Waist circumference, body mass index and waist-height ratio: Are two indices better than one for identifying hypertension risk in older adults?

An Investigation of the Utility of Waist Circumference Predicting Cardiorespiratory Fitness in School Children: A Cross-Sectional Study

The early identification of modifiable risk factors and their monitoring, also within school physical education (PE) classes, are becoming indispensable in the context of public health. The aim of this study was to test whether making use of waist circumference (WC) measurements increases the possibility of predicting the results of cardiorespiratory fitness (CRF) in school-age children, as compared with body mass index (BMI) and other somatic indicators related to body fat. The cross-sectional study covered 190 children aged 10 to 15 years, participating in school PE classes. Body height (BH), body weight (BW), WC, hip circumference (HC) and percentage of body fat (BF%) were measured. BMI, waist to hip ratio (WHR) and waist to height ratio (WHtR) were calculated, and a CRF test was performed by means of a 20 m shuttle run test (20mSRT). The peak heart rate (HR_peak) of the children was also measured. The regression model that was developed showed that WC (R² = 47.1%), beyond BF% (R² = 50.3%) and WHtR (R² = 50.0%), was a useful measure of CRF, and stronger than BMI (R² = 45.8%) or WHR (R² = 39.2%). The risk of obtaining the CRF result classified below a good level (below the percentile range of P60-P80) was significantly higher in children with a larger WC (odds ratio (OR) for the WC change of 1 cm equals 1.14 (95% CI: 1.09-1.20; p < 0.001)). The simplicity of measuring WC and the possibility of using this measurement in the calculation of WHtR with reference to CRF indicate its usefulness in the prophylactic exams of school children.

The influence of body composition and fat distribution on circadian blood pressure rhythm and nocturnal mean arterial pressure dipping in patients with obesity

Loss of physiological nocturnal blood pressure (BP) decline is an independent predictor of cardiovascular risk and mortality. The aim of the study was to investigate the influence of body composition and fat distribution on 24-hour BP pattern and nocturnal dipping of mean arterial pressure (MAP) in patients with obesity. The study comprised 436 patients, 18 to 65 years old (306 women), with BMI ≥30 kg/m2. Body composition was assessed with dual-energy X-ray absorptiometry (DXA) and blood pressure was assessed by 24-hour BP monitoring. The prevalence of hypertension was 64.5% in patients with BMI <40 kg/m2 and increased to 78.7% in individuals with BMI ≥50 kg/m2 (p = 0.034). The whole-body DXA scans showed that the hypertensive patients were characterized by a greater lean body mass (LBM) and a higher abdominal-fat-to-total-fat-mass ratio (AbdF/FM), while the normotensive participants had greater fat mass, higher body fat percentage and more peripheral fat. Loss of physiological nocturnal MAP decline was diagnosed in 50.2% of the patients. The percentage of non-dippers increased significantly: from 38.2% in patients with BMI <40 kg/m2 to 50.3% in those with BMI 40.0-44.9 kg/m2, 59.0% in patients with BMI 45.0-49.9 kg/m2, 71.4% in those with BMI 50.0-54.9 kg/m2 and 83.3% in patients with BMI ≥55 kg/m2 (p = 0.032, p = 0.003, p<0.001, and p = 0.002 vs. BMI <40 kg/m2, respectively). The multivariable regression analysis showed that patients at the highest quartiles of body weight, BMI, LBM and AbdF/FM had significantly reduced nocturnal MAP dipping compared with patients at the lowest quartiles, respectively.

‘I don't know which is the chicken and which is the egg’: A qualitative study of weight loss‐related beliefs and behaviours among adults with psoriasis and comorbid obesity

OBJECTIVES

Obesity is a common (30%-40%) comorbidity of psoriasis. Weight loss is shown to improve the severity of psoriasis; however, little is known about the factors that may influence successful weight loss in the context of obesity and psoriasis. The current qualitative study aimed to explore the obesity-associated beliefs, perceptions, and behaviours related to weight loss in psoriasis. Preferences for a weight loss intervention were also explored.

DESIGN

Qualitative in-depth semi-structured interviews were conducted with 24 adults (62.5% male) with moderate-to-severe psoriasis and obesity (mean body mass index = 35.2 kg/m² , SD = 4.1), recruited through a patient organization website in the UK. Data were analysed using inductive thematic analysis.

RESULTS

Most participants viewed psoriasis as unrelated to obesity. A well-controlled psoriasis and improvements in psoriasis symptoms were considered as major motivators for engaging in a weight loss program by individuals who viewed psoriasis and obesity as related conditions. Comfort eating was perceived as an escape strategy from the psoriasis-induced negative emotions. Participants shared their dissatisfaction with current weight loss recommendations which were too generic. They suggested that a desirable weight loss program would require both emotional and behavioural support, with an emphasis on psoriasis' burden.

CONCLUSION

The findings accentuate the importance of (1) clinicians discussing the link between obesity and psoriasis with patients, (2) weight loss advice to include both behavioural and emotional support, and (3) a weight loss advice to consider the psoriasis burden and the perceived barriers which may potentially lead to improved outcomes to obesity management in psoriasis.

The importance of illness severity and multimorbidity in the association between mental health and body weight in psoriasis: Cross-sectional and longitudinal analysis

Background

High body weight is common in psoriasis and is associated with depression and anxiety. Past studies are mostly cross-sectional and may underestimate the role of demographic and illness-related factors in the association between mental health and body weight in psoriasis.

Objectives

This study explored the association between depression and anxiety with waist circumference and body mass index (BMI) cross-sectionally and at 12 months follow-up, adjusting for demographic and illness-related factors in people with psoriasis.

Method

Routine psoriasis care data were combined with data on depression and anxiety from a large specialist psoriasis centre. The analytical samples consisted of patients with complete data on either waist circumference (N = 326 at time 1; N = 191 at follow-up) or BMI (N = 399 at time 1; N = 233 at follow-up) and corresponding mental health, demographic, and illness-related information. Associations between weight-related outcomes and mental health variables were assessed at time one and at 12 months follow-up, after adjusting for demographic and illness-related factors.

Results

We found no evidence of associations between mental health and waist circumference or BMI, after adjusting for age, gender and illness-related factors. Higher age, male gender and illness-related factors, specifically multimorbidity and psoriasis severity, were positively associated with waist circumference and BMI at both time points.

Conclusion

This study revealed the important role of factors related to illness severity in body weight in psoriasis. The contribution of depression and anxiety to weight was not observed here likely due to the sample and methodology used. Future work should explore other psychosocial factors such as weight-related attitudes and emotional eating in the context of weight in psoriasis, to help inform the development of successful weight-management treatments.

Examining sex disparity in the association of waist circumference, waist-hip ratio and BMI with hypertension among older adults in India

Hypertension is a public health issue touted as a “silent killer” worldwide. The present study aimed to explore the sex differential in the association of anthropometric measures including body mass index, waist circumference, and waist-hip ratio with hypertension among older adults in India. The study used data from the Longitudinal Aging Study in India (LASI) conducted during 2017–18. The sample contains 15,098 males and 16,366 females aged 60 years and above. Descriptive statistics (percentages) along with bivariate analysis were presented. Multivariable binary logistic regression analyses were used to examine the associations between the outcome variable (hypertension) and putative risk or protective factors. About 33.9% of males and 38.2% of females aged 60 years and above suffered from hypertension. After adjusting for the socioeconomic, demographic and health-behavioral factors, the odds of hypertension were 1.37 times (CI: 1.27–1.47), significantly higher among older adults who were obese or overweight than those with no overweight/obese condition. Older adults with high-risk waist circumference and waist-hip ratio had 1.16 times (CI: 1.08–1.25) and 1.42 times (CI: 1.32–1.51) higher odds of suffering from hypertension, respectively compared to their counterparts with no high-risk waist circumference or waist-hip ratio. The interaction effects showed that older females with overweight/obesity [OR: 0.84; CI: 0.61–0.74], high-risk waist circumference [OR: 0.89; CI: 0.78–0.99], and high-risk waist-hip ratio [OR: 0.90; CI: 0.83–0.97] had a lower chance of suffering from hypertension than their male counterparts with the similar anthropometric status. The findings suggested a larger magnitude of the association between obesity, high-risk waist circumference, high-risk waist-hip ratio and prevalent hypertension among older males than females. The study also highlights the importance of measuring obesity and central adiposity in older individuals and using such measures as screening tools for timely identification of hypertension.

Utility of Obesity Indicators for Predicting Hypertension among Older Persons in Limpopo Province, South Africa

In view of the epidemic proportions of obesity in South Africa and its relationship to cardiometabolic diseases, such as hypertension, a cross sectional study was conducted to investigate the utility of obesity indicators for predicting hypertension among older persons (≥60 years, n = 350) in the Limpopo Province of South Africa. The WHO STEPwise approach was used to collect data on demographic and lifestyle factors. Anthropometrics and blood pressure were measured according to the standard procedures. Receiver operating characteristic curves (ROC) were used to investigate and compare the ability of obesity indicators to predict overall hypertension and either increased systolic (SBP) or increased diastolic (DBP) blood pressure. The area under the ROC curve (AUC) was used to assess a certain indicator’s potential to predict overall hypertension and either increased SBP or increased DBP. Multivariate logistic regression analysis was used to determine the relationship of hypertension with obesity indicators. The mean age of the participants was 69 years (±SD = 7), and hypertension (46%), general obesity (36%) and abdominal obesity (57%) were prevalent among older persons. The obesity indicator body mass index (BMI) (AUC = 0.603 (0.52; 0.69)) was the best predictor of hypertension in older men. Waist circumference (WC) (AUC = 0.640 (0.56; 0.72)) and waist-to-height ratio (WHtR) (AUC = 0.605 (0.52; 0.69)) were better predictors of hypertension than BMI and waist-to-hip ratio (WHR) in older women. After adjustment for risk factors, only WC (AOR = 1.22 (1.16; 1.79)) was significantly associated with hypertension in older women, proposing WC as a screening tool for the prediction of hypertension in South African older women.

Obesity as a Risk Factor for Hypertension and Diabetes among Truck Drivers in a Logistics Company, South Africa

Despite the occupational nature of truckers predisposing them to cardiovascular diseases and risk factors, data is scarce on their prevalence of obesity and its association with developing hypertension (HBP) and diabetes in South Africa. Extracted from the original cross-sectional study of a sample of 312 employees in a logistics company, a census of 96 male truckers was used to determine the prevalence of obesity and its association with HBP and diabetes. WHO STEPwise approach was used to collect data, including systolic (SBP) and diastolic (DBP) blood pressure and anthropometry measurements. HBP is defined as SBP/DBP ≥ 140/90 mmHg, overweight/obesity as BMI ≥ 25 kg/m2, abdominal obesity by waist circumference as WC ≥ 90cm, waist-to-hip-ratio as WHR ≥ 0.90, and waist-to-height ratio as WHtR ≥ 0.5. Data were analysed using SPSS 22. The mean age of truckers was 46 years, 29% were smokers, and 57% alcohol users, while 26% were physically inactive. The prevalence of overweight (44%) and obesity (30%) were observed, while abdominal obesity was high; WC (59%), WHR (65%), and WHtR (80%). HBP (57%) was prevalent and diabetes was 14%. The odds of developing HBP were high for obese truckers by WC [AOR = 4.68; CI = 1.92–11.34)] and by WHtR [AOR = 5.49 CI = 1.74–17.27), while diabetes was associated with WHR (AOR = 1.19; CI = 1.19–31.21). This study showed an associative link between obesity, HBP, and diabetes among the truckers, which is informative for a relevant prevention programme tailored to their needs.

Metabolic syndrome and its association with changes in modifiable risk factors: Epifloripa aging study

Purpose

To estimate the prevalence of Metabolic Syndrome (MetS) and its association with changes in modifiable risk factors in older adults from southern Brazil.

Methods

A longitudinal study was performed with data from EpiFloripa Aging study. We defined MetS by the existence of three or more of the following risk factors for cardiovascular disease (CVD): waist circumference (WC) (≥ 92 cm in men and ≥ 87 cm in women); fasting glucose (≥100 mg/dl); decreased HDL cholesterol (<40 mg/dl in men and <50 mg/dl in women); hypertriglyceridemia (≥150 mg/dl) and blood pressure (≥130/85 mmHg). We evaluated the changes in modifiable risk factors (smoking, alcohol consumption, fruit and vegetable consumption, physical activity, and body mass index) between the two moments of the study (2009/10 and 2013/14). Directed acyclic graph and logistic regression models were used.

Results

Among the 599 participants, the prevalence of MetS was 64.0% (95% CI, 58.7-68.9). In the adjusted analysis, those who remained or became persons who are overweight (OR = 4.59; 95% CI: 3.05-6.89) and those who remained or became insufficiently active (OR = 1.92; 95% CI: 1.23-2.98) were more likely to present MetS.

Conclusion

Our findings suggest that being or becoming overweight and being or becoming insufficiently active are modifiable factors associated with MetS. These results highlight the need for developing preventive strategies for the observed risk indicators to mitigate the prevalence of MetS in older adults.

Association of body mass index and waist circumference with high blood pressure in older adults

BACKGROUND

The relationship between obesity and prevalent high blood pressure in older adults has predominantly been estimated using categorical measures of body mass index (BMI) and waist circumference (WC), masking the shape of the dose-response relationship. We aimed to examine the precise relationship of BMI, WC with high blood pressure and to assess the appropriate level of BMI and WC for high blood pressure.

METHODS

We examined data for 126,123 individuals in Xinzheng city aged ≥60 years from a population based study from January to December 2019. Logistic regression and restricted cubic spline models were applied to assess the relationship and the appropriate level of BMI and WC for high blood pressure. An additive interaction analysis was used to test synergistic effects between a higher BMI and WC for high blood pressure.

RESULTS

The full-adjusted odds ratios (ORs) with 95% confidence intervals (CIs) of an increase of 1 kg/m² in BMI and 1 cm in WC for high blood pressure were 1.084 (1.080-1.087) and 1.026(1.024-1.027), respectively. Multivariable adjusted restricted cubic spline analyses showed the nonlinear relationships of BMI and WC with high blood pressure in both men and women (all P < 0.001). The risk of high blood pressure increased steeply with increasing BMI from ≥25 kg/m² and WC ≥ 88 cm or 86 cm for males and females, respectively. And we observed a significant additive interaction between a higher BMI and WC such that the prevalence of high blood pressure was significantly enhanced.

CONCLUSION

These findings suggest increased high blood pressure prevalence in the older adults with increased BMI and WC. BMI ≤ 25 kg/m2 and WC ≤ 88 cm or 86 cm for males and females may be the best suggestion with regard to primary prevention of high blood pressure in older adults.

Composite BMI and Waist-to-Height Ratio Index for Risk Assessment of Non-alcoholic Fatty Liver Disease in Adult Populations

Background: As obesity becomes more prevalent, non-alcoholic fatty liver disease (NAFLD) is also becoming a major worldwide health problem and the most common cause of chronic liver disease. A new obesity classification method based on a composite index which includes both the body mass index (BMI) and the waist-to-height ratio (WHtR) was recently proposed. However, the usefulness of this approach to assess the risk of NAFLD is unclear. Methods: This is a cross-sectional study of 1,276 adult individuals in Dalian, China. The Mann Whitney U test, χ2 test and t-test were used to compare differences between groups. Binary logistic regression analysis was used to identify independent risk factors. Based on BMI and WHtR tertiles, individuals were divided into five new groups. Spearman correlation and receiver operating characteristic curve (ROC) analyses were performed to compare the NAFLD risk factors among groups based on BMI alone, WHtR alone, or the combination of both indexes. Results: BMI, waistline circumference (WC), WHtR, alanine aminotransferase (ALT), weight, triglycerides (TG), γ-glutamyl transpeptidase (GGT), serum uric acid (SUA), red blood cell (RBC) counts, hemoglobin levels (HGB), fasting blood glucose (FBG) and aspartate aminotransferase (AST) levels were identified as high risk factors for NAFLD (all AUC > 0.7). Logistic regression analysis suggested that BMI and WHtR were independent predictors of the appearance of NAFLD (the ORs for BMI and WHtR were 1.595 and 4.060E-11, respectively; all P < 0.001). The combination of BMI and WHtR tertiles significantly improved the correlation coefficient and Area under the receiver operating characteristic curve (AUC) for NAFLD risk factors in subjects classified as overweight or obese when compared with either BMI or WHtR alone. Conclusions: BMI, WC, WHtR, ALT, weight, TG, GGT, SUA, RBC, HGB, FBG, AST were high risk factors for NAFLD. The composite BMI and WHtR index improved body fat classification and the ability to detect individuals with NAFLD risk, offering a more precise method for the early identification of high- and low-risk NAFLD patients.

The burden of hypertension in Ecuador: a systematic review and meta-analysis

Hypertension is a major risk factor of cardiovascular diseases, which occurrence has increased consistently worldwide. With this in mind, this review was designed to evaluate the prevalence of hypertension in Ecuador. We systematically searched publications in Medline, Cumulative Index of Nursing and Allied Health Literature, Cochrane Database, and Ibero-America electronic databases for articles published through September 2019 and reporting the prevalence of hypertension in Ecuador. Selected data were subjected to meta-analysis, and pooled prevalence and their 95% (95% CI) were calculated. Seventeen articles have been selected according to the inclusion/exclusion criteria of the study. The overall estimate of the pooled prevalence of hypertension was 35.8% (CI: 31.3-38.4). Most importantly, the prevalence of hypertension increased markedly with age and obesity. Pooled estimates for the four age subdivisions (<30 years), (≥30 and ≤50 years), (>50 and ≤60 years) and (>60 years) were 9.4% (CI: 7.3-11.5), 22.0% (CI: 19.0-25.0), 26.1% (22.2-30.0) and 48.7% (CI: 45.4-52.0), respectively. Moreover, the pooled estimate of subjects with BMI ≥ 30 kg/m² (57.7%, CIs: 45.6-69.8) was markedly higher than those with BMI < 30 kg/m² (30.4%, CI: 23.3-38.4). Although limited, available data reported higher rates of hypertension in Afro-Ecuadorians than other ethnicities. This study underlines a high prevalence of hypertension in adults nationwide, but mostly in elderly and obese individuals. The magnitude of this burden emphasizes the need for robust and targeted interventions to control hypertension, and ultimately reverse the trend of cardiovascular diseases.

Prevalence of arterial hypertension and associated factors: a population-based study

SUMMARY OBJECTIVE To estimate the prevalence of hypertension in adults and analyze its association with socioeconomic, demographic, and lifestyle risk factors. METHODS Home-based cross-sectional epidemiological study conducted with adults of both sexes living in the cities of Teresina and Picos (PI). The prevalence of hypertension was estimated by self-reported diagnosis. The associations between hypertension and the following variables were tested: age, gender, skin color, education, family income, marital status, alcohol and cigarette consumption, physical activity, and nutritional status. RESULTS A total of 1,057 adult individuals with a mean age of 38.6 ± 11.5 years participated in the study, of which 62.3% were female. The prevalence of hypertension in the population was 16.4%. In the crude analysis, a significant association was observed between the prevalence of hypertension and factors such as older age, lower education, single marital status, brown skin color, smoking, and overweight (p < 0.05). However, after adjustments, only the associations with older age, brown skin color, sedentary lifestyle and overweight remained significant. CONCLUSION Older age, brown skin color, sedentary lifestyle, and the presence of overweight or obesity were significantly associated with hypertension. Among the modifiable risk factors, a sedentary lifestyle and overweight stand out as important for the genesis of hypertension, subject to intervention measures.

Bell's palsy and obesity, alcohol consumption and smoking: A nested case-control study using a national health screening cohort

The aim of this study was to investigate the association of body mass index (BMI), alcohol consumption, and smoking status with the occurrence of Bell’s palsy. The Korean National Health Insurance Service-Health Screening Cohort of a ≥ 40-year-old population from 2000–2003 was used. A total of 5,632 Bell’s palsy participants were matched with 22,528 control participants in terms of age, sex, income, region of residence, and past medical histories of hypertension, diabetes, and dyslipidemia. Bell’s palsy was classified by a history of ≥2 diagnoses with ICD-10 code (G510) and steroid treatment. BMI (kg/m²) was classified as <18.5 (underweight), ≥18.5 to <23 (normal), ≥23 to <25 (overweight), ≥25 to <30 (obese I), and ≥30 (obese II). Alcohol consumption was divided into non-drinkers and those who drank 2–3 times a month, 1–2 times a week, and ≥3 times a week. Smoking status was categorized as current smokers, past smokers, and non-smokers. The odds of obesity, alcohol consumption, and smoking with Bell’s palsy were analyzed using logistic regression analysis. BMI showed proportionally positive associations with Bell’s palsy (adjusted OR [95% CI] = 0.61 [0.47–0.79] for underweight, 1.16 [1.08–1.26] for normal, 1.24 [1.15–1.33] for obese I, and 1.61 [1.38–1.88] for obese II, P < 0.001). The odds of alcohol consumption with Bell’s palsy were 0.90 (95% confidence interval [CI] = 0.82–0.99) for 2–3 times a month, 0.77 (95% CI = 0.69–0.85) for 1–2 times a week, and 0.79 (95% CI = 0.71–0.88) for ≥3 times a week compared to nondrinkers (P < 0.001). Smoking did not show a relationship with the occurrence of Bell’s palsy. Obesity was related to the risk of Bell’s palsy in the population over 40 years old. On the other hand, alcohol consumption was negatively associated with the occurrence of Bell’s palsy.

Obesity-related hypertension: a review of pathophysiology, management, and the role of metabolic surgery

Obesity is a significant public health challenge worldwide and is inextricably linked to adverse cardiovascular outcomes. The relationship between excess adiposity and increased blood pressure is well established, and it is estimated that obesity accounts for 65-78% of cases of primary hypertension. The mechanisms through which obesity causes hypertension are complex and include sympathetic nervous system overactivation, stimulation of the renin-angiotensin-aldosterone system, alterations in adipose-derived cytokines, insulin resistance, and structural and functional renal changes. Weight loss is the primary goal of treatment for obesity-related hypertension, although few individuals achieve success with nonpharmacological management alone. Specific considerations apply when selecting the most appropriate pharmacological therapy for obese hypertensive patients. Metabolic surgery has proved to be the most effective means of ensuring substantial and sustained weight loss and has also been shown to confer beneficial effects in type 2 diabetes mellitus. Increasing evidence suggests that metabolic surgery may also be an effective treatment for obesity-related hypertension, although prospective data on long-term blood pressure outcomes are awaited. This review will discuss the pathophysiological mechanisms that link obesity with hypertension and will provide an overview of treatment strategies, with a focus on metabolic surgery.

Associated Factors of Hypertension in Women and Men in Vietnam: A Cross-Sectional Study

Background: Hypertension is a direct cardiovascular disease risk. It causes a heavy burden on the healthcare system globally. We aim to assess hypertension occurrence and its associated factors among women and men in Vietnam. Methods: A cross-sectional study was conducted from January to February 2019 on 2203 community-dwelling women and men aged 18 years or above. Participants’ characteristics, comorbidity, behaviors, and physical measures were evaluated. Hypertension was classified as systolic/diastolic blood pressure ≥140/90 mmHg or using antihypertensive medication. We analyzed data using logistic regression models. Results: The prevalence of hypertension was 24.3% (20.9% in women, 29.1% in men). For women, older age (odds ratio, OR, 6.80–12.41; p < 0.001), income above the poverty line (OR, 0.64; p = 0.008), diabetes comorbid (OR, 2.98; p < 0.001), added salts consumption (OR, 1.80; p < 0.001), overweight/obesity (OR, 1.64; p = 0.005), abdominal obesity (OR, 2.07; p < 0.001) were associated with hypertension. For men, older age (OR, 2.67–5.92; p < 0.001), diabetes comorbid (OR, 2.25; p = 0.010), smoking (OR, 1.38; p = 0.046), and overweight/obesity (OR, 2.18; p < 0.001) were associated with hypertension. Conclusions: Hypertension is prevalent in Vietnamese people. The associated factors of hypertension are varied by gender.

Relationship between obesity indices and hypertension among middle-aged and elderly populations in Taiwan: a community-based, cross-sectional study

OBJECTIVE

Obesity and hypertension (HTN) have become increasingly prevalent in Taiwan. People with obesity are more likely to have HTN. In this study, we evaluated several anthropometric measurements for the prediction of HTN in middle-aged and elderly populations in Taiwan.

DESIGN

Cross-sectional observational study.

SETTING

Community-based investigation in Guishan Township of northern Taiwan.

PARTICIPANTS

A total of 396 people were recruited from a northern Taiwan community for a cross-sectional study. Anthropometrics and blood pressure were measured at the annual health exam. The obesity indices included body mass index (BMI), body fat (BF) percentage and waist circumference (WC).

OUTCOME MEASURES

Statistical analyses, including Pearson's correlation, multiple logistic regression and the area under ROC curves (AUCs) between HTN and anthropometric measurements, were used in this study.

RESULTS

Of the 396 people recruited, 200 had HTN. The age-adjusted Pearson's coefficients of BMI, BF percentage and WC were 0.23 (p<0.001), 0.14 (p=0.01) and 0.26 (p<0.001), respectively. Multiple logistic regression of the HTN-related obesity indices showed that the ORs of BMI, BF percentage and WC were 1.15 (95% CI 1.08 to 1.23, p<0.001), 1.07 (95% CI 1.03 to 1.11, p<0.001) and 1.06 (95% CI 1.03 to 1.08, p<0.001), respectively. The AUCs of BMI, BF percentage and WC were 0.626 (95% CI 0.572 to 0.681, p<0.001), 0.556 (95% CI 0.500 to 0.613, p=0.052) and 0.640 (95% CI 0.586 to 0.694, p<0.001), respectively.

CONCLUSIONS

WC is a more reliable predictor of HTN than BMI or BF percentage. The effect of abdominal fat distribution on blood pressure is greater than that of total BF amount.

[Anthropometric measurements of general and central obesity and discriminative capacity on cardiovascular risk: RICARTO study]

INTRODUCTION AND OBJECTIVES

Overweight and obese patients have an increased risk of cardiovascular disease and general mortality. It is not clear which obesity index should be used in the clinic. The objective is to compare the relationship between body mass index (BMI), waist circumference (WC), waist-height ratio (WHR), and conicity index (Conicity-I) with 10-year Framingham cardiovascular risk (CVR).

MATERIAL AND METHODS

Population cross-sectional study in subjects ≥18years, residents in the Toledo (Spain) Health Area. Selection by random sampling. Measurements were made of the BMI, WC, and weight to height ratio with standardised methods. Framingham CVR. Calculation of AUC, and optimal cut-off points.

RESULTS

The study included 1,309 subjects, with mean age of 48.9±15.8years, and 55% women. The response rate was 36.6%. In women, the index that was best associated with CVR in women was the WC with an AUC=0.85 (95%CI: 0.81-0.88). In men it was the I-Conicity, with an AUC=0.81 (95%CI: 0.77-0.84). Cut points for BMI were similar in women (27.08kg/m²) and men (26.99kg/m²). The WC was lower in women (87.75cm) than in men (94.5cm). The WHR was higher in women (0.59) than in men (0.56). The I-Conicity was slightly lower in women (1.25) than in men (1.28). In women, all the ROC curves were closest to each other.

CONCLUSIONS

The central obesity indexes (WC and WHR) discriminated better than the BMI the CVR. In women, all the indices had greater AUCs than in men, except for the I-Conicity.

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.

Abdominal obesity linked to a longer cone-mediated dark-adaptation recovery time in healthy eyes

Obesity has been associated with abnormal lipid metabolism and with tissue hypoxia. Human Bruch's membrane (BrM) lipid deposits have been proposed to create a diffusion barrier to metabolic exchange between the choroid and photoreceptors, delaying the regeneration of photopigments. The speed of retinal dark adaptation (DA) is dependent on the regeneration of these photopigments. While the retina is extremely sensitive to hypoxia, the inner retina, which encodes visual contrast, is more affected by hypoxia than the outer retina. This study examines the association between adiposity measures and the time course of DA measured psychophysically through contrast detection to test the functionality of both the outer and inner retina. Cone-mediated DA recovery of contrast threshold (CT) was measured following near-total photopigment bleach for 6 min in 52 healthy eyes of 52 individuals (42.6 ± 18.3 years). Stimuli were sine-wave gratings of low-spatial frequency (1 cycle-per-degree (cpd)) and low luminance (1 cd/m²) generated at the centre of a CRT monitor. CT recovery functions were fitted to an exponential decay model to determine the time constant (τ, seconds) of cone sensitivity recovery, final cone CT (CT_f) and CT elevation (CT₀). Weight, height and waist circumference (WC) were measured and body mass index (BMI) and waist-to-height ratio (WHtR) calculated. Relationships were examined through Spearman correlation and through multiple linear regression using age, optical and adiposity measures as independent variables. The repeatability of cone time constant measurements was estimated by the Bland-Altman method and reported as the coefficient of repeatability (CoR). Mean ± SD of time constant and CT_f were 57.3 ± 27.7 s and -1.78 ± 0.20 log₁₀ units respectively. Cone time constant showed positive Spearman correlation with WC (p = 0.008) and WHtR (p = 0.023) but not with BMI (p = 0.058). Only WHtR emerged as an independent predictor of time constant (p = 0.001). CT_f was not correlated with any adiposity measures. Mean cone time constant was 41 s slower in subjects (25%, n = 13) with abdominal obesity (WHtR≥0.5). Mean CT_f was not significantly different in subjects with or without abdominal obesity. CoR for cone time constant was ±16 s. In adult subjects, greater abdominal obesity (WHtR) was related to a longer contrast recovery time for cone-mediated DA (time to dark-adapt) suggesting outer retinal dysfunction. Final contrast threshold, preferentially processed by inner retinal cells, was unaffected by abdominal obesity.

Personalised measures of obesity using waist to height ratios from an Australian health screening program

Objectives

The aim of the current study is to generate waist circumference to height ratio cut-off values for obesity categories from a model of the relationship between body mass index and waist circumference to height ratio. We compare the waist circumference to height ratio discovered in this way with cut-off values currently prevalent in practice that were originally derived using pragmatic criteria.

Method

Personalized data including age, gender, height, weight, waist circumference and presence of diabetes, hypertension and cardiovascular disease for 847 participants over eight years were assembled from participants attending a rural Australian health review clinic (DiabHealth). Obesity was classified based on the conventional body mass index measure (weight/height²) and compared to the waist circumference to height ratio. Correlations between the measures were evaluated on the screening data, and independently on data from the National Health and Nutrition Examination Survey that included age categories.

Results

This article recommends waist circumference to height ratio cut-off values based on an Australian rural sample and verified using the National Health and Nutrition Examination Survey database that facilitates the classification of obesity in clinical practice. Gender independent cut-off values are provided for waist circumference to height ratio that identify healthy (waist circumference to height ratio ≥0.45), overweight (0.53) and the three obese (0.60, 0.68, 0.75) categories verified on the National Health and Nutrition Examination Survey dataset. A strong linearity between the waist circumference to height ratio and the body mass index measure is demonstrated.

Conclusion

The recommended waist circumference to height ratio cut-off values provided a useful index for assessing stages of obesity and risk of chronic disease for improved healthcare in clinical practice.

Optimal cut-off for obesity and markers of metabolic syndrome for Ethiopian adults

BACKGROUND

Metabolic syndrome (MetS) is defined as the presence of central obesity plus any two of the following markers: high triglycerides (> 150 mg/dl), low high density lipoprotein (HDL) cholesterol < 40 mg/dl in men and < 50 mg/dl in women, hypertension (blood pressure > 130/85 mmHg or use of antihypertensive medication), high fasting blood glucose (> 100 mg/dl or use of treatment for diabetes mellitus). Since recently, metabolic syndrome and obesity have become emerging problems of both low and middle income countries, although they have been the leading cause of morbidity and mortality in high income countries for the past decades. It has been indicated that the international anthropometric cut-off for detecting obesity is not appropriate for Ethiopians. This study developed optimal cut off values for anthropometric indicators of obesity and markers of metabolic syndrome for Ethiopian adults to enhance preventive interventions.

METHODS

A total of 704 employees of Jimma University were randomly selected using their payroll as a sampling frame. Data on socio-demographic, anthropometry, clinical and blood samples were collected from February to April 2015. Receiver Operating Characteristic Curve analyses were used to determine optimal anthropometric cut-off values for obesity and markers of the metabolic syndrome. WHO indicators of obesity based on body fat percent (> 25% for males and > 35% for females) were used as binary classifiers for developing anthropometric cut-offs. Optimal cut-off values were presented using sensitivity, specificity and area under the curve.

RESULTS

The optimal cut-off for obesity using body mass index was 22.2 k/m2 for males and 24.5 kg/m2 for females. Similarly, the optimal waist circumference cut-off for obesity was 83.7 cm for males and 78.0 cm for females. The cut-off values for detecting obesity using waist to hip ratio and waist to height ratio were: WHR (0.88) and WHtR (0.49) for males, while they were 0.82 and 0.50 for females, respectively. Anthropometric cut-off values for markers of metabolic syndrome were lower compared to the international values. For females, the optimal BMI cut-offs for metabolic syndrome markers ranged from 24.8 kg/m2 (triglycerides) to 26.8 kg/m2 (fasting blood sugar). For WC the optimal cut-off ranged from of 82.1 cm (triglyceride) to 96.0 cm(HDL); while for WHtR the optimal values varied from 0.47(HDL) to 0.56(fasting blood sugar). Likewise, the optimal cut-offs of WHR for markers of metabolic syndrome ranged from 0.78(fasting blood sugar) to 0.89(HDL and blood pressure). For males, the optimal BMI cut-offs for metabolic syndrome markers ranged from 21.0 kg/m2 (HDL) to 23.5 kg/m2 (blood pressure). For WC, the optimal cut-off ranged from 85.3 cm (triglyceride) to 96.0 cm(fasting blood sugar); while for WHtR the optimal values varied from 0.47(BP, FBS and HDL) to 0.53(Triglyceride). Similarly, the optimal cut-offs of WHR form markers of metabolic syndrome ranged from 0.86(blood pressure) to 0.95(fasting blood sugar).

CONCLUSION

The optimal anthropometric cut-offs for obesity and markers of metabolic syndrome in Ethiopian adults are lower than the international values. The findings imply that the international cut-off for WC, WHtR, WHR and BMI underestimate obesity and metabolic syndrome markers among Ethiopian adults, which should be considered in developing intervention strategies. It is recommended to use the new cut-offs for public health interventions to curb the increasing magnitude of obesity and associated metabolic syndrome and diet related non-communicable diseases in Ethiopia.

Associations between anthropometric indices, blood pressure and physical fitness performance in young Swiss men: a cross-sectional study

OBJECTIVES

To assess the benefit of waist circumference (WC) measurements during routine conscription medical examination in two military conscription centres in Switzerland. We compared the prevalence of overweight and obesity assessed by body mass index (BMI) with the prevalence of elevated disease risks assessed by WC and waist-to-height ratio (WHtR). We investigated how these measures were associated with systolic blood pressure, physical fitness performance and socioeconomic determinants.

DESIGN

Cross-sectional survey.

SETTING

Two Swiss conscription centres in 2016.

PARTICIPANTS

1548 Swiss male conscripts, 18-22 years old.

MAIN OUTCOME

Prevalences of elevated WC, WHtR and BMI values according to WHO categories. Secondary outcomes include systolic blood pressure, physical fitness performance and endurance performance.

RESULTS

Using BMI cut-points, 25.0% of all conscripts were overweight or obese. When applying WC cut-points, 9.2% had an increased disease risk, while 14.8% of the conscripts were at risk using WHtR cut-points. In the BMI range of 25.0-27.4 kg/m², 3.6% showed an increased disease risk when using WC and 24.6% when using WHtR cut-points. Of the conscripts with a BMI of 27.5-29.9 kg/m², 72.4% had an increased disease risk using WHtR, and 42.5% when using WC cut-points. Determinants of elevated BMI, WC and WHtR were low occupational status, rural residential area, older age and location in central and Northwest Switzerland. Systolic blood pressure increased with increasing BMI, WC and WHtR. Physical fitness and endurance test performances decreased with increasing BMI, WC and WHtR.

CONCLUSION

In addition to BMI, WC and WHtR add relevant information to the health assessment of young men. However, the prevalence of overweight/increased health risk differed when using BMI, WC or WHtR. Further studies should include measures of body composition to test whether these differences arise from muscular young men within the overweight BMI range, who had a normal WC.

Association of divalent cations and insulin resistance with thyroid hormones in patients with type 2 diabetes mellitus

AIM

The study was primarily aimed at investigating the association of Magnesium and Zinc levels in the serum of adult Non- obese and Obese type 2 diabetic patients, with particular reference to thyroid comorbidity.

METHODS

108 patients with T2DM of both genders (24 Non obese and 84 Obese) were enrolled from a tertiary health care unit in Puducherry. The cardio-metabolic risk factors were assessed through body mass index, Waist hip ratio, blood pressure, fasting blood glucose, lipid profile and glycated haemoglobin. Zinc and Magnesium were quantitated. Insulin resistance was by Homeostasis model assessment. Serum free T4, T3 and TSH were also measured.

RESULTS

In non-obese type 2 diabetic group, Glycated haemoglobin had a strong positive correlation with free T4(r=0.784; p=0.003).TSH also depicted a positive association with HOMA-IR (r=0.924; p<0.001); whereas,T3 and Insulin had negative correlation with Magnesium (r=-0.599* and r=-0.620*; p 0.04 and 0.031). The levels of Zinc and Magnesium in the serum of obese diabetic patients had a positive correlation among them (r=0.565#; p<0.001). TAG/HDL ratio a measure of small dense LDL is positively correlated with LDL in both groups (r=0.881 and 0.912) with p value<0.001 for both.

CONCLUSION

Correlation among Glycemic control, Insulin resistance, Thyroid hormones, divalent cations and dyslipidemia depict differential characteristics in obese and non-obese type2 diabetes with Thyroid comorbidity.