Waist circumference and waist-to-hip ratio as predictors of serum concentration of lipids in Brazilian men

Meta-analysis of the effects of smoking and smoking cessation on triglyceride levels

Smoking increases lipid levels, including triglycerides, leading to increased cardiovascular disease risk. We performed a meta-analysis to quantify the effects of smoking and smoking cessation on triglyceride levels. The PubMed and Scopus databases were searched to identify studies reporting either triglyceride levels in smokers and non-smokers or the effects of smoking cessation on triglyceride levels. Fixed- and random-effects models were used to perform the analyses when three or more studies/comparisons were available. We identified 169 and 21 studies evaluating the effects of smoking and smoking cessation, respectively, on triglyceride levels. Triglyceride levels were 0.50 mmol/L (95% confidence interval: 0.49-0.50 mmol/L) higher in smokers than non-smokers, but the effect differed widely across studies. No statistically significant effect was observed on triglyceride levels between baseline and 6 weeks (mean difference [MD] = 0.02 [-0.09, 0.12] mmol/L), 2 months (MD = 0.03 [-0.21, 0.27] mmol/L), 3 months (MD = 0.08 [-0.03, 0.21] mmol/L), or 1 year (MD = 0.04 [-0.06, 0.14] mmol/L) after quitting. However, a slightly significant decrease in triglyceride levels was observed at 1 month after cessation (MD = -0.15 [-0.15, -0.01] mmol/L). The results of this meta-analysis provide a basis for understanding the effects of smoking and smoking cessation on triglyceride levels, which could have important implications for public health.

Childhood trauma and cardiometabolic risk in severe mental disorders: The mediating role of cognitive control

Background

Cardiometabolic risk is increased in severe mental disorders (SMDs), and there appears to be a relationship between childhood trauma and cardiometabolic risk, possibly related to adverse health behavior. The current study examined the association between childhood trauma and serum lipids and adiposity in SMDs and the potential mediating role of cognitive and personality characteristics.

Methods

Participants with schizophrenia and bipolar spectrum disorders (N = 819) were included, cardiometabolic risk factors (serum lipids, body mass index, and waist circumference) were measured, and history of childhood trauma was assessed by the Childhood Trauma Questionnaire. Cognitive and personality characteristics were available in subsamples, with assessments of cognitive control, impulsiveness, self-esteem, and affective lability. Linear regressions and mediation analyses with Hayes’ PROCESS were performed, adjusting for age, sex, antipsychotic agent propensity of metabolic side-effect, and diagnostic group.

Results

Experience of three or more subtypes of childhood trauma was positively associated with waist circumference in patients with SMDs (p = 0.014). There were no other significant associations between trauma variables and lipid or adiposity measures in the total sample. Cognitive control was a significant mediator between experience of one or two subtypes of childhood trauma and waist circumference.

Conclusions

The results indicate childhood trauma as a predisposing factor for increased waist circumference in individuals with SMDs. Poorer cognitive control, suggestive of adverse health behavior, might be a mediating factor of the association, and the findings indicate the potential importance of increased focus on these factors in prevention and treatment regimens targeting cardiometabolic health.

Association between Aerobic Exercise and High-Density Lipoprotein Cholesterol Levels across Various Ranges of Body Mass Index and Waist-Hip Ratio and the Modulating Role of the Hepatic Lipase rs1800588 Variant

Changes in concentrations of high-density lipoprotein cholesterol (HDL-C) are modified by several factors. We examined the relationship between aerobic exercise and HDL-C among different categories of body mass index (BMI) and waist-hip ratio (WHR) and the impact of rs1800588 variant in the hepatic lipase (LIPC) gene. We analyzed data from 6184 men and 8353 women aged 30-70 years. Participants were grouped into two WHR categories: Normal (0 < WHR < 0.9 for men and 0 < WHR < 0.8 for women) and abnormal (WHR ≥ 0.9 for men and WHR ≥ 0.8 for women). The BMI categories were: Underweight (BMI < 18.5 kg/m²), normal weight (18.5 ≤ BMI < 24 kg/m²), overweight (24 ≤ BMI < 27 kg/m²), and obese (BMI ≥ 27 kg/m²). Multivariate linear regression models were used to investigate associations between HDL-C and exercise. Aerobic exercise was significantly associated with higher HDL-C (β = 1.18325; p < 0.0001) when compared with no exercise. HDL-C was significantly lower in persons with abnormal compared to those with normal WHR (β = -3.06689; p < 0.0001). Compared with normal weight, overweight and obese categories were associated with lower HDL-C, with β values of -4.31095 and -6.44230, respectively (p < 0.0001). Unlike rs1800588 CT and TT genotypes, associations between aerobic exercise and HDL were not significant among CC carriers no matter their BMI or WHR.

Waist-to-height ratio and the conicity index are associated to cardiometabolic risk factors in the elderly population

The purpose of this study was to determine and compare a magnitude of the association between anthropometric indicators with risk of cardiometabolic risk in the elderly. This is a cross-sectional study with 402 elderly people attended by the Family Health Strategy in the city of Viçosa-MG. Risk factors for excess body fat, hypertension, blood glucose and serum lipid changes. An association between conicity index (CI) and waist-to-height ratio (WtHR) with cardiometabolic risk factors was assessed by multiple linear regression analysis. Sample was composed of 60.4% of women and 36.3% of overweight elderly. The connectivity index and a waist-to-height ratio were higher in 57.2% and 88.1% in the elderly, respectively. The results showed that the increase in body fat, diastolic blood pressure, triglycerides, glycemia and reduction of HDL-cholesterol are related to higher values of anthropometric indices evaluated. However, the waist-to-height ratio presented a greater magnitude of association with the cardiometabolic risk factors than the connectivity index.

Cut-off points of anthropometric markers associated with hypertension in the Brazilian population: National Health Survey, 2013

Objective

To identify cut-off points for waist circumference (WC), waist-to-height ratio (WHtR) and BMI associated with hypertension in the Brazilian adult and elderly population.

Design

Cross-sectional study. The receiver-operating characteristic (ROC) curve was used to determine the cut-off points of WC, WHtR and BMI in the prediction of hypertension. Those who had systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg and those who reported use of antihypertensive medication were considered hypertensive.

Setting

Brazil.

Participants

Participants from the National Health Survey, the Brazilian household-based survey conducted in 2013, of both sexes and age ≥20 years.

Results

Cut-off points for WC and WHtR increased with age in both sexes. WC cut-off limits ranged between 88·0 and 95·9 cm in men and between 85·0 and 93·2 cm in women. For WHtR, cut-off scores ranged from 0·51 to 0·58 for men and from 0·53 to 0·61 for women. Additionally, the area under the ROC curve (AUC) for all age and sex groups was greater than 0·60 while the lower limit of the AUC 95 % CI for both WC and WHtR was not less than 0·50. The performance of BMI was similar to that of indicators of fat location.

Conclusions

All analysed anthropometric indicators had similar performance in identifying hypertension in the Brazilian population.

Association of obesity with hypertension and dyslipidemia in type 2 diabetes mellitus subjects

AIM

Obesity and diabetes are contributed to cardiovascular disease risk. The current study was performed to evaluate the association of central and general obesity and cardio-metabolic risk factors, including dyslipidemia and hypertension in T2DM patients.

METHODS

This was a cross-sectional study in T2DM adults. Body mass index (BMI) was used to identify general obesity and waist circumference (WC) was measured to define abdominal obesity (based on ATP III). Biochemical analyses, and anthropometric and blood pressure measurements were done for all participants.

RESULTS

Participants with central obesity showed significantly higher systolic (132.5mmHg vs. 125.4mmHg, p=0.024) and diastolic blood pressures (84.9mmHg vs. 80mmHg, p=0.007) than participants without obesity. Dyslipidemia was more prevalent in all participants either by BMI (98.3% vs. 97%, 95% CI: 0.18-17.53) or by WC (97.2% vs. 98%, 95% CI: 0.07-7.19). Abdominal adiposity in diabetic subjects showed significant reverse association with high level of physical activity (OR=0.22, 95% CI: 0.06-0.85). Hypertriglyceridemia rate was increased with both central (OR=2.11; p=0.040) and general obesity (OR=2.68; p=0.021). After adjustment for energy intake and age, females had higher risk of general (OR=4.57, 95% CI=1.88-11.11) and central obesity (OR=7.93, 95% CI=3.48-18.08).

CONCLUSIONS

Females were more susceptible to obesity. Hypertension was associated with both obesity measures. Dyslipidemia, except for hypertriglyceridemia, was correlated to neither abdominal nor general obesity.

Dietary patterns associated with anthropometric indicators of abdominal fat in adults

This study aimed to identify dietary patterns and assess their association with abdominal fat. A cross-sectional study was conducted in the Central West Region of Brazil with a probabilistic sample of 208 adults of both sexes. Data on food intake was obtained using a food frequency questionnaire and factor analysis (principal components) was conducted to identify dietary patterns. Waist circumference (WC) and waist-to-hip ratio (WHR) were used to assess abdominal fat. The association between dietary patterns and body fat distribution was examined using multiple linear regression analysis adjusted for confounders. Three dietary patterns were identified: Western, regional traditional, and prudent. A positive association was found between the Western pattern and WC (p = 0.04) and WHR (p = 0.001) and between the regional traditional pattern and WHR (p = 0.05) among women. A slight association was also found between the latter pattern and WC (p = 0.07) also among women. An association was found between the Western and regional traditional dietary patterns and a larger concentration of abdominal fat among women.

[Lipid and glucose profiles in outpatients and their correlation with anthropometric indices]

INTRODUCTION AND OBJECTIVE

Obesity is associated with high rates of dyslipidemia and glucose intolerance. The objective of this study was to evaluate the correlation of anthropometric indices with the lipid and glucose profiles of outpatients.

METHODS

We performed a cross-sectional study assessing anthropometric and metabolic parameters in a sample of 550 individuals.

RESULTS

The prevalence of overweight exceeded 80%, with no difference between the sexes. However, 80.9% of women vs. 52.1% of men had waist circumference in the very high risk range (P=000). Glucose and lipid abnormalities were found in over 40% of the sample. In men, no correlation was found between anthropometric indices and metabolic profile. In women, HDL cholesterol was negatively correlated with body mass index waist circumference and waist-to-height ratio. Triglycerides were positively correlated with body mass index, waist circumference and waist-to-height ratio and fasting plasma glucose with waist circumference and waist-to-height ratio. After adjustment for age and nutritional status, the correlations only remained significant between HDL cholesterol and anthropometric indices.

CONCLUSIONS

Among women, the anthropometric indices waist circumference, waist-to-height ratio and body mass index proved good predictors of HDL cholesterol, showing the importance of using these parameters in clinical practice and for screening of cardiovascular risk.

Smoking and abdominal fat in blood donors

OBJECTIVE

To assess the association between smoking and abdominal fat among male blood donors.

METHODS

This was a cross-sectional study involving 1,235 adult male blood donors (age, 20-59 years) in the city of Cuiabá, Brazil. Socioeconomic, demographic, and anthropometric data, as well as information on the lifestyle of the participants, were collected. In this study, waist circumference and waist-to-hip ratio were used as markers of abdominal fat. The association between these two markers and smoking was analyzed by multiple linear regression in separate models, adjusted for potential confounders.

RESULTS

Of the 1,235 respondents, 273 (22.1%) reported being smokers, and, of those, 99 (36.3%) reported smoking more than 15 cigarettes per day. The average body mass index was lower among smokers than among nonsmokers (p < 0.001). In the multiple linear regression analyses, smoking was associated with waist circumference and waist-to-hip ratio for smokers of 6-10 cigarettes/day and of > 11 cigarettes/day.

CONCLUSIONS

In our sample, smoking was positively associated with indicators of abdominal fat, regardless of potential confounding factors, including the consumption of alcoholic beverages.

Association of conicity index and renal progression in pre-dialysis chronic kidney disease

BACKGROUND/OBJECTIVES

Abdominal fat deposition is represented by means of the conicity index (CI), an anthropometric estimate that models the relative accumulation of abdominal fat. We examined the influence of markers of cardiovascular disease in terms of inflammation and lipid profile and body fat distribution on the progression of renal disease in patients with stable chronic kidney disease (CKD) stages 3-5.

MATERIAL AND METHODS

We studied 104 pre-dialysis CKD patients (64 males, 62%; age 64.6 ± 14.7 years). Glomerular filtration rate (GFR) was estimated (44.62 ± 14.38 mL/min/1.73 m2) by modification of diet in renal disease formula. GFR values were estimated at baseline and at the end of the 12-month follow-up. Patients were stratified into three groups: group 1 had a loss of GFR ≥20%; group 2 had a loss of GFR 10-20%; and group 3 patients had stable renal functions or GFR change <10% at the end of 12 months. Body mass index (BMI), waist/hip ratio (WHR), and CI were subsequently computed. Renal resistive index (RRI) was measured using Doppler ultrasonography.

RESULTS

CI was strongly correlated with total cholesterol (r = 0.37, p < 0.01), low-density lipoprotein (LDL) (r = 0.53, p < 0.01), C-reactive protein (r = 0.21, p < 0.05), and serum potassium (r = 0.216, p < 0.02), whereas BMI and WHR were not associated with these parameters. The values of CI, serum cholesterol, LDL, alkaline phosphatase, alanine aminotransferase, lactate dehydrogenase activity, the degree of proteinuria and microalbuminuria, and RRI were significantly lower in group 3. In linear regression model, LDL (r2 = 0.17, p = 0.02), uric acid (r2 = 0.19, p < 0.01), and RRI (r2 = 0.64, p < 0.01) were independently associated with CI for all groups.

CONCLUSION

CI is an independent predictor of systemic inflammation, cardiovascular risk, and GFR in patients during the pre-dialysis period.

Anthropometric cutoff values for detecting metabolic abnormalities in Jordanian adults

OBJECTIVES

To determine cutoff values for body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) as indicators of metabolic abnormalities in the adult Jordanian population.

METHODS

A structured questionnaire was administered to collect relevant information. Anthropometric measurements and biochemical measurements were carried out. Receiver-operating characteristic curve analyses were used to examine the overall discriminatory power of the four anthropometric indices.

RESULTS

WC cutoff values varied from 88.5 to 91.8 cm in men and from 84.5 to 88.5 cm in women. The BMI cutoff values varied from 26.2 to 27.2 kg/m(2) in men and from 27.2 to 30.0 kg/m(2) in women. The WHR cutoff values varied from 0.88 to 0.90 in men and from 80.0 to 0.83 in women. The WHtR cutoff values varied from 0.50 to 0.51 in men and women. Of all anthropometric indices, WHtR had the strongest association with each metabolic abnormality in men and women.

CONCLUSION

BMI, WC, WHR, and WHtR were found to be associated with cardiovascular disease risk factors, with WHtR being the better predictor. We recommend that health care professionals use WHtR, with a cutoff value of 0.5 for screening and counseling Jordanian people.

Short-term nutritional counseling reduces body mass index, waist circumference, triceps skinfold and triglycerides in women with metabolic syndrome

BACKGROUND

It is recognized that the growing epidemic of metabolic syndrome is related to dietary and lifestyle changes.

OBJECTIVE

The purpose of this study was to evaluate short-term application of nutritional counseling in women with metabolic syndrome.

METHODS

This follow-up study was conducted from September to November 2008 with thirty three women > or =35 years old screened clinically for nutritional counseling. Dietary intake was reported, and biochemical and body composition measures were taken at baseline and after three months of follow-up.

RESULTS

Of the 33 women evaluated, 29 patients completed the study. The prevalence of type 2 diabetes mellitus, hypertension, dyslipidemia, and obesity was high at 38%, 72.4%, 55.2%, and 75.8%, respectively. At the end of three-months of follow-up, a significant decline in body mass index, waist circumference, triceps skinfold, and triglycerides was observed, as was an increase in calcium and vitamin D intake. The multiple regression analysis showed that changes in body mass index, triceps skinfold, waist circumference and triglyceride levels after nutritional intervention were positively associated with changes in anthropometric (loss of body weight) and biochemical (decrease of TG/HDL-c ratio) parameters. Moreover, waist circumference changes were negatively associated with changes in calcium and vitamin D intake.

CONCLUSION

Short-term nutritional counseling improved some factors of metabolic syndrome. Moreover, the increases in calcium and vitamin D consumption can be associated with the improvement in markers of metabolic syndrome.

Associação entre marcadores antropométricos de adiposidade corporal e hipertensão arterial na população adulta de Cuiabá, Mato Grosso

OBJETIVO: Avaliar a associação entre marcadores antropométricos de adiposidade corporal (índice de massa corporal e circunferência da cintura) e hipertensão arterial. MÉTODOS: Estudo de corte transversal, de base populacional, realizado no período de 2003 a 2004, com 1.298 indivíduos de 20 a 59 anos. Foram considerados hipertensos os indivíduos com pressão arterial > 140/90 mmHg ou em uso de medicação anti-hipertensiva. As associações entre os indicadores antropométricos e a hipertensão arterial foram analisadas por regressão de Poisson, ajustada por potenciais fatores de confusão (sexo, idade, escolaridade, tabagismo, consumo de bebida alcoólica e atividade física no lazer). A curva ROC foi utilizada para determinar o melhor ponto de corte do IMC para detecção da hipertensão arterial. RESULTADOS: A prevalência de hipertensão arterial foi de 28,3%, sendo 33,5% no sexo masculino e 23,5% no feminino. Após ajuste para o IMC e potenciais fatores de confusão, a circunferência da cintura perdeu associação com o desfecho avaliado, permanecendo apenas o IMC com poder de explicação para a hipertensão arterial (RP = 1,05, p = 0,001). O melhor ponto de corte para o IMC no sexo masculino foi de 25,6 Kg/m², e no sexo feminino 25,7 Kg/m². CONCLUSÕES: A associação observada entre a circunferência da cintura e a hipertensão arterial em muitos estudos pode estar relacionada à ausência de controle de potenciais fatores de confusão nas análises, bem como à não remoção do efeito da adiposidade total. Novas investigações devem ser conduzidas na população brasileira, a fim de se verificar as verdadeiras associações entre indicadores antropométricos e vários desfechos, estudando-se também os melhores pontos de corte desses indicadores.

Consumo de bebida alcoólica e adiposidade abdominal em doadores de sangue

OBJETIVO: Analisar a associação entre o consumo de bebidas alcoólicas e adiposidade abdominal. MÉTODOS: Estudo transversal com uma amostra de homens doadores de sangue (N=1.235), de 20 a 59 anos, em Cuiabá (MT), realizado de agosto/1999 a janeiro/2000. Os indicadores de adiposidade abdominal foram circunferência da cintura e relação cintura/quadril, ajustados pela adiposidade total. As medidas aferidas foram: peso, estatura, circunferências da cintura e do quadril. O consumo de álcool foi avaliado utilizando-se um questionário sobre tipo, freqüência e quantidade da bebida consumida. A associação entre o consumo de álcool e adiposidade abdominal foi analisada por regressão linear múltipla, com os modelos ajustados para idade, atividade física, tabagismo e adiposidade total. RESULTADOS: Após ajuste, a circunferência da cintura e a relação cintura quadril mantiveram-se associadas positivamente ao consumo de cerveja (p=0,02) e ao total de álcool consumido (p=0,01 e 0,03, respectivamente). O consumo de aguardente mostrou associação somente com a circunferência da cintura (p=0,04). CONCLUSÕES: O consumo de álcool, particularmente de cerveja, associou-se com a localização abdominal de gordura.

[Waist measure and waist-to-hip ratio and identification of clinical conditions of cardiovascular risk: multicentric study in type 2 diabetes mellitus patients]

Abdominal obesity is associated with cardiovascular disease. This study aims to compare two measures of abdominal obesity [waist and wais-to-hip ratio (WHR)] in patients with DM2 to identify cardiovascular risk factors: ischemic cardiopathy, hypertension, dislipidemia, obesity and diabetic nephropathy. A multicentric study was performed in 820 patients with type 2 DM. Waist circumference strongly correlated with body mass index (BMI), for men (r= 0.814; P< 0.05) and women (r= 0.770; P< 0.05). On the other hand, WRH was weakly correlated (r= 0.263, P< 0.05 for men; r= 0.092, P< 0.05 for women). Only waist circumference correlated with systolic pressure (r= 0.211, P< 0.05 for men; r= 0,224, P< 0.05 for women). ROC curve analysis demonstrated the superiority of waist circumference measurement compared to WHR regarding obesity and hypertension for men and women, and dyslipidemia for men. In conclusion, waist circumference is better correlated with cardiovascular risk factor than WRH.

Associação das medidas antropométricas de localização de gordura central com os componentes da síndrome metabólica em uma amostra probabilística de adolescentes de escolas públicas

Avaliou-se a associação entre medidas antropométricas de localização de gordura central: circunferências da cintura (CC) e abdominal (CA) e as razões cintura/quadril (RCQ) e cintura/estatura (RCE), independente do percentual de gordura corporal (%GC) e índice de massa corporal (IMC), com os componentes da síndrome metabólica (SM) em uma amostra probabilística de 610 (222 meninos e 388 meninas) adolescentes de 12 a 19 anos de escolas públicas de Niterói, RJ. Foram avaliados glicose e perfil lipídico pelo método enzimático automatizado, insulina pela técnica de radioimunoensaio, %GC pela bioimpedância elétrica e a pressão arterial sistólica (PAS) e diastólica com manômetro digital. A associação entre as medidas antropométricas foi verificada por meio de regressão linear múltipla, com ajuste para IMC, %GC e idade. Nos meninos, a associação positiva entre CC (b = 1,03, p < 0,01) e RCE (b = 2,33, p < 0,05; b = 2,12 e p < 0,01) com triglicerídios foi mantida independente de IMC e % de GC, respectivamente. A CC se correlacionou com a PAS independente do %GC, tanto nos meninos (b = 0,70 p < 0,01) quanto nas meninas (b = 0,68 p < 0,01). Conclui-se que a CC foi a medida de gordura central que apresentou a melhor associação com os componentes da SM nos adolescentes.

Determination of the Leading Central Obesity Index among Cardiovascular Risk Factors in Iranian Women

Background

It is unknown whether the waist circumference (WC) or the waist-to-hip ratio (WHR) is a better predictor of cardiovascular risk factors at different ages.

Objective

To compare WC and WHR as predictors of cardiovascular risk factors and to determine the prevalence of some cardiovascular risk factors in overweight and obese adult women at different ages.

Methods

In this clinical cross-sectional study, 714 overweight and obese women aged 20 to 70 years who were referred to two nutrition clinics in Sistan and Baluchestan province, Islamic Republic of Iran, were studied. The subjects were classified into three groups, 20 to < 35, 35 to < 50, and > or = 50 years of age. Anthropometric indices were measured according to the standard protocol. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and TC/HDL-C ratios were enzymatically determined.

Results

Older subjects (> or = 50 years old) had significantly higher values of body mass index (BMI), WC, TC, TG, and LDL-C than those in the two younger age classes. The prevalence rates of obesity, high WC, high WHR, high TC, high TG, high LDL-C, and high TC/HDL-C ratios were higher in the older subjects. After adjustment for age and BMI, multiple linear regression showed that WC was significantly related to TC and TG in the 20- to < 35-year-old group and to TG in the 35- to < 50-year-old group. In the older participants, WHR was significantly related to TG.

Conclusions

The prevalence of cardiovascular risk factors increases with age. In clinical practice, WC is a better index for predicting some cardiovascular risk factors in younger and middle-aged women; however, for older women, WHR is better.

A comparative study of methods for diagnosis of obesity in an urban mixed-race population in Minas Gerais, Brazil

Background

Obesity is defined as an excess of total body fat and may be assessed by different methods. The objective of the present study was to establish the discriminatory power of anthropometric data in determining obesity.

Methods

The subjects comprised 685 individuals, aged 20–79 years, sampled from a population-based survey. The following indicators were used: body mass index (BMI), waist circumference (WC) and total body fat percentage estimated with both Siri's equation (%BF Siri) and foot-to-foot bioelectrical impedance analysis (%BF BIA). Sensitivity and specificity of different cut-off points for each method were determined using %BF BIA as reference.

Results

Of 685 participants, 57.6% were aged ≥ 40 years, 69.9% were women and 72.6% self-referred themselves as non-white. To classify obesity based on sex and age among women aged < 40 years, the cut-off points were BMI of 26.0 kg m− 2, WC of 84.0 cm and %BF Siri of 34.0%; in those aged ≥ 40 years, the cut-off points were 28.0 kg m− 2, 90.0 cm and 37.4%, respectively. The cut-off points among men aged < 40 years were BMI of 26.3 kg m− 2, WC of 86.0 cm and %BF Siri of 22.5%, and in those aged ≥ 40 years, 26.3 kg m− 2, 89.0 cm and 24.5%, respectively. BMI was the method with the largest area under the curve (AUC) independent of sex and sex/age, yet no differences were observed in AUC between BMI and WC (P>0.05). Classifying according to skin colour did not change cut-off points in any indicator.

Conclusion

BMI and WC better discriminate obesity among women and men aged ≥ 40 years from a mixed-race population.

Food preference questionnaire as a screening tool for assessing dietary risk of cardiovascular disease within health risk appraisals

OBJECTIVE

Nutrition components of health risk appraisals (HRAs) aim to rapidly and accurately assess dietary behaviors that increase disease risk. Because cognitive research suggests that recalling food likes/dislikes may be simpler and more accurate than recalling intake, we tested whether a preference measure was predictive of cardiovascular disease risk factors within an HRA.

METHODS

HRA participants (422 primarily non-Hispanic white men, mean age 46+/-10 years) from a manufacturing company completed surveys to assess fat and sweet food/beverage preference; frequency of consuming fat and sweet foods/beverages, alcoholic beverages, fiber-rich foods (whole grains, fruits, and vegetables); and physical activity. Per measured risk factors, 34% had central obesity (waist circumference>or=102 cm), 32% had hypertension (>or=140 and/or>or=90 mm Hg), 52% had prehypertension (>or=120 to 139 and/or>or=80 to 89 mm Hg), and 52% had an elevated total cholesterol level (>or=200 mg/dL [5.2 mmol/L]).

STATISTICAL ANALYSES

Multiple linear regression models explaining variability in waist circumference, blood pressure, and serum lipids were tested.

RESULTS

Although preference and intake pairs for fat and sweets were significantly correlated, intake of fat and sweets failed to associate significantly with any risk factor. Significant variance in waist circumference was explained by age, fat preference, fiber intake, and physical activity. Those with greater circumferences liked fat more, consumed less fiber, and exercised less. Waist circumference in turn contributed significantly to models predicting serum lipid levels and blood pressure. Alcohol intake explained variability in serum lipid levels-higher intakes were associated with higher high-density lipoprotein cholesterol levels. The models predicting risk were generally more explanatory in younger (<50 years) than in older men.

CONCLUSIONS

Including a preference measure within an HRA appears to enhance cardiovascular disease risk factor assessment. Fat preference, intake of fiber-rich foods, and alcohol proved the best dietary determinants of cardiovascular disease risk factors.

Stroke-Independent Association Between Metabolic Syndrome and Functional Dependence, Depression, and Low Quality of Life in Elderly Community-Dwelling Brazilian People

OBJECTIVES

Metabolic syndrome (Met.S) is a risk factor for stroke, dementia, and ischemic heart disease (IHD). It is unclear whether Met.S is an independent risk factor for functional dependence, depression, cognitive impairment, and low health-related quality of life (HRQoL) in a population free of clinical stroke.

DESIGN

Cross-sectional.

SETTING

Two communities in southern Brazil.

PARTICIPANTS

Four hundred twenty people aged 60 and older.

MEASUREMENTS

An adapted (body mass index > or =30 kg/m(2) and blood pressure > or =140/90) Adult Treatment Panel III definition was used in diagnosing Met.S. Depression (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised) and Mini-Mental State Examination were evaluated along with activities of daily living (ADLs) and instrumental activities of daily living (IADLs). HRQoL was measured using a visual analogue scale (0-10). All values were adjusted for age, sex, and presence of IHD.

RESULTS

Forty (9.5%) subjects had a stroke and were excluded from the final analysis. Met.S was present in 37.4% of the stroke-free population. Met.S was significantly and independently associated with 2.24 times as much ADL dependence, 2.39 times as much IADL dependence, a 2.12 times higher risk of depression, a 2.27 times higher likelihood of cognitive impairment, and a 1.62 times higher chance of low self-perceived HRQoL (all P<0.05). Adjustment for its own components reduced the strength of the above associations but did not eliminate their statistical significance. If Met.S were removed from this population, dependence, depression, cognitive impairment, and low QoL would be reduced 15.0% to 21.4%.

CONCLUSION

Met.S was significantly associated with functional dependence, depression, cognitive impairment, and low HRQoL, and its effects were independent of clinical stroke, IHD, and its own individual components.

C-Reactive Protein in Nipple Aspirate Fluid

BACKGROUND

Proteins expressed in nipple aspirate fluid (NAF) have been associated with breast cancer risk and may serve to detect inflammatory or premalignant states. Obesity, hyperlipidemia, and metabolic syndrome are associated with increased rates of breast cancer and are systemic markers of chronic inflammation.

OBJECTIVE

The aim of this study was to determine if one NAF protein, C-reactive protein (CRP), associated elsewhere in the human with cancer, relates to reproductive, nutrition, and body composition and activity factors.

METHODS

Women (n = 59) aged 30 to 64 years from the midwestern United States and Kenya were evaluated regarding the relation between reproductive (age, pregnancy, and breast-feeding indices), nutrition (serum lipids, serum, or NAF carotenoid), body composition and activity (activity, waist-hip ratio, fat percentage (% fat), and body mass index [BMI]) factors and CRP in NAF.

RESULTS

Age at first pregnancy (p < .05), gravidity (p < .05), wean time from breast-feeding last baby (p < .05), serum triglycerides (p = .01), % fat (p < .05), and BMI (p < .05) were related significantly to CRP levels in NAF. A model derived from selective women's reproductive, nutritional, and body composition and activity factors significantly (p < .05) accounted for the variance in breast microenvironment inflammation as measured by CRP in NAFs.

DISCUSSION

Detecting CRP in NAF may indicate local mammary inflammation, which has been associated with carcinogenesis. Specific NAF risk modeling that addresses reproductive, nutritional, and body composition and activity factors may be used for further advances in the prevention of breast cancer and the early detection and treatment of the disease.

Characteristics predicting dyslipidemia in drug-naïve type 2 diabetes patients

BACKGROUND

Plasma lipid concentrations are related to a variety of attributes in obese subjects, but these relationships have not been extensively examined in type 2 diabetes patients.

METHODS

A cross-sectional survey was conducted on type 2 diabetes patients who had never been treated with antihypertensives, lipid-lowering agents, and oral antidiabetic drugs other than sulfonylureas. Statistical analysis was performed to search for the correlation between lipid profiles and various parameters.

RESULTS

Among diabetic men, the plasma triglyceride (TG) level was positively correlated with the waist-to-hip ratio (WHR) and alcohol consumption, whereas high-density lipoprotein cholesterol (HDL-C) was negatively correlated with age and body mass index (BMI). Obese persons and alcohol drinkers were more likely to need pharmacologic treatment for dyslipidemia. Among diabetic women, the plasma TG level was positively correlated with WHR and the duration of diabetes since diagnosis, while HDL-C was negatively correlated with WHR and BMI. The necessity of treatment for dyslipidemia increased with the duration of diabetes.

CONCLUSION

We recommend a more intensive monitoring of lipid levels in drug-naive diabetic patients who possess the characteristics of alcohol consumption or older age (men), long duration of diabetes (women), and higher BMI or WHR (both genders).

Desempenho de pontos de corte do índice de massa corporal de diferentes referências na predição de gordura corporal em adolescentes

Avaliamos a acurácia de pontos de corte do Índice de Massa Corporal (IMC) para identificar adolescentes com sobrepeso, comparando com percentual de gordura corporal, estimado pela bioimpedância elétrica, em uma amostra probabilística de 610 adolescentes de 12 a 19 anos (222 meninos e 388 meninas), estudantes de escolas públicas de Niterói, Rio de Janeiro, Brasil. A curva ROC foi utilizada para avaliar a sensibilidade e especificidade de pontos de corte de IMC de uma referência nacional, duas norte-americanas e uma internacional. Os pontos de corte da amostra estudada foram inferiores aos das demais referências, com sensibilidade de 76% a 95% e especificidade de 75% a 95%. Os pontos de corte nacionais foram também mais sensíveis (53% a 100%), se comparados às outras referências (40% a 86%). O critério internacional apresentou melhor sensibilidade para adolescentes mais velhos e as referências americanas, para os mais jovens. O IMC foi um bom proxy de adiposidade, mas o uso de pontos de corte de referências de outras populações merece cautela, pois pode gerar erro na classificação de adolescente com sobrepeso em até 60%.

[Accuracy of waist circumference and waist-to-hip ratio as predictors of dyslipidemia in a cross-sectional study among blood donors in Cuiabá, Mato Grosso State, Brazil]

This study evaluated the accuracy of anthropometric fat location indices (waist circumference and waist-to-hip ratio) as predictors of dyslipidemia, in addition to defining their respective cut-offs. The sample consisted of 416 healthy male blood donors from 20 to 58 years of age at the Blood Center in Cuiabá, capital of Mato Grosso State, Brazil. Serum lipids were determined through the enzymatic method. Data analysis through the ROC curve identified the best indicator and the cut-off with the largest statistically significant area under the ROC curve. The best cut-off points for waist-to-hip ratio and waist circumference were 0.90 and 85cm, respectively. The area under the ROC curve between waist circumference and high cholesterol/HDL relation included the 0.50 value, so waist circumference could not be considered a predictor of dyslipidemia. The best sensitivity and specificity were in the youngest group. Waist-to-hip ratio was a better predictor of dyslipidemia than waist circumference, although the latter showed better discriminating power to detect hypertriglyceridemia. The most accurate cut-off points were lower than those set by the World Health Organization.

Factors associated with obesity in an adult Mediterranean population: influence on plasma lipid profile

OBJECTIVE

The aim of the study was to identify factors associated with obesity, and their influence on plasma lipid profile in an adult Mediterranean population.

DESIGN

The data were obtained from a cross-sectional epidemiological survey.

SETTING

The study population resided in Andalusia, a western Mediterranean region in southern Spain.

SUBJECTS

The survey was carried out with a random sample of 3421 subjects (1747 men, 1674 women) between 25 and 60 years of age. Blood samples were obtained for biochemical assays in a random subsample of 340 subjects (167 men, 173 women).

INTERVENTIONS

Food consumption was assessed by 48-h recall. Height, weight, triceps, biceps, subscapular and suprailiac skinfolds, mid-upper arm, waist (WC) and hip circumferences, glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides were measured. Information about lifestyles was obtained with a questionnaire.

RESULTS

Of the adult population we studied, 18.9% were obese (body mass index [BMI] > or = 30 kg/m2). A larger proportion of men than women were overweight, but the opposite was found for obesity. Mean plasma lipid values were not modified significantly by obesity or lifestyle factors, and were within the normal range. Sex, age, physical exercise and lower educational level were associated directly with the risk of obesity, and smoking was associated inversely with the risk of obesity. In obese smokers WC and waist-hip ratio were larger, and levels of HDL-cholesterol were lower (p < 0.05) than in obese nonsmokers. Glucemia was higher in obese persons who consumed alcohol (p < 0.05) than in obese persons who did not consume alcohol. The risk of hypercholesterolemia and high levels of LDL-cholesterol was associated only with age, and the risk of low levels of HDL-cholesterol was associated only with high WC.

CONCLUSION

Our results provide an estimate of the prevalence of obesity in the adult population in southern Spain, and of the associated factors. Sex, age, leisure-time physical exercise and educational level appear to influence obesity. Only age and WC but not BMI were associated with a risk of dyslipidemia. No dietary associations were observed between energy or macronutrient intake and plasma lipid concentrations in overweight or obese persons.