Cut-points for waist circumference in Europids and South Asians

Diagnostic performance of US for suspected appendicitis: Does multi-categorical reporting provide better estimates of disease in adults, and what factors are associated with false or indeterminate results?

PURPOSE

To identify factors associated with false or indeterminate US result for suspected appendicitis, and assess whether multi-categorical reporting of US yields more precise estimates regarding the probability of appendicitis.

METHODS

562 US examinations for suspected appendicitis between May 2013-April 2015 were categorized as true (77/562 true positives or true negatives) or false/indeterminate (485/562 false negatives, false positives or indeterminates) based on results from a prior study. Of 541 examinations with images available retrospectively, a category of A-E was assigned as follows: non-visualized appendix with secondary findings (A) absent or (B) present; appendix visualized and considered (C) negative, (D) equivocal, or (E) positive for appendicitis. The following factors were recorded: age; sex; scan time (daytime vs. off-hours); resident/fellow involvement; abdominal subspecialty radiologist; radiologist experience (>5 years or not); and tenderness on interrogation. Associations between factors and US result were assessed (t-tests, Fisher's exact test and multivariate logistic regression).

RESULTS

The true group had proportionally more males (18/77 (23.4%) vs. 66/485 (13.6%), p = 0.04) and patients with sonographic tenderness (43/77 (55.8%) vs. 132/353 (27.3%), p < 0.0001). There was no significant difference or association with other factors. On multivariate logistic regression, false/indeterminate results were 1.9 times (95% CIs 1.0-3.5) more likely among females and 3.8 times more likely in the absence of tenderness (95% CIs 2.3-6.4). The proportion of patients with appendicitis in categories A-E was 34/410 (8.3%), 24/44 (54.5%), 0/18 (0%), 0/3 (0%) and 61/66 (92.4%), respectively.

CONCLUSIONS

Females and absence of tenderness were associated with a false/indeterminate US. Categorical reporting provides more granular estimates of the post-test probability of appendicitis.

Added and Free Sugars Intake and Metabolic Biomarkers in Japanese Adolescents

Reduction in the intakes of added and free sugars is a recommendation to lower cardiometabolic risks. Sugars intake is considered lowest in the Asian-Pacific region, particularly Japan. We examined the association between sugars intake and cardiometabolic risks in Japanese adolescents. We included 3242 students (mean age, 13.56 years) living in Shunan City, Japan, between 2006 and 2010. Sugars intake was estimated using the brief-type self-administered diet history questionnaire. Anthropometrics, serum lipids, fasting plasma glucose, and blood pressure were measured. Metabolic syndrome was determined by the combination of overweight and other risks. Intakes of added and free sugars were 7.6–7.9%E and 8.4–8.8%E of the total energy intake (%E), respectively. Categories based on quintiles of added or free sugars intakes were associated with fasting glucose, systolic blood pressure, and the z-score of metabolic syndrome (P_trend ≤ 0.025). Other than the association between added sugars ≥10%E and high glucose (odds ratio 1.51, 95% confidence interval 1.04–2.19, p = 0.031), non-significantly high intakes of added or free sugars for risks occurred. Association was observed between added or free sugars intake and cardiometabolic biomarkers in Japanese adolescents, and added sugars intake <10%E could prevent glucose intolerance but not metabolic syndrome.

Obesity and Periodontal Disease: A Narrative Review on Current Evidence and Putative Molecular Links

Background:

Obesity represents one of the main health problems worldwide and is considered a risk factor for several diseases, including periodontitis, which is a microbially-associated inflammatory disease affecting the tooth-supporting structures.

Objective:

The aim of this review was to report the current direct and indirect evidence concerning the possible association between obesity and periodontitis and their putative molecular links.

Methods:

A literature search was conducted between January 1999 and September 2019, in PubMed/MEDLINE and Science Direct databases, using pertinent keyword combined by Boolean operators. Through a multi-step screening process (literature search; articles title and abstract evaluation and full-text reading), studies fitting inclusion/exclusion criteria were considered for the review.

Results:

35 studies were included in the present review (17 observational studies; 7 systematic reviews; 11 systematic reviews with meta-analysis), focusing on the direct and indirect evidence of the possible association between obesity and periodontitis and their potential etiopathogenic molecular links

Conclusion:

Although the majority of the studies reported a positive association between obesity and periodontitis, the heterogeneity of the classification criteria and of the clinical parameters employed in the studies for both obesity and periodontitis evaluation, complicated the comparison of the results, thus considered inconclusive. Although several putative molecular pathogenic links between obesity and periodontitis have been highlighted, further studies, with longer follow-ups and with homogeneous clinical criteria, are needed to better understand the putative relation between obesity and periodontal disease.

Prevalence of the Metabolic Syndrome and its determinants among Nepalese adults: Findings from a nationally representative cross-sectional study

Metabolic syndrome (MetS) increases the risk of cardiovascular diseases and diabetes mellitus. This study is designed to assess the prevalence and determinants of MetS among Nepalese adults from a nationally representative study. This study is based on Stepwise Approach to Surveillance (STEPS) Survey from Nepal. This survey was done among 4200 adults aged 15-69 years from 210 clusters selected proportionately across Nepal's three ecological zones (Mountain, Hill and Terai). Subsequently, using systematic sampling, twenty households per cluster and one participant per household were selected. The overall prevalence of MetS is 15% and 16% according to Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) criteria respectively. A triad of low HDL-C, abdominal obesity and high BP was the most prevalent (8.18%), followed by abdominal obesity, low HDL-C cholesterol and high triglycerides (8%). Less than two percent of participants had all the five components of the syndrome and 19% of participants had none. The prevalence steadily rose across the age group with adults aged 45-69 years having the highest prevalence (28-30%) and comparable prevalence across two definitions of MetS. A notably high burden for females, urban, hill or Terai resident were seen among other factors.

Effectiveness of the CANRISK tool in the identification of dysglycemia in First Nations and Métis in Canada

INTRODUCTION

First Nations/Métis populations develop diabetes earlier and at higher rates than other Canadians. The Canadian diabetes risk questionnaire (CANRISK) was developed as a diabetes screening tool for Canadians aged 40 years or over. The primary aim of this paper is to assess the effectiveness of the existing CANRISK tool and risk scores in detecting dysglycemia in First Nations/Métis participants, including among those under the age of 40. A secondary aim was to determine whether alternative waist circumference (WC) and body mass index (BMI) cut-off points improved the predictive ability of logistic regression models using CANRISK variables to predict dysglycemia.

METHODS

Information from a self-administered CANRISK questionnaire, anthropometric measurements, and results of a standard oral glucose tolerance test (OGTT) were collected from First Nations and Métis participants (n = 1479). Sensitivity and specificity of CANRISK scores using published risk score cut-off points were calculated. Logistic regression was conducted with alternative ethnicity-specific BMI and WC cut-off points to predict dysglycemia using CANRISK variables.

RESULTS

Compared with OGTT results, using a CANRISK score cut-off point of 33, the sensitivity and specificity of CANRISK was 68% and 63% among individuals aged 40 or over; it was 27% and 87%, respectively among those under 40. Using a lower cut-off point of 21, the sensitivity for individuals under 40 improved to 77% with a specificity of 44%. Though specificity at this threshold was low, the higher level of sensitivity reflects the importance of the identification of high risk individuals in this population. Despite altered cut-off points of BMI and WC, logistic regression models demonstrated similar predictive ability.

CONCLUSION

CANRISK functioned well as a preliminary step for diabetes screening in a broad age range of First Nations and Métis in Canada, with an adjusted CANRISK cutoff point for individuals under 40, and with no incremental improvement from using alternative BMI/WC cut-off points.

Obesity and Type 2 Diabetes: Two Diseases with a Need for Combined Treatment Strategies - EASO Can Lead the Way

Obesity is a chronic metabolic disease affecting adults and children worldwide. It has become one of the leading causes of death, as obesity is known to be the main risk factor for a number of non-communicable diseases, in particular type 2 diabetes. This close relationship led to the connotation 'diabesity', highlighting the fact that the majority of individuals with diabetes are overweight or obese. Until today the BMI is still used to classify overweight and obesity. Since reduced muscle mass is highly prevalent throughout the BMI range, the measurement of body composition is strongly recommended. Moreover, it is essential for monitoring the course of weight reduction, which is part of every effective anti-obesity treatment. Weight reduction can be achieved via different weight loss strategies, including lifestyle intervention (diet and exercise), pharmacotherapy, or bariatric surgery. However, not all of these strategies are suitable for all patients, and any further needs should be considered. Besides, attention should also be drawn to concomitant therapies. These therapies may promote additional weight gain and further trigger the deterioration of blood glucose control. Thus, therapeutic strategies are warranted, which can be easily used for the management of obese patients with type 2 diabetes to achieve their glycemic and weight loss goals.

Deriving an optimal threshold of waist circumference for detecting cardiometabolic risk in sub-Saharan Africa

BACKGROUND

Waist circumference (WC) thresholds derived from western populations continue to be used in sub-Saharan Africa (SSA) despite increasing evidence of ethnic variation in the association between adiposity and cardiometabolic disease and availability of data from African populations. We aimed to derive a SSA-specific optimal WC cut-point for identifying individuals at increased cardiometabolic risk.

METHODS

We used individual level cross-sectional data on 24 181 participants aged ⩾15 years from 17 studies conducted between 1990 and 2014 in eight countries in SSA. Receiver operating characteristic curves were used to derive optimal WC cut-points for detecting the presence of at least two components of metabolic syndrome (MS), excluding WC.

RESULTS

The optimal WC cut-point was 81.2 cm (95% CI 78.5-83.8 cm) and 81.0 cm (95% CI 79.2-82.8 cm) for men and women, respectively, with comparable accuracy in men and women. Sensitivity was higher in women (64%, 95% CI 63-65) than in men (53%, 95% CI 51-55), and increased with the prevalence of obesity. Having WC above the derived cut-point was associated with a twofold probability of having at least two components of MS (age-adjusted odds ratio 2.6, 95% CI 2.4-2.9, for men and 2.2, 95% CI 2.0-2.3, for women).

CONCLUSION

The optimal WC cut-point for identifying men at increased cardiometabolic risk is lower (⩾81.2 cm) than current guidelines (⩾94.0 cm) recommend, and similar to that in women in SSA. Prospective studies are needed to confirm these cut-points based on cardiometabolic outcomes.International Journal of Obesity advance online publication, 31 October 2017; doi:10.1038/ijo.2017.240.

The use and interpretation of anthropometric measures in cancer epidemiology: A perspective from the world cancer research fund international continuous update project

Anthropometric measures relating to body size, weight and composition are increasingly being associated with cancer risk and progression. Whilst practical in epidemiologic research, where population-level associations with disease are revealed, it is important to be aware that such measures are imperfect markers of the internal physiological processes that are the actual correlates of cancer development. Body mass index (BMI), the most commonly used marker for adiposity, may mask differences between lean and adipose tissue, or fat distribution, which varies across individuals, ethnicities, and stage in the lifespan. Other measures, such as weight gain in adulthood, waist circumference and waist-to-hip ratio, contribute information on adipose tissue distribution and insulin sensitivity. Single anthropometric measures do not capture maturational events, including the presence of critical windows of susceptibility (i.e., age of menarche and menopause), which presents a challenge in epidemiologic work. Integration of experimental research on underlying dynamic genetic, hormonal, and other non-nutritional mechanisms is necessary for a confident conclusion of the overall evidence in cancer development and progression. This article discusses the challenges confronted in evaluating and interpreting the current evidence linking anthropometric factors and cancer risk as a basis for issuing recommendations for cancer prevention.

Investigation of Genetic Variation Underlying Central Obesity amongst South Asians

South Asians are 1/4 of the world's population and have increased susceptibility to central obesity and related cardiometabolic disease. Knowledge of genetic variants affecting risk of central obesity is largely based on genome-wide association studies of common SNPs in Europeans. To evaluate the contribution of DNA sequence variation to the higher levels of central obesity (defined as waist hip ratio adjusted for body mass index, WHR) among South Asians compared to Europeans we carried out: i) a genome-wide association analysis of >6M genetic variants in 10,318 South Asians with focused analysis of population-specific SNPs; ii) an exome-wide association analysis of ~250K SNPs in protein-coding regions in 2,637 South Asians; iii) a comparison of risk allele frequencies and effect sizes of 48 known WHR SNPs in 12,240 South Asians compared to Europeans. In genome-wide analyses, we found no novel associations between common genetic variants and WHR in South Asians at P<5x10-8; variants showing equivocal association with WHR (P<1x10-5) did not replicate at P<0.05 in an independent cohort of South Asians (N = 1,922) or in published, predominantly European meta-analysis data. In the targeted analyses of 122,391 population-specific SNPs we also found no associations with WHR in South Asians at P<0.05 after multiple testing correction. Exome-wide analyses showed no new associations between genetic variants and WHR in South Asians, either individually at P<1.5x10-6 or grouped by gene locus at P<2.5x10-6. At known WHR loci, risk allele frequencies were not higher in South Asians compared to Europeans (P = 0.77), while effect sizes were unexpectedly smaller in South Asians than Europeans (P<5.0x10-8). Our findings argue against an important contribution for population-specific or cosmopolitan genetic variants underlying the increased risk of central obesity in South Asians compared to Europeans.

Waist-to-height ratio as a measure of abdominal obesity in southern Chinese and European children and adolescents

BACKGROUND

Waist-to-height ratio (WHtR), with a 0.5 threshold (WHtR0.5), is regarded as a simple age- and gender-independent criterion of abdominal obesity (AO) and a better predictor than the 90th percentile of waist circumference (WCP90).

OBJECTIVE

An analysis of gender and ethnic differences of WHtR and other AO indices between children and adolescents from southern China (HK: Hong-Kong, China) and Europe (LD: Łódź, Poland).

SUBJECTS

Two large cross-sectional surveys of children and adolescents aged 7-19 years, one from LD (13 172) and one from HK (14 566).

METHODS

The percentile and standardized values of WHtR and other parameters (WC, body mass index (BMI)) were assessed using the LMS method. The WHtR values corresponding to WCP90 and to the BMI definition of global obesity (BMIP95) were evaluated with the polynomial regression model. The compliance of the AO prevalence data, obtained with two criteria (WCP90 vs WHtR0.5) was analyzed using Cohen's kappa index (κC).

RESULTS

The WHtR data of Polish subjects were generally higher than those of their HK peers, and the ethic differences increased with age. The WHtR values of HK boys showed a stronger relationship with BMI z-score. WHtR corresponding to WCP90 assumed values <0.5. An application of Cohen's kappa coefficient (κC) to Polish subjects showed either 'substantial' (κC>0.6) or 'almost perfect' (κC>0.8) agreement in the AO prevalence for both criteria (WCP90 and WHtR0.5). For these criteria, either 'fair' (κC <0.4) or 'moderate' (κC<0.6) AO consistency ratings were observed among HK girls. In HK boys, a significant difference in the prevalence of AO was observed, independent of the criterion used.

CONCLUSIONS

Our results provide further evidence of the need for developing ethnic-specific WC charts and for recommending that a WHtR cutoff of 0.5 may not be appropriate to predict cardiometabolic risk in children of different ethnic groups.

Body fatness charts based on BMI and waist circumference

OBJECTIVE

To present percent body fat (PBF) charts based on body mass index (BMI) and waist circumference (WC) which can supplement current public health guidelines for obesity.

METHODS

Based on data from the National Health and Nutrition Examination Survey (NHANES) III for 18- to 65-year-olds, a semi-parametric spline approach was utilized, in which no specific functional forms for BMI and WC are assumed, to depict graphically the relationship between BMI, WC, and PBF. Four distinct PBF charts were created, categorized by gender and ethnicity which are based on data from 2,170 white females, 1,902 African American females, 1,905 white males, and 1,635 African American males.

RESULTS

PBF prediction based on the semi-parametric spline model outperformed competing linear models. For men, BMI is largely inconsequential, and WC plays a primary role in determining PBF levels. For women, the interaction between BMI and WC is more complex. To have low body fat, women would need to watch both their BMI and WC measurements carefully.

CONCLUSIONS

PBF charts, which incorporate information from three dimensions that are as simple to read as a BMI chart to help determine a person's level of fatness, were proposed.

Body Composition in Asians and Caucasians: Comparative Analyses and Influences on Cardiometabolic Outcomes

Within the last four decades Asia has witnessed major transformation in its population demographics, which gave rise to changes in food availability, food habits and lifestyle. A significant consequence of these changes has been the continuing rise in overweight and obesity across Asia. In parallel, there has been a significant rise in Asians in the incidence of the major chronic diseases, particularly in cardiometabolic disorders such as metabolic syndrome, type 2 diabetes, hypertension, and other cardiovascular diseases. Given that the majority of the evidence, to date, investigating the associations between adiposity and cardiometabolic disorder risk have been obtained from studies undertaken either in European or in North American Caucasians, in this chapter, we have reviewed differences in body fat content and distribution between East Asians, South Asians, and Caucasians. The evidence is consistent that the content and distribution of body fat are markedly different between the various ethnic groups. We found that Asians have a greater predisposition towards adiposity at higher BMI than in Caucasians. Moreover, at any given level of adiposity, Asians have a much greater predisposition to risk of cardiometabolic disorders than Caucasians. We therefore strongly endorse the need for different adiposity cutoffs in Asians as compared to the Caucasians. We have also reviewed the predictive abilities of the various body composition/adiposity measures in determining risk of cardiometabolic disorders in Asians.

Identifying evidence for public health guidance: a comparison of citation searching with Web of Science and Google Scholar

AIM

To examine how effectively forwards citation searching with Web of Science (WOS) or Google Scholar (GS) identified evidence to support public health guidance published by the National Institute for Health and Care Excellence.

METHOD

Forwards citation searching was performed using GS on a base set of 46 publications and replicated using WOS.

OUTCOMES

WOS and GS were compared in terms of recall; precision; number needed to read (NNR); administrative time and costs; and screening time and costs. Outcomes for all publications were compared with those for a subset of highly important publications.

RESULTS

The searches identified 43 relevant publications. The WOS process had 86.05% recall and 1.58% precision. The GS process had 90.7% recall and 1.62% precision. The NNR to identify one relevant publication was 63.3 with WOS and 61.72 with GS. There were nine highly important publications. WOS had 100% recall, 0.38% precision and NNR of 260.22. GS had 88.89% recall, 0.33% precision and NNR of 300.88. Administering the WOS results took 4 h and cost £88-£136, compared with 75 h and £1650-£2550 with GS.

CONCLUSION

WOS is recommended over GS, as citation searching was more effective, while the administrative and screening times and costs were lower.

Normal liver stiffness: A study in living donors with normal liver histology

AIM: To define the normal range of liver stiffness (LS) values using transient elastography in living-related liver transplantation candidate donors with normal liver histology.

METHODS: LS was measured using Fibroscan in 50 (16 women, 34 men) healthy potential donors (mean age 28.4 ± 5.9 years) who were being evaluated for liver donation for their relatives at the National Liver Institute, Menoufeya University, Egypt. All potential donors had normal liver tests and were negative for hepatitis B or C virus infection. Abdominal ultrasounds showed normal findings. None of the subjects had diabetes, hypertension, renal impairment, heart disease, or body mass index > 30 kg/m². All subjects had normal liver histology upon liver biopsy. They all donated the right lobe of their liver with successful outcomes.

RESULTS: The mean LS was 4.3 ± 1.2 kPa (range: 1.8-7.1 kPa). The 5^th and 95^th percentiles of normal LS were 2.6 kPa and 6.8 kPa, respectively, with a median of 4 kPa; the interquartile range was 0.6 ± 0.4. LS measurements were not significantly different between men and women (4.4 ± 1.1 kPa vs 3.9 ± 1.3 kPa) and did not correlate with age. However, stiffness values were significantly lower in subjects with a body mass index < 26 kg/m² compared to those with an index ≥ 26 kg/m² (4.0 ± 1.1 kPa vs 4.6 ± 1.2 kPa; P <0.05). There were no differences in hospital stay or postoperative bilirubin, albumin,alanine and aspartate transaminases, or creatinine levels (at discharge) between donors with livers stiffness ≤ 4 kPa and those with stiffness > 4 kPa.

CONCLUSION: Healthy donors with normal liver histology have a median LS of 4 kPa. Stiffness values are elevated relative to increase in body mass index.

Ethnicity-specific obesity cut-points in the development of Type 2 diabetes - a prospective study including three ethnic groups in the United Kingdom

AIMS

Conventional definitions of obesity, e.g. body mass index (BMI) ≥ 30 kg/m² or waist circumference cut-points of 102 cm (men) and 88 cm (women), may underestimate metabolic risk in non-Europeans. We prospectively identified equivalent ethnicity-specific obesity cut-points for the estimation of diabetes risk in British South Asians, African-Caribbeans and Europeans.

METHODS

We studied a population-based cohort from London, UK (1356 Europeans, 842 South Asians, 335 African-Caribbeans) who were aged 40-69 years at baseline (1988-1991), when they underwent anthropometry, fasting and post-load (75 g oral glucose tolerance test) blood tests. Incident Type 2 diabetes was identified from primary care records, participant recall and/or follow-up biochemistry. Ethnicity-specific obesity cut-points in association with diabetes incidence were estimated using negative binomial regression.

RESULTS

Diabetes incidence rates (per 1000 person years) at a median follow-up of 19 years were 20.8 (95% CI: 18.4, 23.6) and 12.0 (8.3, 17.2) in South Asian men and women, 16.5 (12.7, 21.4) and 17.5 (13.0, 23.7) in African-Caribbean men and women, and 7.4 (6.3, 8.7), and 7.2 (5.3, 9.8) in European men and women. For incidence rates equivalent to those at a BMI of 30 kg/m² in European men and women, age- and sex-adjusted cut-points were: South Asians, 25.2 (23.4, 26.6) kg/m²; and African-Caribbeans, 27.2 (25.2, 28.6) kg/m². For South Asian and African-Caribbean men, respectively, waist circumference cut-points of 90.4 (85.0, 94.5) and 90.6 (85.0, 94.5) cm were equivalent to a value of 102 cm in European men. Waist circumference cut-points of 84.0 (74.0, 90.0) cm in South Asian women and 81.2 (71.4, 87.4) cm in African-Caribbean women were equivalent to a value of 88 cm in European women.

CONCLUSIONS

In prospective analyses, British South Asians and African-Caribbeans had equivalent diabetes incidence rates at substantially lower obesity levels than the conventional European cut-points.

Optimal waist circumference cut-off values for predicting cardiovascular risk factors in a multi-ethnic Malaysian population

INTRODUCTION

Previous studies have proposed the lower waist circumference (WC) cutoffs be used for defining abdominal obesity in Asian populations.

OBJECTIVE

To determine the optimal cut-offs of waist circumference (WC) in predicting cardiovascular (CV) risk factors in the multi-ethnic Malaysian population.

METHODS

We analysed data from 32,703 respondents (14,980 men and 17,723 women) aged 18 years and above who participated in the Third National Health and Morbidity Survey in 2006. Gender-specific logistic regression analyses were used to examine associations between WC and three CV risk factors (diabetes mellitus, hypertension, and hypercholesterolemia). The Receiver Operating Characteristic (ROC) curves were used to determine the cut-off values of WC with optimum sensitivity and specificity for detecting these CV risk factors.

RESULTS

The odds ratio for having diabetes mellitus, hypertension, and hypercholesterolemia, or at least one of these risks, increased significantly as the WC cut-off point increased. Optimal WC cut-off values for predicting the presence of diabetes mellitus, hypertension, hypercholesterolemia and at least one of the three CV risk factors varied from 81.4 to 85.5 cm for men and 79.8 to 80.7 cm for women.

CONCLUSIONS

Our findings indicate that WC cut-offs of 81 cm for men and 80 cm for women are appropriate for defining abdominal obesity and for recommendation to undergo cardiovascular risk screening and weight management in the Malaysian adult population.

Specific cut-off points for waist circumference and waist-to-height ratio as predictors of cardiometabolic risk in Black subjects: a cross-sectional study in Benin and Haiti

PURPOSE

Waist circumference (WC) and waist-to-height ratio (WHtR) are widely used as indicators of abdominal adiposity and the cut-off values have been validated primarily in Caucasians. In this study we identified the WC and WHtR cut-off points that best predicted cardiometabolic risk (CMR) in groups of African (Benin) and African ancestry (Haiti) Black subjects.

METHODS

This cross-sectional study included 452 apparently healthy subjects from Cotonou (Benin) and Port-au-Prince (Haiti), 217 women and 235 men from 25 to 60 years. CMR biomarkers were the metabolic syndrome components. Additional CMR biomarkers were a high atherogenicity index (total serum cholesterol/high density lipoprotein cholesterol ≥4 in women and ≥5 in men); insulin resistance set at the 75th percentile of the calculated Homeostasis Model Assessment index (HOMA-IR); and inflammation defined as high-sensitivity C-reactive protein (hsCRP) concentrations between 3 and 10 mg/L. WC and WHtR were tested as predictors of two out of the three most prevalent CMR biomarkers. Receiver operating characteristic (ROC) curves, Youden's index, and likelihood ratios were used to assess the performance of specific WC and WHtR cut-offs.

RESULTS

High atherogenicity index (59.5%), high blood pressure (23.2%), and insulin resistance (25% by definition) were the most prevalent CMR biomarkers in the study groups. WC and WHtR were equally valid as predictors of CMR. Optimal WC cut-offs were 80 cm and 94 cm in men and women, respectively, which is exactly the reverse of the generic cut-offs. The standard 0.50 cut-off of WHtR appeared valid for men, but it had to be increased to 0.59 in women.

CONCLUSION

CMR was widespread in these population groups. The present study suggests that in order to identify Africans with high CMR, WC thresholds will have to be increased in women and lowered in men. Data on larger samples are needed.

Developing suitable methods of nutritional status assessment: a continuous challenge

Reliable information about the nutritional status is essential to identify potential critical nutrients and the population groups at risk of deficiency, as well as to develop effective public health policies to counteract unfavorable nutrition patterns that contribute to morbidity and mortality. In this review, the important role of biomarkers in the assessment of nutritional status is outlined, major strengths and limitations of established and new biomarkers are described, and important criteria for biomarker selection and development are discussed. Indeed, biomarkers offer a more objective assessment tool than pure dietary approaches that suffer from inadequate data reporting in particular, although biomarkers are often only measured in subsamples because of the higher costs and proband burden they entail. However, biomarkers are subject to individual variability and influences from other factors besides the nutrient of interest. Rapid turnover or tight control of nutrient concentrations in blood (homeostasis) limits their sensitivity as biomarkers, as in the case of many trace elements. The existence of different forms of a micronutrient in the body adds additional complexity. Functional biomarkers, such as enzyme activities, mirror long-term status better but are subject to confounding factors, and some are influenced by several micronutrients, not specific for only 1, so using a combination of biomarkers is advisable. Additionally, the applicability of a biomarker also depends on the existence of adequate reference values and cutoff points for the target population. Therefore, a careful selection is warranted, especially when biomarkers are to be used in larger samples.

Influence of Adult Knee Height, Age at First Birth, Migration, and Current Age on Adult Physical Function of Bangladeshi Mothers and Daughters in the United Kingdom and Bangladesh

In the United Kingdom, Bangladeshi women have the lowest self-reported levels of physical activity and some of the highest levels of metabolic disease of all ethnic groups. To better understand these risks for poor health we employed life course and intergenerational hypotheses to predict lower body physical function in a sample of 121 Bangladeshi mothers (40–70 years old) and one of their adult daughters (17–36 years old) living in Bangladesh or in the UK. For the mothers, older age and shorter knee height predicted reduced lower body physical function. Knee height is a biomarker of nutrition and health status between birth and puberty. Age at first birth did not have a significant effect. For daughters, older age and migration to the UK predicted reduced lower body physical function. We controlled for total stature and fatness in all analyses. UK-born daughters were taller than BD-born daughters living in the UK, mostly due to differences in knee height. These new findings support previous research indicating that early life health and adequate nutritional status, along with appropriate adult physical activity and diet, may decrease risks for poor physical function, morbidity, and premature mortality.

Should physical activity recommendations be ethnicity-specific? Evidence from a cross-sectional study of South Asian and European men

BACKGROUND

Expert bodies and health organisations recommend that adults undertake at least 150 min.week(-1) of moderate-intensity physical activity (MPA). However, the underpinning data largely emanate from studies of populations of European descent. It is unclear whether this level of activity is appropriate for other ethnic groups, particularly South Asians, who have increased cardio-metabolic disease risk compared to Europeans. The aim of this study was to explore the level of MPA required in South Asians to confer a similar cardio-metabolic risk profile to that observed in Europeans undertaking the currently recommended MPA level of 150 min.week(-1).

METHODS

Seventy-five South Asian and 83 European men, aged 40-70, without cardiovascular disease or diabetes had fasted blood taken, blood pressure measured, physical activity assessed objectively (using accelerometry), and anthropometric measures made. Factor analysis was used to summarise measured risk biomarkers into underlying latent 'factors' for glycaemia, insulin resistance, lipid metabolism, blood pressure, and overall cardio-metabolic risk. Age-adjusted regression models were used to determine the equivalent level of MPA (in bouts of ≥ 10 minutes) in South Asians needed to elicit the same value in each factor as Europeans undertaking 150 min.week(-1) MPA.

FINDINGS

For all factors, except blood pressure, equivalent MPA values in South Asians were significantly higher than 150 min.week(-1); the equivalent MPA value for the overall cardio-metabolic risk factor was 266 (95% CI 185-347) min.week(-1).

CONCLUSIONS

South Asian men may need to undertake greater levels of MPA than Europeans to exhibit a similar cardio-metabolic risk profile, suggesting that a conceptual case can be made for ethnicity-specific physical activity guidance. Further study is needed to extend these findings to women and to replicate them prospectively in a larger cohort.

Differences in subcutaneous abdominal adiposity regions in four ethnic groups

OBJECTIVE

Previous studies have identified ethnic specific differences in visceral adipose tissue (VAT), which may account for ethnic differences in cardio-metabolic risk. However, two distinctive sub-compartments of abdominal subcutaneous adipose tissue (SAT) have been recently identified that may also differ among ethnic groups. Therefore, the relationship between SAT compartments and body fat mass (BFM) between Aboriginal, Chinese, and South Asian cohorts compared to Europeans was investigated.

DESIGN AND METHODS

Healthy Aboriginal, Chinese, European, and South Asian (n = 822) men and women (30-65 years) were assessed for BFM via dual energy X-ray absorptiometry, and SAT areas using computer tomography. SAT was subdivided into superficial SAT (SSAT) and deep SAT (DSAT) via the fascia-superficialis. Linear regression was performed using DSAT and SSAT as separate dependent variables and BFM and ethnicity as primary independent variables adjusting for confounders.

RESULTS

Aboriginal (181.0 cm(2) ; p = 0.045) and South Asians (178.3 cm(2) ; p = 0.013) had significantly higher amounts of DSAT, whereas the Chinese cohort had significantly less when compared with Europeans (114.3 cm(2) ; p = <0.001). The Aboriginal cohort had a significantly higher amount of SSAT than Europeans (123.13 cm(2) vs. 108.7 cm(2) ; p = 0.04). Ethnicity modified the relationship between DSAT and BFM (p < 0.001 for interaction) such that Aboriginals and majority of South Asians had a significantly greater DSAT.

CONCLUSION

These data further demonstrate ethnic differences in body fat distribution such that Aboriginals and South Asians have greater amounts of DSAT. This may contribute to the increased cardio-metabolic risk in these groups.

Sex hormone-binding globulin and the risk for metabolic syndrome in children of South Asian Indian origin

OBJECTIVE

To determine whether the plasma level of sex hormone-binding globulin (SHBG) identifies South Asian Indian children at risk for metabolic syndrome.

METHODS

Adults and their children aged 5 to 9 years were recruited at the annual health fair at the Hindu temple serving the South Asian Indian community in Louisville, Kentucky. Anthropometric data were collected in adults and children, and blood pressure, lipid, and glucose levels were measured in adults. SHBG levels were measured in children using a fingerstick blood sample. In adults, metabolic syndrome was diagnosed according to the International Diabetes Federation criteria. Twelve months later, follow-up anthropometric data were obtained for a portion of the children.

RESULTS

The study included 30 sets of parents and 30 children. The prevalence of metabolic syndrome among 310 adults attending the health fair was 42% in men and 39% in women. Children with 1 parent with metabolic syndrome had 24% lower SHBG levels that increased to 55% if both parents had metabolic syndrome. SHBG levels were inversely related to waist circumference and to body mass index percentile. Both SHBG and waist circumference predicted weight gain over 1 year in children. CONCLUSIONS Low SHBG levels were found in South Asian Indian children whose parents had attributes of metabolic syndrome. The dose dependency of SHBG is consistent with inheritance of a genetic trait, and if the results are applicable to other racial/ethnic groups, SHBG may be a useful marker to identify at-risk children for early intervention.

Double burden: a cross-sectional survey assessing factors associated with underweight and overweight status in Danang, Vietnam

BACKGROUND

Many low- to middle-income countries are faced with an increasing prevalence of overweight/obesity while that for underweight remains high, a duality termed "double burden"; both are key risk factors for chronic diseases. This cross-sectional study assesses the prevalence and factors for underweight and overweight/obesity among adults in Danang, Vietnam, using WHO standard and suggested Asian-specific BMI cut-offs.

METHODS

In 2010, 1713 residents age ≥ 35 years from 900 households in 6 of 56 urban, rural and mixed urban-rural communes in Danang were selected using multistage-cluster sampling methodology to participate; 1621 qualified adults enrolled. Participants completed a health survey based on WHO STEPwise Approach to Chronic Disease Risk Factor Surveillance and additional questions on chest pain and stroke symptoms. Anthropometric and other measurements were conducted. Relative risk regression was used to identify independent risk factors for underweight or overweight/obesity according to WHO standard cut-offs and suggested Asian-specific cut-offs (<18.5 kg/m2 or 23-27.49 kg/m2; and ≥ 27.5 kg/m2).

RESULTS

We observed 12.4% prevalence of underweight and 16.0% for overweight/obesity using WHO standard. The prevalence of overweight/obesity doubled (33.7%) when Asian-specific cut-offs were applied. For both definitions, rural communes had the highest prevalence of underweight while urban communes had the highest prevalence of overweight/obesity. Being underweight was associated with less urbanization. Factors independently associated with being underweight included older age, rural living, current smoking, and lower systolic pressure. Factors independently associated with Asian-specific BMI definition for being overweight/obese included older age, urbanization, higher systolic pressure, and diabetes. Age was not an independent factor with WHO standard cut-offs; however, myocarial infarction and diabetes showed strong associations.

CONCLUSIONS

The double burden of underweight and overweight/obesity observed in Danang is consistent with patterns found for large cities in Vietnam that are undergoing rapid economic growth and urbanization of lifestyle. Factors independently associated with underweight and overweight/obesity status by WHO standard and Asian-specific definitions include urbanization and modifiable lifestyle factors. Further studies are needed to define ethnic specific BMI cut-offs for Vietnam and to explore strategies to reduce the rising prevalence of overweight/obesity.

Metabolic risk susceptibility in men is partially related to adiponectin/leptin ratio

BACKGROUND

High adiponectin/leptin ratio may be protective from metabolic risks imparted by high triglyceride, low HDL, and insulin resistance.

METHODS

This cross-sectional study examines plasma adipokine levels in 428 adult men who were subgrouped according to low (<6.5  μ g/mL)and high (≥6.5  μ g/mL)adiponectin levels or a low or high ratio of adiponectin/leptin.

RESULTS

Men with high adiponectin/leptin ratio had lower plasma triglyceride and higher HDL cholesterol than those with low ratio. Similarly, those with high adiponectin/leptin ratio had lower TG/HDL cholesterol ratio and HOMA2-IR than those with low ratio. In contrast, levels of adiponectin or the ratio of adiponectin/leptin did not associate with systolic blood pressure. But the ratio of adiponectin/leptin decreased progressively with the increase in the number of risk factors for metabolic syndrome.

CONCLUSION

Adipokine levels may reflect adipose tissue triglyceride storage capacity and insulin sensitivity. Leptin is an index of fat mass, and adiponectin is a biomarker of triglyceride metabolism and insulin sensitivity. Men with high adiponectin/leptin ratios have better triglyceride profile and insulin sensitivity than men with a low ratio regardless of waist girth.

Waist circumference and the risk of hypertension and prediabetes among Filipino women

OBJECTIVES

To examine waist circumference as a risk factor for having hypertension only, impaired fasting glucose only, or both hypertension and impaired fasting glucose, and assess whether the associations vary according to overweight status. Furthermore, optimal cut-offs for waist circumference in overweight women and non-overweight women were explored.

DATA AND METHODS

Data from 1,871 women aged 35-68 years in the 2005 Cebu Longitudinal Health and Nutrition Survey were used. Multinomial logistic regressions were used to model how waist circumference influenced the likelihood of having the three illness categories compared to having neither condition. Waist circumference cut-offs were explored using receiver operating characteristic analysis.

RESULTS

Adjusted for age and other confounders, each cm increase in waist circumference increased the odds of hypertension by 5 % for non-overweight women and 3 % for overweight women; impaired fasting glucose by 9 and 3 % for non-overweight and overweight women, respectively; and hypertension and impaired fasting glucose by 17 % among non-overweight versus 9 % for overweight women. Waist circumference cut-offs for non-overweight women were lower than overweight women.

CONCLUSION

Waist circumference was significantly associated with impaired fasting glucose and both hypertension and impaired fasting glucose, and the associations vary by overweight status.

Defining obesity cut-off points for migrant South Asians

BACKGROUND

Body mass index (BMI) and waist circumference (WC) are used to define cardiovascular and type 2 diabetes risk. We aimed to derive appropriate BMI and WC obesity cut-off points in a migrant South Asian population.

METHODS

4688 White Europeans and 1333 South Asians resident in the UK aged 40-75 years inclusive were screened for type 2 diabetes. Principal components analysis was used to derive a glycaemia, lipid, and a blood pressure factor. Regression models for each factor, adjusted for age and stratified by sex, were used to identify BMI and WC cut-off points in South Asians that correspond to those defined for White Europeans.

FINDINGS

For South Asian males, derived BMI obesity cut-off points equivalent to 30.0 kg/m(2) in White Europeans were 22.6 kg/m(2) (95% Confidence Interval (95% CI) 20.7 kg/m(2) to 24.5 kg/m(2)) for the glycaemia factor, 26.0 kg/m(2) (95% CI 24.7 kg/m(2) to 27.3 kg/m(2)) for the lipid factor, and 28.4 kg/m(2) (95% CI 26.5 kg/m(2) to 30.4 kg/m(2)) for the blood pressure factor. For WC, derived cut-off points for South Asian males equivalent to 102 cm in White Europeans were 83.8 cm (95% CI 79.3 cm to 88.2 cm) for the glycaemia factor, 91.4 cm (95% CI 86.9 cm to 95.8 cm) for the lipid factor, and 99.3 cm (95% CI 93.3 cm to 105.2 cm) for the blood pressure factor. Lower ethnicity cut-off points were seen for females for both BMI and WC.

CONCLUSIONS

Substantially lower obesity cut-off points are needed in South Asians to detect an equivalent level of dysglycemia and dyslipidemia as observed in White Europeans. South Asian ethnicity could be considered as a similar level of risk as obesity (in White Europeans) for the development of type 2 diabetes.

Reevaluating the diagnostic criteria for metabolic syndrome in the Taiwanese population

OBJECTIVE

Metabolic syndrome (MS) represents a constellation of conditions, which, taken together, increase an individual's risk for the development of type 2 diabetes and cardiovascular disease. Numerous guidelines have been suggested; however, increasing evidence has suggested that universal recommendations are not applicable across different ethnic groups. To date, no specific screening recommendations exist for the Taiwanese population.

MATERIALS AND METHODS

A total of 8913 Taiwanese (>18 years) were enrolled and evaluated for MS based on the International Diabetes Federation (IDF) criteria established for the Asian population, in an attempt to reevaluate the appropriate guidelines for diagnosing MS in the Taiwanese population.

RESULTS

Among the risk factors assessed, hypertension (24.72%), hyperglycemia (6.86%), and elevated triglycerides (18.50%) were significantly more prevalent among men (p < 0.01). Low high-density lipoprotein was not significantly different between genders. The prevalence of MS was 24.83% (1171/4716) for men and 15.48% (650/4197) for women. When modified cutoff points for waist circumference (WC) were analyzed (≥ 86.0 cm for men, ≥ 76.0 cm for women), the prevalence of MS increased to 40.88% (1928/4716) for men and 27.88% (1170/4197) for women. Not unexpectedly, the odds ratio for developing MS increased with an increasing WC, as well as with an increasing number of risk factors for MS.

CONCLUSIONS

The suggested IDF guidelines for defining MS in the Asian population, including WC, seem appropriate for use in the Taiwanese population but need modification. Further studies are warranted to identify other anthropometric measures specific to the population that would enhance the ability to diagnose MS.

Diagnostic ability of obesity measures to identify metabolic risk factors in South African women

BACKGROUND

Currently, guidelines for obesity thresholds relating to metabolic risk in South African women have not been established. Therefore, the aim of the study was to investigate the level and diagnostic ability of obesity measures [waist circumference (WC), waist-to-height ratio (WHtR), and visceral adipose tissue (VAT) area] to identify black and white South African women with elevated blood pressure, dyslipidemia, and insulin resistance.

METHODS

Blood pressure, fasting insulin, glucose, and lipids were measured in 241 black and 188 white South African women. Receiver operator characteristic (ROC) curve analyses were performed to determine the diagnostic ability of WC, WHtR, and computer tomography (CT)-derived VAT to identify subjects above metabolic risk thresholds. The Youden index was used to calculate obesity thresholds for metabolic risk variables.

RESULTS

WC, WHtR, and VAT were significant determinants of all metabolic risk variables (P<0.05), and differences in the ROC area under the curve (AUC) between obesity measures were small (≈0.08) for all metabolic risk variables, in both ethnic groups. However, the ROC AUC vales for all obesity measures were greater in white compared to black women (P<0.01). WC and VAT thresholds were lower in black women compared to white women, whereas WHtR thresholds varied less between ethnicities.

CONCLUSIONS

Due to the cost, access, and radiation exposure, CT-derived VAT is not recommended above the use of simple anthropometric measures (WC and WHtR) for the determination of metabolic risk. Furthermore, thresholds of WHtR, due to low variability between ethnicities, may be more useful than WC for ethnic comparisons of risk.

Diagnosis of prediabetes

A rational approach to diagnosing prediabetes is essential to identify those who would benefit from entering diabetes prevention programs. Impaired fasting glucose and impaired glucose tolerance are similar in relation to their ability to identify those at risk of diabetes or cardiovascular disease; however, because they identify different segments of the at-risk population, there is value in undertaking glucose tolerance testing to ensure that both conditions can be diagnosed. Simple noninvasive diabetes risk scores offer a valuable entry point in the diagnosis of prediabetes, enabling the identification of those who need blood testing.