Low body mass index is a risk factor for impaired endothelium-dependent vasodilation in humans: role of nitric oxide and oxidative stress

Air pollution-linked epigenetic modifications in placental DNA: Prognostic potential for identifying future foetal anomalies

Prenatal exposure to air pollution is a significant risk factor for the mother and the developing foetus. The accumulation of pollutants in the placenta can cause a self-cascade loop of pro-inflammatory cytokine responses and DNA double-strand breaks. Previous research has shown that airborne particulate matter can damage the epigenome and disturb mitochondrial machinery, ultimately impairing placental function. Mitochondria are essential for preserving cellular homeostasis, energy metabolism, redox equilibrium, and epigenetic reprogramming. As these organelles are subtle targets of environmental exposures, any disruption in the signaling pathways can result in epigenomic instability, which can impact gene expression and mitochondrial function. This, in turn, can lead to changes in DNA methylation, post-translational histone modifications, and aberrant expression of microRNAs in proliferating trophoblast cells. The placenta has two distinct layers, cytotrophoblasts, and syncytiotrophoblasts, each with its mitochondria, which play important roles in preeclampsia, gestational diabetes, and overall health. Foetal nucleic acids enter maternal circulation during placental development because of necrotic, apoptotic, and inflammatory mechanisms. These nucleic acids reflect normal or abnormal ongoing cellular changes during prenatal foetal development. Detecting cell-free DNA in the bloodstream can be a biomarker for predicting negative pregnancy-related outcomes and recognizing abnormalities in foetal growth. Hence, a thorough understanding of how air pollution induces epigenetic variations within the placenta could offer crucial insights into underlying mechanisms and prolonged repercussions on foetal development and susceptibility in later stages of life.

The effect of body mass index on stroke prognosis: A systematic review and meta-analysis of 32 cohort studies with 330,353 patients

BACKGROUND

Many studies have explored the impact of body mass index (BMI) on stroke prognosis, yet findings remain inconsistent.

AIMS

The aims of this study were to conduct a systematic review and meta-analyses to summarize the existing evidence on BMI and stroke outcomes.

METHODS

PubMed, Web of Science, Embase, The Cochrane Library, CNKI, CBM, Wanfang Database, and VIP Database were systematically searched from inception to 1 January 2023. Cohort studies were included if they reported on a population of patients with stroke, evaluated BMI on stroke outcomes (mortality/recurrence/score of modified Rankin scale (mRs)), and reported original data. Data extraction and quality assessment were independently undertaken by two reviewers. Stata 16.0 software was used for meta-analysis.

RESULTS

Thirty-two studies involving 330,353 patients (5 Chinese language articles) were included in the analysis. The proportion of underweight, overweight, and obese patients was 1.85%, 18.2%, and 15.6%, respectively. Compared with normal weight, being underweight was associated with an increased risk of mortality (relative risk (RR) = 1.78, 95% confidence interval (CI) = 1.60-1.96), poor functional outcomes defined as modified Rankin scale ⩾ 3 (RR = 1.33, 95% CI = 1.22-1.45), and stroke recurrence (RR = 1.19, 95% CI = 1.04-1.37). Being overweight but not obese was associated with reduced mortality (RR = 0.81, 95% CI = 0.74-0.89) and better functional outcomes (RR = 0.92, 95% CI = 0.89-0.96), but did not alter the risk of stroke recurrence (RR = 1.03, 95% CI = 0.90-1.17). Obesity was associated with lower risk of mortality (RR = 0.76, 95% CI = 0.72-0.81) and better functional outcomes (RR = 0.89, 95% CI = 0.84-0.94).

CONCLUSIONS

Our findings indicate that in patients with stroke, being underweight is associated with an increased risk of mortality, poor functional outcomes, and stroke recurrence. In contrast, being overweight but not obese, or being obese, was associated with a decreased risk of mortality and better functional outcomes. This is consistent with the obesity paradox in stroke, whereby obesity increases stroke risk in the general population but is associated with improved outcome in patients suffering stroke.

The Silent Threat to Women's Fertility: Uncovering the Devastating Effects of Oxidative Stress

Oxidative stress (OS), which arises through an imbalance between the formation of reactive oxygen species (ROS) and antioxidant defenses, plays a key role in the pathophysiology of female infertility, with the latter constituting just one of a number of diseases linked to OS as a potential cause. The aim of the present article is to review the literature regarding the association between OS and female infertility. Among the reproductive diseases considered are endometriosis and polycystic ovary syndrome (PCOS), while environmental pollutants, lifestyle variables, and underlying medical conditions possibly resulting in OS are additionally examined. Current evidence points to OS likely contributing to the pathophysiology of the above reproductive disorders, with the amount of damage done by OS being influenced by such variables as duration and severity of exposure and the individual's age and genetic predisposition. Also discussed are the processes via which OS may affect female fertility, these including DNA damage and mitochondrial dysfunction. Finally, the last section of the manuscript contains an evaluation of treatment options, including antioxidants and lifestyle modification, capable of minimizing OS in infertile women. The prime message underlined by this review is the importance of considering OS in the diagnosis and treatment of female infertility. Further studies are, nevertheless required to identify the best treatment regimen and its ideal duration.

Pathophysiological Impact of the MEK5/ERK5 Pathway in Oxidative Stress

Oxidative stress regulates many physiological and pathological processes. Indeed, a low increase in the basal level of reactive oxygen species (ROS) is essential for various cellular functions, including signal transduction, gene expression, cell survival or death, as well as antioxidant capacity. However, if the amount of generated ROS overcomes the antioxidant capacity, excessive ROS results in cellular dysfunctions as a consequence of damage to cellular components, including DNA, lipids and proteins, and may eventually lead to cell death or carcinogenesis. Both in vitro and in vivo investigations have shown that activation of the mitogen-activated protein kinase kinase 5/extracellular signal-regulated kinase 5 (MEK5/ERK5) pathway is frequently involved in oxidative stress-elicited effects. In particular, accumulating evidence identified a prominent role of this pathway in the anti-oxidative response. In this respect, activation of krüppel-like factor 2/4 and nuclear factor erythroid 2-related factor 2 emerged among the most frequent events in ERK5-mediated response to oxidative stress. This review summarizes what is known about the role of the MEK5/ERK5 pathway in the response to oxidative stress in pathophysiological contexts within the cardiovascular, respiratory, lymphohematopoietic, urinary and central nervous systems. The possible beneficial or detrimental effects exerted by the MEK5/ERK5 pathway in the above systems are also discussed.

Oxidative stress on vessels at the maternal-fetal interface for female reproductive system disorders: Update

Considerable evidence shows that oxidative stress exists in the pathophysiological process of female reproductive system diseases. At present, there have been many studies on oxidative stress of placenta during pregnancy, especially for preeclampsia. However, studies that directly focus on the effects of oxidative stress on blood vessels at the maternal-fetal interface and their associated possible outcomes are still incomplete and ambiguous. To provide an option for early clinical prediction and therapeutic application of oxidative stress in female reproductive system diseases, this paper briefly describes the composition of the maternal-fetal interface and the molecular mediators produced by oxidative stress, focuses on the sources of oxidative stress and the signaling pathways of oxidative stress at the maternal-fetal interface, expounds the adverse consequences of oxidative stress on blood vessels, and deeply discusses the relationship between oxidative stress and some pregnancy complications and other female reproductive system diseases.

Underweight predicts poststroke cardiovascular events in patients without atrial fibrillation

BACKGROUND AND PURPOSE

The purpose of this study was to determine whether underweight is associated with poststroke cardiovascular events and whether such association is different according to the presence of atrial fibrillation (AF).

METHODS

Patients with acute stroke or transient ischemic attack who were prospectively registered in a multicenter stroke database from April 2008 to July 2020 were analyzed, excluding those aged 75 or older and those who were overweight. We prospectively captured major adverse cardiovascular events (MACE) within one year after stroke. Cox-proportional hazard regression analysis was conducted for each subgroup with or without AF after adjusting for predetermined vascular risk factors and potential confounders.

RESULTS

Among 30,912 patients, 1494 (4.8%) cases were underweight and 29,418 (95.2%) cases were normal weight. The cumulative event rate of 1-year MACE was higher in the underweight group (9.0%) than in the normal weight group (5.6%). In Cox-proportional regression, underweight was associated with significantly higher MACE (adjusted hazard ratio [HR]: 1.62, 95% confidence interval [CI]: 1.26-2.09) and recurrent stroke (adjusted HR: 1.42, 95% CI: 1.02-1.98) in all study patients. In patients with AF, the risk of MACE for the underweight group was not significantly increased. In contrast, in patients without AF, the underweight group had a consistently higher risk of MACE (adjusted HR: 1.66, 95% CI: 1.25-2.22) and recurrent stroke (adjusted HR: 1.50, 95% CI: 1.05-2.14).

CONCLUSIONS

Underweight increased the risk of MACE and recurrent stroke within one year after acute stroke, especially in stroke without AF.

Obesity and Endothelial Function

Obesity is a major public health problem and is related to increasing rates of cardiovascular morbidity and mortality. Over 1.9 billion adults are overweight or obese worldwide and the prevalence of obesity is increasing. Obesity influences endothelial function through obesity-related complications such as hypertension, dyslipidemia, diabetes, metabolic syndrome, and obstructive sleep apnea syndrome. The excess fat accumulation in obesity causes adipocyte dysfunction and induces oxidative stress, insulin resistance, and inflammation leading to endothelial dysfunction. Several anthropometric indices and imaging modalities that are used to evaluate obesity have demonstrated an association between obesity and endothelial function. In the past few decades, there has been great focus on the mechanisms underlying endothelial dysfunction caused by obesity for the prevention and treatment of cardiovascular events. This review focuses on pathophysiological mechanisms of obesity-induced endothelial dysfunction and therapeutic targets of obesity.

Safety and efficacy of direct oral anticoagulants in comparison with warfarin across different BMI ranges: A systematic review and meta-analysis

Background

Many publications have compared various outcomes defining safety and efficacy of DOACs across different BMI ranges. Our meta-analysis compares warfarin and DOACs for its treatment effects over different BMI ranges.

Methods

A systematic search was conducted from inception to May 2021 on PubMed, Scopus and Embase databases. The data was extracted and pooled using a random effects model. Our study consisted of patients being treated for VTE and AF, across different BMI categories. For the comparison of DOAC, risk ratios (RR) with 95% confidence intervals (CIs) were used, whilst for the second comparison between warfarin and DOACs odds ratios (OR) were used.

Results

In our first comparison, 12 studies (n = 254,908 patients) were included. For our second comparison, six studies (n = 109,609 patients) were included. Major bleeding events in the underweight group were higher than normal weight [RR: 1.89 (1.10, 3.23); P = 0.02; I² = 0%]. Overweight patients were related with reduced rates of VTE than in patients with normal BMI [RR: 0.86 (0.76, 0.97); P = 0.02; I² = 0%]. In comparison with patients receiving warfarin, DOACs had significantly reduced risk of major bleeding in normal weight, overweight and obese [OR: 0.64 (0.49, 0.83); P = 0.0007 I² = 90%].

Conclusion

The risk of VTE reduces with an increasing BMI, hence there could be a possible obesity paradox in patients with anticoagulation therapy. In comparison to warfarin, DOACs proved to be the safer option by having a reduced risk of bleeding across all BMI categories.

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Warfarin therapy and its effectiveness for prevention of thromboembolism.

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Effect of warfarin and DOACs over different BMI ranges.

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Safety and efficacy of DOACs across different BMI ranges.

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Lower risk of bleeding in normal weight, overweight, and obese patients with DOACs.

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Warfarin and DOACs across different BMI categories in VTE and AF patients.

Prevalence of overweight/obesity, hypertension and its associated factors among women from Northeast India

OBJECTIVE

To assess prevalence of overweight/obesity, hypertension and its risk factors among women from North-eastern States of India.

METHODS

A community based cross-sectional study was carried out in two north-eastern States. Information was collected on household's socio-economic & demographic particulars. Height (cm), weight (kg), waist and hip circumferences and blood pressure were measured on all the selected women. Association between overweight/obesity, hypertension with socio-demographic variables was tested using Chi-square and logistic regression was done. Total 1047 women were covered from both the states.

RESULTS

The prevalence of chronic energy deficiency was 19% & 10%, overweight/obesity (BMI≥23) was 17.5% & 26% and hypertension was 15% & 17% (age adjusted 19.6% & 17%) respectively among women from Meghalaya & Nagaland. The prevalence of pre-hypertension was observed more among women from Nagaland (36.5%) as compared to Meghalaya (18.3%). Only 31% women were aware of hypertension and 6% had history of hypertension and 82% of them were on treatment. The prevalence of hypertension was observed high among 36-49 years and among overweight/obese women. On logistic regression, only age, BMI and use of additional salt was observed to be significantly associated with hypertension, while living in pucca house was associated with overweight/obesity.

CONCLUSIONS

The prevalence of hypertension was similar in both the states (15-17%) and pre-hypertension was high among women from Nagaland. This is warning sign for women in Nagaland. There is an urgent need to undertake more health & nutrition education sessions along with regular check-up for early diagnosis and treatment of hypertension.

Association of Visceral Obesity-Related Indices With Coronary Collateralization in Patients With Chronic Total Occlusion

Background: Obesity is an independent risk factor for cardiovascular disease. We investigated whether and to what extent visceral obesity-related indices were associated with coronary collateralization (CC) in chronic total occlusion (CTO) patients.

Methods: This retrospective cohort study involved 1,008 consecutive patients with CTO who underwent CTO-percutaneous coronary artery intervention (PCI). CC was graded according to the Rentrop scoring system. Data on demographic and clinical characteristics were collected by cardiovascular doctors. Logistic regression, receiver operating characteristic (ROC) curve and Kaplan-Meier analyses were performed to assess the predictive value of visceral obesity-related indices for CC.

Results: Overall, 1,008 inpatients were assigned to the poor CC group (n = 592) and good CC group (n = 416). In multivariate-adjusted logistic regression analyses, all visceral obesity-related indices (P-value < 0.001) were significantly associated with CC. After ROC analysis and the Delong test, the Chinese visceral adiposity index (CVAI) had the largest area under the curve (AUC) of 0.741 (0.711–0.771). Further analysis revealed that CVAI quartile remained a risk factor for poor CC in all groups, CVAI was associated with a 1.018-fold higher risk of poor CC (OR = 1.018, 95% CI: 1.014–1.021, P < 0.001). Individuals in the top CVAI quartile group had the highest risk of poor CC (OR = 10.657, 95% CI: 6.492–17.493, P < 0.001). Subgroup analyses showed similar results, and CVAI quartile remained a risk factor for poor CC. Moreover, increased CVAI predicted poor prognosis in CTO patients.

Conclusion: In summary, this study indicated that all the increased visceral obesity-related indices were significantly associated with increased poor CC risk. After adjusting for potential risks, CVAI had the best performance for estimating CC and predicting prognosis in CTO patients.

Sex, Age, BMI, and C-Reactive Protein Impact the Odds of Developing Hypertension-Findings Based on Data From the Health and Retirement Study (HRS)

BACKGROUND

Hypertension is a major contributor to cardiovascular diseases and premature death, therefore determining factors that contribute to such a high burden of disease is critically important. This study examined anthropometric and physical measurements, as well as blood and saliva biomarkers, as predictors for hypertension using datasets from the 2008 Health and Retirement Study.

METHODS

A total of 2,924 participants (aged 74.84 ± 6.45 years) were included. Binary logistic regression was performed to ascertain the effects of sex, age, telomere length, C-reactive protein (CRP), body mass index (BMI), and additional markers on the odds of developing hypertension.

RESULTS

Males had 2.3 times the odds (odds ratio (OR) = 2.313, confidence interval (CI) 95% (1.391, 3.845); P = 0.001) of being hypertensive if they were obese, females had 1.7 times the odds (OR = 1.788, CI 95% (1.260, 2.536); P = 0.001) if overweight, and 2.4 times (OR = 2.479, CI 95% (1.693, 3.630); P < 0.001) if obese. Age in females was an independent predictor where every 1-year increase in age was tied to a 5.1% increase in being hypertensive (OR = 1.051, CI 95% (1.027, 1.075); P <0.001), and CRP (>3 mg/l) had 1.4 times the odds (OR = 1.447, CI 95% (1.079, 1.942); P = 0.014).

CONCLUSIONS

This study provides verification for BMI as a predictor for hypertension and proposes age and CRP as predictors for females. Specific sex differences and life stage should be considered when evaluating hypertension risk to improve clinical outcomes and promote healthy aging.

Endothelin-1 axes in the framework of predictive, preventive and personalised (3P) medicine

Endothelin-1 (ET-1) is involved in the regulation of a myriad of processes highly relevant for physical and mental well-being; female and male health; in the modulation of senses, pain, stress reactions and drug sensitivity as well as healing processes, amongst others. Shifted ET-1 homeostasis may influence and predict the development and progression of suboptimal health conditions, metabolic impairments with cascading complications, ageing and related pathologies, cardiovascular diseases, neurodegenerative pathologies, aggressive malignancies, modulating, therefore, individual outcomes of both non-communicable and infectious diseases such as COVID-19. This article provides an in-depth analysis of the involvement of ET-1 and related regulatory pathways in physiological and pathophysiological processes and estimates its capacity as a predictor of ageing and related pathologies,a sensor of lifestyle quality and progression of suboptimal health conditions to diseases for their targeted preventionand as a potent target for cost-effective treatments tailored to the person.

Health screening program revealed risk factors associated with development and progression of papillomacular bundle defect

BACKGROUND/AIMS

The papillomacular bundle (PMB) area is an important anatomical site associated with central vision. As preventive medicine and health screening examinations are now becoming commonplace, the incidental detection of papillomacular bundle defect (PMBD) on fundus photography has been increasing. However, clinical significance of incidental PMBD has not been well documented to date. Thus, through long-term and longitudinal observation, we aimed to investigate the risk factors for the development and progression of PMBD and its predictive role associated with systemic diseases and glaucoma.

METHODS

This longitudinal study included subjects who had undergone standardized health screening. We retrospectively reviewed patients for whom PMBD had been detected in fundus photography and followed up for more than 5 years. For a comparative analysis, non-PMBD groups of age- and gender-matched healthy controls were selected.

RESULTS

A total of about 67,000 fundus photographs were analyzed for 8.0 years, and 587 PMBD eyes were found. Among them, 234 eyes of 234 patients who had had fundus photographs taken for more than 5 years were finally included. A total of 216 eyes (92.3%) did not progress during the 8.1 ± 2.7 years, whereas 18 eyes (7.7%) showed progression at 7.6 ± 2.9 years after initial detection. A multivariate logistic regression analysis using 224 non-PMBD healthy controls revealed low body mass index (BMI < 20 kg/m2), systemic hypertension, and sclerotic changes of retinal artery as the significant risk factors for the development of PMBD. Regarding PMBD progression, low BMI, concomitant retinal nerve fiber layer defect (RNFLD) at non-PMB sites, optic disc hemorrhage, and higher vertical cup/disc ratio were individual significant risk factors.

CONCLUSION

PMBD is associated with ischemic effects. Although the majority of PMBD do not progress, some of cases are associated with glaucomatous damage in a long-term way. PMBD might be a personalized indicator representing ischemia-associated diseases and a predictive factor for diagnosis and preventive management of glaucoma.

Association of Low-BMI with Aortic Stiffness in Young Healthy Individuals

BACKGROUND

Increased arterial stiffness is an independent predictor of cardiovascular morbidity and mortality. It is not known whether low-BMI has any detrimental effect on arterial wall early during young age.

OBJECTIVES

The present study was aimed to determine if low-BMI can increase arterial stiffness in young healthy individuals.

METHODS

A cross-sectional study was conducted on young healthy subjects (n=100) with low-BMI <18.5 (n=50) and normal-BMI: 18.5-24.9 (n=50) with age ranging between 15-23 years. BMI, heart rate, blood pressure and arterial stiffness indices such as regional pulse wave velocity (PWV) between brachial-ankle (baPWV), carotid-femoral (cfPWV), heart-ankle (haPWV), heart-brachial (hbPWV) were measured.

RESULTS

A significantly increased pulse pressure (p=0.014), baPWV (1059.2 ± 140.26 cm/s Vs 994.66 ± 129.23 cm/s; p=0.019) and cfPWV (641.03 ± 113.83 cm/s Vs 583.96 ± 120.48 cm/s; p=0.017) was found in individuals with low-BMI than normal-BMI group. There was a significant negative correlation between BMI and central arterial PWV. Further multiple regression analysis showed that BMI was robustly associated with cf-PWV (p=0.004) and baPWV (p=0.016) even after multiple adjustments with potential confounders using several models.

CONCLUSIONS

These findings show a significant increased aortic stiffness and pulse pressure in low-BMI subjects compared to those with normal BMI. Low-BMI was inversely and independently associated with central arterial or aortic stiffness. These findings suggest that low-BMI may be a risk factor for aortic stiffness in young healthy individuals.

Association of Body Mass Index with Endothelial Function in Asian Men

BACKGROUND

The association of body weight with cardiovascular events is still controversial. We evaluated the relationship between body mass index (BMI) and endothelial function.

METHODS

We measured flow-mediated vasodilation (FMD) and BMI in 7682 men. All participants were divided into four groups by BMI: underweight (<18.5 kg/m²), normal weight (18.5 to 24.9 kg/m²), overweight (25.0 to 29.9 kg/m²), and obesity (≥30.0 kg/m²).

RESULTS

Multiple logistic regression analysis revealed that overweight (OR: 1.30, 95% CI: 1.14-1.47; P < 0.001) and obesity (OR: 1.40, 95% CI: 1.09-1.80; P = 0.009) were associated with an increased risk of a low quartile of FMD. In 5571 younger adults (<60 years), overweight (OR: 1.34, 95% CI: 1.16-1.55; P < 0.001) and obesity (OR: 1.37, 95% CI: 1.04-1.81; P = 0.03) were associated with an increased risk of a low quartile of FMD, and underweight (OR: 0.56, 95% CI: 0.35-0.89; P = 0.01) was associated with a reduced risk of a low quartile of FMD. In 2111 older adults (≥60 years), underweight (OR: 2.16, 95% CI: 1.22-3.80; P = 0.008) was associated with an increased risk of a low quartile of FMD, and overweight and obesity were not associated with a risk of a low quartile of FMD.

CONCLUSIONS

In Asian men, endothelial function was impaired in the overweight and obesity groups compared with that in the normal weight group. The risk for endothelial dysfunction was higher in obese younger adults than in obese older adults. The association of BMI with endothelial function may be different in young and elderly men.

CLINICAL TRIAL REGISTRATION INFORMATION

http://www.umin.ac.jp (University Hospital Medical Information Network Clinical Trials Registry) (UMIN000012952).

Low Body Weight Increases the Risk of Ischemic Stroke and Major Bleeding in Atrial Fibrillation: The COOL-AF Registry

We aimed to determine if low body weight (LBW) status (<50 kg) is independently associated with increased risk of ischemic stroke and bleeding in Thai patients with non-valvular atrial fibrillation (NVAF). (1) Background: It has been unclear whether LBW influence clinical outcome of patients with NVAF. (2) Methods: This prospective multicenter cohort study included patients enrolled in the COOL-AF Registry. The following data were collected: demographic data, medical history, risk factors and comorbid conditions, laboratory and investigation data, and medications. Follow-up data were collected every 6 months. Clinical events during follow-up were confirmed by the adjudication committee. (3) Results: A total of 3367 patients were enrolled. The mean age was 67.2 ± 11.2 years. LBW was present in 338 patients (11.3%). Anticoagulant and antiplatelet was prescribed in 75.3% and 26.2% of patients, respectively. Ischemic stroke, major bleeding, intracerebral hemorrhage (ICH), and death occurred during follow-up in 2.9%, 4.4%, 1.4%, and 7.7% of patients, respectively, during 25.7 months follow-up. LBW was an independent predictor of ischemic stroke, major bleeding, ICH, and death, with a hazard ratio of 2.40, 1.79, 2.37, and 2.65, respectively. (4) Conclusions: LBW was independently associated with increased risk of adverse outcomes in Thai patients with NVAF. This should be carefully considered when balancing the risks and benefits of stroke prevention among patients with different body weights.

The Association Between Body Mass Index and Open-angle Glaucoma in a South Korean Population-based Sample

PURPOSE

The purpose of this article is to investigate the association between body mass index (BMI) and open-angle glaucoma (OAG) in a sample of the South Korean population.

MATERIALS AND METHODS

The sample consisted of a cross-sectional, population-based sample of 10,978 participants, 40 years of age and older, enrolled in the 2008 to 2011 Korean National Health and Nutrition Examination Survey. All participants had measured intraocular pressure <22 mm Hg and open anterior chamber angles. OAG was defined using disc and visual field criteria established by the International Society for Geographical and Epidemiological Ophthalmology. Multivariable analyses were performed to determine the association between BMI and OAG. These analyses were also performed in a sex-stratified and age-stratified manner.

RESULTS

After adjusting for potential confounding variables, lower BMI (<19 kg/m) was associated with greater risk of OAG compared with normal BMI (19 to 24.9 kg/m) [odds ratio (OR), 2.28; 95% confidence interval (CI), 1.22-4.26]. In sex-stratified analyses, low BMI remained adversely related to glaucoma in women (OR, 3.45; 95% CI, 1.42-8.38) but not in men (OR, 1.72; 95% CI, 0.71-4.20). In age-stratified analyses, lower BMI was adversely related to glaucoma among subjects 40- to 49-year old (OR, 5.16; 95% CI, 1.86-14.36) but differences in glaucoma prevalence were not statistically significant between those with low versus normal BMI in other age strata.

CONCLUSIONS

Lower BMI was associated with increased odds of OAG in a sample of the South Korean population. Multivariate analysis revealed the association to be statistically significant in women and those in the youngest age stratum.

Circulating markers of nitric oxide homeostasis and cardiometabolic diseases: insights from population-based studies

Emerging data suggest that impaired nitric oxide (NO) homeostasis has a key role in development of cardiometabolic disorders. The association between circulating levels of NO metabolites, i.e. nitrate and nitrite (NOx), and risk of chronic diseases has not yet been fully clarified. This work aims to address epidemiologic aspects of NO metabolism and discusses different physiologic and pathophysiologic conditions influencing circulating NOx. Further, cross-sectional associations of serum NOx with metabolic disorders are described and along the way, potential short-term and long-term power of serum NOx for predicting cardiometabolic outcomes are reviewed. Results from population-based studies show that circulating NOx is affected by aging, smoking habits, pregnancy, menopause status, thyroid hormones, and various pathologic conditions including type 2 diabetes, insulin resistance, hypertension, and renal dysfunction. Lifestyle factors, especially dietary habits, but also smoking habits and the degree of physical activity influence NO homeostasis and the circulating levels of NOx. Elevated serum NOx, due to increased iNOS activity, is associated with increased incidence of metabolic syndrome, different obesity phenotypes, and cardiovascular events.

High prevalence of hypertension and its selected risk factors among adult tribal population in Central India

A community based cross-sectional study was carried out to assess the prevalence of hypertension and associated risk factors like salt intake, 24-h urinary sodium excretion and body mass index (BMI) among tribal population of Mandla District, Central India. A total of 3090 individuals, from 1258 house hold drawn from 33 sampled villages and 12 urban wards were studied for blood pressure measurements and clinical examination, while 414 urine samples were collected for estimation of 24-h sodium excretion. Bivariate and multivariate logistic regression were used to assess the associations of BMI, urinary sodium output and other risk factors with hypertension. Across the sample, 28.2% of males and 23.6% of females had either stage-I or stage-II hypertension. More than 8% of subjects <30 years were hypertensive. The prevalence of hypertension shows a strong association with the increase in BMI and tribals with BMI > 25 were considerably more to have high blood pressure. Salt intake is directly related to the hypertension. The prevalence of hypertension was significantly greater among those whose salt intake was more than 10 g per day. A positive association between urine sodium excretion and blood pressure was observed. The results of the present study show that the tribal population is also affected by the life style diseases at par with the non-tribal population.

Body mass index moderates the relationship between C-reactive protein and depressive symptoms: evidence from the China Health and Retirement Longitudinal Study

The present study aimed to investigate the role of abnormal body mass index (BMI, kg/m²) in the depression-CRP (C-reactive protein) relationship in a healthy middle-aged and elderly Chinese population. Analytical samples were drawn from the China Health and Retirement Longitudinal Study (CHARLS), and participants were categorized by different BMI levels. Depressive subtypes were evaluated both at baseline and follow-up using the Center for Epidemiology Studies Depression scale. Hs-CRP and other variables were measured at baseline. Multiple linear regression analyses were used to evaluate the cross-sectional and longitudinal relationship between depression and baseline hs-CRP. Depression was significantly negatively associated with BMI (ρ = −0.077, p < 0.0001), with underweight associated with worse depressive symptoms than other BMI groups. Both cross-sectional and longitudinal associations between serum hs-CRP and depressive subtypes were significantly positive in the underweight group (p < 0.05). However, in the other BMI groups (from normal weight to obesity), the CRP-depression relationship was no longer significant (p > 0.05). The significant relationship between CRP and depression in the underweight group suggested that not only obesity but also a low BMI could explain a substantial portion of the inflammation-depression link.

Relation of Body Mass Index With Adverse Outcomes Among Patients With Atrial Fibrillation: A Meta-Analysis and Systematic Review

BACKGROUND

Several studies have investigated the impact of body mass index (BMI) on the prognosis of atrial fibrillation, but the results remain controversial. We sought to estimate the association of BMI with atrial fibrillation-related outcomes.

METHODS AND RESULTS

We systematically searched the Cochrane Library, PubMed, and Elsevier databases for all studies reporting associations between BMI and atrial fibrillation-related outcomes. Relative risks (RRs) and 95% CIs were extracted and pooled. Nine studies with 49 364 participants were included. Underweight BMI was associated with an increased risk of stroke or systemic embolism (RR 1.67, 95% CI 1.12-2.49), all-cause mortaliity (RR 2.61, 95% CI 2.21-3.09), and cardiovascular death (RR 2.49, 95% CI 1.38-4.50). Nevertheless, the pooled RRs of overweight and obese patients were lower than those of normal-weight patients for stroke or systemic embolism (overweight: RR 0.91, 95% CI 0.80-1.04; obese: RR 0.84, 95% CI 0.72-0.98; grade 1 obesity: RR 0.89, 95% CI 0.71-1.11; grade 2 obesity: RR 0.64, 95% CI 0.45-0.91; grade 3 obesity: RR 0.82, 95% CI 0.54-1.25), all-cause death (overweight: RR 0.78, 95% CI 0.62-0.96; obese: RR 0.84, 95% CI 0.64-1.10; grade 1 obesity: RR 0.64, 95% CI 0.57-0.73; grade 2 obesity: RR 0.70, 95% CI 0.47-1.03; grade 3 obesity: RR 0.72, 95% CI 0.59-0.88), and cardiovascular death (overweight: RR 0.79, 95% CI 0.58-1.08; obese: RR 0.99, 95% CI 0.79-1.24).

CONCLUSIONS

Underweight BMI is associated with an increased risk of stroke or systemic embolism, cardiovascular death, and all-cause death in Asian patients with atrial fibrillation, whereas in all atrial fibrillation patients, overweight and obese BMI was not associated with increased risks of these outcomes.

Enhancement of arterial pulsation during flow-mediated dilation is impaired in the presence of ischemic heart disease

Purpose

The aim of this study is to investigate the relationship between arterial pulse amplitude change under increased shear stress and the presence of ischemic heart disease (IHD).

Methods

This study comprised 31 subjects, including 14 subjects with IHD. We investigated the change in brachial artery pulse amplitude during flow-mediated dilation (FMD) using ultrasonography.

Results

The arterial pulse amplitude increased during FMD in 19 subjects, whereas it decreased in 12 subjects. There was a marked difference in the change in arterial pulse amplitude (the maximum amplitude of the arterial pulse amplitude during FMD/the arterial pulse amplitude at baseline) between subjects with and without IHD (0.98 ± 0.53 and 1.37 ± 0.53, p = 0.028). Furthermore, decreased arterial pulse amplitude during FMD was a significant predictor of IHD after adjustment of age, blood pressure, the presence of each type of coronary risks, the value of FMD and sex (p = 0.0001).

Conclusions

The decrease of arterial pulsation amplitude during FMD was a useful predictive parameter for IHD.

Electronic supplementary material

The online version of this article (doi:10.1186/s40064-016-2794-0) contains supplementary material, which is available to authorized users.

Comparison of Risk Factor Profiles for Primary Open-Angle Glaucoma Subtypes Defined by Pattern of Visual Field Loss: A Prospective Study

PURPOSE

We explored whether risk factor associations differed by primary open-angle glaucoma (POAG) subtypes defined by visual field (VF) loss pattern (i.e., paracentral or peripheral).

METHODS

We included 77,157 women in the Nurses' Health Study (NHS) and 42,773 men in the Health Professionals Follow-up Study (HPFS 1986-2010), and incident medical record confirmed cases of paracentral (n = 440) and peripheral (n = 865) POAG subtypes. We evaluated African heritage, glaucoma family history, body mass index (BMI), mean arterial blood pressure, diabetes mellitus, physical activity, smoking, caffeine intake, and alcohol intake. We used competing risk Cox regression analyses modeling age as the metameter and stratified by age, cohort, and event type. We sequentially identified factors with the least significant differences in associations with POAG subtypes ("stepwise down" approach with P for heterogeneity [P-het] < 0.10 as threshold).

RESULTS

Body mass index was more inversely associated with the POAG paracentral VF loss subtype than the peripheral VF loss subtype (per 10 kg/m2; hazard ratio [HR] = 0.67 [95% confidence interval (CI): 0.52, 0.86] versus HR = 0.93 [95% CI: 0.78, 1.10]; P-het = 0.03) as was smoking (per 10 pack-years; HR = 0.92 [95% CI: 0.87, 0.98] versus HR = 0.98 [95% CI: 0.94, 1.01]; P-het = 0.09). These findings were robust in sensitivity analyses using a "stepwise up" approach (identify factors that showed the most significant differences). Nonheterogeneous (P-het > 0.10) adverse associations with both POAG subtypes were observed with glaucoma family history, diabetes, African heritage, greater caffeine intake, and higher mean arterial pressure.

CONCLUSIONS

These data indicate that POAG with early paracentral VF loss has distinct as well as common determinants compared with POAG with peripheral VF loss.

Low BMI is inversely associated with arterial stiffness in Africans

In low socio-economic status communities in South Africa, African men showed a low BMI. Data on the effect of low BMI on cardiovascular function are scant. The present study aimed to assess the associations between low BMI and markers of cardiovascular function such as pulse wave velocity (PWV) and blood pressure in Africans aged 35-65 years, with low socio-economic status. The study population (n 496) was stratified into a low-BMI group with BMI ≤ 20 kg/m² and a normal-BMI group with BMI >20 kg/m² and ≤ 25 kg/m². Blood pressure (Omron HEM-757) and PWV (Complior SP; Artech-Medical) was determined. Africans with low BMI showed an increased arterial stiffness with significantly higher PWV compared with the normal-BMI group (men: P= 0.001; women: P= 0.026), which remained after adjustment. In men with low BMI, PWV correlated negatively with BMI before (r -0.204; P= 0.012) and after (r -0.200; P= 0.020) adjustment. Forward stepwise regression analyses indicated a negative association between PWV and BMI in African men. A J-curve was evident suggesting a detrimental effect of low BMI on cardiovascular function in Africans. A low BMI may contribute to the high prevalence of cardiovascular-related morbidity and mortality within a developing country.

Protective effects of novel metal-nonoates on the cellular components of the vascular system

At the cardiovascular level, nitric oxide (NO) controls smooth muscle functions, maintains vascular integrity, and exerts an antihypertensive effect. Metal-nonoates are a recently discovered class of NO donors, with NO release modulated through the complexation of the N-aminoethylpiperazine N-diazeniumdiolate ligand to metal ions, and thus representing a significant innovation with respect to the drugs traditionally used. In this study, we characterized the vascular protective effects of the most effective compound of this class, Ni(PipNONO)Cl, compared with the commercial N-diazeniumdiolate group derivate, diethylenetriamine/nitric oxide (DETA/NO). Ni(PipNONO)Cl induced a concentration-dependent relaxation of precontracted rat aortic rings. The ED50 was 0.67 µM, compared with 4.3 µM obtained with DETA/NO. When tested on cultured microvascular endothelial cells, Ni(PipNONO)Cl exerted a protective effect on the endothelium, promoting cell proliferation and survival in the picomolar range. The administration of Ni(PipNONO)Cl to vascular smooth muscle cells reduced the cell number, promoting their apoptosis at a high concentration (10 µM). Inhibition of smooth muscle cell migration, a hallmark of atherosclerosis, was accompanied by cytoskeletal rearrangement and loss of lamellipodia. When added to isolated platelets, Ni(PipNONO)Cl significantly reduced ADP-induced aggregation. Since atherosclerosis is accompanied by an inflammatory environment, cultured endothelial cells were exposed to interleukin (IL)-1β. In the presence of IL-1β, Ni(PipNONO)Cl inhibited cyclooxygenase-2 and inducible nitric oxide synthase upregulation, and reduced endothelial permeability and the platelet and monocyte adhesion markers CD31 and CD40 at the plasma membrane. Overall, these data indicate that Ni(PipNONO)Cl exerts vascular protective effects relevant for vascular dysfunction and prevention of atherosclerosis and thrombosis.

Protective effects of dietary carotenoids on risk of hip fracture in men: the Singapore Chinese Health Study

Experimental and epidemiologic data suggest that carotenoids in vegetables and fruits may benefit bone health due to their antioxidant properties. The relationship between dietary total and specific carotenoids, as well as vegetables and fruits, and risk of hip fracture was examined among Chinese in Singapore. We used data from the Singapore Chinese Health Study, a prospective cohort of 63,257 men and women who were of ages 45 to 74 years between 1993 and 1998. At recruitment, subjects were interviewed on lifestyle factors and medical history. Usual diet was measured using a validated food frequency questionnaire. During a mean follow-up of 9.9 years, we identified 1630 hip fracture incident cases. Among men, consumption of vegetables was associated with lower hip fracture risk. Similarly, dietary total carotenoids and specific carotenoids, α-carotene, β-carotene, and lutein/zeaxanthin were inversely associated with hip fracture risk. Compared to men in the lowest quartile of nutrient density, men in the highest quartile had statistically significant 26% to 39% risk reduction (all p for trend <0.05). When stratified by body mass index (BMI), the greatest protective effects of total vegetables and carotenoids were found in men with BMI <20 kg/m(2) (p for trend ≤0.004). There was no association between dietary carotenoids or vegetables/fruits and hip fracture risk among women. This study suggests that adequate intake of vegetables may reduce risk of osteoporotic fractures among elderly men and that the antioxidant effects of carotenoids may counteract the mechanism of osteoporosis related to leanness.

Obesity paradox in different populations: evidence and controversies

ABSTRACT: An inverse association between BMI and mortality has been reported in patients with coronary heart disease and heart failure. This ‘obesity paradox‘ has recently been reported in other disease states, including stroke, hypertension, incident diabetes, atrial fibrillation, hemodialysis and transcatheter aortic valve replacement. Cardiorespiratory fitness influences the obesity paradox and this inverse association may be present only in individuals with low fitness levels. Intentional weight loss, exercise training and improving lean mass are important and should be advised to all patients. Recent studies have also explored the association between measures of central obesity and direct measures of body fat with mortality. This review will summarize the evidence, controversies and mechanisms associated with the puzzling obesity paradox.

Endothelial dysfunction and hypertension in aging

Hypertension is one of the common diseases in the elderly. The prevalence of hypertension markedly increases with advancing age. Both aging and hypertension have a critical role in cardiovascular and cerebrovascular complications. Although aging and hypertension, either independently or collectively, impair endothelial function, aging and hypertension may have similar cascades for the pathogenesis and development of endothelial dysfunction. Nitric oxide (NO) has an important role in regulation of vascular tone. Decrease in NO bioavailability by endothelial dysfunction would lead to elevation of blood pressure. An imbalance of reduced production of NO or increased production of reactive oxygen species, mainly superoxide, may promote endothelial dysfunction. One possible mechanism by which the prevalence of hypertension is increased in relation to aging may be advancing endothelial dysfunction associated with aging through an increase in oxidative stress. In addition, endothelial cell senescence is also involved in aging-related endothelial dysfunction. In this review, we focus on recent findings and interactions between endothelial function, oxidative stress and hypertension in aging.

The effects of oxidative stress on female reproduction: a review

Oxidative stress (OS), a state characterized by an imbalance between pro-oxidant molecules including reactive oxygen and nitrogen species, and antioxidant defenses, has been identified to play a key role in the pathogenesis of subfertility in both males and females. The adverse effects of OS on sperm quality and functions have been well documented. In females, on the other hand, the impact of OS on oocytes and reproductive functions remains unclear. This imbalance between pro-oxidants and antioxidants can lead to a number of reproductive diseases such as endometriosis, polycystic ovary syndrome (PCOS), and unexplained infertility. Pregnancy complications such as spontaneous abortion, recurrent pregnancy loss, and preeclampsia, can also develop in response to OS. Studies have shown that extremes of body weight and lifestyle factors such as cigarette smoking, alcohol use, and recreational drug use can promote excess free radical production, which could affect fertility. Exposures to environmental pollutants are of increasing concern, as they too have been found to trigger oxidative states, possibly contributing to female infertility. This article will review the currently available literature on the roles of reactive species and OS in both normal and abnormal reproductive physiological processes. Antioxidant supplementation may be effective in controlling the production of ROS and continues to be explored as a potential strategy to overcome reproductive disorders associated with infertility. However, investigations conducted to date have been through animal or in vitro studies, which have produced largely conflicting results. The impact of OS on assisted reproductive techniques (ART) will be addressed, in addition to the possible benefits of antioxidant supplementation of ART culture media to increase the likelihood for ART success. Future randomized controlled clinical trials on humans are necessary to elucidate the precise mechanisms through which OS affects female reproductive abilities, and will facilitate further explorations of the possible benefits of antioxidants to treat infertility.

Combined effect of cardiorespiratory fitness and adiposity on mortality in patients with coronary artery disease

BACKGROUND

High cardiorespiratory fitness and body mass index (BMI) are associated with decreased mortality in patients with coronary artery disease. Our objective was to determine the joint impact of fitness and adiposity measures on all-cause mortality in this subgroup.

METHODS

Coronary artery disease patients (n = 855) enrolled in the Mayo Clinic cardiac rehabilitation program from 1993 to 2007 were included. Fitness levels were determined by cardiopulmonary exercise testing. Patients were divided into low and high fitness by sex-specific median values of peak oxygen consumption and total treadmill time. Adiposity was measured through BMI and waist-to-hip ratio (WHR).

RESULTS

There were 159 deaths during 9.7 ± 3.6 years of mean follow-up. After adjusting for potential confounding factors, low fitness, shorter treadmill time, low BMI, and high WHR were significantly associated with increased mortality. Using low WHR-high fitness group as reference, significantly increased mortality was noted in low WHR-low fitness (hazard ratio 4.2, 95% CI, 1.8-9.8), centrally obese-high fitness (2.3, 1.0-5.4), and centrally obese-low fitness (6.1, 2.7-13.6) groups. Overweight-high fitness (2.2, 0.63-7.4), obese-high fitness (3.2, 0.88-11.4), and obese-low fitness (3.3, 0.96-11.4) subjects did not have a significantly different mortality as compared with the reference group of normal weight-high fitness subjects, whereas normal weight-low fitness (9.6, 2.9-31.8) and overweight-low fitness (6.8, 2.1-22.2) groups had significantly increased mortality.

CONCLUSIONS

Low fitness and central obesity were independently and cumulatively associated with increased mortality in coronary artery disease patients attending cardiac rehabilitation. The association of BMI with mortality is complex and altered by fitness levels.

Risk factors for myocardial infarction among low socioeconomic status South Indian population

BACKGROUND

As longevity increases, cases of myocardial infarction (MI) are likely to be more. Cardiovascular disease (CVD) is a major global health problem reaching epidemic proportions in the Indian subcontinent, also among low socio-economic status (SES) and thin individuals.

OBJECTIVES

The present study was undertaken to elicit risk factors for MI among low SES Southern Indians and to find out its association with body mass index (BMI).

MATERIALS AND METHODS

A case-control study of patients with MI matched against healthy control subjects was carried out in a tertiary care teaching hospital. Standard methods were followed to elicit risk factors and BMI. Chi-square and Fishers exact test for categorical versus categorical, to show relationship with risk factors were analyzed.

RESULTS

A total of 949 patients (male (M) = 692 and post menopausal female (F) = 257) and 611 age and sex matched healthy controls were included. In our study, BMI was below 23 in 48.2% of patients and below 21 in 22.5%. The risk of developing MI was significantly more in males (odds ratio (OR) = 3.3, 95% confidence interval (C.I.) = 2.69-4.13), among females with post-menopausal duration (PMD) of more than or equal to 3 years (OR = 9.27, 95% C.I. = 6.36-13.50) and in those with BMI less than 23 with one or other risk factors (P = 0.002, OR = 1.38, 95% C.I. = 1.13-1.70).

CONCLUSION

BMI cannot be considered as a lone independent risk factor, as the study population had low BMI but had one or more modifiable risk factors. It would be advisable to keep BMI at least 21 kg/m2 for screening program. Health education on life style modification and programs to diagnose and control diabetes and hypertension have to be initiated at community level in order to reduce the occurrence.

Increased serum nitric oxide concentration after bariatric surgery--a potential mechanism for cardiovascular benefit

BACKGROUND

It is believed that endothelial dysfunction associated with obesity contributes to reduced vascular production of nitric oxide (NO). Weight reduction after bariatric surgery is known to decrease the risk of cardiovascular disease. The purpose of this study was to determine whether bariatric surgery leads to improvement of metabolic markers of endothelial function: serum NO and its precursor (arginine) concentrations in obese patients.

METHODS

Serum NO and L-arginine concentrations were measured in 25 morbidly obese patients directly before and 6 months after bariatric surgery. Moreover, selected parameters that may be involved in development of endothelial dysfunction were also studied. Control group consisted of ten healthy individuals with normal body weight.

RESULTS

Six months after bariatric surgery, serum NO concentration was approximately 40% higher than before surgery. Surprisingly, serum NO concentration in nonobese controls was essentially similar to obese patients before surgery. In contrast, serum L-arginine concentration was higher in obese patients than in controls and decreased significantly after surgery. The body weight, blood pressure, triacylglycerols, LDL/HDL-cholesterol ratio, insulin, homeostasis model assessment score (HOMA-index), C-reactive protein, and white blood cell count were higher in obese patients as compared with controls and decreased significantly after surgery.

CONCLUSIONS

Our results indicate that improvement of insulin resistance, lipidemia, and blood pressure as well as reduction of systemic inflammation after bariatric surgery were associated with the increase of serum NO concentration. We propose that the increase in serum NO concentration contribute to diverse beneficial effects of weight loss after bariatric surgery especially in the context of risk of atherosclerosis.

N epsilon-(hexanoyl) lysine, a new oxidative stress marker, is increased in metabolic syndrome, but not in obstructive sleep apnea

BACKGROUND

It is well known that oxidative stress is induced by metabolic syndrome (MetS), leading to cardiovascular diseases. On the other hand, obstructive sleep apnea syndrome (OSAS) is frequently complicated with MetS, and OSAS is also considered to induce oxidative stress. Thus, we examined the plasma and urine markers of oxidative stress and antioxidant status in patients with OSAS with or without MetS.

METHODS

Sixty-nine Japanese men suspected of having OSAS were recruited. We divided all patients into 3 groups: nonobese patients, obese patients without MetS, and patients with MetS. Oxidative stress markers, plasma and urine 8-hydroxydeoxyguanosine (8-OHdG) and plasma N epsilon-(hexanoyl) lysine (HEL), and an antioxidant status marker, plasma total antioxidant status, were measured by enzyme-linked immunosorbent assay.

RESULTS

The plasma HEL level was significantly increased in patients with MetS, whereas neither plasma and urine 8-OHdG levels nor plasma total antioxidant status level was different in patients with MetS. Furthermore, the plasma HEL level was significantly and positively correlated with fasting plasma glucose, serum insulin, and homeostasis model assessment-insulin resistance index in all subjects.

CONCLUSIONS

The oxidative stress is strongly associated with the presence of MetS but not related to the presence or severity of OSAS. Furthermore, we demonstrated that the plasma concentration of HEL is a more sensitive biomarker of oxidative stress in patients with MetS than the plasma and urine levels of 8-OHdG.

Role of marginal vitamin C deficiency in atherogenesis: in vivo models and clinical studies

Vitamin C is a pivotal redox modulater in many biological reactions of which several remain poorly understood. Naturally, vitamin C has been the subject of many investigations over the past decades in relation to its possible beneficial effects on cardiovascular disease primarily based on its powerful yet general antioxidant properties. However, growing epidemiological, clinical and experimental evidence now suggests a more specific role of ascorbate in vasomotion and in the prevention of atherosclerosis. For example, in contrast to most other biological antioxidants, administration of vitamin C can apparently induce vasodilation. Millions of people worldwide can be diagnosed with vitamin C deficiency according to accepted definitions. In this perspective, the present review examines the evidence for a specific link between vitamin C deficiency and increased risk of atherosclerosis as well as the possible mechanisms by which vitamin C may exert its protective function.

Interactive effect of central obesity and hypertension on cognitive function in older out-patients with Type 2 diabetes

AIM

Central obesity, hypertension and diabetes mellitus have been related individually to cognitive dysfunction. We aimed to study the interactive effects of these co-occurring risk factors on cognitive decline, which remain unclear in older patients with diabetes.

METHODS

We assessed metabolic profiles and neuropsychological functions in 60 older out-patients with Type 2 diabetes to examine the associations of central obesity with cognitive functions, while controlling for other confounding factors in these subjects.

RESULTS

Waist circumference was associated with poor performance in digits forward (r2 = 0.11, P = 0.02), choice reaction time (r2 = 0.08, P = 0.04) and cognitive reaction time (r2 = 0.07, P < 0.05) even after adjustment for potential confounders including age, gender, education and HbA1c. There were also significant interactions between central obesity and hypertension with respect to performance of digits forward (P = 0.04) and delayed verbal cued recall (P = 0.03).

CONCLUSION

Our findings suggest that, in addition to glycaemic control, central obesity and hypertension influence cognitive functions, such as attention and psychomotor speed in older patients with Type 2 diabetes.

Relation between body mass index and endothelium-dependent vasodilatation in healthy postmenopausal women

OBJECTIVE

To evaluate whether endothelium-dependent vasodilatation is related to anthropometric parameters in 105 healthy postmenopausal women 47-68 years of age.

METHODS

Flow-dependent, endothelium-dependent vasodilatation was considered as the maximal dilatation following deflation of a cuff placed on the forearm and inflated to supra-systolic blood pressure values for 4 min. Endothelium-independent vasodilatation was considered as the maximal dilatation induced by sublingual nitroglycerine (400 microg).

RESULTS

Among parameters such as height, weight, body mass index (BMI), waist, hip, waist/hip ratio, lipids, glucose or insulin, only BMI, an indirect index of adiposity, was independently and directly related to baseline brachial artery diameter (b = 0.042, r = 0.269, p = 0.0055) and flow-mediated endothelium-dependent vasodilatation either expressed as net (b = 0.034, r = 0.315, p = 0.001) or percentage (b = 0.376, r = 0.202, p = 0.039) change. Stratification for BMI categories showed that women with BMI < 22 kg/m(2) had an endothelium-dependent vasodilatation, significantly lower than that of women with BMI >or= 30 kg/m(2) (0.711 +/- 0.076 mm vs. 1.107 +/- 0.141 mm; p = 0.0114). BMI was not related to endothelium-independent vasodilatation.

CONCLUSIONS

Present results show that, in healthy postmenopausal women, endothelium-dependent vasodilatation is related to BMI, arteries of slender women dilating less than those of their heavier counterparts. A low BMI does not appear to be beneficial for artery vasodilatation in healthy postmenopausal women.

Association of body mass index with cognitive function in elderly hypertensive Japanese

BACKGROUND

As hypertension, obesity, and leanness are reported to be associated with poor cognitive function, it is possible that obesity or leanness in hypertensive patients may also be associated strongly with poor cognitive function.

METHODS

We recruited 184 elderly hypertensive patients comprising 93 very elderly (aged >or=80 years) and 91 younger elderly (aged 61-79 years) subjects. A mini-mental state examination (MMSE) and 24-h ambulatory blood pressure monitoring (ABPM) were performed in all participants. Patients were classified as either lean, normal physique, or obese according to the body mass index (BMI) quartile. The prevalence of poor cognitive function, total MMSE score, and MMSE subscores were compared between the groups.

RESULTS

The prevalence of poor cognitive function, total MMSE score, and MMSE subscore attention/calculation were significantly different between the groups both in the total study population and in the very elderly patients. The multiple logistic regression model showed that leanness was a significant determinant of poor cognitive function in both the total study population (odds ratio (OR) 2.54, 95% confidence interval (CI) 1.13-5.73, P = 0.02) and the very elderly patients (OR 3.94, 95% CI 1.31-11.82, P = 0.01). Obesity was not a significant determinant in either the total study population, very elderly, or younger elderly groups.

CONCLUSION

While obesity in hypertensive elderly patients was not associated with poor cognitive function, leanness in hypertensive elderly patients was, especially in the very elderly.

Weight loss alone improves conduit and resistance artery endothelial function in young and older overweight/obese adults

Obesity is associated with vascular endothelial dysfunction, as indicated by impaired endothelium-dependent dilation. Presently there is no direct evidence that energy intake-restricted weight loss alone improves conduit or resistance artery endothelium-dependent dilation, the mechanisms involved, or whether improvements differ with patient age. A total of 40 overweight or obese (body mass index: >or=25<40 kg/m(2)) nondiabetic men and women aged 21 to 69 years completed 12 weeks of reduced energy intake (n=26; 15 male) or attention control (n=14; 9 male) and 4 weeks of weight maintenance (randomized trial). Energy intake restriction reduced estimated total energy intake (33%), body weight (10.5%), total and abdominal body fat, plasma leptin, oxidized low-density lipoprotein, and improved several metabolic risk factors. Brachial artery flow-mediated dilation was increased by 30% (6.0+/-0.7% versus 7.9+/-0.7%Delta; P=0.01; n=17). Peak forearm blood flow during intrabrachial artery infusion of acetylcholine was increased by 26% (16.8+/-1.4 versus 21.1+/-1.9 mL/100 mL per minute; P<0.05; n=15); this was inversely related to the reduction in the abdominal visceral:subcutaneous fat ratio (r=-0.46; P<0.05) and was abolished by inhibition of NO synthesis with N(G)-monomethyl-L-arginine. Improvements in endothelium-dependent dilation were not related to age: mean increases in subjects >50 years of age were similar to or greater than those <50 years of age. Energy intake-restricted weight loss alone is an effective intervention for improving peripheral conduit and resistance artery endothelial function in young and older overweight/obese adults. The improvements in resistance artery function are mediated by an increase in NO bioavailability and are related to reductions in abdominal visceral fat.

Epidemiological evidence of altered cardiac autonomic function in overweight but not underweight subjects

BACKGROUND

Little is known about the altered cardiac autonomic function (CAF) across different levels of body mass index (BMI), including underweight, normal weight, overweight and obesity. This study provides a thorough analysis to clarify the CAF change in subjects with underweight, overweight and obesity.

METHODS

According to the World Health Organization (WHO) Asia-Pacific BMI cutoffs, a total of 1437 participants were classified as underweight (n=74), normal weight (n=588), overweight (n=313), obesity I (n=390) and obesity II (n=72). CAF was determined by standard deviation of normal-to-normal (SDNN) intervals or RR intervals, power spectrum in low (LF) and high frequency (HF) (LF, 0.04-0.15 Hz; HF, 0.15-0.40 Hz), and LF/HF ratio at supine for 5 min, the ratio between the 30th and the 15th RR interval after standing from the supine position (30/15 ratio) and the average heart-rate change while taking six deep breaths in 1 min (HR(DB)).

RESULTS

There were significant differences in age, gender, socioeconomic status, blood pressure, HOMA insulin resistance index, fasting glucose, cholesterol, triglyceride and high-density lipoprotein (HDL)-C, and the prevalence of hypertension, ischemic/left bundle branch block (LBBB) electrocardiography (EKG) pattern, current smoking and alcohol use among subjects with underweight, normal weight, overweight, obesity I and II. Univariate analysis showed that SDNN, HR(DB), HF power and the square root of the LF/HF ratio differed among these five groups. Multivariate analysis showed that obesity I and II were inverse correlates of HR(DB) and HF power. Overweight, obesity I and II were positively associated with the square root of the LF/HF ratio. No BMI status was related to SDNN, 30/15 ratio or LF power. Underweight was not the independent correlate of any CAF indices.

CONCLUSIONS

The risk for altered CAF is significant in overweight and obese subjects, independent of cardiovascular risk factors. Underweight is not apparently associated with CAF change.

Interaction of obesity and skeletal bone mineral density in tooth retention in Japanese postmenopausal women

OBJECTIVE

To investigate whether being overweight is associated with increased or decreased risk of tooth loss in Japanese postmenopausal women.

DESIGN

The number of remaining teeth (total, anterior, and posterior teeth), mandibular bone height, and mandibular cortical mass were evaluated on the dental panoramic radiographs of 450 Japanese postmenopausal women. The bone mineral densities (BMDs) at the lumbar spine and femoral neck were measured by dual-energy x-ray absorptiometry. These measurements were compared among participants in three body mass index (BMI) categories (underweight, normal BMI, and overweight).

RESULTS

Analysis of covariance adjusted for confounding variables revealed that participants who were overweight had a significantly lower number of total (P = 0.019) and anterior (P = 0.012) remaining teeth than did those with normal BMI, although the former had significantly higher skeletal BMD values than the latter. No significant difference was observed in mandibular bone height between the overweight participants and those with normal BMI. There were no significant differences in the number of remaining teeth between the under- and overweight participants. Overweight participants had significantly higher skeletal BMDs (P < 0.001) and tended to have larger mandibular cortical masses than those who were underweight.

CONCLUSIONS

Despite their higher skeletal BMD, postmenopausal women who are overweight may have an increased risk of tooth loss, especially of the anterior teeth, compared with women who have normal BMI. This risk appears to be similar to that for underweight women.