Simple anthropometric indexes and cardiovascular risk factors in Chinese

Degree of association between the body mass index (BMI), waist-hip ratio (WHR), waist-height ratio (WHtR), body adiposity index (BAI) and conicity index (CI) in physically active older adults

BACKGROUND

Aging is the main factor in the eventual development of cardiovascular disease (CVD) the prevalence of which is increasing progressively along with life expectancy. Therefore, it is essential to identify the most effective indicators for predicting the possible development of CVD. Anthropometric indices provide useful information for CVD risk evaluation. These are widely used for the simplicity of their estimates and their high correlation in the positive identification of CVD. The most used in the general population are the body mass index (BMI), the waist to hip ratio (WHR) and waist to height ratio (WHtR), body adiposity index (BAI) and conicity index (CI). However, the behavior and association of such indices in physically active people over 65 years of age is not well established.

PURPOSE

To analyze the behavior and association of the BMI, WHR, WHtR, BAI and CI in a group of active people over 65 years of age.

METHODS

A group of 608 European participants with a mean age of 68.05 ± 5.43yrs, composed of 74.2% female and 28.5% male, was randomly selected and evaluated for anthropometric parameters and body composition by a bio-impedance measuring device with four electrode sensor systems. A descriptive analysis was completed via measures of central tendency (mean and standard deviation) and percentage analysis. As the distribution of the sample was normal (parametric), an association analysis was carried out through the Pearson correlation coefficient (r), in order to determine the relationship between anthropometric and body composition indices. A P value of <0.05 was considered to indicate statistical significance.

RESULTS

The results show that BMI, BAI and WHtR are significantly related to % body fat (Fat %), with BMI reaching the highest correlation (r = 0.612), followed by BAI (r = 0.556) and WHtR (r = 0.521). When the association between indices is considered, the WHtR and BAI and WHtR and BMI are those with the highest significant correlation (r = 0.981 and r = 0,789, respectively). As for the effects of gender, good to strong correlations were found between the BMI and the WHtR (r = 0.731 for female, r = 0.568 for male) and between the WHtR and the BAI (r = 0.989 for female, r = 0.985 for male).

CONCLUSION

The most accurate anthropometric index for indicating the level of body fat present in an active population of 65 years of age or over seems to be the BMI, followed by the BAI and WHtR. However, the degree of association between body fat and anthropometric parameters seems to be conditioned by gender.

Central Adiposity Indicators Maintain a Stronger Association With the Risk of Hypertension: A Prospective Cohort Study in Southwest China

Objectives: Studies have linked obesity to an increased risk of hypertension, but the optimal adiposity indicators to predict hypertension remains controversial. We comprehensively explored the correlation between body mass index, waist circumference (WC), waist-to-height ratio (WHtR), long-term weight and WC change, and hypertension in an adult population in Southwest China.

Methods: We studied 9,280 participants from 48 townships of 12 districts with a follow-up of 10 years in the Guizhou Population Health Cohort Study. We used Pearson’s correlation coefficients combined with Dunn and Clark’s z test and Zou’s confidence interval test, receiver operating characteristic (ROC) analyses, and multivariate Cox proportional hazards regressions adjusting for demographic characteristics, lifestyle habits, disease history, and lipid information of participants.

Results: Baseline central adiposity indicators (WC and WHtR) had closer associations with hypertension than BMI, and long-term WC change was more predictive of hypertension compared with weight change in the studied population.

Conclusion: Central adiposity indicators maintain a stronger association with the risk of hypertension, hinting at the importance of WC management in the precaution of hypertension.

Effectiveness of Body Roundness Index (BRI) and a Body Shape Index (ABSI) in Predicting Hypertension: A Systematic Review and Meta-Analysis of Observational Studies

INTRODUCTION

The body roundness index (BRI) and a body shape index (ABSI) are novel anthropometric indices established to determine both the amount visceral adipose tissue and body fat.

OBJECTIVE

to investigate whether BRI and ABSI are better predictors of hypertension than body mass index (BMI), waist circumference (WC) or waist-to-height ratio (WHtR). Methods: A systematic search was conducted in the Scopus, PubMed and Web of Science databases up until 31 December 2020.

RESULTS

The estimated pooled area under curve [AUC (95% CI)] for BRI [0.67 (0.65-0.70)] for the prediction of hypertension were superior to that of ABSI (0.58 (0.56-0.60)), similar to that of BMI [0.67 (0.64-0.69)], and lower than those WC [0.68 (0.66-0.70)] and WHtR [0.68 (0.66-0.71)]. Nevertheless, the difference of BRI compared to WC and WHtR in the context of predicting hypertension was non-significant. ABSI was significantly lower (p < 0.05) than BRI, BMI, WC and WHtR. Similar findings were observed with the summary receiver operating characteristic curve (AUC-SROC). There were no significant differences between subgroups according to type of population or diagnostic criteria of hypertension. The diagnostic odds ratio (dORs) proved that increased BRI and ABSI were related with an elevated hypertension risk.

CONCLUSIONS

BRI and ABSI have discriminatory power for hypertension in adult women and men from different populations. Although, WHtR and WC provided the best performance when assessing hypertension, no significant differences were found for BRI. Finally, BRI was significantly better predictor of hypertension than ABSI.

Sagittal abdominal diameter and its socioeconomic correlates: perspective of sex differences

Background

Sagittal abdominal diameter (SAD) is an anthropometric index associated with visceral adiposity. It remains unclear whether SAD and its socio-economic correlates differ in women and men, which limits the epidemiological and clinical applications of the SAD measurement. The aims of this study are to examine the sex differences in SAD and its socio-economic correlates.

Methods

A complex stratified multistage clustered sampling design was used to select 6975 men and 7079 women aged 18 years or more from the National Health Nutrition and Examination Survey 2011–2016, representative of the US civilian non-institutionalized population. SAD was measured in accordance to the standard protocols using a two-arm abdominal caliper. The sex differences in SAD and its socio-economic correlates were evaluated by performing weighted independent t tests and weighted multiple regression.

Results

SAD was lower in women than in men in the entire sample, as well as in all the subgroups characterized by age, race, birth place, household income, and body mass index except for non-Hispanic blacks and those with household income < $20,000. Adjusted for other characteristics, age, birth place, household income, and body mass index were associated with SAD in both women and men. Black women were associated with higher SAD then white women (p < .0001), and Hispanic and Asian men were associated with lower SAD than white men (both p < .01). Women born in other countries were more likely to have lower SAD than women born in the US (p < .0001), and so were men (p = .0118). Both women and men with a household income of <$75,000 had higher SAD than those with an income of over $75,000. The associations of age, race, and household income with SAD differed in women and men.

Conclusion

SAD is lower in women than in men, in the general population as well as in the most socio-economic subgroups. While socio-economic correlates of SAD are similar in women and men, the associations of age, race, and household income with SAD vary across sex.

Supplementary Information

Supplementary information accompanies this paper at 10.1186/s12889-020-09805-z.

Effectiveness of body roundness index in predicting metabolic syndrome: A systematic review and meta-analysis

Body roundness index (BRI) is a new anthropometric index developed to predict both body fat and the percentage of visceral adipose tissue. Our aim was to investigate whether BRI is superior to traditional anthropometric indices in predicting metabolic syndrome (MetS). This systematic review and meta-analysis was conducted using Pubmed, Scopus and Web of Sciences databases. The estimated pooled areas under curve (AUCs) for BRI predicting MetS was higher than body mass index (BMI), waist-to-hip ratio (WHR), body shape index (ABSI) and body adiposity index (BAI), similar to waist circumference (WC) and lower than waist-to-height ratio (WHtR). However, the difference between BRI and BMI, WC and WHtR predicting MetS was statistically non-significant. Similar results were found with the summary receiver operating characteristic curve (AUC-SROC). In addition, the non-Chinese population had pooled AUCs greater than the Chinese population for all indices. Pooled ORs showed that BRI is associated with an increased MetS risk. In conclusion, BRI had good discriminatory power for MetS in adults of both sexes from diverse populations (AUC > 0.7; AUC-SROC>0.7). However, WC and WHtR offer the best performance when screening for MetS, and non-significant differences were found with BRI. In contrast, BRI was superior to BMI, WHR, ABSI and BAI in predicting MetS.

Epidemiology of Diabetes Mellitus and Cardiovascular Disease

PURPOSE OF REVIEW

Diabetes mellitus (DM) has become a rising epidemic in the last century, more pressing in the last few decades with the exponential rise of obesity, and has become one of the leading causes of death worldwide.

RECENT FINDINGS

Genetic variants have also been a new field of epidemiology research to determine the underlying genetic component of those risk factors and the association of DM with CVD. In light of its significant prevalence, patients remain unaware of their disease progression that arises from genetic and metabolic risk factors. As compared to non-diabetics, those with type 2 DM carry a higher mortality risk from cardiovascular disease (CVD) across different ethnicity groups and sex. The most common cardiovascular manifestations in those with DM include heart failure, peripheral arterial disease, and coronary heart disease. Although DM does predispose patients to CVD, it in fact is not a risk equivalent, but carries significant heterogeneity in risk for CVD.

Comparing the ability of anthropometric indicators in determining the prevalence of hypertension among Indian tribes

OBJECTIVE

We compared the ability of the selected anthropometric indicators to best predict the prevalence of hypertension among the Indian tribes.

METHODS

A cross-sectional study was undertaken among 1431 adult participants (705 males and 726 females) between the ages of 20 and 60 years from six major tribes in India. Selected anthropometric indicators such as body mass index (BMI), waist-hip-ratio (WHR), waist-height-ratio (WHtR), percentage body fat (PBF), visceral fat (VF), minimum-waist-circumference (MWC) and sum-of-the-four skinfold thickness (SF4), along with the physiological parameters such as blood pressure were recorded. Discriminant analysis (DA) was performed to examine and compare the ability of the selected anthropometric indicators towards classifying hypertension among males, females and the total population.

RESULTS

Significant independent association was observed for hypertension and similar conditions within gender and selected age-group categories. The overall hypertension prevalence among the studied tribes was observed at 12.6%. Standardized function coefficients (SFCs) in discriminant analysis revealed PBF(0.89, 0.36, and 0.76 for overall, males, and females respectively) as the most powerful discriminator of hypertension. In addition, visceral fat (0.74, 1.46, and 0.58 for overall, males and females respectively) was observed to be the other significant indicator of hypertensive blood pressure. These exploratory findings for the first time indicate fat deposition, rather than body density alone, as an emerging physiological and metabolic risk among Indian tribes.

CONCLUSION

In the context of the highly prevalent chronic undernutrition, internal fat deposition is a major classifying factor of physiological and metabolic intolerance. It also indicates the increasing trend in lifestyle changes and the associated adversities among the Indian tribes.

Waist-to-height ratio index for predicting incidences of hypertension: the ARIRANG study

BACKGROUND

Several anthropometric indices such as body mass index (BMI) and waist circumference (WC) have been examined as indicators of cardiovascular diseases, in both adults and children. However, the waist-to-height ratio (WHtR) is considered a better predictor for the detection of cardiovascular risk factors, than BMI. We investigated the association between the WHtR and incident hypertension.

METHODS

A total of 1718 participants, aged 39-72 years, were recruited in this longitudinal study. Participants were divided into 2 groups according to the development of hypertension during 2005-2008 (baseline) and 2008-2011 (follow-up). Logistic regression models were used to evaluate the WHtR as a significant predictor of hypertension.

RESULTS

During the 2.8 years of follow-up, 185 new cases of hypertension (10.8%) were diagnosed, with an incidence rate of approximately 4% per year. The WHtR was significantly higher in the participants who had developed hypertension than in those who had not (0.54 ± 0.05 vs. 0.51 ± 0.05, p < 0.001). After adjusting for age, sex, smoking status, alcohol intake, regular exercise status, total cholesterol, and systolic blood pressure, at the baseline, the logistic regression analysis indicated that the participants with the highest quartile of the WHtR (WHtR≥0.54) were 4.51 times more likely to have hypertension than those with the lowest quartile (odds ratio 4.51; 95% confidence interval 2.41-8.43; p < .0001). The area under the curve for the WHtR, in identifying hypertension risk, was significantly greater than that for the BMI (p = 0.0233).

CONCLUSION

A positive association between WHtR and the incidence of hypertension was observed in Korean adults. The findings of the present community-based prospective study suggest that the WHtR may be a better predictor of incident hypertension.

The product of fasting plasma glucose and triglycerides improves risk prediction of type 2 diabetes in middle-aged Koreans

BACKGROUND

Screening for risk of type 2 diabetes mellitus (T2DM) is an important public health issue. Previous studies report that fasting plasma glucose (FPG) and triglyceride (TG)-related indices, such as lipid accumulation product (LAP) and the product of fasting glucose and triglyceride (TyG index), are associated with incident T2DM. We aimed to evaluate whether FPG or TG-related indices can improve the predictive ability of a diabetes risk model for middle-aged Koreans.

METHODS

7708 Koreans aged 40-69 years without diabetes at baseline were eligible from the Korean Genome and Epidemiology Study. The overall cumulative incidence of T2DM was 21.1% (766 cases) in men and 19.6% (797 cases) in women. Therefore, the overall cumulative incidence of T2DM was 20.3% (1563 cases). Multiple logistic regression analysis was conducted to compare the odds ratios (ORs) for incident T2DM for each index. The area under the receiver operating characteristic curve (AROC), continuous net reclassification improvement (cNRI), and integrated discrimination improvement (IDI) were calculated when each measure was added to the basic risk model for diabetes.

RESULTS

All the TG-related indices and FPG were more strongly associated with incident T2DM than WC in our study population. The adjusted ORs for the highest quartiles of WC, TG, FPG, LAP, and TyG index compared to the lowest, were 1.64 (95% CI, 1.13-2.38), 2.03 (1.59-2.61), 3.85 (2.99-4.97), 2.47 (1.82-3.34), and 2.79 (2.16-3.60) in men, and 1.17 (0.83-1.65), 2.42 (1.90-3.08), 2.15 (1.71-2.71), 2.44 (1.82-3.26), and 2.85 (2.22-3.66) in women, respectively. The addition of TG-related parameters or FPG, but not WC, to the basic risk model for T2DM (including age, body mass index, family history of diabetes, hypertension, current smoking, current drinking, and regular exercise) significantly increased cNRI, IDI, and AROC in both sexes.

CONCLUSIONS

Adding either TyG index or FPG into the basic risk model for T2DM increases its prediction and reclassification ability. Compared to FPG, TyG index was a more robust T2DM predictor in the stratified sex and fasting glucose level. Therefore, TyG index should be considered as a screening tool for identification of people at high risk for T2DM in practice.

Epidemiology in diabetes mellitus and cardiovascular disease

As one of the leading causes of death in the USA, diabetes mellitus (DM) has become an epidemic over the past few decades. Despite the high prevalence of diagnosed DM, close to half of all people with DM are unaware of their disease. The risk of type 2 DM is determined by interplay of genetic and metabolic factors. Patients with type 2 DM have a higher risk of death from cardiovascular causes compared with their nondiabetic counterparts, and the mortality rate of DM associated cardiovascular disease is different among ethnicity groups and sex groups. Because of its adverse effect on people's health, DM also imposes an economic burden on individuals and households affected, as well as on the healthcare system. Current guidelines for cardiovascular disease prevention have focused on lifestyle management, blood pressure control, lipid control, blood glucose control, antiplatelet agent use, and tobacco use cessation.

Comparing Utility of Anthropometric Indices Based on Gender Differences in Predicting Dyslipidaemia in Healthy Adults

INTRODUCTION

Anthropometry is a simple reliable method for quantifying body proportions by measuring body length, weight and circumferences.

AIM

Our intention in this study was to compare sensitivities and positive predictive values of waist circumference (WC), waist-hip ratio (WHR), waist-height ratio (WHtR) and body mass index (BMI) in identifying healthy subjects, males and females separately for identifying obesity associated dyslipidemia.

MATERIALS AND METHODS

We analysed randomly selected 100 healthy subjects (males:58%, females:42%) between 25 and 60 years of age attending tertiary health care center in South India, after obtaining informed consent and Institutional Ethical Clearance. WC, WHR, WHtR and BMI of all the enrolled subjects were measured and estimated. Their fasting serum lipid profile was assessed. Subjects were divided based on their gender and each group was then categorized as obese and non-obese using anthropometric parameters and their individual serum lipid profile values depending on the cut off standards as per WHO and ATP III guidelines and compared. Data obtained was statistically analysed.

RESULTS

Mean values of WC, WHR, WHtR and BMI were highly significant (p<0.000) in obese in both males (97.43 ± 6.21cm, 0.96 ± 0.04, 0.61 ± 0.05, 27.72 ± 2.45kg/m(2)) and females (91.82 ± 5.18cm, 0.92 ± 0.06, 0.60 ± 0.04, 27.70 ± 3.44kg/m(2)) when considered separately compared to non-obese males (82.27 ± 5.33cm, 0.83 ± 0.033, 0.51 ± 0.03, 22.80 ± 2.11kg/m(2)) and females (71.68 ± 7.33cm, 0.78 ± 0.03, 0.48 ± 0.03, 21.82 ± 1.98kg/m(2) respectively). WC was more sensitive for predicting the altered lipid profile (85%) in females and WHR (65%) in males. WHR showed higher ability to correctly predict the occurrence of dyslipidemia in the obese males (90% positive predictive value) and WHtR in females (92%).

CONCLUSION

The present study inferred that WC, WHR are more sensitive while WHR and WHtR have a higher positive predictive value than BMI in identifying dyslipidemia in healthy males and females.

Anthropometric indices as predictors of hypertension among men and women aged 40-69 years in the Korean population: the Korean Genome and Epidemiology Study

Background

Obesity is one of the most significant risk factors for hypertension. However, there is controversy regarding which measure is the best predictor of hypertension risk. We compared body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) in subjects as predictive indicators for development of hypertension.

Methods

The data were obtained from the Korean Genome and Epidemiology Study (KoGES), a large population-based prospective cohort study. A total of 4,454 subjects (2,128 men and 2,326 women) aged 40–69 years who did not have hypertension at baseline were included in this study. Incident hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or anti-hypertensive medication use during the 4-year follow up. Receiver operating characteristic (ROC) analysis was used to compare discrimination abilities for anthropometric indices for hypertension. Hazard ratios were calculated by Cox proportional hazard model with adjustment for age, smoking status, alcohol consumption, diabetes and family history of hypertension by sexes.

Results

In men, the area under the ROC curve (AROC) was 0.62 for WC, WHR, and WHtR and 0.58 for BMI. In women, the AROCs for BMI, WC, WHR, and WHtR were 0.57, 0.66, 0.68, and 0.68, respectively. After adjustment for risk factors, a 1 standard deviation increase in BMI, WC, WHR, WHtR were significantly related to incident hypertension, respectively (hazard ratio: 1.39, 1.50, 1.40 and 1.49 in men, 1.31, 1.44, 1.35 and 1.48 in women).

Conclusions

The central obesity indices WC, WHR, and WHtR were better than BMI for the prediction of hypertension in middle-aged Korean people. WHtR facilitates prediction of incident hypertension because of the single standard regardless of sex, ethnicity, and age group. Therefore, WHtR is recommended as a screening tool for the prediction of hypertension.

Increased plasma levels of retinol-binding protein 4 with visceral obesity is associated with cardiovascular risk factors

Aims/Introduction:  Visceral obesity has been suggested to be an independent risk factor for cardiovascular disease (CVD); the role of adipokines in the risk for CVD is less clear. Aim of this study was to investigate the relationship between parameters of visceral obesity and index of CVD risk factors.

Materials and Methods:  A cross‐sectional analysis of healthy males (n = 116) and females (n = 175) for evaluation of clinical, laboratory and anthropometric parameters were undertaken. Abdominal subcutaneous (SAT) and visceral adipose tissues (VAT) were measured by computed tomography. Adipokines, including retinol‐binding protein 4 (RBP4) and adiponectin, were determined. The risk for CVD was estimated using the 10‐year Framingham Coronary Heart Disease Risk Point scale (Framingham score).

Results:  The Framingham score was increased in subjects with metabolic syndrome, and significantly increased with various indices of obesity, traditional risk factors of CVD, C‐reactive protein (CRP) and RBP4, but decreased with adiponectin. With multiple linear regression analysis, the Framingham score independently associated with age, smoking status, body mass index, triglyceride and RBP4. The magnitude of the Framingham score showed a linear trend of increase with CRP, VAT and RBP4 (all P < 0.001), but of decrease with SAT and adiponectin (all P < 0.05) at stratified levels of obesity.

Conclusions:  RBP4 is increased with visceral fat accumulation and associated with CVD risk factors independent of obesity or traditional risk factors. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2012.00213.x, 2012)

The alarm and action levels of waist circumference in overweight and obese Turkish women

SUMMARY

OBJECTIVE

To determine 'alarm and action levels' of waist circumference (WC) in overweight and obese Turkish women and investigate the relationship with cardiovascular risk factors.Research subjects and methods: Four thousand three hundred and seventy-five women aged 18-81 years selected from Istanbul Faculty of Medicine Obesity outpatient clinic. WC, waist-to-hip ratio (WHR), body mass index [(BMI) (weight (kg)/height (m(2)))], blood pressure, and biochemical parameters were analyzed.

RESULTS

There was strong correlation between BMI and WC levels (r: 0.852). The regression equation which describes this correlation [WC = 1.68 × BMI (kg/m(2)) + 39.2 ± 1.6] was applied to 500 random samples in order to define alarm and action levels for WC. Our results indicated that alarm level of WC at BMI 25 kg/m(2) is 81 cm and action level of WC at BMI 30 kg/m(2) is 90 cm. Validating samples were divided into three groups: group I (WC levels below 81 cm, n: 421), group II (WC levels between 81 and 90 cm, n: 718), group III (WC levels above 90 cm, n: 2736) and further correlative analyses were performed. Strong differences within alarm and action groups in terms of cardiovascular risk factors were identified. The prevalence and mean values of cardiovascular risk factors significantly increased with WC. In group 1 one or more risk factor prevalence was 64.8%, whereas in groups 2 and 3 prevalence was increased to 76.8 and 89%, respectively.

CONCLUSION

Turkish women with WC greater than 81 cm should gain no further weight and those greater than 90 cm should reduce their weight.

Relationship of body compositional and nutritional parameters with blood pressure in adults

BACKGROUND

Obesity has been regarded as a single best predictor and major controllable contributor to hypertension. The present study aimed to assess the relationship between body compositional and nutritional parameters with blood pressure in rural Bengalee adults.

METHODS

Anthropometric measures, blood pressure and nutritional parameters were measured in 522 rural Bengalee adults using standard protocols. Receiver operating characteristic analysis was carried out to identify cut-off values of body mass index (BMI) and percentage of body fat (BF%) as associated factors of hypertension and hypotension.

RESULTS

Most of the subjects were normotensive. However, a notable percentage had hypertension (males: 21.86%; females: 15.27%), although the prevalence of hypotension was low (males: 10.53%; females: 8.73%). Obesity indicators were significantly higher in hypertensive individuals than hypotensive and normotensive individuals. All anthropometric parameters and obesity indicators were significantly correlated (P < 0.001) with blood pressure. Blood pressure increased steadily from being underweight through to normal and then to overweight/obese individuals. There were significant differences in the percentage of hypertension and hypotension between nutritional categories. Blood pressure had significant positive correlation with energy, carbohydrate and fat intake, whereas protein and calcium were negatively associated with blood pressure. The suggested cut-off values of BMI and BF%, which were taken as associated factors of hypertension, were 21.86 kg m⁻² and 20.31%, and those of hypotension were 18.18 kg m⁻² and 13.3%, respectively.

CONCLUSIONS

In lean rural Bengalee populations, high BMI levels may be associated with an increased risk of hypertension. The cut-off values of BMI and BF% in the present study suggested associated factors for cardiovascular risk factors and these values may be of help with respect to reducing mean population blood pressure levels.

Differentiating the associations of waist circumference and body mass index with cardiovascular disease risk in a Chinese population

It is not known which obesity index best explains variations in cardiovascular disease risk across populations. The objective of this study was to differentiate the associations of waist circumference (WC) and body mass index (BMI) with cardiovascular disease risk in a Chinese population. Cardiovascular risk factors, WC, and BMI were measured in 13 817 adults aged more than 18 years in Shanghai. Higher WC tertiles were associated with higher blood pressure and higher cholesterol, triacylglycerol, and glucose concentrations within each tertile of BMI and vice versa. The odds ratios (ORs) of hypertension, dyslipidemia, and metabolic syndrome increased with successive WC (or BMI) tertiles after adjustment for BMI (or WC) and several covariates. However, BMI tertiles were not associated with the ORs of diabetes after adjustment for WC. WC may be better than BMI as an alternative measure of body fatness or fat distribution for predicting diabetic risks in Chinese adults.

Optimal cut-off values of anthropometric markers to predict hypertension in North Indian population

The aim of the study was to determine the cut-offs of anthropometric markers for detecting hypertension in an endogamous North Indian population. A cross-sectional study was carried out to collect data from 578 adult Aggarwal Baniya subjects (271 men and 307 women, mean age: 43.4 ± 5.3 and 38.7 ± 4.9 respectively) using multistage, stratified sampling method. Individual body weight, height, waist circumference (WC), hip circumference, blood pressure were assessed. Receiver operating characteristic (ROC) analysis was used to find out the optimal cut-off values of various anthropometric markers to predict hypertension. The likelihood ratios for having hypertension in subjects with various cut-off values were calculated. Logistic regression analysis was used to examine the independent relationship between the anthropometric markers and odds of having hypertension. The BMI cut-off to predict hypertension was 22.8 kg/m(2) in men and 28.8 kg/m(2) in women. The optimal WC cut-offs varied from 91-92 cm in both men and women. The WHR cut-off was about 0.90 in men and 0.78 in women respectively, and the optimal WHtR cut-off was 0.56 in men and 0.43 in women. The cut-off levels for BMI, WC and WHtR corresponded to the inflexion points in the likelihood ratio graphs. The area under curve (AUC) and odds ratios showed that the risk of having hypertension was highest with respect to increased BMI and that BMI is the best predictor of having hypertension. The cut-off points for detecting cardiovascular risk factors among our population are lower than the criteria by the World Health Organization. Although these results may not be readily applied to the rest of the Indian populations due to the multiethnic composition, they point to the necessity of similar studies with large randomized samples to find the cut-off levels for chronic conditions in different populations.

Osteoporosis and type 2 diabetes mellitus: what do we know, and what we can do?

Diabetes mellitus (DM) is a pandemic and chronic metabolic disorder with substantial morbidity and mortality. In addition, osteoporosis (OP) is a silent disease with a harmful impact on morbidity and mortality. Therefore, this systematic review focuses on the relationship between OP and type 2 diabetes mellitus (T2DM). Systematic reviews of full-length articles published in English from January 1950 to October 2010 were identified in PubMed and other available electronic databases on the Universiti Sains Malaysia Library Database. The following keywords were used for the search: T2DM, OP, bone mass, skeletal. Studies of more than 50 patients with T2DM were included. Forty-seven studies were identified. The majority of articles (26) showed increased bone mineral density (BMD), while 13 articles revealed decreased BMD; moreover, eight articles revealed normal or no difference in bone mass. There were conflicting results concerning the influence of T2DM on BMD in association with gender, glycemic control, and body mass index. However, patients with T2DM display an increased fracture risk despite a higher BMD, which is mainly attributable to the increased risk of falling. As a conclusion, screening, identification, and prevention of potential risk factors for OP in T2DM patients are crucial and important in terms of preserving a good quality of life in diabetic patients and decreasing the risk of fracture. Patients with T2DM may additionally benefit from early visual assessment, regular exercise to improve muscle strength and balance, and specific measures for preventing falls. Patient education about an adequate calcium and vitamin D intake and regular exercise is important for improving muscle strength and balance. Furthermore, adequate glycemic control and the prevention of diabetic complications are the starting point of therapy in diabetic patients.

Body fat distribution and their associations with cardiovascular risk, insulin resistance and β-cell function: are there differences between men and women?

OBJECTIVE

The objective was to examine the independent and gender-specific effects of WC and BMI on CVD risk factors, insulin resistance and β-cell function.

DESIGN

A cross-sectional study of 2931 adults aged 20-79 years was carried out in Fujian province by multi-stratified sampling from July 2007 to May 2008. Gender-specific differences of WC and BMI on CVD risk factors, insulin resistance and β-cell function were displayed jointly by WC and BMI tertiles. The homeostasis model assessment of insulin resistance (HOMA-IR) index and the quantitative insulin-sensitivity check index (QUICKI): l/(log G0 ± log I0) were used to estimate insulin sensitivity; insulin secretion was assessed using the HOMA-β index; β-cell function was quantified as the ratio of the incremental insulin to glucose responses over the first 30 min during the OGTT (△I30/△G30). The oral disposition index (DIo) was calculated as ΔI(30) /ΔG(30) × 1/fasting insulin. The Matsuda index is defined as 10,000/sqrt (FBG × FPI × [G × I]) where FPG is fasting glucose, FPI is fasting insulin, G is mean glucose during the OGTT (calculated from glucose samples at 0, 30, and 120 min), and I is mean insulin during the OGTT (calculated from insulin samples at 0, 30, and 120 min).

RESULTS

Waist circumference and BMI correlated with each other in both men (0.756, p < 0.001) and women (0.728, p < 0.001). The two indexes were independently associated with CVD risk factors (such as hypertension, metabolic syndrome, and dyslipidaemia) in both men and women. BMI was better than WC in assessing the risk of diabetes in men (p = 0.003 for BMI, and p = 0.234 for WC), while WC was better than BMI in predicting diabetes in women (p < 0.001 for WC, and p = 0.831 for BMI). There were significant associations between BMI and insulin resistance or β-cell function even after adjustment for WC except for DIo in male subjects, but WC only associated with HOMA-IR positively or the Matsuda index and QUICKI negatively after adjustment for BMI. For women, associations between WC and insulin resistance or β-cell function remained strong even after adjustment for BMI besides DIo. However, there were no independent relations of BMI to insulin resistance and β-cell function except for Matsuda index with a significant negative association after adjustment for WC in women.

CONCLUSION

Body mass index and WC were independently associated with CVD risk factors. There were differences in the gender-specific relevance of measures of body fat distribution in assessing the insulin resistance, β-cell function and thus the risk of diabetes. Therefore, WC should be measured in addition to BMI to assess CVD risk accurately and implement efficient treatment strategies.

Use of knee height for the estimation of stature in elderly Turkish people and their relationship with cardiometabolic risk factors

The determination of the approximately truest value in height measurement is important in many fields, but it is difficult to perform true measurements, especially in the elderly individuals. We planned to investigate the following items in geriatric Turkish population: to calculate the decrease in height with advancing age by using the standing height measurement and estimated height derived from the knee height; to evaluate the significance of difference between the two measurement methods in the calculation of body mass index (BMI) and waist/height ratio (WHtR); to determine the cut-off value of WHtR according to estimated height in elderly individuals. We studied 551 cases aged between 19 and 97 years. Knee height was measured using a sliding caliper in a sitting position. Linear regression analysis was carried out to derive predictive equations for the estimation of stature with adults (≤ 50 years of age) according to the gender. This equation was then used to estimate height among elderly subjects. Of the cases, 60.3% were <60 years (mean: 48.75 ± 7.50); 39.7% of the cases were >60 years (mean: 69.51 ± 7.12). Estimated BMI (EBMI) measurements in the females and males >60 years were in average 1.23 kg/m(2) and 0.92 kg/m(2) higher than their real BMIs, respectively. EBMI measurements in the females <60 years were 0.32 kg/m(2) higher than their real BMIs (p<0.01). There is a statistically significant difference between WHtR in the females of both age groups, and in the males >60 years, as compared to our estimated WHtR (EWHtR) measurements (p<0.01). The cut-off point of WHtR was 0.61 and 0.58 in the female and male cases of >60 years in our study, respectively. WHtR seemed to be a better anthropometric index that could predict most cardiometabolic risk factors in our study. EWHtR emerged to be a better cardiometabolic risk index especially in the elderly group.

Anthropometric cutoff values for detecting metabolic abnormalities in Jordanian adults

OBJECTIVES

To determine cutoff values for body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) as indicators of metabolic abnormalities in the adult Jordanian population.

METHODS

A structured questionnaire was administered to collect relevant information. Anthropometric measurements and biochemical measurements were carried out. Receiver-operating characteristic curve analyses were used to examine the overall discriminatory power of the four anthropometric indices.

RESULTS

WC cutoff values varied from 88.5 to 91.8 cm in men and from 84.5 to 88.5 cm in women. The BMI cutoff values varied from 26.2 to 27.2 kg/m(2) in men and from 27.2 to 30.0 kg/m(2) in women. The WHR cutoff values varied from 0.88 to 0.90 in men and from 80.0 to 0.83 in women. The WHtR cutoff values varied from 0.50 to 0.51 in men and women. Of all anthropometric indices, WHtR had the strongest association with each metabolic abnormality in men and women.

CONCLUSION

BMI, WC, WHR, and WHtR were found to be associated with cardiovascular disease risk factors, with WHtR being the better predictor. We recommend that health care professionals use WHtR, with a cutoff value of 0.5 for screening and counseling Jordanian people.

Associations between gender, age and waist circumference

In December 2008, the World Health Organization (WHO) convened a consultation to discuss cut-points for waist circumference (WC). As part of that effort, this paper examines the impact of gender and age on WC. As WC is influenced by body weight, body composition and fat distribution, their associations with gender and age were reviewed. We also noted the relationships with sex hormones, parity and menopause. We then summarized data on gender, age and WC. This presentation is not intended to be comprehensive, but to provide an overview of the available research. There are large differences in body composition in men and women, with women having more body fat. Fat distribution also differs with gender, with men having a relatively more central distribution of fat. These differences begin early in life and become more apparent in puberty due to changes in sex hormone levels. In both, men and women, waist and waist-to-hip ratio increase with age. A large portion of this increase is driven by gains in body weight, but the increases observed are larger than those that would be predicted from increases in the body mass index alone, and increases in WC are seen with aging in the absence of weight gain. The current practice of using seperate waist cut-points by gender is appropriate. Although WC increases with age, so does the risk of many chronic diseases. An evaluation of the need for age-specific waist cut-points in adults would need to consider disease risk.

Comparison of waist circumference with body mass index for predicting abdominal adipose tissue

AIMS

To compare waist circumference (WC) with body mass index (BMI) for the prediction of abdominal adipose tissues in Japanese men and women.

METHODS

1432 men and 1038 women aged 38-60 years were recruited. WC, BMI, visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) using CT scans were measured.

RESULTS

Women had a lower mean VAT than men (79.3 cm(2) vs. 132.3 cm(2); p<0.001) and a higher mean SAT (196.2 cm(2) vs. 139.7 cm(2); p<0.001). The correlation with WC or BMI was greatest for total adipose tissue (TAT), followed by SAT, and least for VAT. The correlation coefficients were not significantly different between WC and BMI for any adipose tissue except for VAT in men (p<0.05). Age was positively correlated with VAT in both genders (p<0.001). Using multiple regression analyses on VAT, R(2) values using WC and age were 0.45 in men and 0.48 in women. For SAT, the values were 0.57 in men and 0.59 in women.

CONCLUSIONS

The relationship with WC or BMI was greatest for TAT and SAT, and least for VAT. WC and BMI provided essentially similar estimates of TAT, VAT, and SAT in both genders.

Obesidade e sua relação com fatores de risco para doenças cardiovasculares em uma população nipo-brasileira

OBJETIVO: Descrever associações entre excesso de peso e obesidade abdominal com fatores de risco cardiovascular na população nipo-brasileira de Mombuca, Guatapará, SP. MÉTODOS: Participaram do estudo 131 indivíduos com descendência japonesa (69,2% da primeira e 30,8% da segunda geração), com idade > 20 anos, correspondendo a 66,8% da população residente dessa faixa etária. Os dados foram coletados por meio de questionários padronizados e foram realizados exames clínicos e laboratoriais. RESULTADOS: A prevalência de sobrepeso foi de 29,6% entre os homens e de 25,6% entre as mulheres e a de obesidade foi de 46,3% entre os homens e de 39,0% entre as mulheres. Entre os homens a prevalência de obesidade abdominal foi de 55,6% e entre as mulheres de 20,8%. O índice de massa corpórea foi associado independentemente com triglicérides, circunferência abdominal e idade; a pressão arterial sistólica com a circunferência abdominal. CONCLUSÃO: O presente estudo enfatiza a necessidade de medidas de intervenção para a prevenção da obesidade na população nipo-brasileira de Mombuca.

Relationship of anthropometric indicators with blood pressure levels and the risk of hypertension in Nigerian adults

BACKGROUND AND PURPOSE

Studies on cardiovascular risks in relation to anthropometric factors are limited in Sub-Sahara Africa. The aims of this study were to examine the relationship between anthropometric parameters and blood pressure; and to evaluate body mass index (BMI) across the range of underweight and obesity as a primary risk factor of hypertension in adult Nigerians.

MATERIAL AND METHODS

2097 adults aged between 20 and 100 years consented and participated in this door-to-door survey. All participants underwent blood pressure and anthropometric measurements using standard procedures. The population study was separated in normotensive and hypertensive males and females and the possible risk for hypertension were categorized into different classes of value based on BMI definition.

RESULTS

The relative risks (odds ratio [OR] and 95% confidence interval [CI]) of developing hypertension among the obese compared with the underweight, normal weight, and overweight persons were (OR 5.75; CI 5.67-5.83), (OR 1.73; CI 1.65-1.81), and (OR 1.54; CI 1.46-1.62) for all the participants, respectively. Among obese (BMI >/= 30.0 Kg/m(2)) males, the OR for hypertension was three times (OR 2.78; CI 2.76-2.80) that of normal weight (BMI >/= 18.5-24.9 Kg/m(2)) males. Females with obesity had a risk of hypertension three times (OR 3.34; CI 3.33-3.35) that of normal weight females.

CONCLUSION

Our results indicated that the there was a significant positive correlation of obesity indicator with blood pressure. In Nigeria, we found a strong gradient between higher BMI and increased risk of hypertension among all ages. Approaches to reduce the risk of hypertension may include prevention of overweight and obesity.

Overweight and obesity trends among Japanese adults: a 10-year follow-up of the JPHC Study

OBJECTIVE

Limited data are available regarding longitudinal changes in body weight. Here, we describe changes in the prevalences of overweight and obesity and calculated the incidence of these indices during a 10-year follow-up period for a large-scale cohort study in Japan.

DESIGN

Longitudinal analysis of data from a population-based cohort study, the Japan Public Health Center (JPHC) Study.

PARTICIPANTS

A total of 65 095 Japanese men and women, who were between the ages of 40 and 69 years at baseline and participated in the 5th- and 10th-year follow-up surveys of the JPHC, were enroled in the study.

MEASUREMENTS

Mean body mass index (BMI), calculated using self-reported height and weight, and the prevalences of overweight (BMI >or=25 kg/m(2)) and obesity (BMI >or=30 kg/m(2)) at each survey period. Incidences of overweight and obesity during the 10-year period.

RESULTS

On an average, individuals living in Okinawa had much higher BMIs than those living on the Main islands for all sex and age groups. During the follow-up period, the prevalences of overweight and obesity steadily increased in the cohorts aged less than 50 years at baseline in both sexes. Men in younger cohorts had a higher mean BMI than those in the same age group of older cohorts, whereas the opposite trend was observed in women. The incidence of overweight individuals was greater in Okinawa than on the Main islands and among younger generations than among older ones.

CONCLUSION

A longitudinal analysis at the individual level showed that the prevalences of overweight and obesity increased among middle-aged Japanese participants during the follow-up period. Among men, an increasing prevalence of obesity was observed among the younger generations. These findings should be taken into consideration when planning preventive strategies for obesity and its related diseases.

Association of hypertension with changes in the body mass index of university students

BACKGROUND

There are few longitudinal studies on the associations of obesity with hypertension in young adults.

OBJECTIVES

To analyze longitudinally to what extent weight gain associates with hypertension in young adults.

METHODS

The subjects of this study consisted of 6,178 university students (male 4,098; female 2,080). The associations of hypertension with body type change were longitudinally examined by using the records of health examinations while at university. The prevalence ratios (PRs) for hypertension in their senior year were calculated on groups that changed toward obese against those that changed toward underweight. The logistic regression analyses were used to estimate odds ratios (ORs) for hypertension in their senior year of each factor. The analyses were conducted on (i) all subjects, (ii) non-hypertensive subjects in their freshman year, and (iii) by schools, in order to take into account physical activities.

RESULTS

The PRs of hypertension in subjects changed toward obese from their freshmen to seniors against ones toward underweight were 1.47 (95% CI; 1.00-2.15) for males and 3.50 (0.93-13.22) for females. In analyses limited to non-hypertensive subjects in their freshman year, results were similar to those of all subjects. The analyses by school also showed similar results to those including all subjects. In logistic regression analyses, although the factor most strongly associated with hypertension was body type in their senior year, the body type in their freshman still showed significant association with hypertension after the adjustment of senior year body type and hypertension in freshman year. The ORs for hypertension in obese subjects to normal weight ones in their senior year were 9.13 (95% CI; 5.77-14.45) for males and 22.59 (5.69-89.67) for females after adjusted by hypertension in freshman, body type in freshman and school.

CONCLUSIONS

These data suggest that the increase of BMI is linked to hypertension in university students.

Determination of the Leading Central Obesity Index among Cardiovascular Risk Factors in Iranian Women

Background

It is unknown whether the waist circumference (WC) or the waist-to-hip ratio (WHR) is a better predictor of cardiovascular risk factors at different ages.

Objective

To compare WC and WHR as predictors of cardiovascular risk factors and to determine the prevalence of some cardiovascular risk factors in overweight and obese adult women at different ages.

Methods

In this clinical cross-sectional study, 714 overweight and obese women aged 20 to 70 years who were referred to two nutrition clinics in Sistan and Baluchestan province, Islamic Republic of Iran, were studied. The subjects were classified into three groups, 20 to < 35, 35 to < 50, and > or = 50 years of age. Anthropometric indices were measured according to the standard protocol. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and TC/HDL-C ratios were enzymatically determined.

Results

Older subjects (> or = 50 years old) had significantly higher values of body mass index (BMI), WC, TC, TG, and LDL-C than those in the two younger age classes. The prevalence rates of obesity, high WC, high WHR, high TC, high TG, high LDL-C, and high TC/HDL-C ratios were higher in the older subjects. After adjustment for age and BMI, multiple linear regression showed that WC was significantly related to TC and TG in the 20- to < 35-year-old group and to TG in the 35- to < 50-year-old group. In the older participants, WHR was significantly related to TG.

Conclusions

The prevalence of cardiovascular risk factors increases with age. In clinical practice, WC is a better index for predicting some cardiovascular risk factors in younger and middle-aged women; however, for older women, WHR is better.

Low levels of awareness of suboptimal health conditions in a high-risk working population: the "better health for better Hong Kong" health promotion campaign

The incidences of cardiovascular risk factors such as obesity and diabetes are rising in many Asian populations. In April 2000, a 5-year territory-wide health promotion campaign supported by Li Ka Shing Foundation was launched in Hong Kong by the Health InfoWorld of Hospital Authority. From the general working class, 4,832 Chinese people were randomly recruited into this campaign. There were 2,370 men (49.0%) and 2,462 women (51.0%; median age = 43.0 years, range = 17-83 years). Of these, 37.5% were obese (BMI > or = 25 kg/m2 or waist circumference > or = 80 cm in women and > or = 90 cm in men), 22.3% had hypertension, 11.6% were smokers, 31.0% had hypercholesterolaemia (total cholesterol > or = 5.2 mmol/l), 2.2% had diabetes, and 0.7% had a past history of cardiovascular disease. There were 1,338 participants (27.7%) who had 2 or more risk factors (more men than women: 36.9% vs. 18.9%, p < .001). Despite this high prevalence of multiple risk factors, most (83.1%) perceived their health status as satisfactory (more men than women: 85.6% vs. 80.7%, p < .001). In conclusion, the combination of high prevalence of multiple risk factors and low levels of awareness of their suboptimal health status herald a looming epidemic of life-threatening diseases in a group of middle-aged Hong Kong people. Massive public education is an important and essential, although it may not be self-sufficient, factor to reduce the socioeconomic impacts of this epidemic.

Prevalence and significance of generalized and central body obesity in an urban Asian Indian population in Chennai, India (CURES: 47)

OBJECTIVES

To determine the prevalence of generalized and abdominal obesity in urban Asian Indians and compare the association of body mass index (BMI) and waist circumference (WC) with metabolic risk variables.

METHODS

Subjects were recruited from the Chennai Urban Rural Epidemiology Study (CURES) carried out between 2001 and 2004 and involved 2350/2600 eligible subjects (response rate 90.4%). Anthropometric measurements, lipids and oral glucose tolerance tests were carried out. Generalized obesity (BMI>or=23 kg m(-2)) and abdominal obesity (WC>or=90 cm in men and >or=80 cm in women) were defined using WHO Asia Pacific guidelines.

RESULTS

The age standardized prevalence of generalized obesity was 45.9% (95% CI: 43.9-47.9%), (women: 47.4%; men: 43.2%, P=0.210), while that of abdominal obesity was 46.6% (95% CI: 44.6-48.6%), (women: 56.2%> men: 35.1%, P<0.001). Area under the curve for identifying subjects with any three metabolic risk factors using BMI was 0.66, 95% CI: 0.63-0.69, P<0.001, while, for WC, it was 0.70, 95% CI: 0.66-0.74, P<0.001 for men, and 0.69, 95% CI: 0.65-0.74, P<0.001 for women. Isolated generalized obesity (normal WC, increased BMI) was present in 12.7% of men and 6.1% of women. Isolated abdominal obesity (increased WC, normal BMI) was present in 4.7% of men and 14% of women. Combined obesity was present in 32.6% of men and 43.3% of women.

CONCLUSIONS

In Asian Indians, the prevalence of combined obesity is high among both sexes, while isolated generalized obesity is more common in men and isolated abdominal obesity more common in women. However, these prevalence rates vary markedly depending on cut points used. WC is a better marker of obesity-related metabolic risk than BMI in women compared to men in this population.

Impact of Patient's Weight on Stroke Rehabilitation Results

OBJECTIVE

To evaluate the influence of patient's weight on rehabilitation results after first stroke.

DESIGN

Retrospective, comparative study. The sample comprised 84 males and females, first-time stroke patients, who had been hospitalized in the department of rehabilitation at the Hartzfeld Geriatric Hospital, Gedera, Israel for a full 3 mos and who, on admission, had scored between 40 and 60 on the total Functional Improvement Measure (FIM) test. We evaluated the difference in total FIM improvement between normal-weight, overweight, and obese patients.

RESULTS

The relative improvement of FIM score was significantly higher in normal-weight patients than in overweight patients, and improvement in overweight patients was significantly higher than in obese ones. We also found a statistically significant negative correlation (r = -0.27, P = 0.014) between relative improvement of FIM score and body mass index (BMI) in the total sample.

CONCLUSIONS

Our study revealed that during the first 12 wks, rehabilitation is statistically significantly less effective in overweight and, particularly, in obese patients (evaluated by BMI). We also found a statistically significant negative association between the individual's BMI and relative improvement of the FIM score, representing the functional status of the stroke patient.

Cut-off values for anthropometric variables that confer increased risk of type 2 diabetes mellitus and hypertension in Iraq

BACKGROUND

Body mass index (BMI) is often used to reflect total body fat amount (general obesity), whereas waist circumference (WC), waist-to-hip ratio (WHpR) or waist-to height ratio (WHtR) is used as a surrogate of body fat centralization (central obesity). The purpose of the present study was to identify cut-offs for BMI and upper-body adiposity (WC, WHpR, and WHtR) that, associated with increased risk of type 2 DM and hypertension in Iraqi adults, would be consistent with overweight and central adiposity.

METHODS

This was a community-based cross-sectional survey for establishing cut-off values for BMI and upper-body adiposity (WC, WHpR or WHtR) associated with increased risk of type 2 DM and hypertension from one district in Southern Iraq, Basrah (Abu-Al-khasib). The total number of persons involved was 12,986 (6693 men and 6293 women), aged 45.6 +/- 15.7 years.

RESULTS

The cut-off point in men associated with increased risk of type 2 DM and hypertension were BMI 25.4 and 24.9, WC 90 and 95 cm, WHpR 0.92 for both and WHtR 0.52 and 0.55, respectively. For women, the cut-off point associated with increased risk of type 2 DM and hypertension were BMI 26.1 and 26.5, WC 91 and 95 cm, WHpR 0.91 for both, and for WHtR 0.56 and 0.59, respectively. The best index for association with type 2 DM was WHpR with cut-off point of 0.92 for men and 0.91 for women. For hypertension, the best index is WHtR (with cut-off point of 0.55 for men and 0.59 for women), whereas the least reliable index was the BMI for both type 2 DM and hypertension.

CONCLUSIONS

Our finding showed that, in Iraqi adults, WHpR has the strongest association with type 2 DM and WHtR for hypertension.

Coexistence of maternal central adiposity and child stunting in Mexico

OBJECTIVE

To assess the coexistence of maternal adiposity and child stunting (CS) in Mexico, estimate its national prevalence and identify the associated socio-demographic factors.

METHODS

A secondary analysis from the Mexican Nutrition Survey 1999, a nationally representative survey, was conducted. Mother and children subsamples were matched and a total of 6225 mother/child pairs were obtained. Stunting was defined as height-for-age z-scores <-2.0. Maternal body mass index (BMI) was classified according to World Health Organization recommended cutoff points. Waist-to-hip ratio (WHR) was calculated by dividing waist by hip circumferences. Logistic regression models were fitted to explore the coexistence of CS and maternal central adiposity (MCA) (WHR> or =0.85) while controlling for biological and socio-demographic factors.

RESULTS

A total of 5974 pairs had complete information. MCA coexisted with CS in 6.2% of the mother/child pairs. The phenomenon was more prevalent in rural locations, in the south region and among indigenous families (14.5, 12.5 and 23.9%). After controlling for child age and maternal BMI, a 78% increase in the likelihood of CS was related to maternal WHR > or =0.85 (odds ratio (OR)=1.78, 95% confidence interval (CI)=1.53, 2.10). After controlling for maternal height, the magnitude of the OR decreased (OR=1.33, 95%CI=1.13, 1.57), but remained significant. Therefore, it is suggested that women with a WHR approximately 1 have had twice the probability of having a stunted child as those with a WHR of 0.65.

CONCLUSION

Although MCA and CS are two conditions frequently regarded as result of opposite determinants, our observation suggests that this is not necessarily the case, particularly in populations undergoing the nutrition transition. MCA was associated not only to chronic diseases, but also to child stunting.

Epidemic obesity and type 2 diabetes in Asia

The proportions of people with type 2 diabetes and obesity have increased throughout Asia, and the rate of increase shows no sign of slowing. People in Asia tend to develop diabetes with a lesser degree of obesity at younger ages, suffer longer with complications of diabetes, and die sooner than people in other regions. Childhood obesity has increased substantially and the prevalence of type 2 diabetes has now reached epidemic levels in Asia. The health consequences of this epidemic threaten to overwhelm health-care systems in the region. Urgent action is needed, and advocacy for lifestyle changes is the first step. Countries should review and implement interventions, and take a comprehensive and integrated public-health approach. At the level of primary prevention, such programmes can be linked to other non-communicable disease prevention programmes that target lifestyle-related issues. The cost of inaction is clear and unacceptable.

Indices of body composition and chronic morbidity: a cross-sectional study of a rural population in central Russia

Our objective was to clarify how different groups of chronic morbidities are associated with indices of body composition, such as body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), skinfold index (SF), and fat-free mass index (FFMI). Our sample comprised Chuvasha residing in numerous villages in a rural area of the Russian Federation. The investigated cohort included 787 males aged 18-89 years, and 716 females aged 18-90 years. We performed a cross-sectional, community-based study of a large sample of individuals not receiving any medications for treatment or prevention of chronic morbidities. To elucidate the association between morbidity and age-adjusted anthropometrical indices, we used one-way analysis of variance, wherein the above indices were the dependent variables, while individuals affected vs. nonaffected for a specific disease were the grouping variables. Individuals with ischemic heart disease, diabetes mellitus, hypertension, and peptic ulcer showed significant differences in their BMI, WC, WHR, and SF. In the first diseases, mean values of anthropometric indices were higher in affected individuals, whereas in the peptic ulcer group, mean values were higher in the nonaffected. Skin diseases and gynecological diseases showed significant differences in WHR. Mean values in affected individuals were lower than in the nonaffected. The group afflicted with local forms of arthritis showed significant differences in FFMI, suggesting that arthritis is not linked to obesity, but is linked to high lean mass. Rheumatic diseases positively correlated with WC and FFMI.

Are waist circumference and body mass index independently associated with cardiovascular disease risk in Chinese adults?

BACKGROUND

In Western populations, waist circumference (WC) is more predictive of cardiovascular disease (CVD) risk than is body mass index (BMI). It is unclear whether the same is true in Asian populations.

OBJECTIVE

The objective was to examine the independent effects of WC and BMI on CVD risk factors in China.

DESIGN

CVD risk factors, BMI, and WC were measured in a nationally representative cross-sectional study of 15 540 Chinese adults aged 35-74 y.

RESULTS

Higher WC tertiles were associated with higher blood pressure and higher cholesterol, triacylglycerol, and glucose concentrations within each tertile of BMI and vice versa. In men, the odds of hypertension, dyslipidemia, and the metabolic syndrome (MS) increased with successive WC tertiles (1.0, 1.1, and 1.8, respectively, for hypertension; 1.0, 1.4, and 2.0, respectively, for dyslipidemia; and 1.0, 2.3, and 4.8, respectively, for MS; P for trend < 0.001 for all), even after adjustment for BMI. Similarly, the odds of hypertension, dyslipidemia, and MS increased with successive BMI tertiles (1.0, 1.5, and 2.6, respectively, for hypertension; 1.0, 1.3, and 1.8, respectively, for dyslipidemia; 1.0, 1.3, and 2.9, respectively for MS; P for trend < 0.001 for all), even after adjustment for WC. However, BMI tertiles were not associated with the odds of diabetes after adjustment for WC (P for trend = 0.67), whereas tertiles of WC were significantly associated with the odds of diabetes after adjustment for BMI (1.0, 1.6, and 2.1, respectively; P for trend = 0.002). The results were similar in women.

CONCLUSIONS

These data show that WC adds additional risk information to that of BMI in Chinese adults. Measurement of both WC and BMI in Chinese adults may enhance CVD risk stratification.

Predictive performance of anthropometric indexes of central obesity for the risk of type 2 diabetes

BACKGROUND

In spite of several available anthropometric indexes, the relative merit of these indexes for the prediction of type 2 diabetes remains unknown. Considering that obesity and diabetes commonly coexist as co-morbidities, our objective was to directly compare the performance of measures of central and general obesity to predict the risk of type 2 diabetes.

METHODS

We conducted a case-control study of type 2 diabetes on 150 cases and 150 age- and gender-matched controls. We directly compared the predictive performance of five anthropometric indexes: four related to central obesity--waist circumference (WC), waist/hip ratio (WHR), abdominal volume index (AVI) and conicity index (CI); and one related to general obesity--body mass index (BMI). We used various statistical approaches like area under (AUC) receiver-operating characteristic (ROC) curves, likelihood ratios, logistic regression and Shannon's entropy to compare the performance of the indexes in the study sample as well as bootstrapped samples.

RESULTS

WC had the highest overall predictive accuracy that was gender insensitive (AUC=0.77 in males and 0.74 in females); a comparable information content as that of AVI (Shannon's entropy=1.81 for WC and 1.84 for AVI) and was a better predictor of the risk of type 2 diabetes than all the remaining indexes. WC also correlated strongly with the biochemical markers of diabetes like blood sugar and lipid profile.

CONCLUSIONS

WC is a simple, non-invasive and accurate predictor of the risk of type 2 diabetes that can potentially be used in screening programs in developing countries.

Associations between Food Variety and Body Fatness in Hong Kong Chinese Adults

BACKGROUND

Food variety is reported to be closely associated with body fatness in Caucasians. The association has not been examined in a Chinese population.

OBJECTIVE

To examine the association between food variety and body fatness in Hong Kong Chinese adults.

DESIGN

One hundred and twenty Hong Kong Chinese adults (aged 18-50 y). Usual dietary intake over a one-week period of all subjects was assessed by using a food frequency questionnaire. Anthropometric parameters were measured using standardized methods.

RESULTS

Varieties of grain and meat were negatively correlated with obesity indices (grain vs. BMI/body fat/waist/hip circumferences: partial r = -47/-0.43/-0.46/-0.42, p < 0.001; meat vs. BMI/body fat/waist/hip circumferences: partial r = -0.31/-0.24/-0.25/-0.29, p < 0.01). In contrast, there was a positive relationship between variety of snack and obesity indices (snack vs. BMI/body fat/waist/hip circumferences: partial r = 0.35/0.42/0.42/0.36, p < 0.001). A food variety ratio derived from varieties of snack, grain and meat, was a stronger predictor of body fat compared with dietary fat in a regression model.

CONCLUSION

Food variety may contribute to the local escalation in the prevalence of obesity. The variety of snack is the promoting factor for obesity while the variety of grains and meats may counteract its development. The findings of this study may have implications for treatment of obesity and the prevention of further weight gain.

Overall obesity and abdominal obesity and the risk of metabolic abnormalities

BACKGROUND

Obesity is a risk factor for multiple chronic diseases.

AIM

To determine the relationship between overall or abdominal obesity and various metabolic abnormalities.

METHODS

The medical records of participants undergoing examination from January 2000 to December 2002 were analysed. Body mass index (BMI; kg/m2) for overall obesity and waist circumference (WC; cm) indicating abdominal obesity were measured. Four groups were studied: (1) BMI < 27kg/m2, WC: female < 80cm or male < 90cm; (2) BMI > or = 27kg/m2, WC: female < 80cm or male < 90cm; (3) BMI < 27kg/m2, WC: female > or = 80cm or male > or = 90cm; (4) BMI > or = 27kg/m2, WC: female > or = 80cm or male > or = 90cm.

RESULTS

There were 1,342 (44%) females and 1,711 males aged 20-87 years. The prevalence of overall obesity was 20.4% and abdominal obesity was 48%. Obese subjects had more metabolic abnormalities than non-obese in terms of risk of hypertension, hyperglycaemia, hypercholesterolaemia, hypertriglyceridaemia, high level of LDL, low level of HDL, high ratio of TC/HDL, hyperuricaemia and fatty liver.

CONCLUSIONS

As overall and abdominal obesity may predict clustering of metabolic abnormalities we suggest that BMI and WC are convenient methods for assessing metabolic abnormalities in primary healthcare settings.

Which anthropometric indices best predict metabolic disorders in Taiwan?

OBJECTIVES

The aim of this survey was to assess the association between the three simple anthropometric indices (body mass index [BMI], waist-to-hip ratio (WHR), and waist circumference [WC]) and various metabolic disorders, and to identify which indices can best predict metabolic disorders in Taiwan.

METHODS

A cross-sectional hospital-based survey was carried out from January to December 2000. We retrospectively analyzed the medical records of all the patients receiving periodic health examination with scheduled items at China Medical University Hospital. Anthropometric indices, metabolic profiles, and abdominal sonography were performed. A total of 746 people aged 19 to 87 were recruited as subjects for this study. The t test, chi2 test, and stepwise multivariate logistic regression were used.

RESULTS

The subjects included 44.5% women and 55.5% men, with a mean age of 50.74 +/- 12.68 years. After controlling for the other covariables, stepwise multivariate logistic regression showed considerable statistical significance between overall obesity and hypertension, hypertriglyceridemia, hyperuricemia, and fatty liver. There is also statistical significance between abdominal obesity and abnormal ratio of total cholesterol HDL (high-density lipoprotein), hyperuricemia, and fatty liver. None of the indices revealed any association with hyperglycemia, hypercholesterolemia, abnormal low-density lipoprotein, or abnormal HDL.

CONCLUSIONS

BMI and WC can best predict some metabolic disorders. For practical reasons, the combined measurement of BMI and WC is the simple and inexpensive anthropometric index for primary health care settings in the routine physical examinations of adults. We hope this study can establish the background data for further investigation on the epidemiology of anthropometric indices in Taiwan.

Serum lipid profile in obese children in China

BACKGROUND

The aim of the present study was to examine the serum lipid profile in obese Chinese children, their serum lipid and apolipoprotein A-I (apoA-I) and B (apoB) levels were examined.

METHODS

The subjects were 153 patients (109 male and 44 female) aged 4-16 years with obesity, who attended the outpatient clinic of Beijing Children's Hospital. Percentage bodyweight (%BW) ([(bodyweight - standard weight)/standard weight]x 100) were obtained. Skinfold thickness and hip and waist circumference were measured. Percentage body fat (%BF) was estimated by bioelectrical impedance analyzer. Serum total cholesterol (TC), high density lipoprotein cholesterol (HDLC), triglyceride (TG), apoA-I and apoB levels were also measured.

RESULTS

TC showed an acceptable level in 86.8% of obese children. The prevalence of high TC levels (3.3%) or high LDLC levels (6.0%) was rather low. The HDLC level was reduced in 31.3% of obese children. Anthropometric variables had no linear relationship to TC, HDLC, TG, LDLC, apoA-I or apoB, but in the older age group (over 10 years old) %BW and %BF showed a weak correlation with HDLC (r = -0.202, r = -0.211, respectively).

CONCLUSION

In obese Chinese children, HDLC as well as TC levels should be examined in order to assess coronary risk.

Indexes of abdominal adiposity in patients with type 2 diabetes

OBJECTIVE

To assess the relationship of waist circumference and weight/height ratio with height, and their association with components of the metabolic syndrome, in Type 2 diabetic patients.

DESIGN

multicenter cross-sectional survey on a cohort enrolled in a prospective observational study.

SUBJECTS

13,232 patients (6816 women and 6416 men) with Type 2 diabetes, not currently affected by macrovascular complications.

MEASUREMENTS

height, weight, waist and hip circumference, waist/hip and waist/height ratios.

RESULTS

waist circumference was significantly correlated with height after adjustment for potential confounders (adjusted r=0.19 and 0.23 in women and men, respectively), while waist/height ratio showed an inverse correlation with height (r=-0.14 and -0.15, respectively). Elevated waist/height ratio was more predictive of hypertension and hypertriglyceridemia, than waist circumference or waist/hip ratio.

CONCLUSIONS

Waist circumference is correlated with height; thresholds for waist circumference could need adjustment for height. Waist/height ratio, although inversely correlated with height, could be a better predictor of abnormalities associated with abdominal adiposity than waist circumference alone.