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Martins CA, Ferreira JRS, Cattafesta M, Neto ETDS, Rocha JLM, Salaroli LB. Cut points of the conicity index as an indicator of abdominal obesity in individuals undergoing hemodialysis: An analysis of latent classes. Nutrition 2023; 106:111890. [PMID: 36459843 DOI: 10.1016/j.nut.2022.111890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/25/2022] [Accepted: 10/11/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Abdominal obesity favors the involvement of cardiometabolic complications in renal patients on hemodialysis. Thus, the aim of the study was to identify the cut-points of the conicity index in individuals undergoing hemodialysis. METHODS This was a cross-sectional study carried out with 953 individuals undergoing hemodialysis in clinics in a metropolitan region of southeastern Brazil. The conicity index was calculated using the following mathematical equation: waist circumference/0.109 × √weight/height. The receiver operating characteristic (ROC) curve was calculated from the analysis of latent classes by cross-validation through a latent variable of abdominal obesity. This latent variable was defined using the response pattern of the observed anthropometric variables considering the presence and absence of abdominal obesity: waist circumference, waist-to-height ratio, and body shape index. The cut-points identified were elucidated by the area under the curve (AUC), Youden index, sensitivity, and specificity. RESULTS The cut-points for the conicity index found for both sexes were similar, resulting in a cut-point for men of 1.275 (AUC, 0.921; Youden index, 0.666), with a sensitivity and specificity of 83% and 83.6%, and a cut-point for women of 1.285 (AUC, 0.921; Youden index, 0.679), with a sensitivity and specificity of 78.6% and 89.3%, respectively. CONCLUSIONS The conicity index showed high discriminatory power for the identification of abdominal obesity in hemodialysis patients, therefore it can be a simple and easily accessible tool to be incorporated into clinical practice in this population.
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Affiliation(s)
- Cleodice Alves Martins
- Graduate Program in Nutrition and Health, Health Sciences Center, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Júlia Rabelo Santos Ferreira
- Graduate Program in Collective Health, Health Sciences Center, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Monica Cattafesta
- Graduate Program in Collective Health, Health Sciences Center, Universidade Federal do Espírito Santo, Vitória, Brazil
| | | | - Jose Luiz Marques Rocha
- Graduate Program in Nutrition and Health, Health Sciences Center, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Luciane Bresciani Salaroli
- Graduate Program in Nutrition and Health, Health Sciences Center, Universidade Federal do Espírito Santo, Vitória, Brazil; Graduate Program in Collective Health, Health Sciences Center, Universidade Federal do Espírito Santo, Vitória, Brazil.
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Nishikage S, Hirota Y, Ogawa W. [Diagnosis and treatment of obesity disease in older adults]. Nihon Ronen Igakkai Zasshi 2023; 60:317-330. [PMID: 38171746 DOI: 10.3143/geriatrics.60.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
In Japan, the proportion of older adults with obesity is rising, highlighting the need for specialized medical care for older adults with obesity. The Japan Society for the Study of Obesity (JASSO) defines 'obesity' as excessive fat storage in adipose tissue with body mass index (BMI) ≥ 25 kg/m2, and "Obesity Disease" as a condition with health disorders associated with obesity and/or visceral fat accumulation.The term 'high-degree obesity' applies to those with BMI≥ 35 kg/m2, and "Obesity Disease" with high-degree obesity is defined as "high-degree Obesity Disease".While the diagnostic criteria for "Obesity Disease" are same regardless of age group, older adults have unique problems. For example, BMI may not accurately reflect fat mass due to age-related height changes and other factors like edema. There's also an 'obesity paradox' in the older adults, where higher BMI may correlate with reduced mortality, though visceral fat is a risk factor.Weight reduction goal is 3% or more of body weight in 3-6 months for "Obesity Disease" and 5-10% or more for "high-degree Obesity Disease" . Management may include calorie-controlled diets and resistance exercises to prevent bone and muscle loss. Advanced treatment options like bariatric/metabolic surgery are also available for "high-degree Obesity Disease" .Recent guidelines from the Japan Geriatrics Society and JASSO provide insights into managing "Obesity Disease" among older adults, considering specific issues like dementia and functional decline. Future therapy need to evolve and provide individualized approaches to manage obesity for older adults.
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Affiliation(s)
- Seiji Nishikage
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine
| | - Yushi Hirota
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine
| | - Wataru Ogawa
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine
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Sun X, Yan AF, Shi Z, Zhao B, Yan N, Li K, Gao L, Xue H, Peng W, Cheskin LJ, Wang Y. Health consequences of obesity and projected future obesity health burden in China. Obesity (Silver Spring) 2022; 30:1724-1751. [PMID: 36000246 DOI: 10.1002/oby.23472] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study examined the effects of overweight/obesity on mortality and morbidity outcomes and the disparities, time trends, and projected future obesity health burden in China. METHODS Cohort studies that were conducted in China and published in English or Chinese between January 1, 1995, and July 31, 2021, were systematically searched. This study focused on overweight/obesity, type 2 diabetes mellitus (T2DM), hypertension, cardiovascular diseases, metabolic syndrome, cancers, and chronic kidney disease. RESULTS A total of 31 cohorts and 50 cohort studies reporting on mortality (n = 20) and morbidities (n = 30) associated with obesity met study inclusion criteria. Overall, BMI was nonlinearly (U-shaped) associated with all-cause mortality and linearly associated with risks of T2DM, cardiovascular diseases, hypertension, cancer, metabolic syndrome, and chronic kidney disease. In 2018, among adults, the prevalence of overweight/obesity, hypertension, and T2DM was 51.2%, 27.5%, and 12.4%, respectively. Their future projected prevalence would be 70.5%, 35.4%, and 18.5% in 2030, respectively. The projected number of adults having these conditions would be 810.65 million, 416.47 million, and 217.64 million, respectively. The urban-rural disparity in overweight/obesity prevalence was projected to shrink and then reverse over time. CONCLUSIONS The current health burden of obesity in China is high and it will sharply increase in coming years and affect population groups differently. China needs to implement vigorous interventions for obesity prevention and treatment.
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Affiliation(s)
- Xiaomin Sun
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - Alice Fang Yan
- Center for Advancing Population Science, Division of Internal Medicine, Department of Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | - Zumin Shi
- Human Nutrition Department, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Bingtong Zhao
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - Na Yan
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - Ke Li
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - Liwang Gao
- Center for Non-communicable Disease Management, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Hong Xue
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
| | - Wen Peng
- Nutrition and Health Promotion Center, Department of Public Health, Medical College, Qinghai University and Global Health Institute, Xi'an Jiaotong University, Xi'an, China
| | - Lawrence J Cheskin
- Department of Nutrition and Food Studies, College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
- Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Youfa Wang
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Xi'an, China
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Association of myocardial infarction and angina pectoris with obesity and biochemical indices in the South Korean population. Sci Rep 2022; 12:13769. [PMID: 35962047 PMCID: PMC9374724 DOI: 10.1038/s41598-022-17961-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/03/2022] [Indexed: 11/08/2022] Open
Abstract
The best obesity index for myocardial infarction or angina pectoris (MIAP) risk assessment remains controversial. Furthermore, the association between biochemical indices and these diseases is unclear. This study examined associations of obesity and biochemical indices with MIAP in the Korean population. This large-scale cross-sectional study was based on the Korea National Health and Nutrition Survey dataset from 2010 to 2019. A total of 22,509 subjects (9452 men and 13,057 women) aged ≥ 50 years were included. Participants consisted of 21,426 individuals without MIAP (men = 8869, women = 12,557) and 1083 with MIAP (men = 583, women = 500). Binary logistic regression was performed to examine the association of MIAP with obesity and biochemical indices. The prevalence of MIAP in Korean adults aged ≥ 50 years was 4.81% (6.57% among men, 3.98% among women). MIAP was more strongly associated with total cholesterol than other variables in men (adjusted OR = 0.436 [0.384-0.495], adjusted p < 0.001) and women (adjusted OR = 0.541 [0.475-0.618], adjusted p < 0.001). The waist-to-height ratio (adjusted OR = 1.325 [1.082-1.623], adjusted p = 0.007) and waist circumference (adjusted OR = 1.290 [1.072-1.553], adjusted p = 0.007) showed a significant association with MIAP in men, with no association between obesity indices and MIAP in women after adjustment. The association between biochemical indices and MIAP differed slightly according to sex. Only total cholesterol, creatinine, and platelets were associated with MIAP in both men and women.
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Wu W, Wu Y, Yang J, Sun D, Wang Y, Ni Z, Yang F, Xie Y, Tan X, Li L, Li L. Relationship between obesity indicators and hypertension-diabetes comorbidity among adults: a population study from Central China. BMJ Open 2022; 12:e052674. [PMID: 35858720 PMCID: PMC9305822 DOI: 10.1136/bmjopen-2021-052674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify the relationship between obesity indicators and hypertension-diabetes comorbidity (HDC) among adults in central China. DESIGN AND SETTING A cross-sectional study was conducted from 1 June 2015 to 30 September 2018 in 11 districts of Hubei Province, China. PARTICIPANTS A total of 29 396 participants aged 18 years or above were enrolled in the study. 2083 subjects with missing data were excluded. Eventually, 25 356 participants were available for the present analysis. MAIN OUTCOME MEASURES Data were subjected to univariable and multivariable logistic regression to examine the association between obesity indicators (body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR)) and HDC prevalence. Crude odds ratio and adjusted OR (AOR) with associated 95% CI were calculated. RESULTS Overall, 2.8% of the respondents had HDC. The odds of HDC prevalence increased with the BMI of the participants (18.5≤BMI (kg/m2)≤23.9-1; 24≤BMI (kg/m2)≤26.9-AOR: 5.66, 95% CI: 4.25 to 7.55; BMI (kg/m2)≥27-AOR: 7.96, 95% CI: 5.83 to 10.87). The risk of HDC also increased with the WHtR of participants (WHtR≤P25-1; P25≤WHtR≤P50-AOR: 1.73, 95% CI: 1.10 to 2.71; P50 ≤WHtR≤P75-AOR: 2.51, 95% CI: 1.60 to 3.92; WHtR≥P75-AOR: 3.22, 95% CI: 2.01 to 5.16). Stratified analysis by gender showed that high BMI and WHtR were risk factors of HDC in males and females. However, the odds of HDC prevalence increased only when WHtR≥P75 in males, whereas the probability of HDC increased when WHtR≥ P25 in females. CONCLUSION High BMI and WHtR can increase the risk of HDC among Chinese adults. Reasonable control of BMI and WHtR may be beneficial in preventing HDC. Females should focus on maintaining an optimal WHtR earlier.
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Affiliation(s)
- Wenwen Wu
- Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
- School of Public Health, Hubei University of Medicine, Shiyan, Hubei, China
| | - Yifan Wu
- Department of Traditional Chinese Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Jinru Yang
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Donghan Sun
- Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Ying Wang
- Department of Nosocomial Infection Management, Wuhan University Zhongnan Hospital, Wuhan, Hubei, China
| | - Ziling Ni
- School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Fen Yang
- Hubei University of Chinese Medicine, Wuhan, Hubei, China
| | - Yaofei Xie
- School of Public Health, Wuhan University, Wuhan, Hubei, China
| | - Xiaodong Tan
- School of Public Health, Wuhan University, Wuhan, Hubei, China
| | - Ling Li
- Dongfeng Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Li Li
- Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
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Hu M, Shi Q, Sun S, Hong HI, Zhang H, Qi F, Zou L, Nie J. Effect of a Low-Carbohydrate Diet With or Without Exercise on Anxiety and Eating Behavior and Associated Changes in Cardiometabolic Health in Overweight Young Women. Front Nutr 2022; 9:894916. [PMID: 35873416 PMCID: PMC9298497 DOI: 10.3389/fnut.2022.894916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022] Open
Abstract
Background The effectiveness of low-carbohydrate diets (LCDs) on weight loss and exercise for improving cardiometabolic fitness have been well documented in the literature, but the effects of LCDs and whether adding exercise to a LCD regime could additionally benefit mental health (e. g., by lowering the level of anxiety) and associated changes in eating behavior are less clear in overweight and obese populations. Therefore, this study aimed to investigate the effects of a 4-week LCD with or without exercise on anxiety and eating behavior, and to explore the associations between changes in the psychological state and physiological parameters (i.e., body composition, aerobic fitness, blood pressure, lipid profile, and metabolic hormones). Methods Seventy-four overweight Chinese women [age: 20.8 ± 3.0 years, body mass index (BMI): 25.3 ± 3.3 kg·m−2] completed the 4-week randomized controlled trial, which included a LCD group (i.e., ~50 g daily carbohydrate intake) with exercise training 5 days/week (LC-EXE, n = 26), a LCD group without exercise training (LC-CON, n = 25) and a control group that did not modify their habitual diets and physical activity (CON, n = 23). Levels of anxiety, eating behavior scores and physiological parameters (i.e., body weight, V̇O2peak, blood pressure, fasting glucose, blood lipids, and serum metabolic hormones including insulin, C-peptide, leptin, and ghrelin) were measured before and after the intervention. Results There were significant reductions in anxiety levels in the LC-EXE compared with the LC-CON group, while no statistical changes were found in eating behaviors in any conditions after the 4-week intervention. Significant reduction in weight (~3.0 kg or 4%, p < 0.01) and decreases in insulin (~30% p < 0.01), C-peptide (~20% p < 0.01), and leptin (~40%, p < 0.01) were found in both LC-CON and LC-EXE groups, but adding exercise to a LCD regime generated no additional effects. There were significant improvements in V̇O2peak (~15% p < 0.01) and anxiety (~25% p < 0.01) in the LC-EXE compared with the LC-CON group, while no statistical differences were found between CON and LC-CON treatments. Further analysis revealed a negative association (r = −0.32, p < 0.01) between changes in levels of anxiety and changes in V̇O2peak in all participates, no other correlations were found between changes in psychological and physiological parameters. Conclusion Although the combination of a LCD and exercise may not induce additional reductions in body weight in overweight young females, exercise could be a useful add-on treatment along with a LCD to improve cardiometabolic health and lower anxiety levels.
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Affiliation(s)
- Mingzhu Hu
- Faculty of Education, University of Macau, Macao, Macao SAR, China
| | - Qingde Shi
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, Macao SAR, China
| | - Shengyan Sun
- Institute of Physical Education, Huzhou University, Huzhou, China
| | - Hin Ieong Hong
- Chan Sui Ki Perpetual Help College, Macao, Macao SAR, China
| | - Haifeng Zhang
- College of Physical Education, Hebei Normal University, Shijiazhuang, China
| | - Fengxue Qi
- Sports, Exercise and Brain Sciences Laboratory, Beijing Sport University, Beijing, China
| | - Liye Zou
- Exercise Psychophysiology Laboratory, Institute of KEEP Collaborative Innovation, School of Psychology, Shenzhen University, Shenzhen, China
| | - Jinlei Nie
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, Macao SAR, China
- *Correspondence: Jinlei Nie
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Wang Y, Zhao L, Gao L, Pan A, Xue H. Health policy and public health implications of obesity in China. Lancet Diabetes Endocrinol 2021; 9:446-461. [PMID: 34097869 DOI: 10.1016/s2213-8587(21)00118-2] [Citation(s) in RCA: 164] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 12/16/2022]
Abstract
China has experienced many drastic social and economic changes and shifts in people's lifestyles since the 1990s, in parallel with the fast rising prevalence of obesity. About half of adults and a fifth of children have overweight or obesity according to the Chinese criteria, making China the country with the highest number of people with overweight or obesity in the world. Assuming that observed time trends would continue in the future, we projected the prevalence of and the number of people affected by overweight and obesity by 2030, and the associated medical costs. The rising incidence of obesity and number of people affected, as well as the related health and economic consequences, place a huge burden on China's health-care system. China has made many efforts to tackle obesity, including the implementation of relevant national policies and programmes. However, these measures are inadequate for controlling the obesity epidemic. In the past decade, China has attached great importance to public health, and the Healthy China 2030 national strategy initiated in 2016 provides a historical opportunity to establish comprehensive national strategies for tackling obesity. China is well positioned to explore an effective model to overcome the obesity epidemic; however, strong commitment and leadership from central and local governments are needed, as well as active participation of all related society sectors and individual citizens. TRANSLATION: For the Chinese translation of the paper see Supplementary Materials section.
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Affiliation(s)
- Youfa Wang
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Xi'an, China.
| | - Li Zhao
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Liwang Gao
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - An Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong Xue
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, VA, USA
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Zeng Q, Li N, Pan XF, Chen L, Pan A. Clinical management and treatment of obesity in China. Lancet Diabetes Endocrinol 2021; 9:393-405. [PMID: 34022157 DOI: 10.1016/s2213-8587(21)00047-4] [Citation(s) in RCA: 107] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 02/03/2021] [Accepted: 02/12/2021] [Indexed: 02/08/2023]
Abstract
China has one of the largest populations with obesity in the world, and obesity has become a major challenge for the country's health-care system. Current guidelines for obesity management are not adequately supported by evidence from clinical studies in Chinese populations. Effective lifestyle interventions suitable for Chinese populations are scarce, insufficient weight-loss medications have been approved by regulatory bodies, and there is low acceptance of non-lifestyle interventions (ie, medications and surgery) among both health-care providers and the general public. Large, well designed, and well implemented clinical trials are needed to strengthen the evidence base for the clinical management of obesity in China. Obesity management can be improved through use of a tiered system involving health management centres, integrated lifestyle interventions and medical treatments, strengthened obesity education and training, and use of advanced electronic health technologies. Resource mobilisation, support from major stakeholders for people with overweight or obesity, and education and changes to social norms among the wider public are also needed. National health policies should prioritise both obesity prevention and improvement of the treatment and management of obesity.
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Affiliation(s)
- Qiang Zeng
- Health Management Institute, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Naishi Li
- Department of Endocrinology, Key Laboratory of Endocrinology of the National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiong-Fei Pan
- Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lulu Chen
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China.
| | - An Pan
- Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Pan XF, Wang L, Pan A. Epidemiology and determinants of obesity in China. Lancet Diabetes Endocrinol 2021; 9:373-392. [PMID: 34022156 DOI: 10.1016/s2213-8587(21)00045-0] [Citation(s) in RCA: 601] [Impact Index Per Article: 200.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 01/15/2021] [Accepted: 02/12/2021] [Indexed: 12/11/2022]
Abstract
Obesity has become a major public health issue in China. Overweight and obesity have increased rapidly in the past four decades, and the latest national prevalence estimates for 2015-19, based on Chinese criteria, were 6·8% for overweight and 3·6% for obesity in children younger than 6 years, 11·1% for overweight and 7·9% for obesity in children and adolescents aged 6-17 years, and 34·3% for overweight and 16·4% for obesity in adults (≥18 years). Prevalence differed by sex, age group, and geographical location, but was substantial in all subpopulations. Strong evidence from prospective cohort studies has linked overweight and obesity to increased risks of major non-communicable diseases and premature mortality in Chinese populations. The growing burden of overweight and obesity could be driven by economic developments, sociocultural norms, and policies that have shaped individual-level risk factors for obesity through urbanisation, urban planning and built environments, and food systems and environments. Substantial changes in dietary patterns have occurred in China, with increased consumption of animal-source foods, refined grains, and highly processed, high-sugar, and high-fat foods, while physical activity levels in all major domains have decreased with increasing sedentary behaviours. The effects of dietary factors and physical inactivity intersect with other individual-level risk factors such as genetic susceptibility, psychosocial factors, obesogens, and in-utero and early-life exposures. In view of the scarcity of research around the individual and collective roles of these upstream and downstream factors, multidisciplinary and transdisciplinary studies are urgently needed to identify systemic approaches that target both the population-level determinants and individual-level risk factors for obesity in China.
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Affiliation(s)
- Xiong-Fei Pan
- Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Limin Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - An Pan
- Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Nutrition Management in Older Adults with Diabetes: A Review on the Importance of Shifting Prevention Strategies from Metabolic Syndrome to Frailty. Nutrients 2020; 12:nu12113367. [PMID: 33139628 PMCID: PMC7693664 DOI: 10.3390/nu12113367] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023] Open
Abstract
The increasing prevalence of older adults with diabetes has become a major social burden. Diabetes, frailty, and cognitive dysfunction are closely related to the mechanisms of aging. Insulin resistance, arteriosclerosis, chronic inflammation, oxidative stress, and mitochondrial dysfunction may be common mechanisms shared by frailty and cognitive impairment. Hyperglycemia, hypoglycemia, obesity, vascular factors, physical inactivity, and malnutrition are important risk factors for cognitive impairment and frailty in older adults with diabetes. The impact of nutrients on health outcomes varies with age; thus, shifting diet therapy strategies from the treatment of obesity/metabolic syndrome to frailty prevention may be necessary in patients with diabetes who are over 75 years of age, have frailty or sarcopenia, and experience malnutrition. For the prevention of frailty, optimal energy intake, sufficient protein and vitamin intake, and healthy dietary patterns should be recommended. The treatment of diabetes after middle age should include the awareness of proper glycemic control aimed at extending healthy life expectancy with proper nutrition, exercise, and social connectivity. Nutritional therapy in combination with exercise, optimal glycemic and metabolic control, and social participation/support for frailty prevention can extend healthy life expectancy and maintain quality of life in older adults with diabetes mellitus.
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「高齢者肥満症診療ガイドライン2018」. Nihon Ronen Igakkai Zasshi 2018. [PMID: 30464154 DOI: 10.3143/geriatrics.55.g1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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12
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Frayling TM, Stoneman CE. Mendelian randomisation in type 2 diabetes and coronary artery disease. Curr Opin Genet Dev 2018; 50:111-120. [PMID: 29935421 DOI: 10.1016/j.gde.2018.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/22/2018] [Accepted: 05/23/2018] [Indexed: 01/29/2023]
Abstract
Type 2 diabetes, coronary artery disease and hypertension are associated with anthropometric and biomarker traits, including waist-to-hip-ratio, body mass index and altered glucose and insulin levels. Clinical trials, for example of weight-loss interventions, show these factors are causal, but lifelong impact of subtle changes in body mass index and body fat distribution are less clear. The use of human genetics can quantify the causal effects of long-term exposure to subtle changes of modifiable risk factors. Mendelian randomisation (MR) uses human genetic variants associated with the risk factor to quantify the relationship between risk factor and disease outcome. The last two years have seen an increase in the number of MR studies investigating the relationship between anthropometric traits and metabolic diseases. This review provides an overview of these recent MR studies in relation to type 2 diabetes, coronary artery disease and hypertension. MR provides evidence for causal associations of waist-to-hip-ratio, body mass index and altered glucose levels with type 2 diabetes, coronary artery disease and hypertension.
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Affiliation(s)
- Timothy M Frayling
- RILD Building, University of Exeter Medical School, Barrack Road, Exeter EX2 5DW, UK
| | - Charli E Stoneman
- RILD Building, University of Exeter Medical School, Barrack Road, Exeter EX2 5DW, UK
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Salari A, Shakiba M, Mahdavi-Roshan M, Gholipour M, Naghshbandi M, Rajabi R. The association between various indices of obesity and severity of atherosclerosis in adults in the north of Iran. Medicine (Baltimore) 2016; 95:e5670. [PMID: 27977617 PMCID: PMC5268063 DOI: 10.1097/md.0000000000005670] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Recent observational studies have reported controversial results for the association between different anthropometric indices of obesity and severity of atherosclerosis. The aim of the current study is to determine the associations between anthropometric indices with severity of atherosclerosis in adult population in north of Iran.The cross-sectional study was performed on 610 participants, who were admitted to a hospital for elective angiographyin Rasht, Iran, Anthropometric indices, including waist circumference (WC), waist-to-height ratio (WHtR), conicity index (CI), body mass index (BMI), and hematological factors, were measured using the standard methods. According to angiography reports, severity of atherosclerosis was determined.Sixty-two percent of participants had moderate to severe atherosclerosis. According to BMI, 44% were overweight and 25.8% were obese. Based on WHtR and WC, 90%, and 57% were obese, respectively. The prevalence of moderate to severe atherosclerosis in centrally obese women was significantly higher than in centrally nonobese women (52% vs 28% P = 0.02). According to multivariate adjustment analysis, age, sex, systolic blood pressure, hemoglobin A1c, uric acid, and triglyceride were independently associated with severity of atherosclerosis. BMI, WC, CI, and WHtR had no significant association with severity of atherosclerosis.Our findings showed that anthropometric indices reflective of general and abdominal obesity were not independently related to the severity of atherosclerosis in adults, in northern Iran.
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Affiliation(s)
- Arsalan Salari
- Department of Cardiology, School of Medicine, Heshmat Hospital, Guilan Interventional Cardiovascular Research Center
| | - Maryam Shakiba
- Department of Cardiology, School of Medicine, Heshmat Hospital, Guilan Interventional Cardiovascular Research Center
| | - Marjan Mahdavi-Roshan
- Department of Cardiology, School of Medicine, Heshmat Hospital, Guilan Interventional Cardiovascular Research Center
- School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mahboobeh Gholipour
- Department of Cardiology, School of Medicine, Heshmat Hospital, Guilan Interventional Cardiovascular Research Center
| | - Moona Naghshbandi
- Department of Cardiology, School of Medicine, Heshmat Hospital, Guilan Interventional Cardiovascular Research Center
| | - Ramin Rajabi
- Department of Cardiology, School of Medicine, Heshmat Hospital, Guilan Interventional Cardiovascular Research Center
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Corrêa MM, Thumé E, De Oliveira ERA, Tomasi E. Performance of the waist-to-height ratio in identifying obesity and predicting non-communicable diseases in the elderly population: A systematic literature review. Arch Gerontol Geriatr 2016; 65:174-82. [DOI: 10.1016/j.archger.2016.03.021] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 03/17/2016] [Accepted: 03/29/2016] [Indexed: 01/12/2023]
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Li H, Yang G, Xiang YB, Zhang X, Zheng W, Gao YT, Shu XO. Body weight, fat distribution and colorectal cancer risk: a report from cohort studies of 134255 Chinese men and women. Int J Obes (Lond) 2016; 37:783-9. [PMID: 22986684 PMCID: PMC3541452 DOI: 10.1038/ijo.2012.152] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the association of body size and fat distribution with risk of colorectal cancer (CRC) in Chinese men and women. DESIGN Population-based, prospective cohort study. SUBJECTS The analysis included 134 255 Chinese adults enrolled in the Shanghai Women’s Health Study and the Shanghai Men’s Health Study, with an average follow-up of 11.0 and 5.5 years, respectively. MEASUREMENTS Waist circumference (WC), body mass index (BMI) and waist-to-hip ratio (WHR) were measured by trained interviewers at baseline. Multivariable Cox models were used to calculate adjusted hazard ratios (HRs) for incident CRC. RESULTS A total of 935 incident CRC cases were identified. Both measures of general adiposity (measured by BMI) and central adiposity (measured by WHR and WC) were significantly associated with increased risk of colon cancer in men but not in women. Multivariable adjusted HRs for colon cancer in men in the highest compared with the lowest quintiles were 2.15 (95% CI: 1.35-3.43; P for trend = 0.0006) for BMI, 1.97 (95% CI: 1.19-3.24; P for trend = 0.0004) for WHR and 2.00 (95% CI: 1.21-3.29; P for trend = 0.0002) for WC. The BMI-associated risk was attenuated in analyses stratified by WHR, while the WHR-associated risk remained significant in the high BMI stratum (HR for comparison of extreme tertiles of WHR: 3.38, 95% CI: 1.47-7.75; P for trend =0.0002). None of these anthropometric measures were significantly associated with rectal cancer. CONCLUSION Obesity, particularly central obesity, was associated with increased risk of colon cancer in men.
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Affiliation(s)
- H Li
- Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Rao G, Powell-Wiley TM, Ancheta I, Hairston K, Kirley K, Lear SA, North KE, Palaniappan L, Rosal MC. Identification of Obesity and Cardiovascular Risk in Ethnically and Racially Diverse Populations: A Scientific Statement From the American Heart Association. Circulation 2015; 132:457-72. [PMID: 26149446 DOI: 10.1161/cir.0000000000000223] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Khan RJ, Harvey DJ, Leistikow BN, Haque KMHSS, Stewart CP. Relationship between obesity and coronary heart disease among urban Bangladeshi men and women. INTEGRATIVE OBESITY AND DIABETES 2015; 1:49-55. [PMID: 26550484 PMCID: PMC4636209 DOI: 10.15761/iod.1000112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The aim of the study was to examine the association of different measures of obesity (body mass index or BMI, waist circumference or WC, waist to hip ratio or WHR and waist height ratio or WHtR) with coronary heart disease (CHD) in a Bangladeshi population. The study included 189 hospitalized CHD cases (133 men and 52 women) and 201 controls (137 men and 68 women). Logistic regression was done to assess the associations between obesity and CHD. The mean age was 53.1 ± 8.3 for men and 51.9 ± 8.4 for women. After adjustment for confounders the odds ratio (OR) of CHD for men was 1.69 (95% CI, 1.24-2.32), 1.94 (95% CI 1.40-2.70), and 1.32 (95% CI, 1.01-2.16) per 1 standard deviation (SD) increase in BMI, WC, and WHtR respectively. The OR for women was 2.64 (CI, 1.61-4.34), 1.82 (95% CI 1.12-2.95), 2.32 (95% CI, 1.36-3.96), and 1.94 (95% CI, 1.23-3.07) per 1 SD increase in BMI, WC, WHtR and WHR respectively. Since both total obesity and abdominal adiposity were associated with development of CHD and since measurement of WC and BMI are inexpensive, both should be included in the clinical setting for CHD risk assessment for this group of population.
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Affiliation(s)
- Rumana J Khan
- Graduate Group in Epidemiology, University of California, Davis, CA, USA
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Program in International and Community Nutrition, University of California, Davis, CA, USA
| | - Danielle J Harvey
- Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Bruce N Leistikow
- Department of Public Health Sciences, University of California, Davis, CA, USA
| | - KMHS Sirajul Haque
- Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Christine P Stewart
- Program in International and Community Nutrition, University of California, Davis, CA, USA
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Goh LGH, Dhaliwal SS, Welborn TA, Lee AH, Della PR. Ethnicity and the association between anthropometric indices of obesity and cardiovascular risk in women: a cross-sectional study. BMJ Open 2014; 4:e004702. [PMID: 24852299 PMCID: PMC4039846 DOI: 10.1136/bmjopen-2013-004702] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES The objectives of this study were to determine whether the cross-sectional associations between anthropometric obesity measures, body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR), and calculated 10-year cardiovascular disease (CVD) risk using the Framingham and general CVD risk score models, are the same for women of Australian, UK and Ireland, North European, South European and Asian descent. This study would investigate which anthropometric obesity measure is most predictive at identifying women at increased CVD risk in each ethnic group. DESIGN Cross-sectional data from the National Heart Foundation Risk Factor Prevalence Study. SETTING Population-based survey in Australia. PARTICIPANTS 4354 women aged 20-69 years with no history of heart disease, diabetes or stroke. Most participants were of Australian, UK and Ireland, North European, South European or Asian descent (97%). OUTCOME MEASURES Anthropometric obesity measures that demonstrated stronger predictive ability of identifying women at increased CVD risk and likelihood of being above the promulgated treatment thresholds of various risk score models. RESULTS Central obesity measures, WC and WHR, were better predictors of cardiovascular risk. WHR reported a stronger predictive ability than WC and BMI in Caucasian women. In Northern European women, BMI was a better indicator of risk using the general CVD (10% threshold) and Framingham (20% threshold) risk score models. WC was the most predictive of cardiovascular risk among Asian women. CONCLUSIONS Ethnicity should be incorporated into CVD assessment. The same anthropometric obesity measure cannot be used across all ethnic groups. Ethnic-specific CVD prevention and treatment strategies need to be further developed.
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Affiliation(s)
- Louise G H Goh
- School of Public Health, Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Satvinder S Dhaliwal
- School of Public Health, Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Timothy A Welborn
- Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Perth, Western Australia, Australia
| | - Andy H Lee
- School of Public Health, Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Phillip R Della
- School of Nursing and Midwifery, Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
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Li HX, Zhang F, Zhao D, Xin Z, Guo SQ, Wang SM, Zhang JJ, Wang J, Li Y, Yang GR, Yang JK. Neck circumference as a measure of neck fat and abdominal visceral fat in Chinese adults. BMC Public Health 2014; 14:311. [PMID: 24708638 PMCID: PMC4004507 DOI: 10.1186/1471-2458-14-311] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 03/26/2014] [Indexed: 11/10/2022] Open
Abstract
Background Visceral adipose tissue (VAT) is a unique pathogenic fatty deposit, in that it is closely correlated with risk of cardiovascular diseases. The present study is to investigate the usefulness of neck circumference (NC) to indicate VAT. Methods Participants aged 35 to 75 years who had taken abdomen and neck computer tomography (CT) examination were included in this study. Neck adipose tissue, abdominal VAT and subcutaneous adipose tissue (SAT) areas, as well as sagittal abdominal diameter (SAD) were measured by CT. Body anthropometrics and metabolic parameters including blood glucose, lipid profiles and blood pressure were also measured. Results A lower abdomen CT examination was carried out on a total of 177 patients (87 male and 90 female) with a mean age of 59 years. Of the 177 participants, 15 men and 15 women also took a neck CT examination. With a comparable age and BMI, neck adipose area was correlated with abdominal VAT area significantly in men (r = 0.57, p = 0.028) and women (r = 0.53, p = 0.041). NC is positively correlated with VAT both in men (r = 0.49, p < 0.001) and women (r = 0.25, p = 0.012). Meanwhile, SAD is the best predictor for visceral fat both in men (r = 0.83, p < 0.001) and women (r = 0.73, p < 0.001). Body mass index (BMI), waist circumference (WC), and waist to height ratio (WHtR) correlated significantly with VAT both in men and women (r = 0.68, 0.42, 0.46 in men and 0.50, 0.23, 0.39 in women, p < 0.001), while waist hip ratio (WHR) displayed the weakest least correlation in men (r = 0.32, p = 0.001) and no correlation in women (r = 0.08, p = 0.442). Additionally, BMI was more strongly correlated with VAT than NC in both sexes (both p < 0.01). Conclusion Significant correlation between NC and VAT was present in Chinese men and women, which may be accounted by the fact that neck fat area is significantly correlated with abdominal VAT. Meanwhile, SAD is the best predictor for visceral fat in the Chinese population.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Jin-Kui Yang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
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Sarry El Din AM, Zaki ME, Kandeel WA, Mohamed SK, El Wakeel KH. Cut-Off Values of Anthropometric Indices for the Prediction of Hypertension in a Sample of Egyptian Adults. Open Access Maced J Med Sci 2014. [DOI: 10.3889/oamjms.2014.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Obesity, particularly abdominal adiposity, is closely associated with premature atherosclerosis and many metabolic modifications including insulin resistance dyslipidemia hypertension and diabetes. Cut-off values for abdominal obesity predicting future cardiovascular disease are known to be population specific.Objective: To identify cut-off points of some anthropometric measurements (BMI, WC, WHR and WHtR) that associated with hypertension in a sample of Egyptian adults.Subjects and Methods: This is a cross-sectional analysis. The blood pressure of 5550 Egyptian adults was measured (2670 females – 2880 males).The subjects represented different geographic localities and different social classes. Anthropometric measurements including height, weight, waist circumferences, and hip circumferences were also measured by practitioners.Results: The cut-off values to detect hypertension in females were 30.08 for BMI, 87.75 for WC , 0.81 for WHR and 0.65 for WHtR, and the corresponding sensitivity and specificity were 69.1; 60.7- 80.9; 48.6 -65.3; 53.4 and 61.4; 58.9, respectively. The cut-off values to detect hypertension in males were 27.98 for BMI, 95.75 for WC, 0.92 for WHR, and 0.57 for WHtR and the corresponding sensitivity and specificity were 62.8; 59.9 -71.9; 51.9 -64.6; 55.8 and 59.7; 55.8, respectively.Conclusion: The BMI, Waist circumference, WHR and WHtR values can predict the presence of hypertension risk in adult Egyptians.
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Saeed AA, Al-Hamdan NA. Anthropometric risk factors and predictors of hypertension among Saudi adult population - a national survey. J Epidemiol Glob Health 2013; 3:197-204. [PMID: 24206791 PMCID: PMC7320412 DOI: 10.1016/j.jegh.2013.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 07/03/2013] [Accepted: 08/08/2013] [Indexed: 12/28/2022] Open
Abstract
This cross-sectional study aimed at determining the anthropometric predictors of hypertension among adults in Saudi Arabia. Multi-stage stratified sampling was used to select 4758 adult participants. The average of three blood pressure measurements using an automatic sphygmomanometer was considered the real blood pressure. Anthropometric measurements and socio-demographics were obtained from participants. The overall prevalence of hypertension was 25.5%. Hypertension was significantly positively associated with selected anthropometric measurements. Selected anthropometric measures were significant predictors of systolic and diastolic blood pressures except for hip measurements. Waist for height ratio was a significant predictor for isolated diastolic hypertension and combined systolic and diastolic hypertension. Waist circumference was the significant predictor for isolated systolic hypertension. Body mass index was a significant predictor for the combined systolic diastolic type. Waist for Hip Ratio was not a significant predictor for any of the hypertension subtypes. Conclusion: Waist for height ratio is the most important predictor for blood pressure level and hypertension disease.
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Affiliation(s)
- Abdalla Abdelwahid Saeed
- King Saud Bin Abdulaziz University - Health Sciences, Dept. of Community Medicine, Faculty of Medicine, King Fahad Medical City, PO Box 58046, Riyadh 11525, Saudi Arabia.
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Tatsumi Y, Watanabe M, Kokubo Y, Nishimura K, Higashiyama A, Okamura T, Okayama A, Miyamoto Y. Effect of age on the association between waist-to-height ratio and incidence of cardiovascular disease: the Suita study. J Epidemiol 2013; 23:351-9. [PMID: 23812103 PMCID: PMC3775529 DOI: 10.2188/jea.je20130004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Waist-to-height ratio (WHtR) has been shown to be a useful screening tool for metabolic syndrome and cardiovascular disease (CVD). We investigated the association of WHtR with CVD incidence by age group. Methods We conducted a 13.0-year cohort study of Japanese adults (2600 men and 2888 women) with no history of CVD. WHtR was calculated as waist circumference (cm) (WC) divided by height (cm). We stratified participants by sex and age group (30–49, 50–69, ≥70 years). Using the Cox proportional hazards model, we calculated hazard ratios (HRs) and 95% CIs for CVD in relation to WHtR quartile for participants aged 50 to 69 years and 70 years or older. Results Men aged 50 to 69 years in the highest quartile had significantly increased risks of CVD and coronary heart disease as compared with the lowest quartile; the HRs (95% CI) were 1.82 (1.13–2.92) and 2.42 (1.15–5.12), respectively. Women aged 50 to 69 years in the highest quartile had a significantly increased risk of stroke (HR, 2.43; 95% CI, 1.01–5.85). No significant results were observed in men or women aged 70 years or older. The likelihood ratio test showed that the predictive value of WHtR was greater than that of WC among men aged 50 to 69 years. Conclusions The association between WHtR and CVD risk differed among age groups. WHtR was useful in identifying middle-aged Japanese at higher risk of CVD and was a better predictor than WC of CVD, especially in men.
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Affiliation(s)
- Yukako Tatsumi
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
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Villegas R, Delahanty R, Gao YT, Long J, Williams SM, Xiang YB, Cai H, Li HL, Hu F, Cai Q, Zheng W, Shu XO. Joint effect of genetic and lifestyle risk factors on type 2 diabetes risk among Chinese men and women. PLoS One 2012. [PMID: 23185337 PMCID: PMC3504028 DOI: 10.1371/journal.pone.0049464] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
More than 40 genetic susceptibility loci have been reported for type 2 diabetes (T2D). Recently, the combined effect of genetic variants has been investigated by calculating a genetic risk score. We evaluated 36 genome-wide association study (GWAS) identified SNPs in 2,679 T2D cases and 3322 controls in middle-age Han Chinese. Fourteen SNPs were significantly associated with T2D in analysis adjusted for age, sex and BMI. We calculated two genetic risk scores (GRS) (GRS1 with all the 36 SNPs and GRS2 with the 14 SNPs significantly associated with T2D). The odds ratio for T2D with each GRS point (per risk allele) was 1.08 (95% CI: 1.06–1.09) for GRS1 and 1.15 (95% CI: 1.13–1.18) for GRS2. The OR for quintiles were 1.00, 1.26, 1.69, 1.95 and 2.18 (P<0.0001) for GRS1 and 1.00, 1.33, 1.60, 2.03 and 2.80 (P<0.001) for GRS2. Participants in the higher tertile of GRS1 and the higher BMI category had a higher risk of T2D compared to those on the lower tertiles of the GRS1 and of BMI (OR = 11.08; 95% CI: 7.39–16.62). We found similar results when we investigated joint effects between GRS1 and WHR terciles and exercise participation. We finally investigated the joint effect between tertiles of GRSs and a composite high risk score (no exercise participation and high BMI and WHR) on T2D risk. We found that compared to participants with low GRS1 and no high risk factors for T2D, those with high GRS1 and three high risk factors had a higher risk of T2D (OR = 13.06; 95% CI: 8.65–19.72) but the interaction factor was of marginal significance. The association was accentuated when we repeated analysis with the GRS2. In conclusion we found an association between GRS and lifestyle factors, alone and in combination, contributed to the risk of and T2D among middle age Chinese.
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Affiliation(s)
- Raquel Villegas
- Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.
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Changes in waist circumference and the incidence of acute myocardial infarction in middle-aged men and women. PLoS One 2011; 6:e26849. [PMID: 22046380 PMCID: PMC3202570 DOI: 10.1371/journal.pone.0026849] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 10/04/2011] [Indexed: 12/20/2022] Open
Abstract
Background Waist circumference (WC) measured at one point in time is positively associated with the risk of acute myocardial infarction (MI), but the association with changes in WC (DWC) is not clear. We investigated the association between DWC and the risk of MI in middle-aged men and women, and evaluated the influence from concurrent changes in BMI (DBMI). Methodology/Principal Findings Data on 38,593 participants from the Danish Diet, Cancer and Health study was analysed. Anthropometry was assessed in 1993–97 and 1999–02. Information on fatal and non-fatal MI was obtained from National Registers. Cases were validated by review of the medical records. Hazard ratios (HR) were calculated from Cox proportional hazard models with individuals considered at risk from 1999–02 until December 30 2009. During 8.4 years of follow-up, 1,041 incident cases of MI occurred. WC was positively associated with the risk of MI, but weakly after adjustment for BMI. DWC was not associated with the risk of MI (HR per 5 cm change = 1.01 (0.95, 1.09) with adjustment for covariates, baseline WC, BMI and DBMI). Associations with DWC were not notably different in sub-groups stratified according to baseline WC or DBMI, or when individuals with MI occurring within the first years of follow-up were excluded. Conclusions/Significance WC was positively associated with the risk of MI in middle-aged men and women, but changes in WC were not. These findings suggest that a reduction in WC may be an insufficient target for prevention of MI in middle-aged men and women.
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Villegas R, Xiang YB, Elasy T, Li HL, Yang G, Cai H, Ye F, Gao YT, Shyr Y, Zheng W, Shu XO. Fish, shellfish, and long-chain n-3 fatty acid consumption and risk of incident type 2 diabetes in middle-aged Chinese men and women. Am J Clin Nutr 2011; 94:543-51. [PMID: 21677058 PMCID: PMC3142729 DOI: 10.3945/ajcn.111.013193] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Long-chain polyunsaturated n-3 (omega-3) fatty acids, found mainly in fish, have been postulated to reduce type 2 diabetes (T2D) risk. However, the role of long-chain n-3 fatty acids and fish intake in the development of T2D remains unresolved. OBJECTIVE We examined associations between fish, shellfish, and long-chain n-3 fatty acids and the risk of T2D in a middle-aged Chinese population. DESIGN This was a prospective population-based cohort study in 51,963 men and 64,193 women free of T2D, cardiovascular disease, and cancer at baseline with valid dietary information. Dietary intake, physical activity, and anthropometric measurements were collected. A Cox regression model was used to evaluate the association of fish, shellfish, and long-chain n-3 fatty acid (in g/d) with risk of T2D. RESULTS Fish, shellfish, and long-chain n-3 fatty acid intakes were inversely associated with T2D in women. The relative risks [RRs (95% CI)] for quintiles of fish intake were 1.00, 0.96 (0.86, 1.06), 0.84 (0.75, 0.94), 0.80 (0.71, 0.90), and 0.89 (0.78, 1.01) (P for trend = 0.003) and for shellfish were 1.00, 0.91 (0.82, 1.01), 0.79 (0.71, 0.89), 0.80 (0.71, 0.91), and 0.86 (0.76, 0.99) (P for trend = 0.006). In men, only the association between shellfish intake and T2D was significant. The RRs (95% CI) for quintiles of fish intake were 1.00, 0.92 (0.75, 1.13), 0.80 (0.65, 1.00), 0.89 (0.72, 1.11), and 0.94 (0.74, 1.17) (P for trend = 0.50) and for shellfish intake were 1.00, 0.93 (0.76, 1.12), 0.70 (0.56, 086), 0.66 (0.53, 0.82), and 0.82 (0.65, 1.02) (P for trend = 0.003). CONCLUSIONS An inverse association between fish and shellfish intake and T2D in women was found. No evidence of a detrimental effect of fish intake in this population was observed.
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Affiliation(s)
- Raquel Villegas
- Vanderbilt University Medical Center, Nashville, TN 37203, USA.
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Karadag B, Ozturk AO, Sener N, Altuntas Y. Use of knee height for the estimation of stature in elderly Turkish people and their relationship with cardiometabolic risk factors. Arch Gerontol Geriatr 2010; 54:82-9. [PMID: 21185093 DOI: 10.1016/j.archger.2010.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 11/29/2010] [Accepted: 11/30/2010] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Berrin Karadag
- Sisli Etfal Education and Research Hospital, Internal Medicine/Endocrinology and Metabolism Clinics, 34377 Sisli, Istanbul, Turkey.
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A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0·5 could be a suitable global boundary value. Nutr Res Rev 2010; 23:247-69. [PMID: 20819243 DOI: 10.1017/s0954422410000144] [Citation(s) in RCA: 803] [Impact Index Per Article: 57.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This systematic review collated seventy-eight studies exploring waist-to-height ratio (WHtR) and waist circumference (WC) or BMI as predictors of diabetes and CVD, published in English between 1950 and 2008. Twenty-two prospective analyses showed that WHtR and WC were significant predictors of these cardiometabolic outcomes more often than BMI, with similar OR, sometimes being significant predictors after adjustment for BMI. Observations from cross-sectional analyses, forty-four in adults, thirteen in children, supported these predictions. Receiver operator characteristic (ROC) analysis revealed mean area under ROC (AUROC) values of 0·704, 0·693 and 0·671 for WHtR, WC and BMI, respectively. Mean boundary values for WHtR, covering all cardiometabolic outcomes, from studies in fourteen different countries and including Caucasian, Asian and Central American subjects, were 0·50 for men and 0·50 for women. WHtR and WC are therefore similar predictors of diabetes and CVD, both being stronger than, and independent of, BMI. To make firmer statistical comparison, a meta-analysis is required. The AUROC analyses indicate that WHtR may be a more useful global clinical screening tool than WC, with a weighted mean boundary value of 0·5, supporting the simple public health message 'keep your waist circumference to less than half your height'.
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Prevention of overweight and obesity: how effective is the current public health approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2010. [PMID: 20617002 DOI: 10.3390/ijerph7030765.] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Obesity is a public health problem that has become epidemic worldwide. Substantial literature has emerged to show that overweight and obesity are major causes of co-morbidities, including type II diabetes, cardiovascular diseases, various cancers and other health problems, which can lead to further morbidity and mortality. The related health care costs are also substantial. Therefore, a public health approach to develop population-based strategies for the prevention of excess weight gain is of great importance. However, public health intervention programs have had limited success in tackling the rising prevalence of obesity. This paper reviews the definition of overweight and obesity and the variations with age and ethnicity; health consequences and factors contributing to the development of obesity; and critically reviews the effectiveness of current public health strategies for risk factor reduction and obesity prevention.
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Villegas R, Yang G, Gao YT, Cai H, Li H, Zheng W, Shu XO. Dietary patterns are associated with lower incidence of type 2 diabetes in middle-aged women: the Shanghai Women's Health Study. Int J Epidemiol 2010; 39:889-99. [PMID: 20231261 DOI: 10.1093/ije/dyq008] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Data linking risk of type 2 diabetes (T2D) and dietary patterns in Chinese populations are scarce. METHODS A population-based prospective study of 64,191 middle-aged women in urban Shanghai, China, who were free of T2D and other chronic diseases at study recruitment, was conducted. Dietary intake, physical activity and anthropometric measurements were assessed through in-person interviews. Dietary patterns were assessed by using K-means cluster analysis. Cox regression model was used to evaluate the association of dietary patterns with the risk of T2D. RESULTS We identified three dietary clusters in this population. Cluster 1 (56.3%; N = 36,159) had the highest intake of staples, cluster 2 (40.4%: N = 25,948) had the highest intake of dairy milk, and cluster 3 (2.9%; N = 1843) had the highest energy intake. Participants in cluster 2 had lower prevalence of obesity, central obesity and hypertension at baseline. Using cluster 1 as the reference, participants in cluster 2 had a lower incidence of T2D after 6.9 years of follow-up [relative risk (RR) 0.78; 95% confidence interval (CI) 0.71-0.86]. The RR for the incidence of T2D for cluster 3 compared with cluster 1 was 1.05 (95% CI 0.81-1.35). The association was not modified by age category, body mass index category, waist-to-hip ratio category or exercise participation. CONCLUSIONS We identified and characterized dietary patterns in middle-aged Chinese women by using cluster analysis. We identified a dietary pattern low in staple foods and high in dairy milk, which was associated with lower risk of T2D. Study of dietary patterns will help elucidate links between diet and disease, and contribute to the development of healthy eating guidelines for health promotion.
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Affiliation(s)
- Raquel Villegas
- Vanderbilt Epidemiology Center, Department of Medicine, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA.
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Chan RS, Woo J. Prevention of overweight and obesity: how effective is the current public health approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2010; 7:765-83. [PMID: 20617002 PMCID: PMC2872299 DOI: 10.3390/ijerph7030765] [Citation(s) in RCA: 222] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 02/25/2010] [Indexed: 12/11/2022]
Abstract
Obesity is a public health problem that has become epidemic worldwide. Substantial literature has emerged to show that overweight and obesity are major causes of co-morbidities, including type II diabetes, cardiovascular diseases, various cancers and other health problems, which can lead to further morbidity and mortality. The related health care costs are also substantial. Therefore, a public health approach to develop population-based strategies for the prevention of excess weight gain is of great importance. However, public health intervention programs have had limited success in tackling the rising prevalence of obesity. This paper reviews the definition of overweight and obesity and the variations with age and ethnicity; health consequences and factors contributing to the development of obesity; and critically reviews the effectiveness of current public health strategies for risk factor reduction and obesity prevention.
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Affiliation(s)
- Ruth S.M Chan
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong, China; E-Mail:
| | - Jean Woo
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong, China; E-Mail:
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Abdominal obesity and peripheral vascular disease in men and women: A comparison of waist-to-thigh ratio and waist circumference as measures of abdominal obesity. Atherosclerosis 2010; 208:253-7. [DOI: 10.1016/j.atherosclerosis.2009.06.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Revised: 06/25/2009] [Accepted: 06/29/2009] [Indexed: 11/17/2022]
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Osher E, Stern N. Obesity in elderly subjects: in sheep's clothing perhaps, but still a wolf! Diabetes Care 2009; 32 Suppl 2:S398-402. [PMID: 19875588 PMCID: PMC2811458 DOI: 10.2337/dc09-s347] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Etty Osher
- Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv-Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Fox KA, Despres JP, Richard AJ, Brette S, Deanfield JE. Does abdominal obesity have a similar impact on cardiovascular disease and diabetes? A study of 91 246 ambulant patients in 27 European Countries. Eur Heart J 2009; 30:3055-63. [DOI: 10.1093/eurheartj/ehp371] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lear SA, James PT, Ko GT, Kumanyika S. Appropriateness of waist circumference and waist-to-hip ratio cutoffs for different ethnic groups. Eur J Clin Nutr 2009; 64:42-61. [DOI: 10.1038/ejcn.2009.70] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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36
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Villegas R, Gao YT, Dai Q, Yang G, Cai H, Li H, Zheng W, Shu XO. Dietary calcium and magnesium intakes and the risk of type 2 diabetes: the Shanghai Women's Health Study. Am J Clin Nutr 2009; 89:1059-67. [PMID: 19225116 PMCID: PMC2667456 DOI: 10.3945/ajcn.2008.27182] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Diet plays a key role in the development of type 2 diabetes (T2D), but little is known about the contributions of specific nutrients in populations in which dietary patterns differ from Western populations. OBJECTIVE We examined associations between calcium and magnesium intakes and the risk of T2D in a Chinese population. DESIGN We used data from a population-based, prospective study of 64,191 women who were free of T2D or other chronic diseases at study recruitment and were living in urban Shanghai, China. Dietary intake, physical activity, and anthropometric measurements were assessed through in-person interviews. A Cox regression model was used to evaluate the association of the exposures under study with the risk of T2D. RESULTS An inverse association between calcium and magnesium intakes and T2D risk was observed. The relative risks for the lowest to the highest quintiles of calcium intake were 1.00, 0.82, 0.73, 0.67, and 0.74 (P for trend < 0.001), and for magnesium they were 1.00, 0.84, 0.84, 0.79, and 0.86 (P for trend < 0.001). Milk intake was also inversely associated with the risk of T2D. CONCLUSION Our data suggest that calcium and magnesium intakes may protect against the development of T2D in this population.
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Affiliation(s)
- Raquel Villegas
- Vanderbilt Epidemiology Center, Department of Medicine, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN 37203-1738, USA.
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Villegas R, Shu XO, Yang G, Matthews CE, Li H, Cai H, Gao YT, Zheng W. Energy balance and type 2 diabetes: a report from the Shanghai Women's Health Study. Nutr Metab Cardiovasc Dis 2009; 19:190-197. [PMID: 18774701 PMCID: PMC2701731 DOI: 10.1016/j.numecd.2008.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Revised: 05/22/2008] [Accepted: 06/08/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS The combined effect of the components of energy balance (energy intake and physical activity) and the development of type 2 diabetes (T2D) has not been adequately investigated. The aim of this study was to examine the components of energy balance and the incidence of T2D in a cohort of middle-aged women. METHODS AND RESULTS A population-based prospective study of 64,227 middle-aged Chinese women who had no prior history of diabetes or chronic disease at study recruitment. Participants completed in-person interviews at baseline and follow-up surveys that collected information on diabetes risk factors including dietary and physical activity habits and disease occurrence. Anthropometric measurements were taken by trained interviewers at recruitment. Average follow-up time was 4.6 years. During 297,755 person-years of follow-up, 1608 new cases of T2D were documented. Body mass index (BMI) and weight gain (since age 20) were strongly associated with T2D incidence. Energy intake (EI) was associated with modestly increased risk, while physical activity (PA) was associated with decreased risk of T2D. Less active women with higher EI had higher risk of T2D (RR=1.96; 95% CI: 1.44, 2.67) than active women with lower EI (P(interaction)=0.02). The EI to PA (EI:PA) ratio was positively associated with T2D risk; the association was more evident among overweight and obese women (BMI > or = 23 kg/m(2)). CONCLUSION These data suggest that energy balance plays an important role in the development of T2D, and this effect may be modified by BMI.
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Affiliation(s)
- Raquel Villegas
- Vanderbilt Epidemiology Center, Department of Medicine, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Xiao Ou Shu
- Vanderbilt Epidemiology Center, Department of Medicine, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Gong Yang
- Vanderbilt Epidemiology Center, Department of Medicine, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Charles E. Matthews
- Vanderbilt Epidemiology Center, Department of Medicine, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Honglan Li
- Department of Epidemiology, Shanghai Cancer Institute and Cancer Institute of Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Hui Cai
- Vanderbilt Epidemiology Center, Department of Medicine, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Yu-Tang Gao
- Department of Epidemiology, Shanghai Cancer Institute and Cancer Institute of Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Wei Zheng
- Vanderbilt Epidemiology Center, Department of Medicine, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
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Sone H, Tanaka S, Iimuro S, Oida K, Yamasaki Y, Ishibashi S, Oikawa S, Katayama S, Ito H, Ohashi Y, Akanuma Y, Yamada N. Waist circumference as a cardiovascular and metabolic risk in Japanese patients with type 2 diabetes. Obesity (Silver Spring) 2009; 17:585-92. [PMID: 19023281 DOI: 10.1038/oby.2008.481] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Excess waist circumference (WC) is a frequently used indicator of abdominal obesity and/or cardiovascular disease (CVD) risk. Nonetheless, search of the literature revealed no prospective studies on the association between WC and CVD events in diabetic patients. In this study, the clinical significance and implications of WC as a cardiovascular and metabolic risk indicator was prospectively investigated in Japanese patients with type 2 diabetes. For this purpose, baseline data on WC, hypertension, and dyslipidemia were collected and subsequent CVD (coronary heart disease and stroke) events during the following 8 years were studied in 1,424 Japanese type 2 diabetic patients, and the cross-sectional/longitudinal associations between WC and CVD risk factors/events were analyzed. Mean WC levels were significantly increased according to the number of coexisting risk factors. However, no significant difference in mean WC between subgroups with and without CVD events was noted, and excess WC alone was not predictive of subsequent CVD events either in male or female subjects even after adjustment for age, smoking, hypertension, and dyslipidemia. In female patients, excess WC (> or =80 cm) was predictive of CVD events only with the coexistence of hypertension. In Japanese diabetic patients, excess WC alone, although a good marker for clustering of CVD risk factors, did not raise the risk of CVD events unless accompanied by hypertension in female patients. Further investigations are necessary before WC as a risk factor can be utilized in clinical settings for the management of diabetes in this population.
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Affiliation(s)
- Hirohito Sone
- Department of Lifestyle Medicine and Applied Nutrition, Ochanomizu University, Tokyo, Japan
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Zhang X, Shu XO, Gao YT, Yang G, Li H, Zheng W. General and abdominal adiposity and risk of stroke in Chinese women. Stroke 2009; 40:1098-104. [PMID: 19211490 DOI: 10.1161/strokeaha.108.539692] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Although both general and abdominal adiposity are well-established risk factors for coronary heart disease, their associations with stroke are less well characterized, particularly in generally lean Asian populations. METHODS We evaluated associations of body mass index (BMI), waist-hip ratio (WHR), waist circumference (WC), and waist-height ratio (WHtR) with stroke risk in the Shanghai Women's Health Study, a population-based prospective cohort study of 74 942 Chinese women aged 40 to 70 years with anthropometric measurement taken at recruitment in 1996 to 2000. For this analysis, we included 67 083 women with no prior history of stroke, coronary heart disease, rheumatic heart disease, cardiac surgery, or cancer at recruitment. Incident stroke was ascertained by biennial home visits and linkage with vital statistics registries. RESULTS Cut points for the highest quintiles of BMI, WHR, WC, and WHtR among this cohort were 26.6 (kg/m(2)), 0.85 (cm/cm), 84.1 (cm), and 0.54 (cm/cm), respectively. During a mean follow-up of 7.3 years, 2403 incident stroke cases were identified. All selected anthropometric measurements were positively and significantly associated with risk of total, ischemic, and hemorrhagic stroke in a dose-response manner (all probability values for trend <0.01). The multivariable-adjusted hazard ratios (95% confidence intervals) for total stroke comparing the highest versus lowest quintiles of these measurements were 1.71 (1.49 to 1.97), 1.59 (1.37 to 1.85), 1.77 (1.53 to 2.05), and 1.91 (1.61 to 2.27) for BMI, WHR, WC, and WHtR, respectively. CONCLUSIONS Increasing levels of general or abdominal adiposity consistently predict increased risk of stroke in predominantly nonobese Chinese women.
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Affiliation(s)
- Xianglan Zhang
- Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, Tenn 37203-1738, USA.
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Cashdan E. Waist‐to‐Hip Ratio across Cultures: Trade‐Offs between Androgen‐ and Estrogen‐Dependent Traits. CURRENT ANTHROPOLOGY 2008. [DOI: 10.1086/593036] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Funada S, Shimazu T, Kakizaki M, Kuriyama S, Sato Y, Matsuda-Ohmori K, Nishino Y, Tsuji I. Body mass index and cardiovascular disease mortality in Japan: the Ohsaki Study. Prev Med 2008; 47:66-70. [PMID: 18462784 DOI: 10.1016/j.ypmed.2008.03.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Revised: 03/12/2008] [Accepted: 03/17/2008] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Although there is a clear positive association between obesity and the incidence and severity of cardiovascular disease, the association between underweight and cardiovascular disease is unclear. The objective of this study was to examine the relation between body mass index (BMI) and cardiovascular disease in Japan, where the proportion of the population that is underweight is relatively high. METHOD A total of 43,916 Japanese adults (21,003 men and 22,913 women) aged 40 to 79 years who had no history of cancer, ischemic heart disease (IHD), or stroke participated in the baseline survey in 1994. Hazard ratios (HR) and their 95% confidence intervals (CIs) for death due to total cardiovascular disease, all strokes, ischemic stroke, hemorrhagic stroke, and IHD were calculated according to BMI by using Cox's proportional hazards regression models. The 22.5-24.9 kg/m(2) BMI category was used as the reference category in all analyses. RESULTS There were U-shaped associations between BMI and total cardiovascular disease, all stroke, hemorrhagic stroke, and IHD mortality, and a J-shaped association between BMI and ischemic stroke mortality. Participants with a BMI <18.5 kg/m(2) had a significantly increased risk of total cardiovascular disease, all stroke, hemorrhagic stroke, and IHD mortality, and the multivariate HR (95% CI) was 1.62 (1.19-2.19), 1.50 (1.02-2.21), 2.11 (1.07-4.17), 1.83 (1.11-3.01), respectively. CONCLUSION Underweight was substantially associated with hemorrhagic stroke and IHD mortality in Japan, while obesity was associated with increased risk of total cardiovascular disease mortality and mortality from individual cardiovascular diseases.
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Affiliation(s)
- Satoshi Funada
- Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
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Nyamdorj R, Qiao Q, Lam TH, Tuomilehto J, Ho SY, Pitkäniemi J, Nakagami T, Mohan V, Janus ED, Ferreira SRG. BMI compared with central obesity indicators in relation to diabetes and hypertension in Asians. Obesity (Silver Spring) 2008; 16:1622-35. [PMID: 18421260 DOI: 10.1038/oby.2008.73] [Citation(s) in RCA: 156] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare BMI with waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-stature ratio (WSR) in association with diabetes or hypertension. METHODS AND PROCEDURES Cross-sectional data from 16 cohorts from the DECODA (Diabetes Epidemiology: Collaborative Analysis of Diagnostic criteria in Asia) study, comprising 9,095 men and 11,732 women, aged 35-74 years, of different ethnicities were included in this meta-analysis. RESULTS Age-adjusted odds ratios (ORs) for diabetes in men (women) for 1 s.d. increase in BMI, WC, WHR, and WSR were 1.52 (1.59), 1.54 (1.70), 1.53 (1.50), and 1.62 (1.70), respectively; and the corresponding ORs for hypertension were 1.68 (1.55), 1.66 (1.51), 1.45 (1.28), and 1.63 (1.50). Paired homogeneity tests (BMI with each of the three) adjusted for age and cohort showed that diabetes had stronger association with WSR than BMI (P=0.001) in men but with WC and WSR than BMI (both P<0.05) in women. Hypertension had stronger association with BMI than WHR in men (P<0.001) and had the strongest with BMI than the others (WHR P<0.001; WSR P<0.01; and WC P<0.05) in women. Areas under the receiver operating characteristic (ROC) curves adjusted for age and cohort were slightly larger for diabetes for WSR 0.735 (0.748) in men (women) and WC 0.749 (women only) than BMI 0.725 (0.742) while for hypertension larger for BMI 0.760 (0.766) than WHR 0.748 (0.751), but their 95% CIs were all overlapped. DISCUSSION WSR was stronger than BMI in association with diabetes, but these indicators were equally strongly associated with hypertension in Asians.
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Ross R, Berentzen T, Bradshaw AJ, Janssen I, Kahn HS, Katzmarzyk PT, Kuk JL, Seidell JC, Snijder MB, Sørensen TIA, Després JP. Does the relationship between waist circumference, morbidity and mortality depend on measurement protocol for waist circumference? Obes Rev 2008; 9:312-25. [PMID: 17956544 DOI: 10.1111/j.1467-789x.2007.00411.x] [Citation(s) in RCA: 203] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
There is currently no consensus regarding the optimal protocol for measurement of waist circumference (WC), and no scientific rationale is provided for any of the WC protocols recommended by leading health authorities. A panel of experts conducted a systematic review of 120 studies (236 samples) to determine whether measurement protocol influenced the relationship of WC with morbidity of cardiovascular disease (CVD) and diabetes and with mortality from all causes and from CVD. Statistically significant associations with WC were reported for 65% (152) of the samples across all outcomes combined. Common WC protocols performed measurement at the minimal waist (33%), midpoint (26%) and umbilicus (27%). Non-significant associations were reported for 27% (64) of the samples. Most of these protocols measured WC at the midpoint (36%), umbilicus (28%) or minimal waist (25%). Significant associations were observed for 17 of the remaining 20 samples, but these were not significant when adjustment was made for covariates. For these samples, the most common WC protocols were the midpoint (35%) and umbilicus (30%). Similar patterns of association between the outcomes and all WC protocols were observed across sample size, sex, age, race and ethnicity. Our findings suggest that WC measurement protocol has no substantial influence on the association between WC, all-cause and CVD mortality, CVD and diabetes.
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Affiliation(s)
- R Ross
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada.
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Hartert TV, Deng X, Hartman TJ, Wen W, Yang G, Gao YT, Jin M, Bai C, Gross M, Roberts LJ, Sheller JR, Christman J, Dupont W, Griffin M, Shu XO. The Shanghai Women's Asthma and Allergy Study: objectives, design, and recruitment results. Am J Epidemiol 2008; 167:1387-96. [PMID: 18397914 PMCID: PMC2430736 DOI: 10.1093/aje/kwn057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The Shanghai Women's Asthma and Allergy Study is the first population-based incidence study designed to assess the associations of dietary antioxidant intake and measures of oxidative stress and antioxidant enzyme activity with development of adult-onset asthma and allergic rhinitis. A total of 65,732 participants in the Shanghai Women's Health Study, an ongoing cohort study in seven districts of Shanghai, People's Republic of China, were recruited to the Shanghai Women's Asthma and Allergy Study from 2003 to 2007. Dietary intake was assessed in the parent study by using a validated and quantitative food frequency questionnaire at baseline recruitment and at the first biennial follow-up survey. Blood and urine samples were collected to measure baseline oxidative stress, antioxidant enzyme activity, and nutrient levels at the baseline survey. Incident asthma and allergic rhinitis were assessed by using a modification of the International Study of Asthma and Allergies in Childhood questionnaire during the biennial in-person survey of the Shanghai Women's Health Study. Diagnosis of asthma was confirmed by either methacholine challenge testing or test of reversibility to beta-agonists. Dietary antioxidant intake, plasma antioxidants, antioxidant enzymes, and urinary isoprostanes, a marker of oxidative stress, were measured prior to disease onset. This paper describes the study objectives, design, population demographics, and recruitment results.
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Affiliation(s)
- Tina V Hartert
- Division of Allergy, Pulmonary and Critical Care Medicine, School of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232-8300, USA.
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Villegas R, Shu XO, Gao YT, Yang G, Elasy T, Li H, Zheng W. Vegetable but not fruit consumption reduces the risk of type 2 diabetes in Chinese women. J Nutr 2008; 138:574-80. [PMID: 18287369 PMCID: PMC2615491 DOI: 10.1093/jn/138.3.574] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
We examined associations between fruit and vegetable intake and the incidence of type 2 diabetes (T2D) in a population-based prospective study of 64,191 women with no history of T2D or other chronic diseases at study recruitment and with valid dietary information. Dietary intake was assessed by in-person interviews using a validated FFQ. During 297,755 person-years of follow-up, 1608 new cases of T2D were documented. We used a Cox regression model to evaluate the association of fruit and vegetable intake (g/d) with the risk of T2D. Quintiles of vegetable intake and T2D were inversely associated. The relative risk for T2D for the upper quintile relative to the lower quintile of vegetable intake was 0.72 (95%CI: 0.61-0.85; P < 0.01) in multivariate analysis. Individual vegetable groups were all inversely and significantly associated with the risk of T2D. Fruit intake was not associated with the incidence of diabetes in this population. Our data suggest that vegetable consumption may protect against the development of T2D.
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Affiliation(s)
- Raquel Villegas
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Department of Medicine, 2525 West End Avenue, Suite 600, Nashville, TN 37203-1738
| | - Xiao Ou Shu
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Department of Medicine, 2525 West End Avenue, Suite 600, Nashville, TN 37203-1738
| | - Yu-Tang Gao
- Shanghai Cancer Institute, 2200 Xie Tu Road, #25, Shanghai, 200032, China
| | - Gong Yang
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Department of Medicine, 2525 West End Avenue, Suite 600, Nashville, TN 37203-1738
| | - Tom Elasy
- Diabetes Research and Training Center, Department of Medicine, 8210 Medical Center East, South Tower, Nashville, TN 37232
| | - Honglan Li
- Shanghai Cancer Institute, 2200 Xie Tu Road, #25, Shanghai, 200032, China
| | - Wei Zheng
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Department of Medicine, 2525 West End Avenue, Suite 600, Nashville, TN 37203-1738
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Dasgupta P, Saha R, Nubé M. Changes in body size, shape and nutritional status of middle-class Bengali boys of Kolkata, India, 1982--2002. ECONOMICS AND HUMAN BIOLOGY 2008; 6:75-94. [PMID: 17618843 DOI: 10.1016/j.ehb.2007.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Accepted: 05/25/2007] [Indexed: 05/16/2023]
Abstract
Growth changes over time among school-aged boys in Kolkata, India, have been investigated using two surveys: 1982--1983 (n=816) and 1999--2002 (n=1187). The two surveys were implemented according to highly similar protocols which strongly adds to the reliability and accuracy of the results of the study. Age-specific average height, weight and BMI all increased during these two decades (by respectively, 3.2cm, 6.1kg and 2.1kg/m2), while relative sitting height and sitting height-subischial leg length ratio decreased for almost all ages between 7.0 and 16.0 years. Moreover, the prevalence of stunting and thinness declined (stunting from 11.2% to 4.9%, p<0.01, thinness from 50.5% to 22%, p<0.01), while the prevalence of overweight increased (from 4.7% to 17.2%, p<0.01). Through analysis of variance, the relationships between various socio-economic factors and anthropometric traits are analyzed. Factors strongly related with positive changes in anthropometric traits are maternal education and family expenditure.
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Affiliation(s)
- Parasmani Dasgupta
- Biological Anthropology Unit, Indian Statistical Institute, 203 B.T. Road, Kolkata 700035, India
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Villegas R, Gao YT, Yang G, Li HL, Elasy T, Zheng W, Shu XO. Duration of breast-feeding and the incidence of type 2 diabetes mellitus in the Shanghai Women's Health Study. Diabetologia 2008; 51:258-66. [PMID: 18040660 PMCID: PMC2170456 DOI: 10.1007/s00125-007-0885-8] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Accepted: 10/22/2007] [Indexed: 11/26/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to examine the association between lifetime breast-feeding and the incidence of type 2 diabetes mellitus in a large population-based cohort study of middle-aged women. METHODS This was a prospective study of 62,095 middle-aged parous women in Shanghai, China, who had no prior history of type 2 diabetes mellitus, cancer or cardiovascular disease at study recruitment. Breast-feeding history, dietary intake, physical activity and anthropometric measurements were assessed by in-person interviews. The Cox regression model was employed to evaluate the association between breast-feeding and the risk of type 2 diabetes mellitus. RESULTS After 4.6 years of follow-up, 1,561 women were diagnosed with type 2 diabetes mellitus. Women who had breastfed their children tended to have a lower risk of diabetes mellitus than those who had never breastfed [relative risk (RR)=0.88; 95% CI, 0.76-1.02; p=0.08]. Increasing duration of breast-feeding was associated with a reduced risk of type 2 diabetes mellitus. The fully adjusted RRs for lifetime breast-feeding duration were 1.00, 0.88, 0.89, 0.88, 0.75 and 0.68 (p trend=0.01) for 0, >0 to 0.99, >0.99 to 1.99, >1.99 to 2.99, >2.99 to 3.99 and >or=4 years in analyses adjusted for age, daily energy intake, BMI, WHR, smoking, alcohol intake, physical activity, occupation, income level, education level, number of live births and presence of hypertension at baseline. CONCLUSIONS/INTERPRETATION Breast-feeding may protect parous women from developing type 2 diabetes mellitus later in life.
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Affiliation(s)
- R. Villegas
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 600, Nashville, TN 37232-1738 USA
| | - Y.-T. Gao
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai, People’s Republic of China
| | - G. Yang
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 600, Nashville, TN 37232-1738 USA
| | - H. L. Li
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai, People’s Republic of China
| | - T. Elasy
- Diabetes Research and Training Center, Vanderbilt University Medical Center, Nashville, TN USA
| | - W. Zheng
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 600, Nashville, TN 37232-1738 USA
| | - X.-O. Shu
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 600, Nashville, TN 37232-1738 USA
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Cheng TO. Central obesity is a more sensitive predictor of cardiovascular disease than body mass index in the Chinese population. Int J Cardiol 2008; 135:385. [PMID: 18234364 DOI: 10.1016/j.ijcard.2007.11.080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Accepted: 11/19/2007] [Indexed: 11/17/2022]
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Abstract
Biomarkers are increasingly employed in empirical studies of human populations to understand physiological processes that change with age, diseases whose onset appears linked to age, and the aging process itself. In this chapter, we describe some of the most commonly used biomarkers in population aging research, including their collection, associations with other markers, and relationships to health outcomes. We discuss biomarkers of the cardiovascular system, metabolic processes, inflammation, activity in the hypothalamic-pituitary axis (HPA) and sympathetic nervous system (SNS), and organ functioning (including kidney, lung, and heart). In addition, we note that markers of functioning of the central nervous system and genetic markers are now becoming part of population measurement. Where possible, we detail interrelationships between these markers by providing correlations between high risk levels of each marker from three population-based surveys: the National Health and Nutrition Examination Survey (NHANES) III, NHANES 1999-2002, and the MacArthur Study of Successful Aging. NHANES III is used instead of NHANES 1999-2002 when specific markers of interest are available only in NHANES III and when we examine the relationship of biomarkers to mortality which is only known for NHANES III. We also describe summary measures combining biomarkers across systems. Finally, we examine associations between individual markers and mortality and provide information about biomarkers of growing interest for future research in population aging and health.
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Affiliation(s)
- Eileen Crimmins
- Andrus Gerontology Center, Davis School of Gerontology, University of Southern California, Los Angeles, California 90089, USA
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Villegas R, Gao YT, Yang G, Li HL, Elasy TA, Zheng W, Shu XO. Legume and soy food intake and the incidence of type 2 diabetes in the Shanghai Women's Health Study. Am J Clin Nutr 2008; 87:162-7. [PMID: 18175751 PMCID: PMC2361384 DOI: 10.1093/ajcn/87.1.162] [Citation(s) in RCA: 237] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It has been postulated that a diet high in legumes may be beneficial for the prevention of type 2 diabetes mellitus (type 2 DM). However, data linking type 2 DM risk and legume intake are limited. OBJECTIVE The objective of the study was to examine the association between legume and soy food consumption and self-reported type 2 DM. DESIGN The study was conducted in a population-based prospective cohort of middle-aged Chinese women. We followed 64,227 women with no history of type 2 DM, cancer, or cardiovascular disease at study recruitment for an average of 4.6 y. Participants completed in-person interviews that collected information on diabetes risk factors, including dietary intake and physical activity in adulthood. Anthropometric measurements were taken. Dietary intake was assessed with a validated food-frequency questionnaire at the baseline survey and at the first follow-up survey administered 2-3 y after study recruitment. RESULTS We observed an inverse association between quintiles of total legume intake and 3 mutually exclusive legume groups (peanuts, soybeans, and other legumes) and type 2 DM incidence. The multivariate-adjusted relative risk of type 2 DM for the upper quintile compared with the lower quintile was 0.62 (95% CI: 0.51, 0.74) for total legumes and 0.53 (95% CI: 0.45, 0.62) for soybeans. The association between soy products (other than soy milk) and soy protein consumption (protein derived from soy beans and their products) with type 2 DM was not significant. CONCLUSIONS Consumption of legumes, soybeans in particular, was inversely associated with the risk type 2 DM.
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Affiliation(s)
- Raquel Villegas
- Department of Medicine, Vanderbilt Epidemiology Center, Nashville, TN 37203-1738, USA
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