Short stature is related to high body fat composition despite body mass index in a Mexican population

Association of the Length of Service of 24/48 Firefighters with the Quality of Their Diet and Selected Anthropometric Parameters

The aim of the study was to examine the association of lengths of service (LS) ≤ 10 years and >10 years in 24/48 shifts with the quality of the observed diet based on the Nutrient Rich Food Index (NRF9.3) and selected anthropometric parameters of 130 firefighters of the State Fire Service (SFS) in Wroclaw, Poland. The study also analysed the individual components of the men's diets required to calculate the NRF9.3 index in both seniority groups. Men with LS > 10 years had statistically significant higher body weight (89.00 kg vs. 81.59 kg), body-fat level (22.80 kg vs. 17.95 kg), waist circumference (96.50 cm vs. 89.00 cm), body-fat percentage (21.94 ± 4.06% vs. 25.00 ± 5.45%), body mass index (BMI) (28.10 kg/m2 vs. 25.40 kg/m2) and waist-hip ratio (WHR) (0.84 0.92 vs. 0.84), compared to the LF ≤ 10 years group. In contrast, the quality of the men's dietary adherence, based on the calculated NRF9.3 index, did not differ between the study groups, and was 662.50 ± 103.1 and 664.78 for the LS ≤ 10 years and LS > 10 years groups, respectively. Based on a statistical analysis using the NRF9.3 diet quality index by tertile (NRF9.3-C), a leading and statistically significant association of LS > 10 years vs. ≤10 years was observed as to most of the anthropometric parameters studied. In contrast, the association of participants' diet quality, as assessed by the NRF9.3 index value, was insignificant for all anthropometric parameters studied.

Extreme Violence and Weight-Related Outcomes in Mexican Adults

Sociological research suggests that violent environments contribute to excess weight, a pressing health issue worldwide. However, this research has neglected extreme forms of violence, such as armed conflicts, a theoretically significant omission because armed conflict could reasonably lead to weight loss, not weight gain. I examine the weight-related, short-term consequences of the Mexican "War on Organized Crime." I combine body mass index (N = 3,341) and waist circumference (N = 3,509) measures from the Mexico Family Life Survey with a novel data set on aggressions, confrontations, and executions between 2009 and 2011 (CIDE-PPD database) and exploit variation in the timing of the outcome relative to violent events taking place in the same residential environment. I find a robust and large positive association between armed conflict events and weight gain in adults and suggestive evidence of the behavioral, emotional, and physiological/biochemical pathways connecting those variables.

Short Stature Modifies the Waist-to-height Ratio cut-off Points as an Indicator of Cardiovascular Risk in Mexican Adult Women and Men

BACKGROUND

Waist-to-height ratio (WHtR) is one of the anthropometric measures associated with cardiovascular risk (CVR). However, WHtR cut-off points may vary depending according to population characteristics, including sex and height.

OBJECTIVE

To identify optimal WHtR cut-off points to predict CVR factors by sex in Mexican adults according to height.

MATERIAL AND METHODS

Information from adults >20 years (n = 3550) from the 2016 National Health and Nutrition Survey were analyzed. Prevalence of high WHtR, CVR factors (glucose and insulin, lipid profile (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides) and blood pressure were estimated by sex and height (short height <1.60 and <1.50 m in men and women, respectively). The maximum proximity procedure was used to establish the point of maximum simultaneous sensitivity and specificity using the operating characteristic curve of the receiver. The estimates were stratified by sex and height condition.

RESULTS

The WHtR cut-off points identified to predict CVR were higher than those suggested for international use (≥0.5), being significantly higher (p <0.0001) for women (0.61) than for men (0.56). Also, the WHtR cut-off points were higher for short stature (men 0.58 and 0.56, women 0.63 and 0.58, with short and normal stature, respectively).

CONCLUSIONS

The WHtR cut-off points for predicting CVR in the Mexican population were higher than 0.5 in both sexes and it was higher for individuals with short stature. The identified cut-off points may be an additional tool in screening the adult population in Mexico to predict CVR.

Comparison of body fat percentage assessments by bioelectrical impedance analysis, anthropometrical prediction equations, and dual-energy X-ray absorptiometry in older women

Background

Individuals with high body fat have a higher risk of mortality. Numerous anthropometric-based predictive equations are available for body composition assessments; furthermore, bioelectrical impedance analysis (BIA) estimates are available. However, in older adults, the validity of body fat estimates requires further investigation.

Objective

To assess the agreement between percentage body fat (BF%) estimates by BIA and five predictive equations based on anthropometric characteristics using dual X-ray absorptiometry (DXA) as reference method. A secondary objective was to identify whether excluding short-stature women improves the agreement of BF% estimates in a group of community-dwelling, older Mexican women.

Methods

A concordance analysis of BF% was performed. A total of 121 older women participated in the study. Anthropometric information, BIA, and DXA body composition estimates were obtained. Five equations using anthropometric data were evaluated in order to determine body fat percentage (BF%) using DXA as reference method. Paired t-test comparisons and standard error of estimates (SEE) were obtained. The Bland-Altman plot with 95% limits of agreement and the concordance correlation coefficient (CCC) were used to evaluate the BF% prediction equations and BIA estimates.

Results

The mean age of the study participants was 73.7 (±5.8) years old. BIA and the anthropometric based equations examined showed mean significant differences when tested in the entire sample. For the taller women (height > 145 cm), no significant difference in the paired comparison was found between DXA and BIA of BF% estimates. The mean BF% was 40.3 (±4.8) and 40.7 (±6.2) for DXA and BIA, respectively. The concordance between methods was good (CCC 0.814), (SEE 2.62). Also, in the taller women subset, the Woolcott equation using waist-to-height ratio presented no significant difference in the paired comparison; however, the error of the estimates was high (SEE 3.37) and the concordance was moderate (CCC 0.693).

Conclusion

This study found that BIA yielded good results in the estimation of BF% among women with heights over 145 cm. Also, in this group, the Woolcott predictive equation based on waist circumference and height ratio showed no significant differences compared to DXA in the paired comparison; however, the large error of estimates observed may limit its application. In older women, short stature may impact the validity of the body fat percentage estimates of anthropometric-based predictive equations.

Impact of maternal height, weight at presentation and gestational weight gain on cardiac adaptation in pregnancy

OBJECTIVE

To compare longitudinal maternal hemodynamic changes throughout gestation between different groups stratified according to weight at presentation and assess the relative influence of height, weight at presentation and gestational weight gain on cardiac adaptation.

METHODS

This was a prospective, longitudinal study assessing maternal hemodynamics using bioreactance technology at 11 + 0 to 13 + 6, 19 + 0 to 24 + 0, 30 + 0 to 34 + 0 and 35 + 0 to 37 + 0 weeks' gestation. Women were divided into three groups according to maternal weight at presentation at the first visit at 11 + 0 to 13 + 6 weeks: Group 1, &lt; 60.0 kg (n = 421); Group 2, 60.0-79.7 kg (n = 904); Group 3, &gt; 79.7 kg (n = 427). A multilevel linear mixed-effects model was used to compare the repeated measures of hemodynamic variables, correcting for demographics, medical and obstetric history, pregnancy complications, maternal weight and time of evaluation. The linear mixed-effects model was then repeated using maternal height, weight at presentation and gestational weight gain Z-scores, and the standardized coefficients were used to evaluate the relative impact of each of these demographic parameters on longitudinal changes of maternal hemodynamics.

RESULTS

Compared with Group 1, women in Group 3 demonstrated higher cardiac output (CO), heart rate (HR) and mean arterial pressure (MAP) throughout pregnancy. Groups 2 and 3 had higher stroke volume (SV) than Group 1 at the first visit, but their SV plateaued between the first and second visits and demonstrated an earlier significant decrease from the second visit to the third visit when compared with Group 1. Compared with Groups 1 and 2, there was a higher prevalence of pre-eclampsia, gestational hypertension and gestational diabetes in Group 3. Maternal height was the most important contributor to CO, peripheral vascular resistance (PVR), SV and HR, while weight at presentation was the most important contributor to MAP. Gestational weight gain was the second most important characteristic influencing the longitudinal changes of PVR and SV.

CONCLUSIONS

Women with greater weight at presentation have a pathological hemodynamic profile, with higher CO, HR and MAP compared to women with lower weight at presentation. Height is the main determinant of CO, SV, HR and PVR, weight is the main determinant of MAP, and gestational weight gain is the second most important determinant of SV and PVR. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Body composition in preschool children with short stature: a case-control study

Background

Short stature is defined as height below 2 standard deviations of the population with the same age, gender. This study is aimed to assess the characteristics of body composition in preschool children with short stature.

Methods

Anthropometric measurements and body composition were assessed in 68 preschool children aged 3 to 6 years old with short stature and 68 normal controls matched on age and gender. Height, weight and body composition (total body water, protein, minerals, body fat mass, fat-free mass, soft lean mass, skeletal muscle mass, and bone mineral contents) in the two groups were measured and compared.

Results

The total body water, protein, minerals, body fat mass, fat-free mass, soft lean mass, skeletal muscle mass, and bone mineral contents were lower in preschool children with short stature than controls (P < 0.05). Body mass index and fat mass index did not differ between groups. Fat-free mass index was significantly lower in short stature group than controls (t = 2.17, P = 0.03). Linear regression analysis showed that there was a positive correlation between height and fat-free mass index [β, 1.99 (0.59, 3.39), P = 0.01], a negative correlation between height and body fat percentage [β, − 0.20 (− 0.38, − 0.01), P = 0.04]. The proportions of fat-free mass in the upper limbs were significantly lower (Right,t = − 2.78,Left t = − 2.76, P < 0.05, respectively) in short stature, although body fat distribution was not.

Conclusions

The fat-free mass such as protein and bone minerals is lower in preschool children with short stature, suggesting the monitoring of fat-free mass for early identification and intervention.

Looking for Crumbs in the Obesity Forest: Anti-obesity Interventions and Obesity-Associated Cardiometabolic Traits in the Mexican Population. History and Systematic Review With Meta-Analyses

Mexicans and Mexican Americans share culture, genetic background, and predisposition for chronic complications associated with obesity and diabetes making imperative efficacious treatments and prevention. Obesity has been treated for centuries focused-on weight loss while other treatments on associated conditions like gout, diabetes (T2D), and hypertriglyceridemia. To date, there is no systematic review that synthesizes the origin of obesity clinics in Mexico and the efforts to investigate treatments for obesity tested by randomized clinical trials (RCT). We conducted systematic searches in Pubmed, Scopus, and Web of Science to retrieve anti-obesity RCT through 2019 and without an inferior temporal limit. The systematic review included RCT of anti-obesity treatments in the Mexican adult population, covering alternative medicine, pharmacological, nutritional, behavioral, and surgical interventions reporting metabolism-associated traits such as BMI, weight, waist circumference, triglycerides, glucose, among others. Only the studies with at least 3 months of treatment were included in the meta-analyses in order to reduce placebo effects. We found 634 entries, after removal of duplicates and screening the studies based on eligibility criteria, we analyzed 43 national, and 2 multinational-collaborative studies. Most of the national studies had small sample sizes, and the implemented strategies do not have replications in the population. The nutrition/behavioral interventions were difficult to blind, and most studies have medium-to-high risk of bias. Nutritional/behavioral interventions and medications showed effects on BMI, waist circumference, and blood pressure. Simple measures like pure water instead of sweet beverages decrease triglycerides and systolic blood pressure. Dark chocolate showed the highest effect for BMI and high blood pressure, and treatment with insulin increased weight in those with T2D. The study of obesity in Mexico has been on-going for more than four decades, the interest on RCT just increased until this millennium, but with small sample sizes and lack of replication. The interventions affect different cardiometabolic associated traits, which should be analyzed in detail in the population living near the Mexico-U.S. border; therefore, bi-national collaboration is desirable to disentangle the cultural effects on this population's treatment response.

Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020221436, identifier: CRD42020221436.

Waist-To-Height Ratio Is a More Accurate Tool for Predicting Hypertension Than Waist-To-Hip Circumference and BMI in Patients With Type 2 Diabetes: A Prospective Study

Background: Anthropometric measures [i.e., body mass index (BMI), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR)] have been used as prediction factors for incident hypertension. However, whether any of these measures is superior to another in the matter of accuracy in predicting hypertension in diabetic patients has been controversial. The present prospective study aimed to determine whether WHtR is a more accurate tool for predicting hypertension than WHR and BMI in patients with type 2 diabetes.

Methods: The study population consisted of 1,685 normotensive patients with type 2 diabetes. BMI, WHR, and WHtR were assessed at baseline and followed up for hypertension incidence for a mean of 4.8 years. A cox regression analysis was performed to assess the association between anthropometric measures (i.e., BMI, WHR, and WHtR) and incident hypertension during the follow-up period. The area under the ROC curve analysis was performed and optimal cutoff values were calculated for each anthropometric measure for hypertension prediction.

Results: WHtR and BMI were significantly associated with an increased incidence of hypertension (HR = 3.296 (0.936–12.857), P < 0.001, and HR = 1.050 (1.030–1.070), P < 0.001, respectively). The discriminative powers for each anthropometric index for hypertension were 0.571 (0.540–0.602) for BMI, 0.518 (0.486–0.550) for WHR, and 0.609 (0.578–0.639) for WHtR. The optimal cutoff points for predicting hypertension in patients with type 2 diabetes were 26.94 (sensitivity = 0.739, specificity = 0.380) for BMI, 0.90 (sensitivity = 0.718, specificity = 0.279) for WHR, and 0.59 (sensitivity = 0.676, specificity = 0.517) for WHtR.

Conclusion: WHtR was a more accurate tool for predicting hypertension compared to WHR and BMI in patients with type 2 diabetes.

Faktor yang Berhubungan dengan Konsumsi Energi Ibu Menyusui di Kecamatan Cipayung, Kota Depok, Indonesia

Latar Belakang: Untuk mendukung kebutuhan gizi yang tinggi saat menyusui, ibu menyusui membutuhkan lebih banyak energi dibandingkan ibu hamil. Namun, berbagai studi melaporkan bahwa konsumsi energi ibu menyusui justru lebih rendah dibandingkan ibu hamil.Tujuan: Mengetahui faktor yang berhubungan dengan konsumsi energi ibu menyusui yang rendah di Kecamatan Cipayung Kota Depok Tahun 2016.Metode: Penelitian ini menganalisis data sekunder dari penelitian eksperimental semu dengan pendekatan kohort prospektif di Kota Depok. Total sampel berjumlah 169 responden. Analisis data pada penelitian ini menggunakan uji chi-square dan uji regresi logistik ganda.Hasil:  Konsumsi energi ibu saat hamil merupakan faktor dominan yang berhubungan dengan konsumsi energi ibu saat menyusui setelah dikontrol dengan paritas dan usia ibu. Ibu yang mengonsumsi energi dalam jumlah kurang saat hamil berisiko 3,5 kali lebih besar untuk mengonsumsi energi dalam jumlah kurang saat menyusui.Kesimpulan: Konsumsi energi ibu hamil sangat penting diperhatikan karena selain diperlukan untuk pertumbuhan dan perkembangan janin, sebagai cadangan lemak yang akan digunakan saat menyusui, juga untuk menjamin agar ibu mengonsumsi energi dalam jumlah cukup saat menyusui. 

Assessment of a proposed BMI formula in predicting body fat percentage among Filipino young adults

Body mass index (BMI), while routinely used in evaluating adiposity, cannot distinguish between fat and lean mass, and thus can misclassify weight status particularly among athletic, physically active, and tall- and short-statured individuals, whose lean-to-fat ratios and body proportions vary considerably from average individuals. Believing that the traditional BMI formula divides weight by too much with short people and by too little with tall people, University of Oxford professor L. N. Trefethen proposed a modified formula in computing BMI. This study was conducted among a sample of Filipino young adults (n = 190) to assess the performance of the modified BMI formula against the traditional one in: (1) predicting body fat percentage (%BF) measured using bioelectric impedance analysis, and (2) diagnosing overweight/obesity. Using robust polynomial regression analysis (covariates: age, waist circumference, smoking history and alcohol intake), the BMI quadratic models had the highest adjusted R2 and the lowest AIC and BIC for both sexes compared to the linear models. The AuROCs of the traditional BMI were higher than those of the proposed BMI, albeit nonsignificant. In conclusion, both traditional and modified BMIs significantly predicted %BF, as well as adequately discriminated between %BF-defined normal and overweight-obese states using optimal BMI cutoff values.

Relationship between Firefighter Physical Fitness and Special Ability Performance: Predictive Research Based on Machine Learning Algorithms

Firefighters require a high level of physical fitness to meet the demands of their job. The correlations and contributions of individual physical health parameters to the tasks of firefighting would enable firefighters to focus on the effects of specific physical conditions during their physical training programs. Therefore, the purpose of the present study was to identify the relationships between various physical health parameters (weight, maximum oxygen uptake, body fat percentage, upper body muscular power and lower body muscular power) and performance on simulated firefighting ability tasks, which included a set of seven tasks (rope climb, run 200 m round trip with load, 60 m carrying a ladder, climb stairs with load, evacuation of 400 m with supplies, run 5 km with an air respirator, run 100 m with the water hose). Through use of a partial least-squares regression (PLSR) algorithm to analyze the linear correlation, we revealed the change in various training performances of specific ability tests with physical fitness parameters. The present study demonstrated significant relationships among physical health parameters and performance on simulated firefighting ability tasks, which also represent that those parameters contributed significantly to the model’s predictive power and were suitable predictors of the simulated firefighting tasks score.

Waist-to-height ratio is a better discriminator of cardiovascular disease than other anthropometric indicators in Kurdish adults

It has been suggested that abdominal obesity might be a better cardiovascular diseases (CVDs) discriminator than overall obesity. The most appropriate obesity measures for estimating CVD events in Kurdish populations have not been well-recognized. The objective of the present study was, therefore, to determine the cutoff points of BMI, waist circumference (WC), waist-to-hip ratio (WHR), and waist to height ratio (WHtR) as the diagnostic cut-offs to discriminate the prevalent cardiovascular diseases. The data collected from Ravansar Non-Communicable Disease (RaNCD) cohort, the first Kurdish population-based study, was analyzed. The information related to BMI, WC, WHR and WHtR of 10,065 adult participants in the age range of 35–65 was analyzed in this study. Receiver operating characteristic (ROC) analyses were conducted to evaluate the optimum cut-off values and to predict the incidence of cardiac events. The results showed that WHtR had the largest areas under the ROC curve for cardiac events in both male and female participants, and this was followed by WHR, WC, and BMI. The optimal cut-off values for determining the cardiac events in the Kurdish population were BMI = 27.02 kg/m² for men and BMI = 27.60 kg/m² for women, WC = 96.05 cm in men and 99.5 cm for women, WHRs = 0.96 in both sexes, and WHtR = 0.56 for men and 0.65 for women. The current study, therefore, showed that WHtR might serve as a better index of prevalent cardiac event than BMI, WHR and WC.

Anthropometric indices predicting incident hypertension in an Iranian population: The Isfahan cohort study

Objective:

The aim of the present study was to assess different obesity indices, as well as their best cut-off point, to predict the occurrence of hypertension (HTN) in an Iranian population.

Methods:

In a population-based study, subjects aged 35 years and older were followed for 7 years. Blood pressure was measured at baseline and after the follow-up. Anthropometry indices included body mass index (BMI), body adiposity index (BAI), the waist-to-height ratio (WHtR), the waist-to-hip ratio (WHpR), and waist and hip circumferences (WC and HC). Logistic regression was employed to calculate the odds ratio (OR) and 95% confidence intervals (CI) per standard deviation (SD) increment. The operating characteristic analysis was used to derive the best cut-off value for each index.

Results:

Among original 6504 participants, 2450 subjects who had no cardiovascular diseases (CVD) and HTN at baseline were revisited, and 542 (22.1%) new cases of HTN were detected. There were minimal differences between most indices in the adjusted models; however, the best HTN predictors were BMI (OR per SD 1.32; 95% CI 1.12–1.56) and almost equally WC (1.35; 1.13–1.60) in men and WC (1.20; 1.04–1.39) in women. As a binary predictor, BMI with a cut-off point of 24.9 kg/m² in men (1.91; 1.40–2.62) and WC with a cut-off point of 98 cm in women (1.57; 1.17–2.10) were the best in adjusted models. WC, WHpR, and WHtR were significantly associated with an increased risk of HTN only in participants whose weight was normal (BMI, 18.5–24.9 kg/m²).

Conclusion:

Therefore, BMI in men and WC in women were the best predictors of HTN, both as continuous and binary factors at their appropriate cut-off points.

Obesity measured as percent body fat, relationship with body mass index, and percentile curves for Mexican pediatric population

In Mexico, the increase in childhood obesity is alarming. Thus, improving the precision of its diagnosis is expected to impact on disease prevention. We estimated obesity prevalence by bioimpedance-based percent body fat (%BF) and body mass index (BMI) in 1061 girls and 1121 boys, from 3 to 17 years old. Multiple regressions and area under receiver operating curves (AUC) were used to determine the predictive value of BMI on %BF and percentile curves were constructed. Overall obesity prevalence estimated by %BF was 43.7%, and by BMI it was 20.1%; it means that the diagnosis by BMI underestimated around 50% of children diagnosed with obesity by %BF (≥30% for girls, ≥25% for boys). The fat mass excess is further underestimated in boys than in girls when using the standard BMI classification. The relationship between %BF and BMI was strong in school children and adolescents (all cases R2>0.70), but not in preschool children (girls R2 = 0.57, boys R2 = 0.23). AUCs showed greater discriminative power of BMI to detect %BF obesity in school children and adolescents (all cases AUC≥0.90) than in preschool children (girls AUC = 0.86; boys AUC = 0.70). Growth percentile charts showed that girls aged 9-17 years and boys aged 8-17 years presented fat excess from the 50th percentile and above. We suggested to change the BMI cut-off for them, considering values at the 75th percentile as overweight, and values at the 85th percentile as obesity, as previously recommended for Mexican children. Improving obesity diagnosis will allow greater efficiency when searching for comorbidities in clinical practice.

Stature in adults as an indicator of socioeconomic inequalities in Mexico

Objective

To estimate the association between stature in Mexican adults and some sociodemographic factors.

Methods

We studied a sample of 30 970 subjects, using anthropometric data from the 2012 National Health and Nutrition Survey (ENSANUT 2012). The first quartile was used as the cutoff to define short stature. We analyzed differences among stature strata for sociodemographic variables by using the Kruskal-Wallis test. We estimated odds ratios to measure the association between stature and sociodemographic variables, controlling for potential confounders.

Results

Persons from the southern region of the country were some three times as likely to be of short stature than were subjects in the northern region. The stature difference between the Mexican states with the highest and the lowest average stature was larger than the average difference in stature between Mexico and the United States of America. Adults who had had less than six years of schooling presented the highest prevalence of short stature, regardless of sex, region of the country, place of residence (rural or urban), or the proportion of indigenous language speakers in a state. In addition, the stratum with the highest marginalization (percentage of the population lacking education and services, with a low income, and living in a small community) showed the highest prevalence of short stature.

Conclusion

In Mexico, adults who are of short stature have unequal living conditions when compared to those of average or high stature, and this could drive increases in health inequity.

Valoración del riesgo cardiometabólico determinado por variables antropometricas en niños escolares con diversidad étnica

El aumento progresivo de la obesidad en la población escolar chilena es preocupante, los niños mapuches, corren un riesgo alto de ser obesos, debido a la rápida transculturación y el acceso deficiente a información de salud pública. El propósito del estudio fue comparar variables antropometricas y su relación con el riesgo cardiometabólico en niños Mapuches y no-Mapuches, pertenecientes a colegios rurales de la IX Región de Chile. Se evaluaron 239 escolares (118 niñas y 121 niños) entre 6 y 12 años, pertenecientes a 3 colegios de rurales de la comuna de Cholchol, Imperial y Galvarino de la región de la Araucanía Chile, perteneciendo 177 escolares a la etnia mapuche, participaron de la investigación de forma voluntaria. Se recolectaron datos respecto a descendencia étnica (mapuche, no mapuche), edad, peso, talla, circunferencia cintura (CC), relación cintura estatura (RCE) y el índice de masa corporal (IMC). En la comparación por sexo y etnia no existieron diferencias significativas (p>0,05). Las variables Antropométricas de peso, CC, RCE, IMC fueron mayores en los sujetos con obesidad y presentaron significancia (p<0.001). El IMC presentó elevada correlación con el CC y presentó significancia (p<0,001). El resultado de la correlación de variables en población Mapuche del IMC con el CC fue mayor (0,909, p<0,001), en comparación a los no-Mapuches. En esta investigación reportó una elevada prevalencia de malnutrición por exceso 43,9% del grupo total estudiado y una alta relación entre el IMC, el CC y la RCE, siendo mayor está en los niños con etnia mapuche.

Body Mass Disorders in Healthy Short Children and in Children with Growth Hormone Deficiency

The aim of the study was to determine the degree of adiposity and the incidence of body mass disorders, including abdominal obesity, in healthy short children and children with growth hormone deficiency. The study included 134 short children (height < 10th percentile) aged 7-15. In this cohort there were 63 (31 boys and 32 girls) children without diagnosed hormonal disorders and 71 patients (35 boys and 36 girls) with growth hormone deficiency. Basic somatic features were assessed and the study participants were categorized according to the percentage of body fat (%FAT), body mass index (BMI), and waist-to-height ratio (WHtR). We found that there were no significant differences in %FAT and the incidence of body weight disorders depending on gender or diagnosis. %FAT deficit was observed in 12-21% of the participants and underweight in almost every fourth child. Overweight involved 3-14% of the participants and obesity was diagnosed in isolated cases (0-3%); both were considerably lower compared to the estimates based on %FAT. Using the cut-off points of WHtR, abdominal adiposity was observed in 3-15% of the participants. In conclusion, quite a large number of short children (between 25 and 50%) are characterized by abnormal body fat or body mass index values. The results indicate a limited usefulness of BMI in evaluating the incidence of overweight and obesity in children characterized by a height deficit.

Obesity indices predict hypertension among indigenous adults in Krau Wildlife Reserve, Peninsular Malaysia

BACKGROUND

The disease burden of indigenous peoples has been augmented by the rising prevalence of obesity and hypertension in this population. This study assessed the ability of obesity indices to predict hypertension among indigenous adults of Peninsular Malaysia.

METHODS

In this cross-sectional study, 482 adults (223 men, 259 women) aged ≥18 years old were measured for body mass index (BMI), waist circumference (WC), waist-height ratio (WHtR), waist-hip ratio (WHR), and blood pressure. Receiver operating characteristic (ROC) analysis was used to determine the predictive ability of obesity indices for hypertension in men and women. Gender-specific logistic regression analyses were done to examine the association between obesity, defined by BMI, WC, WHtR and WHR, and hypertension.

RESULTS

Prevalence of hypertension was 25.5%. Overall, WHtR was the best predictor of the presence of hypertension, in both men and women. The optimal WHtR cut-off values for hypertension were 0.45 and 0.52 in men and women, respectively. Obese adults with WHtR ≥0.5 had about two times increased odds of having hypertension compared to non-obese adults.

CONCLUSIONS

WHtR may serve as a simple and inexpensive screening tool to identify individuals with hypertension in this relatively difficult to reach population.

Height-adjusted percentiles evaluated central obesity in children and adolescents more effectively than just waist circumference

AIM

We compared the prevalence of obesity based on both waist circumference for height and body mass index (BMI) in Iranian children and adolescents.

METHODS

Data on 13 120 children with a mean age of 12.45 ± 3.36 years (50.8% male) from the fourth Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease study were included. Measured waist circumference values were modelled according to age, gender and height percentiles. The prevalence of obesity was estimated using the 90th percentiles for both unadjusted and height-adjusted waist circumferences and compared with the World Health Organization BMI cut-offs. They were analysed further for short, average and tall children.

RESULTS

Waist circumference values increased steadily with age. For short and average height children, the prevalence of obesity was higher when height-adjusted waist circumference was used. For taller children, the prevalence of obesity using height-adjusted waist circumference and BMI was similar, but lower than the prevalence based on measurements unadjusted for height. Height-adjusted waist circumference and BMI identified different children as having obesity, with overlaps of 69.47% for boys and 68.42% for girls.

CONCLUSION

Just using waist circumference underestimated obesity in some Iranian children and measurements should be adjusted for height.

Higher central fat and poor self-body image in short-stature overweight/obese women living in Brazilian shantytowns

Background

Short stature in adult life, a possible consequence of poor perinatal conditions, is associated with higher risk of mortality and social disabilities. We aimed to determine whether low-income, overweight/obese, short-stature (SS) women show alterations in body composition, self-body-image perception, and biochemical profile compared to their non-short (NS) counterparts.

Methods

A cross-sectional study was conducted with women living in shantytowns and mother or relatives to undernourished children treated in a center for recuperation and nutritional education. Inclusion criteria were: (1) age, 19–45 years; (2) stature < 152.3 cm or > 158.7 cm; and (3) body mass index > 25 kg/m². Socioeconomic, anthropometric, biochemical, and body image data were collected. We analyzed 56 SS and 57 NS women.

Results

The SS group showed a higher waist-to-height ratio (WHtR) (mean: 0.63; standard deviation: 0.06 for SS and mean: 0.60; standard deviation: 0.07 for the NS group; p = 0.02), and, in the adjusted analysis, showed lower fat-free mass (Estimated Marginal Mean for the SS group: 45.7 kg 95% confidence intervals (CI) (45.2–46.2) and for the NS group: 46.9 kg 95% CI (46.4–47.4); p < 0.01) and higher fat mass (Estimated Marginal Mean for the SS group: 32.5 95% CI (31.9–33.0) and for the NS group: 31.4 kg 95% CI (30.9–31.9); p < 0.01). Body mass index was a better predictor of current self-body-image perception for NS women. The SS coefficient values were β = 0.141, SE = 0.059, and R²-Nagelkerke = 0.107, and the NS coefficients values were β = 0.307, SE = 0.058, and R²-Nagelkerke = 0.491 (Z = 2.006; p < 0.05). Considering the obese subgroup, six out of 32 (18.8%) SS women and 14 out of 33 (42.4%) NS women perceived themselves as obese (χ² = 4.27; p = 0.03). This difference remained significant even after adjustment by age, schooling, and number of children (p = 0.04). Only the total thyroxin showed significant differences between groups, lower in SS women (p = 0.04).

Discussion

Overweight/obese, low-income SS women have more central adiposity and impaired self-body image perception, and the body mass index is a weaker predictor of it, compared to NS women. Misperception about body size may be linked with an overestimation of health and underestimation of risk, which may lead to a lower utilization of the health care system and inadequate physician counseling. These features may account, at least partially, for the higher mortality risk seen in SS adults.

Measures of body adiposity and visceral adiposity index as predictors of metabolic syndrome among Thai women with PCOS

AIM

To evaluate the relationship between measures of body adiposity and visceral adiposity index (VAI) and risk of metabolic syndrome (MS) and to identify the optimal cut-off points of each measurement in Thai polycystic ovary syndrome (PCOS).

METHODS

A cross-sectional study was completed physical examination, fasting plasma glucose, lipid profiles of 399 PCOS and 42 age-matched normal controls. Body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and VAI were calculated. Associations between different measures and MS were evaluated and the receiver-operating characteristic (ROC) curve was performed to determine appropriate cut-off points for identifying MS.

RESULTS

Percentage of MS in PCOS was 24.6%, whereas none MS in controls. Previously recommended cut-off values for body adiposity and VAI were significantly associated with MS. ROC curve analysis of the only PCOS showed newly obtained optimal cut-off points for BMI and VAI of ≥28 kg/m(2) (AUC = 0.90) and >5.6 (AUC = 0.94), respectively. Values found to be more accurate than the original ones. VAI was the best predictor, followed by BMI and WHtR.

CONCLUSION

All body adiposity and VAI parameters can predict the risk of MS. Optimal values for Thai PCOS were ≥28 kg/m(2) for BMI, ≥0.85 for WHR, ≥0.5 for WHtR and >5.6 for VAI.

Intergenerational influences on the growth of Maya children: The effect of living conditions experienced by mothers and maternal grandmothers during their childhood

OBJECTIVES

To test the hypothesis that living conditions experienced by maternal grandmothers (F1 generation) and mothers (F2 generation) during their childhood are related to height and leg length (LL: height - sitting height) of their 6-to-8 year old children (F3 generation).

METHODS

From September 2011 to June 2012 we obtained height and LL, and calculated z-score values of these measurements for 109 triads (F1 , F2 , F3 ) who are Maya living in Merida, Yucatan, Mexico. Multiple regression models were adjusted to examine the relation of anthropometric and intergenerational socioeconomic parameters of F1 (house index and family size during childhood) and F2 (paternal job loss during childhood) with the z-score values of height and LL of F3 .

RESULTS

Children's height and LL were positively associated with maternal height and LL. This association was relatively stronger in LL. Better categories of grand-maternal house index were significantly associated with higher values of height and LL in grandchildren. Grand-maternal family size was positively related with LL, but not with height.

CONCLUSIONS

Our findings partially support the hypothesis that living conditions experienced by recent maternal ancestors (F1 and F2 ) during their growth period influence the growth of descendants (F3 ). Results suggest that LL is more sensitive to intergenerational influences than is total height and that the transition from a traditional rural lifestyle to urban conditions results in new exposures for risk in human physical growth.

The relationship between anthropometric indices and type 2 diabetes mellitus among adults in north-east China

OBJECTIVE

The present study was performed to test the predictive value of different cut-off points of anthropometric parameters for the presence of type 2 diabetes (T2DM) or glucose tolerance abnormalities in north-east Chinese adults.

DESIGN

Multistage random cluster sampling method in a cross-sectional study.

SETTING

Height, body weight, maximal body weight in the past, waist and hip circumferences, blood pressure, 2 h post-load glucose and other lifestyle factors were measured.

SUBJECTS

We used data from 1058 adults aged 20 years or over, selected in the city of Mudanjiang, in 2005.

RESULTS

BMI, maximal BMI in the past (MAXBMI), waist:hip ratio (WHR), waist:height ratio (WHtR) and waist circumference (WC) were significantly correlated with each other. Partial correlation coefficients between WHtR and WC, and between MAXBMI and BMI, were higher than those between the other indices. The association of anthropometric indices with T2DM or glucose tolerance abnormalities was significantly highest for the collaboration cut-off points of MAXBMI (≥ 23.0 kg/m(2) for T2DM, ≥ 22.0 kg/m(2) for glucose tolerance abnormalities) with WHtR (≥ 0.52). Areas under the receiver-operating characteristic curves also showed that WHtR was a better anthropometric index that discriminated between the presence and absence of T2DM and an excellent indicator with high Youden's index.

CONCLUSIONS

MAXBMI combined with WHtR was a better anthropometric index associated with T2DM or glucose tolerance abnormalities. The combined use of these two measures is a good choice for T2DM prevention and screening.

Waist circumference is the best index for obesity-related cardiovascular disease risk in individuals with spinal cord injury

Obesity is an important identifier of cardiovascular disease (CVD) risk, but is challenging to determine accurately in individuals with spinal cord injury (SCI). Body mass index (BMI) is used worldwide as a simple indicator of obesity, but is difficult to measure in individuals with SCI. Furthermore, standard BMI cutoffs underestimate obesity in this population. Therefore, we aimed to identify the best marker of obesity in individuals with SCI, considering both practicality, and ability to detect adiposity and CVD risk. Five anthropometric measures were evaluated: BMI; waist circumference (WC); waist-to-height ratio (WHtR); waist-to-hip ratio; and neck circumference. We evaluated relationships between these measures and abdominal and total body-fat percentage, seven cardiovascular metabolic risk factors (fasting insulin, glucose, glucose tolerance, triglycerides, high-density lipoprotein, low-density lipoprotein, and total cholesterol), and the Framingham risk score. BMI, WC, and WHtR were correlated with abdominal fat percentage. WC and WHtR were correlated with five metabolic risk factors as well as the Framingham risk score. WC is a more practical measure for an SCI population. The optimal cutoff for identifying adverse CVD risk in individuals with SCI was identified as WC ≥94 cm, with 100% sensitivity and 79% specificity. We propose that WC is a simple, more sensitive alternative to BMI in this population that is easy to use in multiple settings. The cutoff provides a simple tool to predict adverse CVD risk profiles that can be used to guide risk management, as well as as a practical aid for individuals with SCI to maintain a healthy body composition.

Nutritional status of Maya children, their mothers, and their grandmothers residing in the City of Merida, Mexico: revisiting the leg-length hypothesis

OBJECTIVES

To test the hypothesis that leg length-relative-to-stature is a more sensitive indicator of nutrition and health than is total height (HT) or sitting height (SH) in a sample of 109 triads of urban Maya children (6.0-8.99 years), their mothers, and maternal grandmothers from Merida, Mexico.

METHODS

From September 2011 to June 2012, the following factors were obtained from all participants: (1) HT, SH, and leg length (LL); (2) the sitting height ratio (SHR = [SH × 100]/HT), relative leg length index (RLLI = [LL × 100]/height), and percentiles and z-scores of HT, SH, and LL were calculated; and (3) the percentages of stunting for children or very short ZHT for the adults, short ZSH, and short ZLL: HT-for-age, SH-for-age, or LL-for-age below the 5th percentile of the reference were calculated. Correlations were performed to examine the association between z-scores of HT, SH, and LL among three generations.

RESULTS

Stunting in children was 11% (short ZLL = 29%, short ZSH = 7%). Short ZHT was present in 71% of mothers (short ZLL = 54%, short ZSH = 50%) and 90% of grandmothers (short ZLL = 69%, short ZSH = 83%). Significant correlations in ZHT, ZSH, and ZLL were found in mother-to-child and grandmother-to-mother, with the strongest correlations for ZLL.

CONCLUSIONS

These findings support the hypothesis for children and mothers. Based on ZLL, there is evidence that childhood and nutrition have improved somewhat for each younger generation. Persistent environmental adversity during growth resulted in growth deficits for LL and SH for the mothers and grandmothers.

Implication of high-body-fat percentage on cardiometabolic risk in middle-aged, healthy, normal-weight adults

OBJECTIVE

This study investigated the number of Korean adults who had a normal body mass index (BMI) but high body-fat percentage (BF%) and determined their increased risk factors for cardiovascular diseases, including high blood pressure, hyperglycemia, and dyslipidemia.

DESIGN AND METHODS

This cross-sectional study was based on 12,386 subjects (6,534 men and 5,852 women), with a normal BMI, between 30 and 49 years of age. Subjects were categorized into two groups by BF% (normal BF% group, BF% <25 for men, and BF% <30 for women; high BF(%) group, BF% ≥25 for men, and BF% ≥30 for women).

RESULTS

The proportion of subjects with a normal BMI and high BF% was 12.7% (n = 1,572; 291 [4.5%] men and 1,281 [21.9%] women). Subjects with a high BF% had a significantly higher prevalence of high blood pressure (men only), hyperglycemia, and dyslipidemia. Multiple logistic regression analyses revealed that subjects with a normal BMI and high BF% had a 1.63 (adjusted odds ratio, 95% confidence interval: 1.21-2.19) in men and 1.56 (adjusted odds ratio, 95% confidence interval: 1.36-1.80) in women increased risk of one or more cardiovascular risk factors compared to subjects in the normal BMI and normal BF% group, even after adjusting for abdominal obesity.

CONCLUSION

High BF% is associated with a high cardiometabolic risks, regardless of abdominal obesity, in normal-weight Korean adults. Thus, follow-up screening of those with a high BF% may be necessary to detect and prevent cardiometabolic diseases, particularly for women with a normal BMI.

Anthropometric indices of central obesity how discriminators of metabolic syndrome in Brazilian women with polycystic ovary syndrome

BACKGROUND

Central obesity is highly prevalent in women with polycystic ovary syndrome (PCOS) and is strongly associated with metabolic syndrome (MetS).

OBJECTIVES

To define cut-off points of waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), and conicity index (C-Index) to discriminate metabolic syndrome (MetS) in Brazilian women with PCOS.

METHODS

In a cross-sectional study, anthropometric, biochemical and clinical parameters were measured in 113 Brazilian PCOS women (27.2 ± 4.5 years). Receiver operating characteristic (ROC) analysis was used to find out the cut-off points of anthropometric indices to predict MetS according with National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) criteria.

RESULTS

Considering the ROC curve analysis the WC and WHtR had a similar performance in predicting MetS and these parameters were better than WHR and C-Index. The optimal cut-off values of the anthropometric indices for discriminate MetS were: WC = 95 cm; WHtR = 0.59; WHR = 0.88; and C-Index = 1.25. By using these cut-off points the sensitivity and specificity rates of WC and WHtR were higher than those observed for WHR and C-Index.

CONCLUSION

Our results indicated that WC and WHtR are more accurate than WHR and C-Index to predict MetS in Brazilian PCOS 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.

How useful is BMI in predicting adiposity indicators in a sample of Maya children and women with high levels of stunting?

OBJECTIVES

Body mass index (BMI) is used frequently to estimate adiposity levels in children and adults. However, the applicability of BMI to populations with high levels of stunting has been questioned. Stunted people can have disproportionately short legs, which may increase BMI without increasing body fat because of the relatively larger trunk compared with the legs.

METHODS

A sample of 57 urban Maya schoolchildren, aged 7-9 years (31 boys), and 53 adult women underwent anthropometric assessments and bioelectrical impedance analysis. Multiple linear regression was performed to determine whether the ability of BMI to predict adiposity indicators is altered by stunting and sitting height ratio (SHR). The adiposity indicators were waist circumference, sum of skinfolds, upper arm muscle area, upper arm fat area, and arm fat index.

RESULTS

BMI was the strongest predictor of all adiposity indicators and in most cases, explained more of the variance in adiposity of Maya children than Maya women. Abdominal adiposity was better predicted by BMI than peripheral adiposity in Maya women and Maya children. Stunting was significant in predicting adiposity in some models but never substantially changed the variance explained. SHR was never a significant predictor.

CONCLUSIONS

The relationship between BMI and adiposity indicators is not changed by stunting status or body proportions in this short population of urban Maya children and women. BMI can be used as an indicator of adiposity for these children but not the women. It is recommended that BMI is used in conjunction with other estimates of body composition.

Associations between general and abdominal adiposity and mortality in individuals with diabetes mellitus

Individuals with diabetes mellitus are advised to achieve a healthy weight to prevent complications. However, fat mass distribution has hardly been investigated as a risk factor for diabetes complications. The authors studied associations between body mass index, waist circumference, waist/hip ratio, and waist/height ratio and mortality among individuals with diabetes mellitus. Within the European Prospective Investigation into Cancer and Nutrition, a subcohort was defined as 5,435 individuals with a confirmed self-report of diabetes mellitus at baseline in 1992-2000. Participants were aged 57.3 (standard deviation, 6.3) years, 54% were men, the median diabetes duration was 4.6 (interquartile range, 2.0-9.8) years, and 22% of the participants used insulin. Body mass index, as indicator of general obesity, was not associated with higher mortality, whereas all measurements of abdominal obesity showed a positive association. Associations generally were slightly weaker in women. The strongest association was observed for waist/height ratio: In the fifth quintile, the hazard rate ratio was 1.88 (95% confidence interval: 1.33, 2.65) for men and 2.46 (95% confidence interval: 1.46, 4.14) for women. Measurements of abdominal, but not general, adiposity were associated with higher mortality in diabetic individuals. The waist/height ratio showed the strongest association. Respective indicators might be investigated in risk prediction models.

AP diameter shows the strongest correlation with CTDI and DLP in abdominal and chest CT

The purpose of this study is to investigate the relationships among cross-sectional diameters, weight and computed tomography (CT) dose descriptors (CTDI and DLP) to identify which is best used as a measure for the establishment of DRLs in CT. Data (gender, weight, cross-sectional diameters, dose descriptors) from 56 adult patients attending for either a CT examination of the abdomen or chest was obtained from two spiral CT units using automatic milliampere modulation. The AP diameter was demonstrated as the main contributing factor influencing the dose in CT (CTDI: r(2) = 0.269, p-value < or =0.001; DLP: r(2) = 0.260, p-value < or =0.001) since it has a greater correlation with radiation dose than body weight and can thus be its substitute in dose-reduction strategies and establishment of DRLs. The advantages of using the AP diameter are that it can easily be measured prior to scanning or retrospectively from previous CT images. However, further studies on the practicality of this approach are recommended.

Obesity and excess mortality among the elderly in the United States and Mexico

Increasing levels of obesity could compromise future gains in life expectancy in low- and high-income countries. Although excess mortality associated with obesity and, more generally, higher levels of body mass index (BAI) have been investigated in the United States, there is little research about the impact of obesity on mortality in Latin American countries, where very the rapid rate of growth of prevalence of obesity and overweight occur jointly with poor socioeconomic conditions. The aim of this article is to assess the magnitude of excess mortality due to obesity and overweight in Mexico and the United States. For this purpose, we take advantage of two comparable data sets: the Health and Retirement Study 2000 and 2004 for the United States, and the Mexican Health and Aging Study 2001 and 2003 for Mexico. We find higher excess mortality risks among obese and overweight individuals aged 60 and older in Mexico than in the United States. Yet, when analyzing excess mortality among different socioeconomic strata, we observe greater gaps by education in the United States than in Mexico. We also find that although the probability of experiencing obesity-related chronic diseases among individuals with high BMI is larger for the U.S. elderly, the relative risk of dying conditional on experiencing these diseases is higher in Mexico.

Optimal anthropometric factor cutoffs for hyperglycemia, hypertension and dyslipidemia for the Taiwanese population

BACKGROUND

Optimal cutoffs for obesity indices are rarely studied in Asians. We evaluated these cutoffs for diabetes, hypertension, dyslipidemia and any risk factor for the Taiwanese general population.

METHODS

Body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), waist-height ratio (WHeiR) and other data for 4683 (2280 men and 2403 women) participants of the population-based Taiwanese Survey on Hypertension, Hyperglycemia and Hyperlipidemia were used. Areas under curves (AUCs) were analyzed and optimal cutoffs were estimated by maximizing the sums of sensitivity and specificity. Potential confounders included age, smoking, alcohol, betel nut chewing and exercise.

RESULTS

Optimal cutoffs for men and women, respectively, were 23.7-26.3 and 22.1-23.2 kg/m2 for BMI; 85.0-87.0 and 74.0-83.0 cm for WC; 0.87-0.90 and 0.78-0.83 for WHR; and 0.48-0.52 and 0.48-0.52 for WHeiR. AUCs were not significantly different among the indices for diabetes in men and for hypertension in women. In men, WHR was significantly inferior to the other indices for predicting hypertension, dyslipidemia and any risk factor. In women, BMI was significantly inferior to the others for diabetes. For dyslipidemia and any risk factor in women, WHeiR showed the largest AUCs and significant differences were seen in the following pairs: WHeiR vs. BMI and WHeiR vs. WHR for dyslipidemia and WC vs. WHR and WHeiR vs. WHR for any risk factor.

CONCLUSIONS

WC and WHeiR have similar efficacy and are superior to BMI and WHR. However, WHeiR has the extra benefit of a unisex cutoff within a narrow range.

The relationship of longitudinal screening of blood pressure in school-aged children in Sardinia with excessive weight

Our aim in this part of the Sardinian Hypertensive Adolescents Research Programme, also known as the SHARP study, was to use longitudinal screening over a period of 3 years to search for any relationship between hypertension and excessive weight in a number of Southern Italian students. We also sought to establish if this correlation can change according to the criterion used to define children considered to be overweight.We studied 839 children, of whom 52.6% were male, defining hypertension as an average blood pressure exceeding the 95th percentile according to previous Italian reference tables. We defined those overweight using different criteria, first those with a body mass index exceeding 25 kilograms per square metres, second those with the index exceeding the 85th percentile, third using the references established by Rolland-Cachera, and fourth according to the relative body weight. The different methods used in defining overweight produced very different estimates, ranging from 8.9% to 26.4%. Our novel findings were that systolic hypertension was present in all children deemed overweight using any of the criteria, but only use of the second and third criteria produced results related significantly to both systolic and diastolic hypertension. In short, excessive weight is strongly associated with systolic hypertension in adolescence. Definition of those being overweight on the basis of a body mass index exceeding the 85th percentile, or using the references established by Rolland-Cachera, proved to be best related with both systolic and diastolic hypertension.

Short stature and obesity: positive association in adults but inverse association in children and adolescents

Shorter than average adults are at a higher risk for obesity and are also more susceptible to diabetes and CVD, independent of BMI. In contrast, taller children have a higher risk of obesity. We hypothesised that short stature is related to adverse body composition and that the association between stature and obesity differs between generations. In a cross-sectional German database of 213 804 adults and 12 411 children and adolescents, the prevalence of overweight and obesity was compared between percentiles of height. The association between stature and percentage of fat mass (%FM), lean BMI (LBMI; kg/m2) or waist:hip ratio (in children only) was analysed within BMI groups. In adults, the prevalence of BMI >30 kg/m2 gradually increased with decreasing percentile of height whereas in children and adolescents, a positive association between height and weight status was observed. Short-stature women and girls had a 0·8–3·2 % lower %FM than tall subjects (P < 0·05), whereas no trend for %FM was observed in males. When compared with tall subjects, LBMI was 0·2–0·6 kg/m2 lower in short-stature men, as well as obese women (P < 0·05). There was a non-significant trend for a lower LBMI and a higher waist:hip ratio in shorter children. In conclusion, short stature is associated with an increased risk of obesity in adults. Cardiometabolic risk in short stature is not explained by an adverse body composition.

Waist-to-height ratio and coronary artery disease in Taiwanese type 2 diabetic patients

Waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHeiR), and BMI are indicators for obesity. This study examined the usefulness of these indicators for coronary artery disease (CAD) in Taiwanese type 2 diabetic patients. A total of 1,345 (646 men and 699 women) patients aged 63.3 +/- 11.5 years were studied. CAD was defined by history or Minnesota-coded electrocardiogram. The relative importance was evaluated by the magnitude of adjusted odds ratio per 1-s.d. increment, the decrease in -2 log likelihood after adding the index to the logistic model, the c-index, and the Akaiki's information criterion (AIC). Results showed that the four indices were highly intercorrelated and except BMI for men, all indices differed significantly between patients with and without CAD in either sex. In logistic regressions, the respective adjusted odds ratios for WC, WHR, WHeiR, and BMI for every 1-s.d. increment were 1.209 (1.010-1.448), 1.109 (0.935-1.316), 1.231 (1.027-1.474), and 1.207 (0.997-1.461) for men; and were 1.176 (0.995-1.390), 1.105 (0.923-1.322), 1.280 (1.079-1.518), and 1.277 (1.083-1.507) for women. Only WHeiR was significant for both sexes and it also showed the greatest decrease in -2 log likelihood, the largest magnitude of odds ratio, and the smallest AIC while compared with the other indices in either sex. It is concluded that WHeiR has the superiority of independent association with CAD and the highest magnitude of association than WC, WHR, and BMI in both sexes. The usefulness of WHeiR should not be neglected in clinical practice.

Detection of cardio-metabolic risk by BMI and waist circumference among a population of Guatemalan adults

BACKGROUND

BMI and waist circumference (WC) are used to screen for cardio-metabolic risk; however it is unclear how well these indices perform in populations subject to childhood stunting.

OBJECTIVES

To evaluate BMI and WC as indicators of cardio-metabolic risk and to determine optimal cut-off points among 1,325 Guatemalan adults (44 % stunted: 162 cm men).

METHODS

Cardio-metabolic risk factors were systolic/diastolic blood pressure 85 mmHg, glucose 5 mmol/l, TAG 7 mmol/l, ratio of total cholesterol to HDL-cholesterol 0, and the presence of two or more and three or more of the preceding risk factors. Receiver operating characteristic (ROC) curve analysis was used.

RESULTS

Areas under the ROC curve were in the range of 005978 for WC among men and 006472 among women, respectively. Optimal cut-off points for BMI were 242651 kg/m2 stunted; 242656 kg/m2 among women (262769 kg/m2 non-stunted). Optimal cut-off points for WC were 879134 cm stunted; 889333 cm among women (909486 cm non-stunted).

CONCLUSION

Optimal cut-off points for BMI were slightly higher among women than men with no meaningful differences by stature. Optimal cut-off points for WC were several centimetres lower for stunted compared with non-stunted men, and both were substantially lower than the current recommendations among Western populations. Cut-off points derived from Western populations may not be appropriate for developing countries with a high prevalence of stunting.

Obesity and nonalcoholic fatty liver disease

With the increasing prevalence of obesity and type 2 diabetes mellitus in the general population, nonalcoholic fatty liver disease (NAFLD) has become a common diagnosis in clinical practice. Insulin resistance and oxidative stress play an important role in NAFLD development and progression. NAFLD affects one in three adults and one in 10 children/adolescents in the United States. Mortality in patients with NAFLD is significantly higher than in the general population of same age and gender with liver-related complications. Lifestyle intervention may improve NAFLD, but medications that increase insulin sensitivity and the antioxidant defenses in the liver deserve evaluation in carefully controlled trials.

GI epidemiology: nonalcoholic fatty liver disease

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is a common diagnosis in clinical practice. Insulin resistance and oxidative stress play an important role in NAFLD development and progression.

AIM

To review the data available on the epidemiology and natural history of NAFLD as well as the risk factors for its development and the areas where future research is necessary. RESULTS /CONCLUSIONS: NAFLD may affect individuals of any age range and race/ethnicity. NAFLD affects one in three adults and one in ten children/adolescents in the United States. Mortality in patients with NAFLD is significantly higher than in the general population of same age and gender with liver-related complications being a common cause of death. Liver-related morbidity and mortality in NAFLD occurs when the disease has progressed to advanced fibrosis and cirrhosis. Further studies are necessary to determine the impact of NAFLD on health-related quality of life and resources utilization, and to the extent to which preventing the development of the metabolic syndrome would prevent NAFLD development and reduce liver-related morbidity and mortality. Lifestyle intervention may improve NAFLD, but medications that increase insulin sensitivity and the antioxidant defenses in the liver deserve evaluation in carefully controlled trials.

Nonalcoholic fatty liver disease and liver transplantation

Nonalcoholic fatty liver disease affects a substantial proportion of the general population worldwide. This high prevalence of nonalcoholic fatty liver disease has important consequences in the donor selection process for liver transplantation, and in the posttransplant period given the high recurrence rate of disease. This paper reviews the prevalence of nonalcoholic fatty liver disease, its progressive potential, and the implications of this liver condition in both the pre- and post-liver transplantation setting.

Fatness and overweight in women and children from riverine Amerindian communities of the Beni River (Bolivian Amazon)

Obesity is a worldwide public health problem impacting not only industrialized nations but also developing countries. The main objective of this paper was to analyze risk factors for overweight among Amerindian children and their mothers. Data were collected in 15 Amerindian riverside communities from the Beni River (Bolivia). The total sample was of 195 mothers and 452 children, 0-15 years of age. Information about family activity and dietary patterns was collected, and a clinical examination was performed. Stool samples were collected in children for parasitological screening. Anthropometric measurements, including weight, height, arm circumference, and four skinfolds, were taken. A bioelectrical impedance analysis was performed in mothers. In total, 12.2% (95% confidence interval (CI(95%)) 9.1-15.9%) of the children were considered overweight; less than 1% were overtly obese International Obesity Task Force (IOTF) criteria. Among their mothers, 35.3% (CI(95%), 28.7-42.5%) were overweight (BMI (weight/height (2)) >25 kg/m(2)), and 5% (CI(95%), 2.5-5.1%) were obese (BMI >30 kg/m(2)). BMI was moderately related to anthropometric indices of body composition in children, but was highly correlated with fatness in mothers. The risk of overweight was not associated with environmental factors in children. In mothers, there was a significant relationship between BMI, health status, and dietary diversity score. There was a moderate association in boys between fatness and the BMI of their mothers (R(2) = 0.12, P < 0.001), but not in girls. These findings suggest a trend toward accumulation of fat related to possible changes at the economic and agricultural levels, even in remote rural areas.

Relationship between sitting-height-to-stature ratio and adiposity in Brazilian women

Inadequate anthropometric dimensions, such as short leg length or high sitting-height-to-stature ratio (SHSR) in adults, can be considered indices of adverse environmental conditions in early life. Our objective was to describe the association between SHSR, a variable of prepubertal environment, and levels of adiposity in a group of Brazilian women. Six hundred and sixty-nine women aged 20-55 years were studied through a cross-sectional design. Detailed anthropometric measurements were obtained according to standardized procedures. Body mass index (BMI) > or = 30 kg/m2, percent body fat (% BF) measured through bioelectrical impedance >30, and the third tertile of six skinfold sums (SKF sum) were treated as dependent variables. High SHSR was defined as values > or = mean + 1 SD. Data analysis was performed using nonconditional hierarchical multivariate logistic regression, estimating adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for the three dependent variables. Thirty-two percent of women who had high SHSR had low stature, compared with 13.8% in the group with normal SHSR (P < 0.000). After adjustment for age, schooling, total family income, parity, and age of menarche, high SHSR was still associated with BMI > or = 30 kg/m2 (OR, 2.46; 95% CI, 1.31-4.60), % BF >30 (OR, 2.07; 95% CI, 1.11-3.61), and SKF sum (OR, 2.11; 95% CI, 1.33-3.35). These results support the hypothesis that high SHSR, a variable of prepubertal adverse environmental conditions, is independently associated with adiposity in this group of Brazilian women. Responsible factors for high SHSR, other than genetics, should be investigated.

The body mass index is a less-sensitive tool for detecting cases with obesity-associated co-morbidities in short stature subjects

OBJECTIVE

To assess the ability of the body mass index (BMI) to detect obesity-associated morbidity in subjects with a normal or short stature.

METHODS

Information was obtained on 119 975 subjects from a cardiovascular risk factors detection program. Standardized questionnaires were used. Capillary glucose and cholesterol concentrations were measured. Diabetes, arterial hypertension and hypercholesterolemia were selected as end points. Sensitivity, specificity and the likelihood ratio for several BMI thresholds were calculated. ROC curves were constructed to identify the BMI cutoff points with best diagnostic performance. The area under the curve (AUC) was used to assess the proficiency of BMI.

RESULTS

Short stature (height </=150 cm for women or </=160 cm for men) was found in 24 854 subjects (20.7%). These cases had a higher prevalence of type II diabetes and arterial hypertension even after adjusting for confounding variables. In addition, the frequency of the abnormalities was higher even at the lowest BMI values; the prevalence increased in direct proportion with the BMI, but at a lower rate compared to cases with normal stature. The AUC for every co-morbidity was smaller in short stature subjects. The likelihood ratio for detecting co-morbidities increased at the same BMI value in subjects with or without short stature.

CONCLUSIONS

The prevalence of obesity-associated co-morbidities is higher in subjects with short stature compared to those without it. The proficiency of BMI as a diagnostic tool is poor in short stature subjects. This problem is not resolved by decreasing BMI thresholds used to define overweight.