1
|
Palmu S, Kautiainen H, Eriksson JG, Hakovirta H, Korhonen PE. Body surface area is positively associated with ankle-brachial index. Sci Prog 2024; 107:368504241251649. [PMID: 38780467 PMCID: PMC11119366 DOI: 10.1177/00368504241251649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Ankle-brachial index (ABI) measurement is a widely used diagnostic test for lower extremity artery disease. Previously, a larger body surface area (BSA) has been associated with lower blood pressure and lower 2-h post-load glucose concentrations in the oral glucose tolerance test. Our aim was to evaluate whether BSA has an impact on ABI and the prevalence of lower ABI values. METHODS ABI measurements were performed on 972 subjects aged 45 to 70 years at high cardiovascular disease (CVD) risk. Subjects with previously diagnosed kidney disease, CVD, and diabetes were excluded. Their BSA was calculated by the Mosteller formula. Study subjects were divided into five BSA levels corresponding to 12.5th, 25th, 25th, 25th, and 12.5th percentiles of the total distribution. Effect modification by BSA in ABI between sexes was derived from a four-knot restricted cubic splines regression model. RESULTS After adjustments for age, sex, pulse pressure, glucose regulation, waist circumference, alcohol intake, smoking status, leisure-time physical activity and medication, BSA level had a positive linear relationship with ABI (p for linearity <0.001). When BSA was less than 2.0 m2, there was no difference between the sexes, but when BSA was higher than 2.0 m2, men had higher ABI. CONCLUSION BSA shows a positive linear relationship with ABI in CVD risk subjects without manifested CVD. The difference in ABI between men and women is modified by BSA and is appreciable when BSA is larger than 2.0 m2.
Collapse
Affiliation(s)
- Samuel Palmu
- Department of General Practice, University of Turku, Turku, Finland
| | - Hannu Kautiainen
- Folkhälsan Research Center, Helsinki, Finland
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Johan G. Eriksson
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Potential Translational Research programme and Department of Obstetrics and Gynecology, National University Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Harri Hakovirta
- Department of Surgery, University of Turku and Southwest Finland Wellbeing Services County, Turku, Finland
- Department of Surgery, Satasairaala Hospital, Satakunta Wellbeing Services County, Pori, Finland
| | - Päivi E. Korhonen
- Department of General Practice, University of Turku and Southwest Finland Wellbeing Services County, Turku, Finland
| |
Collapse
|
2
|
Tang L, Zeng L. Comparative efficacy of anthropometric indices in predicting 10-year ASCVD risk: insights from NHANES data. Front Cardiovasc Med 2024; 11:1341476. [PMID: 38486705 PMCID: PMC10937732 DOI: 10.3389/fcvm.2024.1341476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
Background Cardiovascular diseases remain a leading cause of morbidity and mortality worldwide. Accurately predicting the 10-year risk of Atherosclerotic Cardiovascular Disease (ASCVD) is crucial for timely intervention and management. This study aimed to evaluate the predictive performance of six anthropometric indices in assessing the 10-year ASCVD risk. Methods Utilizing data from the National Health and Nutrition Examination Survey (NHANES) database (1999-2018), the study involved 11,863 participants after applying exclusion criteria. Six anthropometric indices-waist circumference (WC), body mass index (BMI), waist-to-height ratio (WHtR), a body shape index (ABSI), body roundness index (BRI), and waist-to-height0.5 ratio (WHT.5R)-were calculated. The 10-year ASCVD risk was assessed using the 2013 ACC/AHA guidelines & pooled cohort equations model. Participants were divided into two groups based on an ASCVD risk threshold of 7.5%. Statistical analysis included chi-square tests, odds ratios, and receiver operating characteristic (ROC) curves. Results The study found significant differences in baseline characteristics between participants with ASCVD risk less than 7.5% and those with a risk greater than or equal to 7.5%, stratified by gender. In both male and female groups, individuals with higher ASCVD risk exhibited higher age, waist circumference, BMI, and a higher prevalence of health-compromising behaviors. ABSI emerged as the most accurate predictor of ASCVD risk, with the highest area under the curve (AUC) values in both genders. The optimal cut-off values for ABSI was established for effective risk stratification (cut-off value = 0.08). Conclusion The study underscores the importance of anthropometric indices, particularly ABSI, in predicting the 10-year risk of ASCVD. These findings suggest that ABSI, along with other indices, can be instrumental in identifying individuals at higher risk for ASCVD, thereby aiding in early intervention and prevention strategies.
Collapse
Affiliation(s)
- Li Tang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Ling Zeng
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| |
Collapse
|
3
|
Mohammadi F, Yadegar A, Rabizadeh S, Ayati A, Seyedi SA, Nabipoorashrafi SA, Esteghamati A, Nakhjavani M. Correlates of normal and decreased HDL cholesterol levels in type 2 diabetes: a cohort-based cross-sectional study. Lipids Health Dis 2024; 23:18. [PMID: 38243302 PMCID: PMC10797913 DOI: 10.1186/s12944-024-02010-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND The literature describes an inverse association between the values of triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C). This survey was designed to exhibit the features of people with type 2 diabetes (T2D) who display this inverse association and identify potential contributing factors to having normal HDL-C values. METHODS A total of 6127 persons with T2D were assigned to the present survey. Demographic features and clinical status data were compared between subjects with a substantial inverse association of TG and HDL-C and those without. Logistic regressions were performed to ascertain the role of different factors related to normal HDL-C. Moreover, the restricted cubic spline (RCS) functions were conducted to scrutinize the underlying relationships between the studied variables and low HDL-C levels. RESULTS Patients with high TG (150 ≤ TG < 400) compared to patients with normal TG (TG < 150) were less likely to have normal HDL-C. Younger age, narrow hip, lower levels of blood pressure, two-hour postprandial glucose (2hPP), fasting blood sugar (FBS), hemoglobinA1C (HbA1C), low-density lipoprotein cholesterol (LDL-C), total cholesterol, and non-HDL-C, higher atherogenic index of plasma (AIP), and TG/HDL-C ratio correlate with an inverse connection between the values of HDL-C and TG (all P < 0.05). Age greater than 65 years (odds ratio (OR) 1.260, 95% confidence intervals (CI) 1.124-1.413) had a positive association, whereas female sex (OR 0.467, CI 0.416-0.523) , 25 kg/m2 < body mass index (BMI) (OR 0.786, CI 0.691-0.894), and higher serum creatinine levels (OR 0.481, CI 0.372-0.621) had an inverse association with having normal HDL-C. CONCLUSIONS Patients with an inverse connection between TG and HDL-C values had considerably different anthropometric features, lipid profiles, and glucose indices compared to those without this relationship. Furthermore, patients who aged less than 65 years, had female gender, BMI more than 25 kg/m2, and higher serum creatinine levels were less likely to exhibit normal HDL-C levels.
Collapse
Affiliation(s)
- Fatemeh Mohammadi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Yadegar
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Soghra Rabizadeh
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Aryan Ayati
- Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Arsalan Seyedi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Nabipoorashrafi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
4
|
Müller SM, Floris J, Rohrmann S, Staub K, Matthes KL. Body height among adult male and female Swiss Health Survey participants in 2017: Trends by birth years and associations with self-reported health status and life satisfaction. Prev Med Rep 2022; 29:101980. [PMID: 36161131 PMCID: PMC9502675 DOI: 10.1016/j.pmedr.2022.101980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 09/02/2022] [Accepted: 09/02/2022] [Indexed: 11/25/2022] Open
Abstract
Increase in average body height had slowed down from around the 1970s birth cohorts. Women and men with tertiary education levels were taller than participants holding other education levels. Taller participants were less overweighted and were more satisfied with their lives than shorter participants. Taller participants had better overall health than shorter participants. Taller men were more likely to have lower back pain than shorter men.
The increase in adult height for 150 years is linked to overall improvements in nutrition, hygiene, and living standards. Height is positively associated with general health and success on various levels (e.g. quality of life, earnings or happiness). The aim of this study was to investigate whether different subgroups show different trends across birth cohorts. We wanted to know whether taller individuals considered themselves as healthier and their quality of life as better than shorter individuals. We included 19,435 participants from the Swiss population-based Health Survey 2017. GAM were used to assess nonlinear associations between height and birth year. Multinomial logistic regression was used to predict probabilities of self-rated health in relation to height. The increase in average height slows down from the 1970s birth cohorts. Participants with parents from Central/Northern/Western Europe (men 177.9 cm, women: 165.1 cm) or Eastern Europe (men 178.7 cm, women: 165.7 cm) were taller than participants with parents from South America (men 174.3 cm, women: 161. cm) and Asia (men 173.2 cm, women: 160.1 cm). Participants with tertiary education were taller than participants from education levels (mean difference men: 4.5 cm, women: 5.0 cm). Height was positively associated with self-declared aspects of health and life satisfaction. These results support the conclusion that body height as a co-factor of health aspects should be considered in public health research. Although adult body height can no longer be influenced, nutritional status and thus also healthy growth can be influenced in childhood by public health programs, by eliminating social inequalities, and by strengthen healthy living conditions.
Collapse
Affiliation(s)
| | - Joël Floris
- Institute of Evolutionary Medicine, University of Zurich, Switzerland.,Department of History, University of Zurich, Switzerland
| | - Sabine Rohrmann
- Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Switzerland.,Swiss School of Public Health (SSPH+), Zurich, Switzerland
| | - Kaspar Staub
- Institute of Evolutionary Medicine, University of Zurich, Switzerland.,Swiss School of Public Health (SSPH+), Zurich, Switzerland
| | | |
Collapse
|
5
|
Your height affects your health: genetic determinants and health-related outcomes in Taiwan. BMC Med 2022; 20:250. [PMID: 35831902 PMCID: PMC9281111 DOI: 10.1186/s12916-022-02450-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/22/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Height is an important anthropometric measurement and is associated with many health-related outcomes. Genome-wide association studies (GWASs) have identified hundreds of genetic loci associated with height, mainly in individuals of European ancestry. METHODS We performed genome-wide association analyses and replicated previously reported GWAS-determined single nucleotide polymorphisms (SNPs) in the Taiwanese Han population (Taiwan Biobank; n = 67,452). A genetic instrument composed of 251 SNPs was selected from our GWAS, based on height and replication results as the best-fit polygenic risk score (PRS), in accordance with the clumping and p-value threshold method. We also examined the association between genetically determined height (PRS251) and measured height (phenotype). We performed observational (phenotype) and genetic PRS251 association analyses of height and health-related outcomes. RESULTS GWAS identified 6843 SNPs in 89 genomic regions with genome-wide significance, including 18 novel loci. These were the most strongly associated genetic loci (EFEMP1, DIS3L2, ZBTB38, LCORL, HMGA1, CS, and GDF5) previously reported to play a role in height. There was a positive association between PRS251 and measured height (p < 0.001). Of the 14 traits and 49 diseases analyzed, we observed significant associations of measured and genetically determined height with only eight traits (p < 0.05/[14 + 49]). Height was positively associated with body weight, waist circumference, and hip circumference but negatively associated with body mass index, waist-hip ratio, body fat, total cholesterol, and low-density lipoprotein cholesterol (p < 0.05/[14 + 49]). CONCLUSIONS This study contributes to the understanding of the genetic features of height and health-related outcomes in individuals of Han Chinese ancestry in Taiwan.
Collapse
|
6
|
Wang K, Pan L, Wang D, Dong F, Yu Y, Wang L, Li L, Liu T, Sun L, Zhu G, Feng K, Xu K, Pang X, Chen T, Pan H, Ma J, Zhong Y, Shan G. Association between obesity indicators and cardiovascular risk factors among adults in low-income Han Chinese from southwest China. Medicine (Baltimore) 2020; 99:e20176. [PMID: 32791656 PMCID: PMC7387039 DOI: 10.1097/md.0000000000020176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
There may be differences in optimal anthropometric cut-offs for diagnosing obesity among different regions of China. However, there has been little studies about choosing effective obesity indicators in Han People of low-income Chinese adults in southwest China. The purpose of this study was to compare and evaluate the associations between different obesity indicators and cardiovascular disease risk factors (CVDRF) and choose the optimal cut-off values.A cross-sectional study was carried out in southwest of China, with multi-stage sampling enrolling 2112 subjects aged 20 to 80 years old. Anthropometric measurements included Body mass index (BMI), waist circumference (WC), Hip circumference, waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). We measured the percentage of body fat (PBF) by bioelectrical impedance analyzer to assess the body composition. The validity of different obesity indicators in assessing CVDRF risk were assessed through comparison area under curve of different indicators in assessing CVDRF risk in different gender. Logistic regression models were used to evaluate the association between the obesity indicators and CVDRF.When both male and female were considered, the optimal indicators were WHtR and percentage of body fat PBF for hypertension, WHR and WHtR for dyslipidemia. Both WC and WHtR were optimal indicators in assessing metabolic syndrome risk for both genders. When both disease and gender were considered, WHtR was the best associated indicators with various CVDRF. The cut-off of BMI and WC were consistent to the definition of obesity in Working Group of China. The WHtR positively correlated with the CVDRF. The cut-off of WHtR to do what was approximately 0.50 for adults in both genders in southwest of China.WHtR may be the best associated indicators for obesity-related CVDRF among the others (BMI, WC, Hip circumference, PBF, and WHR) in southwest of China. The cut-off of WHtR was approximately 0.50 for adults in both genders in southwest of China.
Collapse
Affiliation(s)
- Ke Wang
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Epidemiology, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Li Pan
- Department of Epidemiology, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Dingming Wang
- Guizhou Center for Disease Control and Prevention, Guizhou, China
| | - Fen Dong
- Department of Epidemiology, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Yangwen Yu
- Guizhou Center for Disease Control and Prevention, Guizhou, China
| | - Li Wang
- Department of Epidemiology, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Ling Li
- Guizhou Center for Disease Control and Prevention, Guizhou, China
| | - Tao Liu
- Guizhou Center for Disease Control and Prevention, Guizhou, China
| | - Liangxian Sun
- Guizhou Center for Disease Control and Prevention, Guizhou, China
| | - Guangjin Zhu
- Department of Epidemiology, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Kui Feng
- Department of Epidemiology, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Ke Xu
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xinglong Pang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ting Chen
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hui Pan
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jin Ma
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yong Zhong
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Guangliang Shan
- Department of Epidemiology, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| |
Collapse
|
7
|
Short Stature is Associated with Increased Risk of Dyslipidemia in Korean Adolescents and Adults. Sci Rep 2019; 9:14090. [PMID: 31575921 PMCID: PMC6773853 DOI: 10.1038/s41598-019-50524-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 09/12/2019] [Indexed: 12/26/2022] Open
Abstract
Adults with short stature have been previously reported to have increased risk of cardiovascular events and hyper-LDL-cholesterolemia. We aimed to assess the association between height and lipid profiles among Korean adolescents and adults. We analyzed data from the Korea National Health and Nutrition Examination Survey from 2007 to 2015, from 37,889 individuals (aged 12–59 years). In adolescents, total cholesterol (TC) and low density lipoprotein-cholesterol (LDL-C) levels had profound associations with height in both boys and girls, while high density lipoprotein-cholesterol (HDL-C) levels had an inverse association with height only in boys. Height was inversely associated with TC, triglycerides (TG), and LDL-C concentrations in men and women and positively correlated with HDL-C concentration in women. In boys, the odds ratios (ORs) for hypercholesterolemia, hypertriglyceridemia, hyper-LDL-cholesterolemia were higher for shorter subjects (ORs = 2.38~7.01), while only the OR of hyper-LDL-cholesterolemia was significantly higher in girls with short stature (OR = 3.12). In adults, the ORs for hypercholesterolemia, hypo-HDL-cholesterolemia, and hyper-LDL-cholesterolemia were significantly higher in short subjects than in tall subjects after controlling for covariates (ORs = 1.50~2.61). Also, short men showed significantly higher ORs for hypertriglyceridemia (OR = 1.85) than tall men. Short stature was significantly associated with adverse lipid profiles in both adolescents and adults.
Collapse
|
8
|
Zhao Q, Jiang Y, Zhang M, Chu Y, Ji B, Pan H, Ban B. Low-density lipoprotein cholesterol levels are associated with insulin-like growth factor-1 in short-stature children and adolescents: a cross-sectional study. Lipids Health Dis 2019; 18:120. [PMID: 31122262 PMCID: PMC6533685 DOI: 10.1186/s12944-019-1062-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/29/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Elevated low-density lipoprotein cholesterol (LDL-C) levels in childhood have recently been found to be the strongest predictive risk factor for coronary artery disease in adulthood. There is an increased level of LDL-C in children and adolescents with short stature. However, the underlying factors associated with increased LDL-C levels in children and adolescents with short stature are unknown. In addition, the insulin-like growth factor 1 (IGF-1) level in the short-stature population is usually below the normal reference range. The aim of this study was to investigate the relationship between IGF-1 standard deviation score (IGF-1 SDS) and LDL-C level in children and adolescents with short stature. METHODS A cross-sectional study was conducted in a single centre of China, 557 short-stature children and adolescents whose height SDS was lower than - 2 SD after adjustment for age and gender were included. The related clinical and laboratory examinations, including anthropometric parameters, lipid profiles, IGF-1 levels and the levels of other cofactors, were assessed in all participants. RESULTS The univariate analysis results showed a significant negative correlation between IGF-1 SDS and LDL-C levels (P = 0.006). Furthermore, a nonlinear relationship was observed between IGF-1 SDS and LDL-C by smooth curve fitting after adjusting for possible confounders. A multivariate piecewise linear regression model revealed a significant negative correlation between IGF-1 SDS and LDL-C when the IGF-1 level was greater than - 2 SDS (β - 0.07, 95% CI -0.12, - 0.02; P = 0.006). However, we did not observe a significant relationship between IGF-1 SDS and LDL-C when the IGF-1 level was lower than - 2 SDS (β 0.08, 95% CI -0.02, 0.17; P = 0.119). CONCLUSION This study demonstrated a nonlinear relationship between IGF-1 and LDL-C independent of other potential confounding factors, suggesting that circulating IGF-1 may contribute to the regulation of LDL-C levels, thus meriting further investigation.
Collapse
Affiliation(s)
- Qianqian Zhao
- Department of Clinical Medicine, Jining Medical University, 16 Hehua Road, Beihu New District, Jining, Shandong 272067 People’s Republic of China
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining Medical University, 89 Guhuai Road, Jining, Shandong 272029 People’s Republic of China
- Chinese Research Center for Behavior Medicine in Growth and Development, 89 Guhuai Road, Jining, 272029 Shandong People’s Republic of China
| | - Yingzhe Jiang
- Department of Clinical Medicine, Jining Medical University, 16 Hehua Road, Beihu New District, Jining, Shandong 272067 People’s Republic of China
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining Medical University, 89 Guhuai Road, Jining, Shandong 272029 People’s Republic of China
- Chinese Research Center for Behavior Medicine in Growth and Development, 89 Guhuai Road, Jining, 272029 Shandong People’s Republic of China
| | - Mei Zhang
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining Medical University, 89 Guhuai Road, Jining, Shandong 272029 People’s Republic of China
- Chinese Research Center for Behavior Medicine in Growth and Development, 89 Guhuai Road, Jining, 272029 Shandong People’s Republic of China
| | - Yuntian Chu
- School of Health Management and Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030 People’s Republic of China
- Chinese Research Center for Behavior Medicine in Growth and Development, 89 Guhuai Road, Jining, 272029 Shandong People’s Republic of China
| | - Baolan Ji
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining Medical University, 89 Guhuai Road, Jining, Shandong 272029 People’s Republic of China
- Chinese Research Center for Behavior Medicine in Growth and Development, 89 Guhuai Road, Jining, 272029 Shandong People’s Republic of China
| | - Hui Pan
- Key Laboratory of Endocrinology of National Health and Family Planning Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730 People’s Republic of China
- Chinese Research Center for Behavior Medicine in Growth and Development, 89 Guhuai Road, Jining, 272029 Shandong People’s Republic of China
| | - Bo Ban
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining Medical University, 89 Guhuai Road, Jining, Shandong 272029 People’s Republic of China
- Chinese Research Center for Behavior Medicine in Growth and Development, 89 Guhuai Road, Jining, 272029 Shandong People’s Republic of China
| |
Collapse
|
9
|
Álvarez-Nava F, Racines M, Witt J, Guarderas J, Estévez M, Lanes R. Anthropometric variables as cardiovascular risk predictors in a cohort of adult subjects with Turner syndrome. Diabetes Metab Syndr Obes 2019; 12:1795-1809. [PMID: 31571955 PMCID: PMC6750008 DOI: 10.2147/dmso.s214787] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/23/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Excessive adiposity is associated with cardiometabolic complications in Turner syndrome (TS) subjects. Reference data for predictive anthropometric indices of overweight/obesity and metabolic syndrome (MetS) are lacking for subjects with TS. The purpose of this study was to identify the best anthropometric predictor of cardiometabolic risk in a Latin-American cohort of TS subjects. PATIENTS AND METHODS This was a cross-sectional correlational study conducted in adult TS subjects (n=88) over the past seven years. Anthropometric parameters, body composition and biochemical variables were evaluated in a study and in a reference (n=57) group. Overweight/obesity and MetS were diagnosed using international consensus. The area under the ROC curve (AUC-ROC) was then used to determine the value of each anthropometric variable in predicting MetS or overweight/obesity. RESULTS The prevalence of MetS and overweight/obesity in TS subjects was 40% and 48%, respectively. All anthropometric and cardiometabolic variables were significantly increased in TS subjects when compared to the reference group, except for body mass index (BMI) and HDL-c. To detect MetS and overweight/obesity, waist to height ratio (WHtR) was found to have a higher correlation with cardiometabolic variables (TC, LDL-c, HDL-c levels and the LDL-c/HDL-c ratio), and to have a higher AUC-ROC and odds ratio than BMI, waist circumference (WC) and the waist to hip ratio (WHR). CONCLUSION The prevalence of MetS and overweight/obesity is elevated in TS subjects. WHtR was the most useful variable in predicting the presence of MetS and overweight and obesity in this TS cohort. A combination of WHtR with BMI or with WC could have the best clinical utility in identifying adult TS subjects with overweight/obesity and MetS, respectively.
Collapse
Affiliation(s)
- Francisco Álvarez-Nava
- Biological Sciences School, Faculty of Biological Sciences, Central University of Ecuador, Quito, Ecuador
- Genetic Research Institute, University of Zulia, Maracaibo, Venezuela
- Correspondence: Francisco Álvarez-NavaBiological Sciences School, Faculty of Biological Sciences, Central University of Ecuador, Calle Iquique con Calle Sodiro Number N14-121, Parroquia San Blas, Quito, Pichincha170113, EcuadorTel +593 252 8810Fax +593 252 8810Email
| | - Marcia Racines
- Institute of Biomedicine Research, Central University of Ecuador; Quito, Ecuador
| | - Julia Witt
- Biological Sciences School, Faculty of Biological Sciences, Central University of Ecuador, Quito, Ecuador
| | - Jéssica Guarderas
- Biological Sciences School, Faculty of Biological Sciences, Central University of Ecuador, Quito, Ecuador
| | - María Estévez
- Institute of Biomedicine Research, Central University of Ecuador; Quito, Ecuador
- Ecuadorian Foundation in Support of Turner Syndrome, Quito, Ecuador
| | - Roberto Lanes
- Pediatric Endocrine Unit, Hospital de Clinicas Caracas, Caracas, Venezuela
| |
Collapse
|
10
|
Wang F, Chen Y, Chang Y, Sun G, Sun Y. New anthropometric indices or old ones: which perform better in estimating cardiovascular risks in Chinese adults. BMC Cardiovasc Disord 2018; 18:14. [PMID: 29378513 PMCID: PMC5789564 DOI: 10.1186/s12872-018-0754-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/22/2018] [Indexed: 12/11/2022] Open
Abstract
Background Various anthropometric indices can be used to estimate obesity, and it is important to determine which one is the best in predicting the risk of coronary heart disease (CHD) and to define the optimal cut-off point for the best index. Methods This cross-sectional study investigated a consecutive sample of 11,247 adults, who had lived in rural areas of China and were older than 35 years of age. Eight obesity indices, including the body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), abdominal volume index (AVI), body adiposity index (BAI), body roundness index (BRI) and a body shape index (ABSI) were investigated. The risk of CHD was evaluated by the 10-year coronary event risk (Framingham risk score). Receiver operating characteristic (ROC) curve analyses were used to evaluate the predictive ability of the obesity indices for CHD risk. Results Of the whole population, 3636 (32.32%) participants had a risk score higher than 10%. Those who suffered medium or high CHD risk were more likely to have higher mean anthropometric indices, except for BMI in males. In the multivariate-adjusted logistic regression, all these anthropometric measurements were statistically associated with CHD risk in males. After adjusting for all the possible confounders, these anthropometric measurements, except for ABSI, remained as independent indicators of CHD risk in females. According to the ROC analyses, ABSI provided the largest area under the curve (AUC) value in males, and BMI showed the lowest AUC value, with AUC varying from 0.52 to 0.60. WHtR and BRI provided the largest AUC value in female, and similarly, BMI showed the lowest AUC value, with AUC varying from 0.59 to 0.70. The optimal cut-off values were as follows: WHtR (females: 0.54), BRI (females: 4.21), and ABSI (males: 0.078). Conclusions ABSI was the best anthropometric index for estimating CHD risk in males, and WHtR and BRI were the best indicators in females. Males should maintain an ABSI of less than 0.078, and females should maintain a WHtR of less than 0.54 or a BRI of less than 4.21. Electronic supplementary material The online version of this article (10.1186/s12872-018-0754-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Fei Wang
- Department of Cardiology, Jinhua Municipal Central Hospital, 351 Mingyue Street, Wucheng District, Jinhua, 321000, People's Republic of China
| | - Yintao Chen
- Department of Cardiology, the First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, People's Republic of China
| | - Ye Chang
- Department of Cardiology, the First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, People's Republic of China
| | - Guozhe Sun
- Department of Cardiology, the First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, People's Republic of China
| | - Yingxian Sun
- Department of Cardiology, the First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, People's Republic of China.
| |
Collapse
|
11
|
Pyles LA, Lilly CL, Mullett CJ, Polak ES, Elliott EM, Neal WA. LDL cholesterol level in fifth-grade schoolchildren associates with stature. J Lipid Res 2017; 58:2197-2201. [PMID: 28870972 PMCID: PMC5665673 DOI: 10.1194/jlr.p078816] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/16/2017] [Indexed: 11/20/2022] Open
Abstract
Short stature is associated with increased LDL-cholesterol levels and coronary artery disease in adults. We investigated the relationship of stature to LDL levels in children in the West Virginia Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project to determine whether the genetically determined inverse relationship observed in adults would be evident in fifth graders. A cross-sectional survey of schoolchildren was assessed for cardiovascular risk factors. Data collected at school screenings over 18 years in WV schools were analyzed for 63,152 fifth-graders to determine relationship of LDL to stature with consideration of age, gender, and BMI. The first (shortest) quartile showed an LDL level of 93.6 mg/dl compared with an LDL level of 89.7 mg/dl for the fourth (tallest) quartile. Each incremental increase of 1 SD of height lowered LDL by 0.049 mg/dl (P < 0.0001). Multivariate analysis showed LDL to vary inversely as a function of the first (lowest) quartile of height after controlling for gender, median age, BMI percentile for age and gender, and year of screening. The odds ratio for LDL ≥ 130 mg/dl for shortest versus tallest quartile is 1.266 (95% CL 1.162-1.380). The odds ratio for LDL ≥ 160 mg/dl is 1.456 (95% CL 1.163-1.822). The relationship between short stature and LDL, noted in adults, is confirmed in childhood.
Collapse
Affiliation(s)
- Lee A Pyles
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV
| | - Christa L Lilly
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV
- School of Public Health, West Virginia University School of Medicine, Morgantown, WV
| | - Charles J Mullett
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV
| | - Emily S Polak
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV
| | - Eloise M Elliott
- College of Physical Education and Sports Sciences, West Virginia University School of Medicine, Morgantown, WV
| | - William A Neal
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV
| |
Collapse
|
12
|
|
13
|
Chen X, He C, Ma Y, Yang Y, Liu F, Ma X, Li X, Xie X, Chen B. Association of metabolic syndrome with various anthropometric and atherogenic parameters in the Kazakh population in China. Lipids Health Dis 2016; 15:166. [PMID: 27664082 PMCID: PMC5035440 DOI: 10.1186/s12944-016-0338-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 09/17/2016] [Indexed: 12/26/2022] Open
Abstract
Background This study aimed to evaluate the association of the metabolic syndrome (MetS) with various anthropometric and atherogenic parameters in adult Kazakh population in China. Methods Four thousand ninety-four Kazakhs were recruited since 2007 to 2010. MetS and its components were confirmed according to IDF criteria. Area under the curve (AUC) of each variable was compared. Sensitivity (Sen), specificity (Spe), shortest distance in receiver’s operating characteristic curve (ROC) and cutoff of each variable to diagnose MetS were calculated. Results 28.6 % of men and 31.0 % of women had MetS in the Kazakh population. In men, WHtR had the highest AUC value 0.821, followed by BMI (0.801), TG/HDL-C (0.792), WHR (0.776) and BAI (0.666). In women, WHtR also had the highest AUC value (0.835), following by BMI (0.789), WHR (0.778), TG/HDL-C (0.778) and BAI (0.751). WHtR had the shortest ROC distance that was 0.37 and the optimal cutoff was 0.55 in men. In women, WHtR also had the shortest ROC distance of 0.35 and the optimal cutoff was 0.54. Conclusion WHtR is the best predictor of MetS in both Kazakh men and women according to the IDF criteria.
Collapse
Affiliation(s)
- Xiaocui Chen
- Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China
| | - Chunhui He
- Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China.,Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137 South Liyushan Road, Urumqi, 830054, People's Republic of China
| | - Yitong Ma
- Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China. .,Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137 South Liyushan Road, Urumqi, 830054, People's Republic of China.
| | - Yining Yang
- Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China.,Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137 South Liyushan Road, Urumqi, 830054, People's Republic of China
| | - Fen Liu
- Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China
| | - Xiang Ma
- Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China.,Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137 South Liyushan Road, Urumqi, 830054, People's Republic of China
| | - Xiaomei Li
- Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China.,Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137 South Liyushan Road, Urumqi, 830054, People's Republic of China
| | - Xiang Xie
- Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China.,Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137 South Liyushan Road, Urumqi, 830054, People's Republic of China
| | - Bangdang Chen
- Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China.
| |
Collapse
|
14
|
Zhang XH, Zhang M, He J, Yan YZ, Ma JL, Wang K, Ma RL, Guo H, Mu LT, Ding YS, Zhang JY, Liu JM, Li SG, Niu Q, Rui DS, Guo SX. Comparison of Anthropometric and Atherogenic Indices as Screening Tools of Metabolic Syndrome in the Kazakh Adult Population in Xinjiang. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:428. [PMID: 27092520 PMCID: PMC4847090 DOI: 10.3390/ijerph13040428] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/01/2016] [Accepted: 04/11/2016] [Indexed: 12/11/2022]
Abstract
Objective: To compare the screening ability of various anthropometric and atherogenic indices for Metabolic syndrome (MetS) using three common criteria and to evaluate the validity of suitable parameters in combination for the screening of MetS among a Kazakh population in Xinjiang. Methods: A total of 3752 individuals were selected using the stratified cluster random sampling method from nomadic Kazakhs (≥18 years old) in Xinyuan county, Xinjiang, China, which is approximately 4407 km away from the capital Beijing. MetS was defined by the International Diabetes Federation (IDF), National Cholesterol Education Program Adult Treatment Panel III (ATP III) and Joint Interim Statement (JIS) criteria. The receiver operating characteristic curve (ROC) was used to compare the area under the ROC curve (AUC) of each index. The sensitivity, specificity, Youden’s index and cut-offs of each index for the screening of MetS were calculated. Results: According to the IDF, ATP III and JIS criteria, 18.61%, 10.51%, and 24.83% of males and 23.25%, 14.88%, and 25.33% of females had MetS. According to the IDF criteria, the waist-to-height ratio (WHtR) was the index that most accurately identified individuals with and without MetS both in males (AUC = 0.872) and females (AUC = 0.804), with the optimal cut-offs of 0.53 and 0.52, respectively. According to both the ATP III and JIS criteria, the lipid accumulation product (LAP) was the best index to discriminate between individuals with and without MetS in males (AUC = 0.856 and 0.816, respectively) and females (AUC = 0.832 and 0.788, respectively), with optimal cut-offs of 41.21 and 34.76 in males and 28.16 and 26.49 in females, respectively. On the basis of the IDF standard, Youden’s indices of WHtR and LAP serial tests for the screening of MetS were 0.590 and 0.455 in males and females, respectively, and those of WHtR and LAP parallel tests were 0.608 and 0.479, accordingly. Conclusion: According to the IDF, ATP III and JIS criteria, both the WHtR and LAP were better indices for the screening of MetS. The WHtR and LAP parallel test was the most accurate.
Collapse
Affiliation(s)
- Xiang-Hui Zhang
- Department of Public Health, Shihezi University School of Medicine, Shihezi 832000, China.
| | - Mei Zhang
- Department of Public Health, Shihezi University School of Medicine, Shihezi 832000, China.
| | - Jia He
- Department of Public Health, Shihezi University School of Medicine, Shihezi 832000, China.
| | - Yi-Zhong Yan
- Department of Public Health, Shihezi University School of Medicine, Shihezi 832000, China.
| | - Jiao-Long Ma
- Department of Public Health, Shihezi University School of Medicine, Shihezi 832000, China.
| | - Kui Wang
- Department of Public Health, Shihezi University School of Medicine, Shihezi 832000, China.
| | - Ru-Lin Ma
- Department of Public Health, Shihezi University School of Medicine, Shihezi 832000, China.
| | - Heng Guo
- Department of Public Health, Shihezi University School of Medicine, Shihezi 832000, China.
| | - La-Ti Mu
- Department of Public Health, Shihezi University School of Medicine, Shihezi 832000, China.
| | - Yu-Song Ding
- Department of Public Health, Shihezi University School of Medicine, Shihezi 832000, China.
| | - Jing-Yu Zhang
- Department of Public Health, Shihezi University School of Medicine, Shihezi 832000, China.
| | - Jia-Ming Liu
- Department of Public Health, Shihezi University School of Medicine, Shihezi 832000, China.
| | - Shu-Gang Li
- Department of Public Health, Shihezi University School of Medicine, Shihezi 832000, China.
| | - Qiang Niu
- Department of Public Health, Shihezi University School of Medicine, Shihezi 832000, China.
| | - Dong-Sheng Rui
- Department of Public Health, Shihezi University School of Medicine, Shihezi 832000, China.
| | - Shu-Xia Guo
- Department of Public Health, Shihezi University School of Medicine, Shihezi 832000, China.
- Department of Pathology and Key Laboratory of Xinjiang Endemic and Ethnic Diseases, Ministry of Education, Shihezi University School of Medicine, Shihezi 832000, China.
| |
Collapse
|
15
|
Kshatriya GK, Acharya SK. Triple Burden of Obesity, Undernutrition, and Cardiovascular Disease Risk among Indian Tribes. PLoS One 2016; 11:e0147934. [PMID: 26808418 PMCID: PMC4726542 DOI: 10.1371/journal.pone.0147934] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 01/11/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Socio-cultural transitions among individuals from vulnerable groups introduce epidemiological transition, with a concomitant increase in the prevalence of undernutrition, obesity, and cardiovascular disease risks. An accepted conventional wisdom exists for Indian tribes that they are undernourished and away from lifestyle-related diseases. However, the extent of this triple burden affecting them is unknown. In this study, we assessed this triple burden among the 9 major tribes of India. METHODS AND FINDINGS During January 2011 to December 2013, we conducted a cross-sectional study among 1066 men and 1090 women constituting a total of 2156 adults belonging to the 9 major tribal groups: Santals, Oraons, and Koras (West Bengal); Santals, Bhumijs, and Bathudis (Odisha); and Dhodias, Kuknas, and Chaudharis (Gujarat) to estimate the prevalence of the triple burden (undernutrition, overweight or obesity, and hypertension). A high prevalence of undernutrition and hypertension was observed among the Koras (51.9%and 10.6%, respectively), Bathudis (51.3% and 12.1%, respectively), and Oraons (49.6% and 16.5%, respectively). However, the prevalence of overweight and hypertension among the Bhumijs (17.7% and 14.7%, respectively), Dhodias (23.8% and 12.9%, respectively), Kuknas (15.8% and 11.3%, respectively), and Santals of West Bengal (12.2% and 11.8%, respectively) and Odisha (15% and 9.6%, respectively) was most alarming. The prevalence of overweight or obesity among the women was 10.9% and 1.5%, respectively, with 14.0% hypertensive women. The prevalence of overweight and obesity among the men was 14.8% and 1.7%, respectively, with 9.2% hypertensive men. Undernutrition was highly prevalent among men and women. However, data from the past 30 years on systolic blood pressure (SBP) and body mass index (BMI) revealed that the studied tribes were at a higher risk than the general Indian population. In addition, a vast gender disparity with relation to the disease and risk prevalence was observed. CONCLUSION The alarming trend of an increasing prevalence of overweight/obesity, undernutrition, and hypertension is observed among indigenous populations of India, emphasizing the incorporation of a specific health management policy.
Collapse
|
16
|
Kang SH, Cho KH, Park JW, Do JY. Comparison of waist to height ratio and body indices for prediction of metabolic disturbances in the Korean population: the Korean National Health and Nutrition Examination Survey 2008-2011. BMC Endocr Disord 2015; 15:79. [PMID: 26643250 PMCID: PMC4672527 DOI: 10.1186/s12902-015-0075-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 12/01/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The aim of the present study of the general population was to identify the best predictor of metabolic risk among the body index variables evaluated with dual-energy X-ray absorptiometry (DEXA) or anthropometric indices including the waist to height ratio (WHtR). PATIENTS AND METHODS Data from the Korean National Health and Nutrition Examination Survey 2008-2011 were used for the analyses. As a result, 15,965 participants were included in this study. The body mass (BM) index was calculated as the body weight divided by the height squared. The WHtR was calculated as the waist circumference divided by height. Body composition indices such as lean mass (LM), fat mass (FM), trunk fat mass (TFM), and bone mineral content (BMC) were determined by using DEXA. Skeletal muscle mass (SM) was defined as the sum of the lean soft masses of both extremities. The LM, FM, BMC, TFM, and SM indices were calculated by dividing the total LM, total FM, total BMC, TFM, or SM by the height squared. RESULTS The WHtR had the highest area under the curve (AUC) and was the best predictor of metabolic syndrome for both sexes. In addition, the WHtR had the highest AUCs for components of metabolic syndrome (male: AUC 0.823, 95 % confidence interval [CI] 0.814-0.832; female: AUC 0.870, 95 % CI 0.863-0.877). There was a small statistically significant difference in AUC between WHtR and the other indices. Multivariate logistic regression showed that male participants in the second, third, and fourth quartiles had a 4.0 (95 % CI, 3.1-5.2), 9.6 (95 % CI, 7.5-12.3), and 36.1 (95 % CI, 28.0-46.4) times increased risk of metabolic syndrome compared with patients in the first quartile and female participants in the second, third, and fourth quartiles had a 4.3 (95 % CI, 3.1-6.0), 18.0 (95 % CI, 13.3-24.5), and 58.5 (95 % CI, 42.9-79.9) times increased risk of metabolic syndrome compared with patients in the first quartile. CONCLUSION Among the BM, FM, LM, SM, TFM, and WHtR indices, WHtR is most useful to predict the presence of metabolic syndrome and insulin resistance in the Korean population.
Collapse
Affiliation(s)
- Seok Hui Kang
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Hospital, 317-1 Daemyung-Dong, Nam-Ku, Daegu, 705-717, South Korea.
| | - Kyu Hyang Cho
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Hospital, 317-1 Daemyung-Dong, Nam-Ku, Daegu, 705-717, South Korea.
| | - Jong Won Park
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Hospital, 317-1 Daemyung-Dong, Nam-Ku, Daegu, 705-717, South Korea.
| | - Jun Young Do
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Hospital, 317-1 Daemyung-Dong, Nam-Ku, Daegu, 705-717, South Korea.
| |
Collapse
|
17
|
Veghari G, Sedaghat M, Maghsodlo S, Banihashem S, Moharloei P, Angizeh A, Tazik E, Moghaddami A, Joshaghani H. The association between abdominal obesity and serum cholesterol level. Int J Appl Basic Med Res 2015; 5:83-6. [PMID: 26097812 PMCID: PMC4456899 DOI: 10.4103/2229-516x.157150] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 01/07/2015] [Indexed: 11/05/2022] Open
Abstract
Background: The main aim of this study is to evaluate the association between serum cholesterol level and abdominal obesity in adult men and women in the north of Iran. Materials and Methods: This cross-sectional and analytical study was conducted on the 1956 subjects (990 men and 966 women) between 25 and 65 years old chosen by cluster sampling. Plasma cholesterol was measured in the morning after a 12 h fast and determined by auto-analyzer. Hypercholesterolemia (HC) was defined by a total plasma cholesterol level over 200 mg/dl. Waist circumference ≥102 cm and ≥88 cm in men and women were defined as abdominal obesity. SPSS 16.0 software was used for statistical analysis and P < 0.05 considered as statistical significance. Results: Averagely, the mean of age was 44.2 years and mean ± standard deviation of plasma total cholesterol level was 203 ± 11.3 mg/dl. The HC was seen in 50.8% of subjects with a more common in women than in men. Compared with normal subjects, in abdominal obese people, the odds ratio (OR) of HC was (OR = 4.208 [95% confidence interval [CI]: 1.939–9.130]) and (OR = 3.956 [95% CI: 1.821–8.592]) in men aged 25–35 and 35–45 years, respectively. In women aged 25–35 years, it was (OR = 3.444 [95% CI: 1.959–6.056]) in abdominal obese compared with normal subjects. Conclusion: Hypercholesterolemia was revealed as a major health problem among adults, and it was associated with abdominal obesity especially in the early middle-age in the north of Iran. This association was not significant in men and women after the age of 45 and 35, respectively.
Collapse
Affiliation(s)
- Gholamreza Veghari
- Ischemic Disorders Research Center, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mehdi Sedaghat
- Deputy of Health, Golestan University of Medical Sciences, Gorgan, Iran
| | - Siavash Maghsodlo
- Deputy of Health, Golestan University of Medical Sciences, Gorgan, Iran
| | - Samieh Banihashem
- Deputy of Health, Golestan University of Medical Sciences, Gorgan, Iran
| | - Pooneh Moharloei
- Deputy of Health, Golestan University of Medical Sciences, Gorgan, Iran
| | | | - Ebrahim Tazik
- Deputy of Health, Golestan University of Medical Sciences, Gorgan, Iran
| | - Abbas Moghaddami
- Deputy of Health, Golestan University of Medical Sciences, Gorgan, Iran
| | - Hamidreza Joshaghani
- Metabolic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| |
Collapse
|
18
|
Chen BD, Yang YN, Ma YT, Pan S, He CH, Liu F, Ma X, Fu ZY, Li XM, Xie X, Zheng YY. Waist-to-Height Ratio and Triglycerides/High-Density Lipoprotein Cholesterol Were the Optimal Predictors of Metabolic Syndrome in Uighur Men and Women in Xinjiang, China. Metab Syndr Relat Disord 2015; 13:214-20. [PMID: 25781351 DOI: 10.1089/met.2014.0146] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE This study aimed to identify the best single predictor of metabolic syndrome by comparing the predictive ability of various anthropometric and atherogenic parameters among a Uighur population in Xinjiang, northwest China. METHODS A total of 4767 Uighur participants were selected from the Cardiovascular Risk Survey (CRS), which was carried out from October, 2007, to March, 2010. Anthropometric data, blood pressure, serum concentration of serum total cholesterol (TC), triglycerides (TGs), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and fasting glucose were documented. Prevalence of metabolic syndrome and its individual components were confirmed according to International Diabetes Federation (IDF) criteria. Area under the receiver operating characteristic curve (AUC) of each variable for the presence of metabolic syndrome was compared. The sensitivity (Sen), specificity (Spe), distance in the receiver operating characteristic (ROC) curve, and cutoffs of each variable for the presence of metabolic syndrome were calculated. RESULTS In all, 23.7% of men had the metabolic syndrome, whereas 40.1% of women had the metabolic syndrome in a Uighur population in Xinjiang; the prevalence of metabolic syndrome in women was significantly higher than that in men (P<0.001). In men, the waist-to-height ratio (WHtR) had the highest AUC value (AUC=0.838); it was followed by TGs/HDL-C (AUC=0.826), body mass index (BMI) (AUC=0.812), waist-to-hip ratio (WHR) (AUC=0.781), and body adiposity index (BAI) (AUC=0.709). In women, the TGs/HDL-C had the highest AUC value (AUC=0.815); it was followed by WHtR (AUC=0.780), WHR (AUC=0.730), BMI (AUC=0.719), and BAI (AUC=0.699). Similarly, among all five anthropometric and atherogenic parameters, the WHtR had the shortest ROC distance of 0.32 (Sen=85.40%, Spe=71.6%), and the optimal cutoff for WHtR was 0.55 in men. In women, TGs/HDL-C had the shortest ROC distance of 0.35 (Sen=75.29%, Spe=75.18%), and the optimal cutoff of TGs/HDL-C was 1.22. CONCLUSION WHtR was the best predictor of metabolic syndrome in Uighur men, whereas TGs/HDL-C was the best predictor of metabolic syndrome in Uighur women in Xinjiang.
Collapse
Affiliation(s)
- Bang-Dang Chen
- 1 Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University , Urumqi, People's Republic of China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Chen BD, He CH, Ma YT, Yang YN, Liu F, Pan S, Ma X, Li XM, Fu ZY, Xie X, Zheng YY. Best Anthropometric and Atherogenic Predictors of Metabolic Syndrome in the Chinese Han Population in Xinjiang: The Cardiovascular Risk Survey. ANNALS OF NUTRITION AND METABOLISM 2014; 65:280-8. [DOI: 10.1159/000366427] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 08/03/2014] [Indexed: 11/19/2022]
|
20
|
Zhang ZQ, Liu YH, Xu Y, Dai XW, Ling WH, Su YX, Chen YM. The validity of the body adiposity index in predicting percentage body fat and cardiovascular risk factors among Chinese. Clin Endocrinol (Oxf) 2014; 81:356-62. [PMID: 24131445 DOI: 10.1111/cen.12351] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 09/14/2013] [Accepted: 10/14/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Recent research has suggested that body adiposity index (BAI) correlates more closely with percentage body fat (PBF) than body mass index (BMI). Here, we aimed to evaluate BAI's predictive power for PBF and for obesity-associated risk factors in the Chinese population. SUBJECTS A total of 1707 women and 680 men aged 51-77 years were analysed in this community-based cross-sectional study. MEASUREMENTS Body weight, height, waist circumference (WC) and hip circumference (HC) were measured, and BMI and BAI were calculated. Percentage body fat was determined by dual-energy X-ray absorptiometry (DXA). Blood pressure, fasting lipid profiles, glucose and Carotid ultrasound examination determined intima-media thickness (IMT) at the common carotid arteries (CCA) were also measured. RESULTS The Pearson correlation analysis indicated a stronger correlation between BAI and PBF when women and men were pooled together, but this effect disappeared in sex-stratified analysis. Bland-Altman plots suggested that BAI underestimated 5·8% of PBF in women and slightly overestimated 0·28% of PBF in men, but the magnitudes of these biases showed a fat mass-dependent manner. Both the logistic regression and the receiver operating characteristic curve (ROC) analysis indicated that BAI has an inferior predictive power for the presence of hypertension, dyslipidaemia, metabolic syndrome and CCA-intima-media thickening, compared with BMI and WC. CONCLUSION We concluded that BAI was neither a better predictor for PBF nor for cardiovascular risks in Chinese population compared with BMI and WC.
Collapse
Affiliation(s)
- Zhe-Qing Zhang
- Guangdong Provincial Key Laboratory of Food, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | | | | | | | | | | | | |
Collapse
|
21
|
Sedej K, Kotnik P, Avbelj Stefanija M, Grošelj U, Širca Čampa A, Lusa L, Battelino T, Bratina N. Decreased prevalence of hypercholesterolaemia and stabilisation of obesity trends in 5-year-old children: possible effects of changed public health policies. Eur J Endocrinol 2014; 170:293-300. [PMID: 24225029 DOI: 10.1530/eje-13-0566] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Overweight/obesity in children is a worldwide public health problem. Together with hypercholesterolaemia they are associated with early atherosclerotic complications. OBJECTIVES In this study, we aimed to investigate the anthropometric characteristics and total cholesterol (TC) levels in a population of 5-year-old children, to determine trends in the prevalence of overweight/obesity and hypercholesterolaemia in 5-year-old children over a period of 8 years (2001-2009) and to assess the impact of modified national nutritional guidelines for kindergartens implemented in 2005. DESIGN Cross-sectional studies of overweight/obesity prevalence in the years 2001, 2003-2005 and 2009, and hypercholesterolaemia in years 2001 and 2009, in 5-year-old children. SUBJECTS Altogether, 12 832 (6308 girls/6524 boys) children were included. METHODS Overweight/obesity was defined by IOTF criteria. Hypercholesterolaemia was defined by TC level >5 mmol/l. Multivariable logistic regression models were used. RESULTS NO CORRELATION BETWEEN BMI VALUES AND TC LEVELS WAS FOUND. OVERWEIGHT AND OBESITY PREVALENCE WERE STABILISED FROM 2001 TO 2009 (ODDS RATIO (OR) (95% CI): 1.13 (0.99-1.3) and 1.13 (0.89-1.42) respectively). Girls were more frequently overweight/obese than boys (OR (95% CI): 0.71 (0.65-0.79) and 0.75 (0.64-0.89) respectively). Prevalence of hypercholesterolaemia significantly decreased from 2001 to 2009 (OR (95% CI): 0.47 (0.41-0.55)). It was less frequent in boys than in girls (OR (95% CI): O.7 (0.61-0.8)). CONCLUSIONS This is the first study to describe a negative trend in the prevalence of hypercholesterolaemia in pre-pubertal children. In addition, the prevalence of overweight/obesity in these children has been stabilised. Nationwide changes in public health policies could have influenced these observations.
Collapse
Affiliation(s)
- Katarina Sedej
- Department of Endocrinology, Diabetes and Metabolism, University Children's Hospital, University Clinical Centre Ljubljana, Bohoričeva 20, SI-1000 Ljubljana, Slovenia
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Sagun G, Oguz A, Karagoz E, Filizer AT, Tamer G, Mesci B. Application of alternative anthropometric measurements to predict metabolic syndrome. Clinics (Sao Paulo) 2014; 69:347-53. [PMID: 24838901 PMCID: PMC4012236 DOI: 10.6061/clinics/2014(05)09] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 11/06/2013] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The association between rarely used anthropometric measurements (e.g., mid-upper arm, forearm, and calf circumference) and metabolic syndrome has not been proven. The aim of this study was to assess whether mid-upper arm, forearm, calf, and waist circumferences, as well as waist/height ratio and waist-to-hip ratio, were associated with metabolic syndrome. METHODS We enrolled 387 subjects (340 women, 47 men) who were admitted to the obesity outpatient department of Istanbul Medeniyet University Goztepe Training and Research Hospital between September 2010 and December 2010. The following measurements were recorded: waist circumference, hip circumference, waist/height ratio, waist-to-hip ratio, mid-upper arm circumference, forearm circumference, calf circumference, and body composition. Fasting blood samples were collected to measure plasma glucose, lipids, uric acid, insulin, and HbA1c. RESULTS The odds ratios for visceral fat (measured via bioelectric impedance), hip circumference, forearm circumference, and waist circumference/hip circumference were 2.19 (95% CI, 1.30-3.71), 1.89 (95% CI, 1.07-3.35), 2.47 (95% CI, 1.24-4.95), and 2.11(95% CI, 1.26-3.53), respectively. The bioelectric impedance-measured body fat percentage correlated with waist circumference only in subjects without metabolic syndrome; the body fat percentage was negatively correlated with waist circumference/hip circumference in the metabolic syndrome group. All measurements except for forearm circumference were equally well correlated with the bioelectric impedance-measured body fat percentages in both groups. Hip circumference was moderately correlated with bioelectric impedance-measured visceral fat in subjects without metabolic syndrome. Muscle mass (measured via bioelectric impedance) was weakly correlated with waist and forearm circumference in subjects with metabolic syndrome and with calf circumference in subjects without metabolic syndrome. CONCLUSION Waist circumference was not linked to metabolic syndrome in obese and overweight subjects; however, forearm circumference, an unconventional but simple and appropriate anthropometric index, was associated with metabolic syndrome and bioelectric impedance-measured visceral fat, hip circumference, and waist-to-hip ratio.
Collapse
Affiliation(s)
- Gul Sagun
- Department of Internal Medicine, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Aytekin Oguz
- Department of Internal Medicine, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Engin Karagoz
- Department of Internal Medicine, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Arzu Tiğli Filizer
- Department of Family Medicine, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Gonca Tamer
- Department of Endocrinology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Banu Mesci
- Department of Internal Medicine, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
23
|
Adult height and risk of ischemic heart disease, atrial fibrillation, stroke, venous thromboembolism, and premature death: a population based 36-year follow-up study. Eur J Epidemiol 2013; 29:111-8. [DOI: 10.1007/s10654-013-9867-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 11/15/2013] [Indexed: 11/24/2022]
|
24
|
Zhang ZQ, Deng J, He LP, Ling WH, Su YX, Chen YM. Comparison of various anthropometric and body fat indices in identifying cardiometabolic disturbances in Chinese men and women. PLoS One 2013; 8:e70893. [PMID: 23951031 PMCID: PMC3741370 DOI: 10.1371/journal.pone.0070893] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 06/25/2013] [Indexed: 12/28/2022] Open
Abstract
Background Although many adiposity indices may be used to predict obesity-related health risks, uncertainty remains over which of them performs best. Objective This study compared the predictive capability of direct and indirect adiposity measures in identifying people at higher risk of metabolic abnormalities. Methods This population-based cross-sectional study recruited 2780 women and 1160 men. Body weight and height, waist circumference (WC), and hip circumference (HC) were measured and body mass index (BMI), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) were calculated. Body fat (and percentage of fat) over the whole body and the trunk were determined by bioelectrical impedance analysis (BIA). Blood pressure, fasting lipid profiles, and glucose and urine acid levels were assessed. Results In women, the ROC and the multivariate logistic regression analyses both showed that WHtR consistently had the best performance in identifying hypertension, dyslipidemia, hyperuricemia, diabetes/IFG, and metabolic syndrome (MetS). In men, the ROC analysis showed that WHtR was the best predictor of hypertension, WHtR and WC were equally good predictors of dyslipidemia and MetS, and WHtR was the second-best predictor of hyperuricemia and diabetes/IFG. The multivariate logistic regression also found WHtR to be superior in discriminating between MetS, diabetes/IFG, and dyslipidemia while BMI performed better in predicting hypertension and hyperuricemia in men. The BIA-derived indices were the second-worst predictors for all of the endpoints, and HC was the worst. Conclusion WHtR was the best predictor of various metabolic abnormalities. BMI may be used as an alternative measure of obesity for identifying hypertension in both sexes.
Collapse
Affiliation(s)
- Zhe-qing Zhang
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health; School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Juan Deng
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health; School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Li-ping He
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health; School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
- Guangzhou Panyu Central Hospital, Guangzhou, People's Republic of China
| | - Wen-hua Ling
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health; School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yi-xiang Su
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health; School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
- * E-mail: (Y-MC); (Y-XS)
| | - Yu-ming Chen
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health; School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
- * E-mail: (Y-MC); (Y-XS)
| |
Collapse
|
25
|
Waist to height ratio for recording the risks of overweight in schoolchildren in Kerala. Indian Pediatr 2013; 50:493-5. [DOI: 10.1007/s13312-013-0150-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 09/21/2012] [Indexed: 10/26/2022]
|
26
|
Jelenkovic A, Bogl LH, Rose RJ, Kangas AJ, Soininen P, Ala-Korpela M, Kaprio J, Silventoinen K. Association of height and pubertal timing with lipoprotein subclass profile: exploring the role of genetic and environmental effects. Am J Hum Biol 2013; 25:465-72. [PMID: 23649903 DOI: 10.1002/ajhb.22381] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 01/17/2013] [Accepted: 01/23/2013] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Little is known about the relationship between growth and lipoprotein profile. We aimed to analyze common genetic and environmental factors in the association of height from late childhood to adulthood and pubertal timing with serum lipid and lipoprotein subclass profile. METHODS A longitudinal cohort of Finnish twin pairs (FinnTwin12) was analyzed using self-reported height at 11-12, 14, 17 years and measured stature at adult age (21-24 years). Data were available for 719 individual twins including 298 complete pairs. Serum lipids and lipoprotein subclasses were measured by proton nuclear magnetic resonance spectroscopy. Multivariate variance component models for twin data were fitted. Cholesky decomposition was used to partition the phenotypic covariation among traits into additive genetic and unique environmental correlations. RESULTS In men, the strongest associations for both adult height and puberty were observed with total cholesterol, low-density lipoprotein cholesterol, intermediate-density lipoprotein cholesterol, and low-density lipoprotein particle subclasses (max. r = -0.19). In women, the magnitude of the correlations was weaker (max. r = -0.13). Few associations were detected between height during adolescence and adult lipid profile. Early onset of puberty was related to an adverse lipid profile, but delayed pubertal development in girls was associated with an unfavorable profile, as well. All associations were mediated mainly by additive genetic factors, but unique environmental effects cannot be disregarded. CONCLUSIONS Early puberty and shorter adult height relate to higher concentrations of atherogenic lipids and lipoprotein particles in early adulthood. Common genetic effects behind these phenotypes substantially contribute to the observed associations.
Collapse
Affiliation(s)
- Aline Jelenkovic
- Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country UPV/EHU, Leioa, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
27
|
van Valkengoed IGM, Agyemang C, Krediet RT, Stronks K. Ethnic differences in the association between waist-to-height ratio and albumin-creatinine ratio: the observational SUNSET study. BMC Nephrol 2012; 13:26. [PMID: 22564356 PMCID: PMC3492102 DOI: 10.1186/1471-2369-13-26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 04/24/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ethnic differences in the association between central obesity and raised albumin-creatinine ratio (ACR) have not been investigated. Our aim was to determine whether the association between central obesity, defined by the waist-to-height ratio (WHtR), and ACR differed between subjects of Hindustani-Surinamese, African-Surinamese and Dutch origin. METHODS In total, 334 Hindustani-Surinamese (~South Asian), 589 African-Surinamese (~African), and 493 Dutch (~European) men and women, aged 35-60 years, randomly selected from the municipal register of Amsterdam, participated in an interview and physical examination.We calculated the WHtR by dividing the waist circumference by height and the log ACR (logACR, log mg/mmol) by log-transforming the albumin concentration by the creatinine concentration in urine. The association between WHtR and logACR was studied in the total population and stratified by ethnicity. We also tested for interaction. RESULTS In the total population, a higher WHtR was associated with a higher logACR, after adjustment for sex, age, and smoking, body mass index and the presence of type 2 diabetes or hypertension. Among the Hindustani-Surinamese, the adjusted association between WHtR and logACR appeared somewhat stronger than among the other ethnic groups: for every 0.1 increase in the WHtR, the log-ACR increased by 0.522 (0.096-0.949) log mg/mmol among the Hindustani-Surinamese, by 0.334 (0.047-0.622) among the African-Surinamese and by 0.356 (-0.010-0.721) among the Dutch. However, the interaction was not statistically significant. CONCLUSIONS WHtR was associated with a higher ACR among populations of Hindustani-Surinamese, African-Surinamese and Dutch origin. Our study seems to support global use of WHtR in relation to ACR across ethnic groups. However, although not significant, the association appeared slightly stronger among the Hindustani-Surinamese than among the other ethnic groups. If confirmed, this could have implications for use of the WHtR across ethnic groups.
Collapse
Affiliation(s)
- Irene G M van Valkengoed
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | | | | | | |
Collapse
|
28
|
Huang RC, de Klerk N, Mori TA, Newnham JP, Stanley FJ, Landau LI, Oddy WH, Hands B, Beilin LJ. Differential relationships between anthropometry measures and cardiovascular risk factors in boys and girls. ACTA ACUST UNITED AC 2011; 6:e271-82. [DOI: 10.3109/17477166.2010.512388] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
29
|
Dutch versus English advantage in the epidemic of central and generalised obesity is not shared by ethnic minority groups: comparative secondary analysis of cross-sectional data. Int J Obes (Lond) 2011. [DOI: 10.1038/ijo.2010.281] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
30
|
Short stature and obesity: positive association in adults but inverse association in children and adolescents. Br J Nutr 2009; 102:453-61. [DOI: 10.1017/s0007114508190304] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
Collapse
|
31
|
Non-high-density lipoprotein cholesterol levels and recent involuntary weight gain among asymptomatic female subjects. Clin Chem Lab Med 2008; 46:541-4. [DOI: 10.1515/cclm.2008.095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
32
|
Wang G, Wang X, Zhang Q, Ma Z. Response to pioglitazone treatment is associated with the lipoprotein lipase S447X variant in subjects with type 2 diabetes mellitus. Int J Clin Pract 2007; 61:552-7. [PMID: 17394430 DOI: 10.1111/j.1742-1241.2006.01242.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
To investigate the influence of the S447X variant in lipoprotein lipase (LPL) gene on the response rate to therapy with the thiazolidinedione pioglitazone. A total of 113 diabetic patients were treated with pioglitazone 30 mg for 10 weeks. Response to the pioglitazone treatment was defined by either a >10% relative reduction in fasting blood glucose (FBG) or a more than 1% decrease in glycosylated haemoglobin (HbA1c) values after 10 weeks of pioglitazone treatment. The genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism method. Using the criteria >10% relative reduction in FBG after 10 weeks of pioglitaone treatment, responder frequency to pioglitazone treatment in S447S genotype group is significantly higher than S447X genotype group. Meanwhile, the S447X genotype conferred a statistically significant 0.538-fold reduction in response rate to pioglitazone treatment relative to the S447S genotype. Moreover, pioglitazone treatment has significantly beneficial effects on serum lipid profile and blood pressure in S447S genotype carriers. The S447X variant in LPL gene may be a cause for therapy modification by pioglitazone.
Collapse
Affiliation(s)
- G Wang
- Department of Endocrinology, Peking University Third Hospital, Beijing, China.
| | | | | | | |
Collapse
|
33
|
Bosy-Westphal A, Danielzik S, Geisler C, Onur S, Korth O, Selberg O, Pfeuffer M, Schrezenmeir J, Müller MJ. Use of height3:waist circumference3 as an index for metabolic risk assessment? Br J Nutr 2007; 95:1212-20. [PMID: 16768846 DOI: 10.1079/bjn20061763] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Current anthropometric indices for health risk assessment are indirect measures of total or visceral body fat mass that do not consider the inverse relationship of lean body mass to metabolic risk as well as the non-linear relationship between central obesity and insulin resistance.We examined a new anthropometric index that reflects the relationship of waist circumference (WC) as a risk factor to fat-free mass (FFM) as a protective parameter of body composition. In apopulation of 335 adults (191 females and 144 males; mean age 53 (sd 13·9) years) with ahigh prevalence of obesity (27%) and metabolic syndrome (30%) we derived FFM:WC3 from the best fit of the relationship with metabolic risk factors (plasma triacylglycerol levels and insulin resistance by homeostasis model assessment index). Because FFM is known to be proportional to the cube of height, FFM was subsequently replaced by height3 yielding height3:WC3 as an easily applicable anthropometric index. Significant inverse relationships of height3:WC3 to metabolic risk factorswere observed for both sexes. They slightly exceeded those of conventional anthropometric indicessuch as BMI, WC or WC:hip ratio in women but not in men. The exponential character of the denominator WC3 implies that at a given FFM with gradually increasing WC the increasein metabolic risk is lower than proportional. Further studies are needed to evaluate height3:WC3 as an anthropometric index for health risk assessment.
Collapse
Affiliation(s)
- Anja Bosy-Westphal
- Institut für Humanernährung und Lebensmittelkunde, Christian-Albrechts-Universität zu Kiel, Düsternbrooker Weg 17, D-24105 Kiel, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Bosy-Westphal A, Geisler C, Onur S, Korth O, Selberg O, Schrezenmeir J, Müller MJ. Value of body fat mass vs anthropometric obesity indices in the assessment of metabolic risk factors. Int J Obes (Lond) 2006; 30:475-83. [PMID: 16261188 DOI: 10.1038/sj.ijo.0803144] [Citation(s) in RCA: 194] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To compare the value of body fat mass (%FM) to indirect measures of general (body mass index (BMI)) and central adiposity (waist circumference (WC); waist-to-height ratio (WC/ht)) for the prediction of overweight- and obesity-related metabolic risk in a study population with a high prevalence of metabolic syndrome (MSX). METHODS BMI, WC, WC/ht, body composition (by air-displacement plethysmography) and metabolic risk factors: triglycerides, cholesterol, HDL-cholesterol (HDL-C), uric acid, systolic blood pressure (BPsys), insulin resistance by homeostasis model assessment (HOMA-IR) and C-reactive protein (CRP) were measured in 335 adults (191 women, 144 men; mean age 53 +/-13.9 years, prevalence of MSX 30%). RESULTS When compared with BMI and WC, %FM showed weaker associations with metabolic risk factors, except for CRP and BPsys in men. In women, HDL-C and HOMA-IR showed the closest correlations with BMI. For all other risk factors, WC or WC/ht were the best predictors in both sexes. Differences in the strength of correlations between an obesity index and different risk factors exceeded the differences observed between all obesity indices within one risk factor. In stepwise multiple regression analyses, WC/ht was the main predictor of metabolic risk in both sexes combined. However, analysis of the area under receiver operating characteristic curves for prediction of the prevalence of >or=2 component traits of the MSX revealed a similar accuracy of all obesity indices. CONCLUSIONS At the population level, measurement of body FM has no advantage over BMI and WC in the prediction of obesity-related metabolic risk. Although measures of central adiposity (WC, WC/ht) tended to show closer associations with risk factors than measures of general adiposity, the differences were small and depended on the type of risk factor and sex, suggesting an equivalent value of methods.
Collapse
Affiliation(s)
- A Bosy-Westphal
- Institut für Humanernährung und Lebensmittelkunde, Christian-Albrechts Universität zu Kiel, Kiel, Germany
| | | | | | | | | | | | | |
Collapse
|
35
|
Ashwell M, Hsieh SD. Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Int J Food Sci Nutr 2006; 56:303-7. [PMID: 16236591 DOI: 10.1080/09637480500195066] [Citation(s) in RCA: 578] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We suggest that a simple, rapid screening tool-the waist-to-height ratio (WHTR)-could help to overcome debates about the use of different body mass index (BMI) boundary values for assessing health risks in different populations. There are six reasons for our proposal: WHTR is more sensitive than BMI as an early warning of health risks. WHTR is cheaper and easier to measure and calculate than BMI. A boundary value of WHTR = 0.5 indicates increased risk for men and women. A boundary value of WHTR = 0.5 indicates increased risk for people in different ethnic groups. WHTR boundary values can be converted into a consumer-friendly chart. WHTR may allow the same boundary values for children and adults. Communicating messages about health risk could be much simpler if the same anthropometric index and the same public health message can be used throughout childhood, into adult life, and throughout the world. This simple message is: Keep your waist circumference to less than half your height.
Collapse
Affiliation(s)
- Margaret Ashwell
- Oxford Brookes University, Ashwell Associates, Ashwell Street, Ashwell, UK, Headington Campus, Gipsy Lane, Oxford, UK.
| | | |
Collapse
|
36
|
Benetou V, Bamia C, Trichopoulos D, Trichopoulou A. Associations of anthropometric characteristics with blood cholesterol fractions among adults. The Greek EPIC study. Eur J Clin Nutr 2006; 60:942-8. [PMID: 16465197 DOI: 10.1038/sj.ejcn.1602403] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To explore the independent associations of body height, body mass index (BMI), waist circumference and hip circumference with high-density lipoprotein-cholesterol (HDL-cholesterol) and non-high-density lipoprotein-cholesterol (non-HDL-cholesterol), in a large general population sample. DESIGN Cross sectional. SETTING Urban and rural areas throughout Greece. SUBJECTS In total,10 837 volunteers, 2034 men and 8803 women, aged 25-82 years, participants in the European Prospective Investigation into Cancer and Nutrition study (EPIC), who have never smoked and never been treated for dyslipidemia. INTERVENTIONS None. RESULTS The effect of height on non-HDL-cholesterol was opposite but in absolute terms almost as important as that of BMI with no gender interaction. Among women, hip circumference was inversely associated with non-HDL-cholesterol (standardized coefficient bst = -1.11, with standard error (s.e.)=0.42) and positively with HDL-cholesterol (bst = 0.85, s.e.= 0.12) whereas, waist circumference was inversely associated with HDL-cholesterol (bst = -1.16, s.e.=0.13) and strongly positively with non-HDL-cholesterol (bst = 8.83, s.e.= 0.45). Among men, associations were generally weaker (in absolute terms by about 50%) and for hip circumference the association with non-HDL-cholesterol was actually non significantly positive. CONCLUSIONS Height was inversely associated with HDL and non-HDL-cholesterol implicating early life phenomena in the regulation of these variables. Larger hip circumference among women had beneficial effects on blood cholesterol fractions by increasing HDL-cholesterol and reducing non-HDL-cholesterol, whereas among men the relevant effects were less clear cut. The detrimental consequences of large waist circumference on both HDL (reduction) and non-HDL-cholesterol (increase) were also particularly marked among women. SPONSORSHIP The European Prospective Investigation into Cancer and Nutrition (EPIC) is coordinated by the International Agency for Research on Cancer (World Health Organization) and supported by the Europe Against Cancer Program of the European Commission. The Greek segment of the EPIC study is also supported by the Greek Ministry of Health and the Greek Ministry of Education. This study was additionally supported by the fellowship 'Vassilios and Nafsika Tricha'.
Collapse
Affiliation(s)
- V Benetou
- Department of Hygiene and Epidemiology, University of Athens Medical School, Athens, Greece
| | | | | | | |
Collapse
|
37
|
Hsieh SD, Muto T. Metabolic syndrome in Japanese men and women with special reference to the anthropometric criteria for the assessment of obesity: Proposal to use the waist-to-height ratio. Prev Med 2006; 42:135-9. [PMID: 16376978 DOI: 10.1016/j.ypmed.2005.08.007] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2004] [Revised: 08/17/2005] [Accepted: 08/27/2005] [Indexed: 11/21/2022]
Abstract
BACKGROUND Obesity is one of the criteria for defining metabolic syndrome. However, overt obesity in Asians is relatively low despite high prevalence of metabolic risks. METHODS We investigated the effectiveness of various anthropometric indices {body mass index (BMI), waist circumference, waist-to-height ratio (W/Ht)} for the evaluation of coronary risk factors (hypertension, hyperglycemia, hypertriglyceridemia, and low HDL cholesterol) and as one of the criteria for metabolic syndrome (clustering of three or more from one obesity and four coronary risk factors) in Japanese on 6141 men and 2137 women. RESULTS (1) The areas under the receiver operating characteristic curves for the different anthropometric indices to identify any one and two or more coronary risk factors were highest for W/Ht. (2) The sensitivities for the identification of any one and two or more coronary risk factors were greater for W/Ht > or =0.5 than BMI > or =25, > or =23, and indices of waist circumference (Adult Treatment Panel III and Japan Society for the Study of Obesity). (3) The prevalence of metabolic syndrome varied greatly by different anthropometric indices, and the percentages of obesity risk factors in metabolic syndrome were highest for W/Ht > or =0.5 in both genders (approximate 95%). CONCLUSIONS W/Ht >/=0.5 may be the most effective anthropometric index for screening Japanese people for metabolic syndrome.
Collapse
Affiliation(s)
- Shiun Dong Hsieh
- Medical Center of Health Science, Toranomon Hospital, Minato-ku, Tokyo, Japan.
| | | |
Collapse
|
38
|
Silventoinen K, Pankow J, Jousilahti P, Hu G, Tuomilehto J. Educational inequalities in the metabolic syndrome and coronary heart disease among middle-aged men and women. Int J Epidemiol 2005; 34:327-34. [PMID: 15659460 DOI: 10.1093/ije/dyi007] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Previous studies have shown socioeconomic inequalities in the metabolic syndrome and coronary heart disease (CHD), but it is not known whether educational disparities in the metabolic syndrome explain educational inequalities in CHD. We investigated this question in a prospective study of middle-aged men and women. METHODS Baseline data were collected in 1992 in Finland from 864 men and 1045 women aged 45-64 years without history of CHD. A total of 113 new CHD cases were identified by the end of 2001. Logistic and Cox regression models were used in data analysis. RESULTS The metabolic syndrome defined by NCEP criteria was less prevalent in subjects with university education (21% in men and 14% in women) compared with basic level education (41% and 27%, respectively). Adjusting for health behavioural factors had only a slight effect on the educational gradient in the metabolic syndrome. An educational gradient in CHD incidence was clear [hazard ratio (HR) = 0.67 95% confidence interval (CI) 0.48-0.94, men and women combined]. Adjustment for the metabolic syndrome attenuated this gradient only slightly, but when individual components of the metabolic syndrome were included as covariates the attenuation was more substantial (HR = 0.73 95% CI 0.52-1.04). CONCLUSIONS Educational differences in the metabolic syndrome and CHD incidence are clear. Metabolic risk factors explain the gradient in CHD incidence partly, but only when they are treated as independent risk factors. Screening for the metabolic syndrome alone is not sufficient to account for socioeconomic inequalities in cardiovascular disease.
Collapse
Affiliation(s)
- Karri Silventoinen
- Department of Public Health, University of Helsinki, PO Box 41, Mannerheimintie 172, FIN-00014, Finland.
| | | | | | | | | |
Collapse
|
39
|
Henriksson KM, Lindblad U, Gullberg B, Agren B, Nilsson-Ehle P, Råstam L. Development of hypertension over 6 years in a birth cohort of young middle-aged men: the Cardiovascular Risk Factor Study in southern Sweden (CRISS). J Intern Med 2002; 252:21-6. [PMID: 12074734 DOI: 10.1046/j.1365-2796.2002.00996.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To explore the development of hypertension (HT) in a cohort of young middle-aged men. DESIGN Prospective birth-cohort study of men surveyed over 6 years. SETTING Helsingborg County Hospital, Sweden, 1990-97. SUBJECTS A total of 628 men born in 1953-54, all surveyed at 37, 40 and 43 years of age. MAIN OUTCOME MEASURES Systolic blood pressure (SBP), diastolic blood pressure (DBP), S-cholesterol, body mass index (BMI), alcohol consumption, ethnicity. HT was defined as SBP > or = 140 mmHg and/or DBP > or = 90 mmHg, or ongoing treatment. Using SBP < 130 mmHg and DBP < 85 mmHg as reference, the odds of conversion to HT in men with high normal blood pressure (BP) (SBP 130-139 mmHg and DBP 85-89 mmHg) was investigated. RESULTS At age 37, 243 men (39%) had reference BP, 167 (26%) had high normal BP and 218 (35%) were hypertensive. Corresponding numbers at age 40 were 265 (42%), 166 (27%) and 197 (31%); and at age 43, 180 (29%), 142 (22%) and 306 (49%), respectively. High normal BP at baseline was associated with the development of HT both at age 40 (odds ratio (OR)=2.45 confidence interval (CI): 1.42-4.22) and at age 43 (OR=2.46, CI: 1.59-3.80), independent of other cardiovascular disease risk factors and ethnicity. The progression to HT was predicted also by S-cholesterol, alcohol consumption, BMI and weight gain. CONCLUSIONS Over a short-term period, a substantial proportion of young middle-aged men with high normal BP develop HT with overweight and alcohol consumption as important determinants. These findings have implications for the prevention, screening and medical care of HT in this target population.
Collapse
Affiliation(s)
- K M Henriksson
- Department of Community Medicine, Lund University, Malmö, Sweden.
| | | | | | | | | | | |
Collapse
|