The Best Obesity Indices to Discriminate Type 2 Diabetes Mellitus

A population-based prospective study on obesity-related non-communicable diseases in northern Iran: rationale, study design, and baseline analysis

Background

Iran is facing an epidemiological transition with the increasing burden of non-communicable diseases, such as obesity-related disorders and cardiovascular diseases (CVDs). We conducted a population-based prospective study to assess the prevalence and incidence rates of CVDs and obesity-related metabolic disorders and to evaluate the predictive ability of various CVD risk assessment tools in an Iranian population.

Method

We enrolled 5,799 participants in Amol, a city in northern Iran, in 2009-2010 and carried out the first repeated measurement (RM) after seven years (2016-2017). For all participants, demographic, anthropometric, laboratory, hepatobiliary imaging, and electrocardiography data have been collected in the enrollment and the RM. After enrollment, all participants have been and will be followed up annually for 20 years, both actively and passively.

Results

We adopted a multidisciplinary approach to overcome barriers to participation and achieved a 7-year follow-up success rate of 93.0% with an active follow-up of 5,394 participants aged 18-90 years. In the RM, about 64.0% of men and 81.2% of women were obese or overweight. In 2017, about 16.2% and 5.2% of men had moderate or severe non-alcoholic fatty liver disease, while women had a significantly higher prevalence of metabolic syndrome (35.9%), and type 2 diabetes mellitus (20.9%) than men. Of 160 deceased participants, 69 cases (43.1%) died due to CVDs over seven years.

Conclusion

The most prevalent obesity-related chronic disease in the study was metabolic syndrome. Across the enrollment and RM phases, women exhibited a higher prevalence of obesity-related metabolic disorders. Focusing on obesity-related metabolic disorders in a population not represented previously and a multidisciplinary approach for enrolling and following up were the strengths of this study. The study outcomes offer an evidence base for future research and inform policies regarding non-communicable diseases in northern Iran.

Association of body mass index and waist circumference with type 2 diabetes mellitus in older adults: a cross-sectional study

BACKGROUND

The prevalence of obesity and diabetes is rising. The aim of this study was to determine the association of body mass index (BMI) and waist circumference (WC) with type 2 diabetes mellitus (T2DM) in the elderly and to compare the discriminatory abilities of BMI, WC and other anthropometric indicators, including waist-to-height ratio (WHtR), body adiposity estimator (BAE) and body roundness index (BRI) for T2DM.

METHODS

This cross-sectional study included 69,388 subjects aged ≥ 60 years living in Xinzheng, Henan Province, from January to December 2020. The data came from the residents' electronic health records of the Xinzheng Hospital Information System. Logistic regression was used to examine the relationships. Fully adjusted models adjusted for age, sex, place of residence, alcohol consumption, smoking, physical exercise, SBP and RHR. The area under the receiver operating characteristic curve (AUC) was used to compare the discriminatory ability of different anthropometric indicators for T2DM under the influence of potential risk factors.

RESULTS

After adjusting for multiple covariates, compared with the first BMI quintile, the odds ratios (ORs) and 95% confidence intervals (CIs) from the second to fifth quintile for T2DM were 1.416 (1.335-1.502), 1.664 (1.570-1.764), 1.879 (1.774-1.990) and 2.156 (2.037-2.283), respectively. Compared with the first WC quintile, the ORs and 95% CIs from the second to fifth quintiles for T2DM were 1.322 (1.244-1.404), 1.549 (1.459-1.643), 1.705 (1.609-1.807) and 2.169 (2.048-2.297), respectively. Among men, compared with other anthropometric indicators (BMI, WHtR, BAE and BRI), WC showed the highest AUC (AUC: 0.629; 95% CI: 0.622-0.636). Among women, the AUCs of BMI (AUC: 0.600; 95% CI: 0.594-0.606), WC (AUC: 0.600; 95% CI: 0.593-0.606) and BAE (AUC: 0.600; 95% CI: 0.594-0.607) were similar, and the AUCs of BMI, WC and BAE were higher than WHtR, BRI.

CONCLUSIONS

All anthropometric indicators were positively associated with T2DM. In men, WC with the strongest positive association with T2DM was the best predictor of T2DM. In women, BMI was most strongly associated with T2DM, and the predictive powers of BMI, WC and BAE were similar. After adjusting the potential confounding factors including age, sex, place of residence, alcohol consumption, smoking, physical exercise, SBP and RHR, the effect of these factors was eliminated, the findings were independent of the covariates considered.

Comparison of different obesity indices associated with type 2 diabetes mellitus among different sex and age groups in Nantong, China: a cross-section study

Background

Obesity is associated with type 2 diabetes mellitus (T2DM). However, the obesity index that is most closely related to type 2 diabetes remains controversial. Therefore, the aim of this study was to compare the associations of five anthropometric indices (body mass index [BMI], body adiposity index, waist circumference [WC], waist-to-hip ratio, and waist-to-height ratio [WHtR]) with T2DM among Chinese adults divided into four groups according to sex and age.

Methods

A total of 4007 adult participants (1669 men and 2338 women) were included in the study. Odds ratios (ORs) and 95% confidence intervals were used with binary logistic regression models to estimate the risk of T2DM for each obesity index. Furthermore, we compared the area under the receiver operating characteristic curve (AUC) of each obesity index for the criterion of T2DM under the influence of risk factors.

Results

WC had the highest OR (3.211 and 1.452) and AUC (0.783 and 0.614) in both age groups of men. However, WHtR (OR = 2.366, AUC = 0.771) and BMI (OR = 1.596, AUC = 0.647) were the optimal criteria for predicting T2DM among females in the 18–59 and ≥ 60 years age groups, respectively.

Conclusions

This study suggests that there is a positive association between obesity-related anthropometric indices and T2DM in different sex and age groups. WC appears to be the optimal anthropometric index for predicting T2DM in men. The optimal obesity indices related to T2DM were WHtR and BMI for women aged 18–59 and ≥ 60 years, respectively.

Association of adiposity with diabetes: A national research among Chinese adults

BACKGROUND

Adiposity is an established risk factor for diabetes. The different measurements of adiposity for predicting diabetes have been compared in recent studies in Western countries. However, similar researches among Chinese adults are limited.

METHODS

Data were collected from a national survey conducted during September 2014 and May 2015 Among Chinese adults aged 40 years and older across 30 China's provinces. Multilevel model analysis was performed to examine the impacts of different obesity indices [body mass index (BMI), waist circumference (WC), lipid accumulation product index (LAP), visceral adiposity index (VAI), and body adiposity index (BAI)] on the risk of diabetes.

RESULTS

A total of 162 880 participants were included in this study. Of them, 54.47% were female. With an increase in BMI, WC, LAP, VAI, and BAI, the prevalence of diabetes significantly grew (P < 0.001). The multilevel model analysis showed that WC has the strongest impact on diabetes prevalence, while BAI was the weakest. For one SD increment in BMI, WC, LAP, VAI, and BAI, the prevalence of diabetes increased by 27.0% (Odds Ratio (OR) = 1.270, 95% Confidence interval (CI) = 1.251-1.289), 37.4% (OR = 1.374, 95% CI = 1.346-1.401), 28.1% (OR = 1.281, 95% CI = 1.266-1.297), 22.0% (OR = 1.220, 95% CI = 1.204-1.236), and 17.4% (OR = 1.174, 95% CI = 1.151-1.192), respectively.

CONCLUSION

Obesity indicators of BMI, WC, LAP, VAI, and BAI have significant positive relationships with the risk of diabetes. WC has the strongest impact on diabetes, while BAI has the weakest.

Inhibitory kinetics and mechanism of pentacyclic triterpenoid from endophytic Colletotrichum gigasporum against pancreatic lipase

The burden of obesity is increasing all over the world. Except for Orlistat, no effective anti-obesity drug is currently available. Therefore, a search for the new anti-obesity compound is need of time. This study demonstrates macromolecular interaction and inhibitory effect of pentacyclic triterpenoids (PTT) on pancreatic lipase (PL). In the present study PTTs from endophytic Colletotrichum gigasporum were found to show significant inhibitory activity against PL with IC₅₀ of 16.62 ± 1.43 μg/mL. The PTT isolated through bioassay-guided isolation showed a dose-dependent (R² = 0.915) inhibition against porcine PL and the results were comparable with the standard (Orlistat). Based on inhibition kinetic data, the gradual increase in K_{m (app)} with increasing PTT concentration indicated that the mode of interaction of PTT with PL was a competitive type, and it directly competed with the substrate (pNPB) for the active site of PL. In vivo studies in Wistar rats at the oral dose (100 mg/kg body weight) of PTT significantly decreased (p < 0.05) incremental plasma triglyceride levels as compared to group B and TG absorption was down-regulated up to 49.18% vis a vis group D animals. The isolated PTT was identified as lupeol based on chromatographic and spectral data. The endophytic isolate was identified as Colletotrichum gigasporum based on morphology and ITS gene sequencing. The present study indicated that PTT had the potential to be used as a natural PL inhibitor in the treatment of obesity and the isolated endophyte can be a valuable bioresource for it.

Identification of a brain fingerprint for overweight and obesity

The brain plays a central role in the pathophysiology of overweight and obesity. Connectome-based Predictive Modeling (CPM) is a newly developed, data-driven approach that exploits whole-brain functional connectivity to predict a behavior or trait that varies across individuals. We used CPM to determine whether brain "fingerprints" evoked during milkshake consumption could be isolated for common measures of adiposity in 67 adults with overweight and obesity. We found that CPM captures more variance in waist circumference than either percent body fat or BMI, the most frequently used measures to assess brain correlates of obesity. In a post-hoc analysis, we were also able to derive a largely separable functional connectivity network predicting fasting blood insulin. These findings suggest that, in individuals with overweight and obesity, brain network patterns may be more tightly coupled to waist circumference than BMI or percent body fat and that adiposity and glucose tolerance are associated with distinct maps, pointing to dissociable central pathophysiological phenotypes for obesity and diabetes.

New Insights into Adipokines as Potential Biomarkers for Type-2 Diabetes Mellitus

A large number of studies have been focused on investigating serum biomarkers associated with risk or diagnosis of type-2 diabetes mellitus. In the last decade, promising studies have shown that circulating levels of adipokines could be used as a relevant biomarker for diabetes mellitus progression as well as therapeutic future targets. Here, we discuss the possible use of recently described adipokines, including apelin, omentin-1, resistin, FGF-21, neuregulin-4 and visfatin, as early biomarkers for diabetes. In addition, we also include recent findings of other well known adipokines such as leptin and adiponectin. In conclusion, further studies are needed to clarify the pathophysiological significance and clinical value of these biological factors as potential biomarkers in type-2 diabetes and related dysfunctions.

Antidiabetic effects of pterostilbene through PI3K/Akt signal pathway in high fat diet and STZ-induced diabetic rats

Pterostilbene (PTE) is a natural dimethylated analog of resveratrol, which exerts antioxidative, hypolipidemic and hypoglycemic effects; however, the underlying mechanism is not yet clear. In this study, we evaluated the effects of PTE on diabetic rats and clarified the underlying mechanism. Diabetes was induced in rats by streptozotocin (STZ) and a high-sugar and high-fat diet. Rats were then treated with PTE (20, 40 and 80 mg/kg/d) for 8 weeks. Oral glucose tolerance test (OGTT) was performed to measure the glycometabolism of the diabetic rats at the end of the treatment. Fasting blood glucose (FBG), fasting insulin (FINS) and lipid profile were determined using an automatic biochemistry analyzer and serum inflammatory factors were analyzed by enzyme-linked immunosorbent assay. Serum superoxide dismutase (SOD) and malondialdehyde (MDA) were also analyzed by spectrophotometry to evaluate the anti-oxidant effects. The expression of proteins of PPARγ and PI3K/Akt signaling pathway related proteins in adipose tissue of the diabetic rats was analyzed by Western blotting. PTE treatment significantly reduced weight loss, FBG, insulin resistance, serum lipid levels and inflammatory factors. PTE treatment also inhibited oxidative stress by decreasing MDA expression and increasing SOD expression. Simultaneously, PTE treatment significantly ameliorated morphological impairment of the pancreas in diabetic rats. Furthermore, PTE treatment significantly increased the protein expression of PPARγ, PI3K, p-Akt, GLUT4 and IRS-1 in adipose tissues of diabetic rats. This study suggests that PTE can exert antidiabetic effects via the PI3K/Akt signaling pathway.

Triglycerides and waist to height ratio are more accurate than visceral adiposity and body adiposity index to predict impaired fasting glucose

AIMS

To evaluate the clinical accuracy of novel indices visceral adiposity index (VAI) and body adiposity index (BAI) to identify patients with impaired fasting glucose (IFG) and compare with its individual components and other obesity indicators.

METHODS

A cross-sectional study was conducted in Mexican population. Body mass index (BMI), waist circumference, hip circumference, triglycerides (TG), High density lipoprotein cholesterol (HDL-C), VAI, BAI, waist to hip ratio (WHR) and waist to height ratio (WHtR) were determined. We plotted a receiver operating characteristic curves to assess the abilities to discriminate subjects with IFG from those with normal glucose tolerance (NGT) of the measurements. A binary logistic regression analysis was performed to determine the strength of association with IFG.

RESULTS

A total of 280 individuals were included, from which 144 (51.3%) have IFG; the mean age was 47.14 years and 164 (55.5%) were females. Compared with NGT subjects, the participants with IFG had significantly higher levels of BMI, WHtR, VAI, BAI and TG. The measurements with highest area under the curve were TG, (0.631, 95% confidence interval [CI] 0.566-0.697) VAI (0.628, 95% CI 0.563-0.693) and WHtR (0.622, 95% CI 0.557-0.688) and in the adjusted binary logistic regression model, were found to be independently associated with IFG, Odds Ratio of 2.665, (95% CI 1.567-4.533) 2.567 (95% CI 1.527-4.317) and 2.171 (95% CI 1.102-4.276) respectively.

CONCLUSIONS

Our data provide evidence that TG, VAI and WHtR could be considered potential tools for the risk assessment of type 2 diabetes mellitus (T2DM) in this population.

Association between body adiposity index and coronary risk in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

BACKGROUND & AIMS

The body adiposity index (BAI) was recently proposed as a better indicator of body adiposity than body mass index in adults. The association between BAI and cardiometabolic risk factors has been widely investigated. However, the strength and magnitude of these associations varied as a function of the endpoint evaluated, the study design, the population investigated, and the cut-off points used. The aim of this study was to investigate the association between BAI and coronary heart disease (CHD) risk in a large sample of Brazilian adults and to propose the most appropriate cut-off points for BAI for the identification of CHD risk in the adult Brazilian population.

METHODS

Data from 15,092 civil servants (54.4% women) from universities and research institutes in six Brazilian states were evaluated in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). All were aged 35-74 years at baseline. The Framingham coronary risk score was used to identify a very high risk of CHD (≥20% risk of CHD over the next 10 years) and a high risk of CHD (≥10% risk). BAI cut-off points capable of detecting a risk of CHD were determined using ROC curves and associations were tested using Poisson regression with robust variance, according to sex and age. Three multivariable models were examined.

RESULTS

BAI remained positively associated with a very high and high risk of CHD following adjustment for potential confounding factors in all the strata and multivariable models (p < 0.05), with the exception of model 3 (adjusted for education level and waist-to-hip ratio) for very a high risk of CHD in younger women (p = 0.06). In the adjusted models, the prevalence ratios for a very high and high risk of CHD, irrespective of age group, varied between 1.23 (95%CI: 1.09-1.39) and 1.64 (1.33-2.03) and 1.07 (1.03-1.12) and 1.47 (1.36-1.60) in men; and 1.57 (1.08-2.31) and 2.42 (1.36-4.31) and 1.29 (1.13-1.47) and 1.82 (1.54-2.15) in women, respectively. The optimal cut-off points of BAI to determine a risk of CHD were: 28.0 in men of both age groups, and 34.0 in younger women and 36.0 in older women to determine a very high risk; and 26.0 in younger men and 34.0 in women of both age groups to determine a high risk. BAI showed a reasonable ability to predict coronary risk in participants of the ELSA-Brasil (AUC>60%, except for the group of men of 60-74 years of age).

CONCLUSIONS

Higher BAI levels were found to be associated with a greater risk of developing CHD in both men and women of different ages participating in the ELSA-Brasil, suggesting that BAI may be a useful tool for screening for CHD risk in Brazilian adults.

Anthropometric Indicators of Adiposity Related to Body Weight and Body Shape as Cardiometabolic Risk Predictors in British Young Adults: Superiority of Waist-to-Height Ratio

Frequently reported poor dietary habits of young adults increase their risk of metabolic syndrome (MetS). Excess adiposity is the most established predictor of MetS, and numerous anthropometric measures have been proposed as proxy indicators of adiposity. We aimed to assess prevalence of MetS in young adult population and to make comparison between weight- and shape-oriented measures of adiposity to identify the best index in association with measured body fat and as a risk predictor for MetS. Healthy males and females aged 18-25 years from the Northwest of England were recruited using convenience sampling (n=550). As part of the assessment of the overall health of young adults, the biochemical variables and adiposity measures BMI, waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), new BMI, Body Adiposity Index (BAI), Clinica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE), and A Body Shape Index (ABSI) were assessed. Linear regression analysis was used to investigate the association between the proxy indices of adiposity and measured percentage body fat. The odds ratio with 95% confidence interval was used to investigate the relationship between cardiometabolic (CM) risk factors and proxy measures of adiposity. The discriminatory power of these measures for diagnosis of MetS was investigated using area under the receiver operating characteristic curve. Body weight-related indicators of adiposity, particularly CUN-BAE, had stronger association with measured body fat compared with body shape-related indices. In relation with MetS, body shape-related indices, particularly elevated WC and WHtR, had stronger associations with CM risk compared with body weight-related measures. Amongst all indices, the best predictor for CM risk was WHtR, while ABSI had the weakest correlation with body fat, MetS, and CM risk. Indices directly associated with WC and specifically WHtR had greater diagnostic power in detection of CM risk in young adults.

Excess postexercise oxygen consumption and fat oxidation in recreationally trained men following exercise of equal energy expenditure: comparisons of spinning and constant endurance exercise

BACKGROUND

Spinning exercise is one of the most popular types of exercise in fitness industry. Its effects on the post exercise metabolism compared to the isocaloric cyclic endurance exercise are not fully understood. The aim of the present study was to compare the effects of isocaloric (299.1±10.8 kcal) spinning vs. endurance exercise on fat and carbohydrate utilization, glucose, lactate, glycerol and NEFA blood concentration during exercise and recovery.

METHODS

Six recreationally active males (age: 23.5±0.71) were tested in two conditions: 1) 30-min spinning; 2) isocaloric continuous exercise. Each trial was followed by a 3-h recovery. Rates of carbohydrate and fat oxidation, the blood glucose, lactate, glycerol and NEFA concentration were assessed at rest, during exercise and recovery.

RESULTS

Spinning induced significantly higher fat and lower carbohydrate oxidation rate during a recovery period in comparison to isocaloric endurance exercise trial. Spinning induced almost six-fold higher increase in lipid to carbohydrate oxidation rate ratio at the beginning of second hour of postexercise period in comparison to constant intensity trial and reached similar values at 3 hours after exercise. Blood lactate was higher (P<0.01) at the end of exercise in spinning than continuous exercise (8.57±0.9 vs. 0.72±0.1 mmol·L-1), but became similar at the 60 min of recovery.

CONCLUSIONS

These data indicate that spinning induces higher metabolic responses during recovery period, and most effectively shifts the pattern of substrate use toward lipids vs. isocaloric endurance exercise.

The Emerging Role of Zfp217 in Adipogenesis

Zinc finger protein 217 (Zfp217), a member of the krüppel-type zinc finger protein family, plays diverse roles in cell differentiation and development of mammals. Despite extensive research on the functions of Zfp217 in cancer, pluripotency and reprogramming, its physiological roles in adipogenesis remain unknown. Our previous RNA sequencing data suggest the involvement of Zfp217 in adipogenesis. In this study, the potential function of Zfp217 in adipogenesis was investigated through bioinformatics analysis and a series of experiments. The expression of Zfp217 was found to be gradually upregulated during the adipogenic differentiation in C3H10T1/2 cells, which was consistent with that of the adipogenic marker gene Pparg2. Furthermore, there was a positive, significant relationship between Zfp217 expression and adipocyte differentiation. It was also observed that Zfp217 could not only trigger proliferative defect in C3H10T1/2 cells, but also interact with Ezh2 and suppress the downstream target genes of Ezh2. Besides, three microRNAs (miR-503-5p, miR-135a-5p and miR-19a-3p) which target Zfp217 were found to suppress the process of adipogenesis. This is the first report showing that Zfp217 has the capacity to regulate adipogenesis.

Toileting behaviors and overactive bladder in patients with type 2 diabetes: a cross-sectional study in China

Background

Overactive bladder is more prevalent in patients with type 2 diabetes than in those without diabetes. Unhealthy toileting behaviors may be associated with the development and worsening of overactive bladder symptoms. However, little is known about the relationships between toileting behaviors and overactive bladder in patients with diabetes. This study aimed to identify unhealthy toileting behaviors that patients with type 2 diabetes adopted to empty their bladders and investigate the relationships between toileting behaviors and overactive bladder.

Methods

Patients with type 2 diabetes from the endocrinology outpatient department of a hospital in China were recruited. The Toileting Behaviors-Women’s Elimination Behavior and Overactive Bladder Symptom Score questionnaires were used to assess the patients’ toileting behaviors and overactive bladder symptoms. A multivariate logistic regression model was used to explore the relationships between toileting behaviors and overactive bladder.

Results

Almost 14% of patients with diabetes had overactive bladder. The unhealthiest toileting behavior was premature voiding. In the multivariate logistic regression analysis, premature voiding (OR = 1.286, p = 0.016) and straining to void (OR = 1.243, p = 0.026) were associated with overactive bladder. There was a greater likelihood of having overactive bladder when patients engaged in unhealthy toileting behaviors (premature voiding and straining to void).

Conclusions

Overactive bladder in patients with type 2 diabetes was more than twofold higher than that in the general population. Thus, overactive bladder is not just an inconsequential condition for patients with diabetes. Unhealthy toileting behaviors, e.g., premature voiding and straining to void, may contribute to the onset or worsening of overactive bladder in patients with diabetes. Identification and awareness of these modifiable behavioral factors during diabetes care is an essential component of primary prevention, alleviation, and management of overactive bladder symptoms.

The Prevalence of Non-alcoholic Fatty Liver Disease and Diabetes Mellitus in an Iranian Population

BACKGROUND Type II diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD) are important causes of morbidity and mortality worldwide. We aimed to estimate the prevalence of DM in the context of NAFLD. METHODS In this cross-sectional study, we studied 5052 participants, aged 18 years and older, of a baseline population-based cohort in northern Iran (N=6143). The prevalence of DM was estimated in individuals with and without NAFLD. The association between NAFLD and T2DM was evaluated using logistic regression with the adjustment of confounding effects of age, sex, body mass index, lipid profiles, and fasting insulin. RESULTS In men, the prevalence (95% confidence interval) of T2DM was 5.34% (4.35%-6.34%) and 15.06% (13.12%-17.00%) in individuals without and with NAFLD, respectively (p <0.001). In women without NAFLD, the prevalence was 8.27% (6.83%-9.71%) while in the presence of NAFLD, the prevalence was 27.21% (24.59%-29.83%), (p <0.001). In univariate analysis, the chance of having T2DM was 3.700 (3.130-4.380) times more in patients with NAFLD compared with subjects without NAFLD (p<0.001). This chance was reduced (Odds Ratio=1.976, 95% CI: 1.593-2.451, p <0.001) after removing the effects of other variables. CONCLUSION The prevalence of T2DM is increased in the context of NAFLD. This condition may be considered as an independent predictor of T2DM.

Best anthropometric discriminators of incident type 2 diabetes among white and black adults: A longitudinal ARIC study

Objective

To determine which anthropometric measures are the strongest discriminators of incident type 2 diabetes (T2DM) among White and Black males and females in a large U.S. cohort.

Methods

We used Atherosclerosis Risk in Communities study data from 12,121 participants aged 45–64 years without diabetes at baseline who were followed for over 11 years. Anthropometric measures included a body shape index (ABSI), body adiposity index (BAI), body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), waist to height ratio (WHtR), and waist to hip to height ratio (WHHR). All anthropometric measures were repeated at each visit and converted to Z-scores. Hazard ratios and 95% confidence intervals adjusted for age were calculated using repeated measures Cox proportional hazard regression analysis. Akaike Information Criteria was used to select best-fit models. The magnitude of the hazard ratio effect sizes and the Harrell’s C-indexes were used to rank the highest associations and discriminators, respectively.

Results

There were 1,359 incident diabetes cases. Higher values of all anthropometric measures increased the risk for development of T2DM (p < 0.0001) except ABSI, which was not significant in White and Black males. Statistically significant hazard ratios ranged from 1.26–1.63 for males and 1.15–1.88 for females. In general, the largest hazard ratios were those that corresponded to the highest Harrell’s C-Index and lowest Akaike Information Criteria values. Among White and Black males and females, BMI, WC, WHR, and WHtR were comparable in discriminating cases from non-cases of T2DM. ABSI, BAI, and WHHR were inferior discriminators of incident T2DM across all race-gender groups.

Conclusions

BMI, the most commonly used anthropometric measure, and three anthropometric measures that included waist circumference (i.e., WC, WHR, WHtR) were the best anthropometric discriminators of incident T2DM across all race-gender groups in the ARIC cohort.

Esculetin prevents non-alcoholic fatty liver in diabetic mice fed high-fat diet

This study investigated the effects and mechanism of esculetin (6,7-dihydroxycoumarin) on non-alcoholic fatty liver in diabetic mice fed high-fat diet (HFD). The diabetic mice model was induced by injection of streptozotocin, after which they were fed HFD diet with or without esculetin for 11 weeks. Non-diabetic mice were provided a normal diet. Diabetes induced hepatic hypertrophy, lipid accumulation and droplets; however, esculetin reversed these changes. Esculetin treatment in diabetic mice fed HFD significantly down-regulated expression of lipid synthesis genes (Fasn, Dgat2 and Plpp2) and inflammation genes (Tlr4, Myd88, Nfkb, Tnfα and Il6). Moreover, the activities of hepatic lipid synthesis enzymes (fatty acid synthase and phosphatidate phosphohydrolase) and gluconeogenesis enzyme (glucose-6-phosphatase) in the esculetin group were decreased compared with the diabetic group. In addition, esculetin significantly reduced blood HbA_1c, serum cytokines (TNF-α and IL-6) and chemokine (MCP-1) levels compared with the diabetic group without changing the insulin content in serum and the pancreas. Hepatic SOD activity was lower and lipid peroxidation level was higher in the diabetic group than in the normal group; however, esculetin attenuates these differences. Overall, these results demonstrated that esculetin supplementation could protect against development of non-alcoholic fatty liver in diabetes via regulation of lipids, glucose and inflammation.