARDIOVASCULAR EM TRABALHADORES RURAIS

RESUMO Introdução: A obesidade tem provocado diversos agravos à saúde, impulsionada pela industrialização, avanços tecnológicos, urbanização e estilo de vida; esses aspectos estão relacionados com disfunções cardiovasculares. Diversos fatores estão associados aos problemas saúde da população, os quais podem ser previamente identificados com técnicas simples, como medidas antropométricas e escores de risco, usadas para determinar possíveis riscos. Objetivo: Relacionar variáveis antropométricas com o Escore de Risco de Framingham (ERF) em trabalhadores rurais. Métodos: Estudo transversal com 138 trabalhadores rurais, submetidos ao questionário de estilo de vida, avaliação antropométrica, bioquímica, cardiovascular e determinação do ERF. A antropometria foi estimada com os indicadores índice de massa corporal, circunferência da cintura (CC), relação cintura-quadril (RCQ), índice de conicidade (IC) e razão circunferência cintura-estatura (RCEst); o perfil bioquímico identificou colesterol total, colesterol HDL, colesterol LDL, triglicerídeos e glicemia; a função cardiovascular foi avaliada pela pressão arterial sistólica e pressão arterial diastólica em repouso. A partir das informações, os sujeitos foram classificados segundo o ERF em G1 (baixo risco), G2 (risco intermediário) e G3 (alto risco). As análises estatísticas constaram de frequência e percentual, comparação de médias pelo teste Kruskal-Wallis, e correlação de Pearson ou Spearman, considerando p < 0,05. Resultados: Com relação aos ERF, 81,4% sujeitos do sexo feminino e 51,9% do masculino apresentaram baixo risco cardiovascular, com mais da metade dos trabalhadores com respostas inadequadas nos parâmetros RCQ (58,7%), RCEst (67,4%), CT (58,0%) e LDL (52,9%). Na relação do total de pontos absolutos do ERF com as variáveis antropométricas, CC e RCEst demonstraram correlações fracas (0,293 e 0,175, respectivamente) e RCQ e IC, correlações moderadas (0,475 e 0,459, respectivamente). Conclusão: Alguns indicadores antropométricos (RCQ e IC) apresentaram relações mais fortes com o ERF, apontando que são mais efetivas em determinadas populações, além de indicar a maior probabilidade de eventos cardiovasculares nos trabalhadores rurais. Nível de Evidência III; Estudos diagnósticos - Investigação de um exame para diagnóstico.

Correlation of Cardiovascular Risk Factors with Central Obesity and Multiple Body Mass Index in Korea

Background

Body mass index (BMI) and waist circumference (WC) are associated with cardiovascular (CV) risk factors. The aim of this study was to investigate the correlation of CV risk factors by cross-tabulating central obesity with multiple BMI categories in Korea.

Methods

A total of 328,789 adults aged 30–84 years who completed health assessments for National Health Insurance in 2012–2013 in Korea were examined. The participants were divided into two WC and five BMI groups to investigate CV risk factors, including metabolic syndrome (MetS), hypertension, diabetes, and dyslipidemia.

Results

The proportions of central obesity and obesity were 24.2% and 39.5% in men and 19.4% and 28.1% in women, respectively, according to the Korean Society for the Study of Obesity and World Health Organization Asia-Pacific Guideline criteria. The odds ratios (ORs) of CV risk factors in all sexes increased with increases in BMI and WC. Compared to the group with a normal WC and BMI, the adjusted ORs (95% confidence intervals) for having MetS and diabetes in the centrally obese and highest BMI group (BMI ≥30.0 kg/m²) were 35.95 (33.75–38.30) and 3.51 (3.26–3.77) in men and 29.22 (27.36–31.20) and 4.35 (4.02–4.70) in women, respectively. Participants who were centrally obese and obese (BMI ≥25.0 kg/m²) had the strongest correlation with all CV risk factors compared with those who were not centrally obese or obese.

Conclusion

The presence of central obesity in multiple BMI categories may significantly identify individuals at increased risk of CV risk factors.

Elevated Neutrophil-to-Lymphocyte Ratio in Metabolic Syndrome Is Associated with Increased Risk of Colorectal Adenoma

BACKGROUND

Metabolic syndrome (MetS) is an important cardiovascular risk factor for insulin resistance and has been linked to colorectal adenoma via inflammation. The neutrophil-to-lymphocyte ratio (NLR) has been suggested as an important inflammatory marker. We initiated this investigation to determine the relationship between colorectal adenoma and NLR in patients with MetS.

METHODS

We examined participants who visited the Health Promotion Center at Kosin University Gospel Hospital, Busan, Korea. Subjects who underwent both colonoscopy and liver ultrasonography were included. Colorectal adenoma was defined as the presence of a colon polyp with a histologically adenomatous component. MetS was defined according to the modified National Cholesterol Education Program Adult Treatment Panel III definition for South Asians. Anthropometric measurements and biochemical tests of liver and metabolic function were assessed.

RESULTS

A total of 1007 subjects were included in the study sample. Their mean age was 48.3 ± 9.7 years and 262 (26.0%) subjects had MetS, while 439 (43.6%) subjects had pathologically proven colorectal adenoma. Subjects with MetS were older, more likely to be male, and had significantly higher prevalences of colorectal adenoma (49.2% vs. 41.6%, P = 0.032), nonalcoholic fatty liver disease (62.8% vs. 19.5%, P < 0.001), and higher NLR (2.0 ± 0.9 vs. 1.7 ± 0.7, P < 0.001) compared to those without MetS. High NLR (≥2.0) was an independent factor affecting the prevalence of colorectal adenoma [odds ratio (OR) 1.38, confidence interval (95% CI) 1.02-1.88, P = 0.040], especially in subjects with MetS (OR 1.91, 95% CI 1.12-3.28, P = 0.018).

CONCLUSION

High NLR was associated with increased colorectal adenomatous polyps, particularly in subjects with MetS. Screening colonoscopies for the prevention of colorectal adenoma may be warranted for patients with high NLR and MetS.

Increased Waist-to-height Ratio May Contribute to Age-related Increase in Cardiovascular Risk Factors

BACKGROUND

The risk of cardiovascular diseases (CVDs) increases with age. The objective was to determine whether lifestyle and dietary behaviors and anthropometric measures, which are affected by these behaviors, contribute to the increase of CVD risk factors across age categories of 20-50-year-old.

METHODS

In a cross-sectional design, 437 adults aged 20-50-year-old were selected from households living in Shiraz. Risk factors of CVD, including body mass index (BMI), waist-to-height ratio (WHtR), blood pressure, fasting blood glucose (FBG), serum triglycerides, total cholesterol, and low- and high-density lipoprotein cholesterol (LDL-C and HDL-C, respectively) as well as lifestyle behaviors (physical activity and smoking), dietary habits, and food intakes were assessed across the age categories of 20-29, 30-39, and 40-50 years. Linear regression was used to examine the contribution of different variables to the age-related increase of CVD risk factors.

RESULTS

All CVD risk factors, except for HDL-C, significantly increased across age categories. Older subjects had healthier dietary habits and food intakes, but they possessed nonsignificantly lower physical activity and higher smoking rate compared to younger adults. Adjusting for physical activity, smoking, and BMI did not change the significant positive association between age and CVD risk factors but adjusting for WHtR disappeared associations for blood pressure, triglycerides, and metabolic syndrome although significant associations remained for FBG and total and LDL-C.

CONCLUSIONS

Age-related increase of CVD risk factors occurred independent of lifestyle habits. WHtR, but not BMI, may partially contribute to the age-related increase in CVD risk factors.

Effect of Tamsulosin in Lower Urinary Tract Symptom Patients With Metabolic Syndrome

OBJECTIVE

To investigate the efficacy of tamsulosin, a selective alpha-1 blocker, in lower urinary tract symptoms (LUTS) patients with metabolic syndrome (MS).

PATIENTS AND METHODS

This prospective, multicenter clinical trial included men and women (20-75 years old) with LUTS, with or without MS. Patients were categorized as MS+ or MS-, respectively, and all of them were administered tamsulosin 0.2 mg per oral once daily for 24 weeks. Patients were assessed based on the International Prostate Symptom Score, King's Health Questionnaire (KHQ), Overactive Bladder Questionnaire, uroflowmetry with postvoid residuals, and MS factors (blood pressure, waist-to-hip ratio, and serum levels of fasting blood glucose, triglyceride, and high-density lipoprotein cholesterol) at baseline and at 4, 12, and 24 weeks of treatment.

RESULTS

Ninety-two patients were enrolled in this study (53/92 were MS- [57.6%]; 39/92 were MS+ [42.4%]). After 24 weeks of tamsulosin treatment, fasting blood glucose (P = .02) and triglyceride (P < .001) levels of changes were significantly greater in the MS+ group than in the MS- group. Total International Prostate Symptom Score, total Overactive Bladder Questionnaire score, and the scores of each question on the KHQ showed significant improvement after treatment without intergroup differences. In KHQ, although improvements in emotional status, sleep quality, fatigue, and personal distress were greater in the MS+ group (P = .05), the difference between the groups did not reach statistical significance.

CONCLUSION

Tamsulosin was effective in both LUTS patients with and without MS. Furthermore, tamsulosin had beneficial effects on some of the factors associated with MS.

The discriminative ability of waist circumference, body mass index and waist-to-hip ratio in identifying metabolic syndrome: Variations by age, sex and race

OBJECTIVES

Many studies have suggested that there is variation in the capabilities of BMI, WC and WHR in predicting cardiometabolic risk and that it might be confounded by gender, ethnicity and age group. The objective of this study is to examine the discriminative abilities of body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR) to predict two or more non-adipose components of the metabolic syndrome (high blood pressure, hypertriglyceridemia, low high density lipoprotein-cholesterol and high fasting plasma glucose) among the adult Malaysian population by gender, age group and ethnicity.

METHODS

Data from 2572 respondents (1044 men and 1528 women) aged 25-64 years who participated in the Non Communicable Disease Surveillance 2005/2006, a population-based cross sectional study, were analysed. Participants' socio-demographic details, anthropometric indices (BMI, WC and WHR), blood pressure, fasting lipid profile and fasting glucose level were assessed. Receiver operating characteristics curves analysis was used to evaluate the ability of each anthropometric index to discriminate MetS cases from non-MetS cases based on the area under the curve.

RESULTS

Overall, WC had better discriminative ability than WHR for women but did not perform significantly better than BMI in both sexes, whereas BMI was better than WHR in women only. Waist circumference was a better discriminator of MetS compared to WHR in Malay men and women. Waist circumference and BMI performed better than WHR in Chinese women, men aged 25-34 years and women aged 35-44 years.

CONCLUSIONS

The discriminative ability of BMI and WC is better than WHR for predicting two or more non-adipose components of MetS. Therefore, either BMI or WC measurements are recommended in screening for metabolic syndrome in routine clinical practice in the effort to combat cardiovascular disease and type II diabetes mellitus.

Risk profiles for metabolic syndrome and its transition patterns for the elderly in Beijing, 1992-2009

There have been few reports on the development of metabolic disorders, especially when they are considered as a cluster. The purpose of this study was to describe risk profiles for metabolic syndrome (MetS) in elderly dwellers in Beijing, and to find their transition patterns over time. Data were derived from Beijing longitudinal study of aging, a community-based cohort study hosted by Xuanwu hospital. There were 3,257 elderly people aged 55 years or over recruited in 1992. MetS was assessed for the years 1992, 2000, and 2009. Finally, 363 subjects with complete information for components of MetS in the three years were included in the study. The criteria of MetS recommended by the joint interim statement criteria were adopted. Latent transition analysis was used to calculate the transition probabilities between adjacent visits. A risk typology consisting of four time-invariant groups was detected based on the components of MetS for all subjects. Low MetS risk group, BP risk group, BP-HDL risk group, and BP-FPG-TG risk group were found. The probability of staying at the same status was higher at the two intervals across 18 years. Four latent groups were extracted based on three assessments for the components of MetS, together with their transition patterns. Findings suggested various trajectories for MetS components. Different combinations of intervention strategy might be needed for MetS risk groups.

Protocol variations in arm position influence the magnitude of waist girth

Waist girth is recognised as a better predictor of obesity, particularly abdominal obesity, compared to other measures. Although several protocols for waist girth exist, arm position is either ignored, or not specified in unambiguous terms. Therefore, the purpose of this study was to determine if arm position influenced anthropometric waist girth measurement. Waist girth was measured in 92 adults (19 males, 73 females) with arms relaxed, abducted, horizontal, folded across the chest (three variations) and raised vertically. Duplicate measures, in all positions, were recorded by a single International Society for the Advancement of Kinanthropometry (ISAK)-trained technician to a precision of 0.2% technical error of measurement (TEM). Arm position had a significant effect (P < 0.001) on waist girth. Male participants had greater waist girth than females (P < 0.001) and the waist girth differences across the varying arm positions exhibited a significant position-by-gender interaction (P < 0.001). The arm position-by-body mass index (BMI) category interaction was also significant (P = 0.016) with greater differences observed at higher BMI. These findings suggest caution in comparing results of different studies where arm position is not specified and indicate that the arm position corresponding to the ISAK protocol has the lowest error and is therefore recommended.

The role of nutrition and body composition in peripheral arterial disease

Peripheral arterial disease (PAD) has not been as extensively investigated as other cardiovascular diseases. However, the available data suggest that nutrition-based treatment strategies have the potential to reduce the cost-economic burden of PAD substantially. Abdominal obesity is associated with PAD and prospective and cross-sectional studies have shown that a low dietary intake of folate and reduced synthesis of vitamin D are associated with an increased risk of PAD and severe walking impairment in patients who have the disease. However, dietary patterns that are associated with decreased cardiovascular risk might protect against PAD. A small number of clinical trials have provided evidence that increased intakes of niacin and insoluble fiber might be associated with decreased levels of LDL cholesterol and thrombogenic biomarkers, as well as increased serum levels of HDL cholesterol in patients with PAD. However, little evidence that antioxidants, vitamins B(6) and B(12), or essential fatty acid supplements improve clinical outcomes in these patients exists. Overall, data on the effects of nutrition, body composition, and nutritional supplementation on the risk, progression, and prognosis of PAD are scarce. Further research into these areas is required to allow the development of evidence-based nutritional guidelines for the prevention and treatment of the disease.

Metabolic Syndrome and Lower Urinary Tract Symptoms: Epidemiological Study

Increasing evidence from clinical and epidemiological studies has shown associations between lower urinary tract symptoms (LUTS) and major chronic medical diseases. Recent epidemiological studies have revealed that, to a large extent, lifestyle factors associated with metabolism, such as obesity, physical activity, blood glucose, and diet, contribute substantially to the development of these conditions. Multiple studies have demonstrated strong independent associations between LUTS and components of metabolic syndrome. Therefore, modification of lifestyle factors may lower the risk of LUTS. Prevalence of MS is age-dependent with gender differences, and LUTS have different manifestations in men and women. LUTS-associated benign prostatic hyperplasia (BPH) have multiple evidence of correlation with MS factors; however, results were inconsistent in their correlation among prostate volume and prostate-specific antigen. There is limited data on female LUTS or other diseases such as urinary incontinence or overactive bladder and MS. Further research is required to understand their connection in the pathogenesis of LUTS and to establish a more effective prevention and a therapeutic model.

Relationship Between Health-related Behavioral and Psychological Factors and Cardiovascular and Cerebrovascular Diseases Comorbidity Among Korean Adults With Diabetes

PURPOSE

This study aims to explore the relationships between health-related behavioral and psychological factors and cardiovascular and cerebrovascular diseases (CCVD) comorbidities among Korean adults with diabetes mellitus (DM).

METHODS

Data included in the Fourth Korean National Health and Nutrition Examination Survey were used. This study compared three groups: those diagnosed with DM only, DM and hypertension, DM, hypertension and CCVD using multinomial logistic regression analyses and the classification and regression tree (CART) model.

RESULTS

Weight control (OR = 4.01) and depression (OR = 2.37) are related with increased odds of having hypertension and CCVD comorbidity in those with DM. The CART model suggested that the high prevalence risk groups for hypertension or CCVD comorbidities were diabetic adults aged between 51 and 69 with a body mass index of 25 and above and those aged 70 and above.

CONCLUSION

For effective control of CCVD comorbidities among diabetic Korean adults, psychological support for depression and weight control need to be prioritized when managing DM. Weight control intervention needs to be reinforced for DM patients aged between 51 and 69 and that even if BMI is below 25, the occurrence of comorbidities needs to be carefully monitored for DM patients aged 70 or older.

Dietary patterns and the prevalence of metabolic syndrome in Korean women

BACKGROUND AND AIMS

The role of dietary patterns in metabolic syndrome has not been adequately investigated in Asian women. We aimed to identify dietary patterns and to evaluate the cross-sectional relationship between dietary patterns and the prevalence of metabolic syndrome in Korean women.

METHODS AND RESULTS

In a cross-sectional study of 4984 women aged 30-79 years, dietary patterns were derived from 16 food groups using factor analysis. Metabolic syndrome was defined based on the Adult Treatment Panel III of the National Cholesterol Education Program (ATPIII NCEP) criteria as having three or more risk factors using a modified obesity index. Logistic regression was used to estimate the association between dietary pattern and the prevalence of metabolic syndrome. Three dietary patterns (Western, healthy and traditional) were identified. Higher consumption of the healthy pattern was inversely associated with metabolic syndrome (OR [95% CI] for highest vs. lowest quartile: 0.58 [0.50-0.91]; P for trend = 0.012) and most components of metabolic syndrome. In a stratified analysis by menopausal status, the inverse association of the healthy dietary pattern and metabolic syndrome was statistically significant only among postmenopausal women (OR [95% CI] for highest vs. lowest quartile: 0.60 [0.40-0.86]; P for trend = 0.004). The Western and traditional patterns showed no association with metabolic syndrome, but were related to some individual risk factors for metabolic syndrome.

CONCLUSIONS

These results suggest that the healthy dietary pattern is associated with a reduced risk for metabolic syndrome in Korean women, particularly in postmenopausal women.

Association between adiposity indices and cardiometabolic risk factors among adults living in Puerto Rico

OBJECTIVE

To compare the general adiposity index (BMI) with abdominal obesity indices (waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR)) in order to examine the best predictor of cardiometabolic risk factors among Hispanics living in Puerto Rico.

DESIGN

Secondary analysis of measurements taken from a representative sample of adults. Logistic regression models (prevalence odds ratios (POR)), partial Pearson's correlations (controlling for age and sex) and receiver-operating characteristic (ROC) curves were calculated between indices of obesity (BMI, WC, WHR and WHtR) and blood pressure, HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), total cholesterol (TC):HDL-C, TAG, fasting blood glucose, glycosylated Hb, high-sensitivity C-reactive protein (hs-CRP), fibrinogen, plasminogen activator inhibitor-1 (PAI-1) and an aggregated measure of cardiometabolic risk.

SETTING

Household study conducted between 2005 and 2007 in the San Juan Metropolitan Area in Puerto Rico.

SUBJECTS

A representative sample of 858 non-institutionalized adults.

RESULTS

All four obesity indices significantly correlated with the cardiometabolic risk factors. WHtR had the highest POR for high TC:HDL-C, blood pressure, hs-CRP, fibrinogen and PAI-1; WC had the highest POR for low HDL-C and high LDL-C and fasting blood glucose; WHR had the highest POR for overall cardiometabolic risk, TAG and glycosylated Hb. BMI had the lowest POR for most risk factors and smallest ROC curve for overall cardiometabolic risk.

CONCLUSIONS

The findings of the study suggest that general adiposity and abdominal adiposity are both associated with cardiometabolic risk in this population, although WC, WHR and WHtR appear to be slightly better predictors than BMI.

Factors Associated with Insulin Resistance in a Middle-Aged Non-Obese Rural Population: The Chungju Metabolic Disease Cohort (CMC) Study

OBJECTIVES

We aimed to determine the characteristics affecting insulin resistance in non-obese middle-aged adults in a rural community.

METHODS

A total of 1,270 non-diabetic adults aged between 40 and 64 years old with body mass index (BMI) less than 25 kg/m(2) were analyzed. Subjects with insulin resistance were defined as those who had the highest quartile value of the homeostasis model assessment of insulin resistance (HOMA-IR) in a non-diabetic population.

RESULTS

A total of 217 subjects (20.6%) had insulin resistance. Prevalence of metabolic syndrome was significantly higher in insulin-resistant subjects in both men (29.3% vs. 10.3%) and women (34.1% vs. 15.6%). Among metabolic syndrome components, elevated waist circumference and elevated triglyceride were higher in insulin-resistant subjects in both genders. After being controlled for socioeconomic status and lifestyle related covariates, the association between insulin resistance and BMI was statistically significant in the category of 23.0-24.9 kg/m(2) in men (adjusted OR, 4.63; 95% confidence interval [95% CI], 1.77-12.15) using the category of 18.5-20.9 kg/m(2) as a reference. In addition, the association between insulin resistance and abdominal obesity was statistically significant only for men (adjusted OR, 2.57; 95% CI, 1.29-5.11).

CONCLUSION

Insulin resistance appears to be highly associated with high BMI and abdominal obesity, even in non-obese, non-diabetic middle-aged men.

Dietary patterns are associated with body mass index in a Korean population

Changes in dietary habits may be associated with the increased prevalence of obesity in South Korea. Therefore, we aimed to identify major dietary patterns and to evaluate the association between these patterns and body mass index (calculated as kg/m(2)) in a Korean population. Typical dietary intake was assessed using a food frequency questionnaire in a cross-sectional study of 1,118 subjects aged 30 to 70 years who underwent health screening examinations. Dietary patterns were derived from 39 predefined food groups using factor analysis. A body mass index >27.5 was used as an indicator of obesity. Logistic regression was used to evaluate the association between obesity and dietary patterns. Three dietary patterns (vegetable-seafood, meat-fat, and snack) were identified and seem to be closely associated with lifestyle factors, including physical activity, smoking, and alcohol consumption. In the multivariate logistic regression model, the meat-fat dietary pattern was positively associated with obesity (odds ratio for high tertile vs low tertile intake=2.78 [95% confidence interval: 1.43 to 5.42]; P for trend=0.008), whereas the vegetable-seafood and snack dietary patterns showed no association with obesity. Results suggest that diets high in meat, oil, and sugar may be associated with obesity status in Korean adults.

Prevalence of metabolic syndrome and optimal waist circumference cut-off points for adults in Beijing

BACKGROUND

In the modified ATP III definition for metabolic syndrome (MS), the cut-off values for central obesity were set to > or =90 cm for male and > or =80 cm for women. Recently, a new Chinese definition for central obesity was set to > or =90 cm for male and > or =85 cm for women according to the corresponding BMI value of 25 kg/m(2).

OBJECTIVE

The purpose of this study was to explore the optimal WC cut-off points to reflect the cluster of multiple risk factors for adults in Beijing.

METHOD

The data collected during the surveillance of risk factors for non-communicable diseases in Beijing 2005 were used, with a total of 16,711 adults studied. Subjects with two or more components from the modified ATP III definition other than central obesity were considered to have multiple risk factors.

RESULTS

The optimal WC cut-off points were 87 cm in men and 80 cm for women. When applied the WC advised definition for MS, the age-standardized prevalence was 38.0% for male and 32.3% for women, which is significantly higher than using the original one for men (34.7% vs 32.3%, P<0.001).

CONCLUSION

The present study indicated that optimal waist circumference cut-off points were lower than that proposed in the modified ATP III definition, especially for men.

A comparison of the prevalence of the MS and its complications using three proposed definitions in Korean subjects

To compare the prevalence of the metabolic syndrome (MS) using 3 definitions (World Health Organization [WHO], Adult Treatment Panel [ATP III], and International Diabetes Foundation [IDF]) in Korean subjects, we reviewed 6,196 participants (3,436 men and 2,760 women; mean age 51 +/- 11 and 49 +/- 12 years) who underwent a general health status evaluation and had findings of MS components, including serum insulin and microalbuminuria. The prevalence of the MS according to the WHO, ATP III, and IDF definitions (male and female) was 17.1% and 10.3%, 26% and 19.3%, and 22% and 25.4%, respectively. The degrees of agreement according to the k statistics (WHO and IDF, WHO and ATP III, and IDF and ATP III) were modest in both genders. The diagnosis of the MS was associated with a high odds ratio for nonalcoholic fatty liver disease but with a significantly varying prevalence of a Framingham risk score of >10%. The MS was seen in 10% to 30% of otherwise healthy middle-age Korean subjects presenting for health screening and the prevalence varied widely according to the criteria of its definition. The effect of the diagnosis of the MS in terms of cardiovascular risk varies significantly according to the criteria used. In conclusion, a universally accepted definition of the MS is needed for clinical and population-based studies.

Comparison of waist circumference with body mass index for predicting abdominal adipose tissue

AIMS

To compare waist circumference (WC) with body mass index (BMI) for the prediction of abdominal adipose tissues in Japanese men and women.

METHODS

1432 men and 1038 women aged 38-60 years were recruited. WC, BMI, visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) using CT scans were measured.

RESULTS

Women had a lower mean VAT than men (79.3 cm(2) vs. 132.3 cm(2); p<0.001) and a higher mean SAT (196.2 cm(2) vs. 139.7 cm(2); p<0.001). The correlation with WC or BMI was greatest for total adipose tissue (TAT), followed by SAT, and least for VAT. The correlation coefficients were not significantly different between WC and BMI for any adipose tissue except for VAT in men (p<0.05). Age was positively correlated with VAT in both genders (p<0.001). Using multiple regression analyses on VAT, R(2) values using WC and age were 0.45 in men and 0.48 in women. For SAT, the values were 0.57 in men and 0.59 in women.

CONCLUSIONS

The relationship with WC or BMI was greatest for TAT and SAT, and least for VAT. WC and BMI provided essentially similar estimates of TAT, VAT, and SAT in both genders.

Metabolic syndrome by the new IDF criteria in Hong Kong Chinese adolescents and its prediction by using body mass index

AIM

The International Diabetes Federation (IDF) has recently proposed a new set of criteria to define metabolic syndrome (MES) in children and adolescents. We estimated the rate of MES by these new IDF criteria and investigated the use of body mass index (BMI) in predicting MES in Chinese adolescents.

METHODS

This is a cross-sectional, population-based study of 1616 Chinese adolescents. sensitivity, specificity and likelihood ratio were calculated to assess the accuracy in using BMI to predict the presence of MES.

RESULTS

In the study population, 48.6% were boys. The median age was 14.0 and 15.0 years for boys and girls respectively and the overall prevalence of MES was 1.2% (boys 1.5%; girls 0.8%). Using BMI > or =25 kg/m(2), the sensitivity, specificity and likelihood ratio to predict MES were 100%, 85.0% and 6.7% respectively. The corresponding figures were 52.6%, 97.1% and 18.1%, respectively, using BMI > or =30 kg/m(2).

CONCLUSION

Metabolic syndrome was found in 1.2% of Chinese adolescents in Hong Kong. BMI is a useful clinical tool to predict clustering of cardiometabolic risk factors in adolescents.

Management of Obesity in Patients with Peripheral Arterial Disease

Obesity is a major risk factor for cardiovascular disorders, including peripheral arterial disease. This review outlines the evidence for a 6-step process for the management of obesity, starting with identifying the degree and type of obesity, followed by target setting, life style and behavioural changes, imposed hypocaloric diet and physical activity, pharmacological treatment and consideration of eating disorders and/or bariatric surgery.