Trends in waist-to-hip ratio and its determinants in adults in Finland from 1987 to 1997

Obesity-Related Traits Mediate the Effects of Educational Attainment on the Risk of Varicose Veins, Venous Thromboembolism, and Phlebitis

BACKGROUND

 The extent to which educational attainment (EA) influences the risk of varicose veins (VVs), venous thromboembolism (VTE), and phlebitis occurrence, whether this pathway is mediated by obesity-related traits, and the proportion of their mediation is unknown.

METHODS

 A Mendelian randomization (MR) design was used to genetically investigate the causal effects of EA on the risk of VV, VTE, and phlebitis and to assess the mediating effect of obesity-related traits. Causal effects were estimated using primarily the multiplicative random-effects inverse variance-weighted method. This was supplemented by Cochran's Q-statistic, MR-Egger regression, MR funnel plots, and leave-one-out test to evaluate the reliability of the results. For the individual mediation effect, the coefficient product method was mainly utilized to estimate.

RESULTS

 An increase in genetically predicted EA was associated with a lower risk of VV, VTE, and phlebitis, as well as lower body mass index, basal metabolic rate, hip circumference, and waist circumference. As genetically predicted body mass index, basal metabolic rate, hip circumference, and waist circumference increased, the risk of developing VV, VTE, and phlebitis increased, respectively. Body mass index, basal metabolic rate, hip circumference, and waist circumference were identified as mediators of the protective effects of EA on VV, VTE, and phlebitis.

CONCLUSION

 The findings support a causal relationship between higher EA and lower risk of VV, VTE, and phlebitis. Obesity-related traits play a significant mediating role in these pathways, and there are interactions between them, with hip circumference mediating these pathways relatively independently from the other three.

Shift in body fat distribution from lower body to upper body among urban Colombian women, 1988-1989 to 2007-2008

OBJECTIVE

Body fat distribution may be a stronger predictor of metabolic risk than BMI. Yet, few studies have investigated secular changes in body fat distribution in middle-income countries or how those changes vary by socioeconomic status (SES). This study evaluated changes in body fat distribution by SES in Colombia, a middle-income country where BMI is increasing rapidly.

DESIGN

We applied factor analysis to previously published data to assess secular changes in adiposity and body fat distribution in cross-sectional samples of urban Colombian women. Anthropometry was used to assess weight, height and skinfolds (biceps, triceps, subscapular, suprailiac, thigh, calf).

SETTING

Cali, Colombia.

PARTICIPANTS

Women (18-44 years) in 1988-1989 (n 1533) and 2007-2009 (n 577) from three SES groups.

RESULTS

We identified an overall adiposity factor, which increased between 1988-1989 and 2007-2008 in all SES groups, particularly in the middle SES group. We also identified arm, leg and trunk adiposity factors. In all SES groups, leg adiposity decreased, while trunk and arm adiposity increased.

CONCLUSIONS

Factor analysis highlighted three trends that were not readily visible in BMI data and variable-by-variable analysis of skinfolds: (i) overall adiposity increased between time periods in all SES groups; (ii) the adiposity increase was driven by a shift from lower body to upper body; (iii) the adiposity increase was greatest in the middle SES group. Factor analysis provided novel insights into secular changes and socioeconomic variation in body fat distribution during a period of rapid economic development in a middle-income country.

Changes in distributions of waist circumference, waist-to-hip ratio and waist-to-height ratio over an 18-year period among Chinese adults: a longitudinal study using quantile regression

BACKGROUND

Little is known about the long-term shifts in distributions of three abdominal-obesity-related indicators, waist circumference (WC), waist-to-hip ratio (WHpR) and waist-to-height ratio (WHtR) among Chinese adults. Traditional mean regression models used in the previous analyses were limited in their ability to capture cross-distribution among effects. The current study aims to describe the shift in distribution of WC, WHpR, and WHtR over a period of 18 years (1993-2011) in China, and to reveal quantile-specific associations of the three indicators with key covariates.

METHODS

Longitudinal data from seven waves of the China Health and Nutrition Surveys (CHNS) in 1993, 1997, 2000, 2004, 2006, 2009 and 2011 were analyzed. The LMS method was used to illustrate the gender-specific quantile curves of WC, WHtR and WHpR over age. Separate gender-stratified longitudinal quantile regressions were employed to investigate the effect of important factors on the trends of the three indicators.

RESULTS

A total of 11,923 participants aged 18-65 years with 49,507 observations were included in the analysis. The density curves of WC, WHtR and WHpR shifted to right and became wider. The three outcomes all increased with age and increased more at upper percentiles. From the multivariate quantile regression, physical activity was negatively associated in both genders; smoking only had a negative effect on male indicators. Education and drinking behavior both had opposite effects on the three indicators between men and women. Marital status and income were positively associated with the shifts in WC, WHtR and WHpR in male and female WC, while urbanicity index had a positive effect on three outcomes in men but inconsistent effect among female outcomes.

CONCLUSIONS

The abdominal-obesity related indicators of the Chinese adults experienced rapid growth according to our population-based, age- and gender-specific analyses. Over the 18-year study period, major increases in WC, WHtR and WHpR were observed among Chinese adults. Specifically, these increases were greater at upper percentiles and in men. Age, physical activity, energy intake, drinking, smoking, education, income and urbanicity index were associated with elevated abdominal obesity indicators, and the effects differed among percentiles and between genders.

Importance of abdominal circumference and body mass index values in predicting male hypogonadism - A practical approach

OBJECTIVE

The objective of this study was to correlate the values of abdominal circumference (AC) and body mass index (BMI) with the levels of total testosterone (TT), free testosterone (FT) and sexual hormone binding globulin (SHBG). We aimed to analyze the association between the anthropometric values and variations in the hormonal levels.

SUBJECTS AND METHODS

A transversal prospective study was conducted. A total of 159 patients were included in the study.

RESULTS

BMI was inversely correlated with TT and SHBG (p = 0.02 and p = 0.006, respectively). AC was also inversely correlated withTT and SHBG (p = 0.006 and p < 0.0001, respectively). However, BMI did not correlate signicantly with these hormonal levels after adjusting for age.

CONCLUSION

This finding led to the conclusion that AC had a stronger inverse correlation than BMI with TT and SHBG. Our data suggested that AC alone can be used as an anthropometric parameter to help simplify the identification of men with low serum TT levels.

An assessment study of CVD related risk factors in a tribal population of India

BACKGROUND

Non communicable diseases (NCDs) have become a major concern for global health. Cardiovascular diseases (CVDs) contribute 48 % towards the deaths due to NCDs in India. Though studies have been conducted in urban and rural areas, data related to tribal communities is limited. The present study aims to examine various CVD related risk factors including hypertension, elevated fasting blood glucose, obesity and metabolic syndrome among a tribal population.

METHODS

The present study was an observational, cross- sectional study conducted on Rang Bhotias, a tribal population of India. The participants were adults of age between 20 and 60 years. Prior to blood sample collection, interview schedule was administered which included relevant information like age, lifestyle, socio-economic status, education and occupation In addition to this, various anthropometric and physiological measurements were taken. Logistic regression was used to examine the association of the various health disorders related to CVDs with age, gender and behavioural factors (smoking, alcohol consumption and physical activity).

RESULTS

A total of 288 participants were surveyed for the study including 104 males and 184 females. High BMI (56.6 %), hypertension (43.4 %), metabolic syndrome (39.2 %) and abdominal obesity (33.7 %) were the most prevalent CVD risk factors observed in the population. The multivariate logistic regression analysis, conducted to examine the contribution of risk factors including behavioural risk factors on the studied abnormalities, revealed age to be a significant risk factor for all the abnormalities except elevated fasting blood glucose. Gender and physical inactivity contributed significantly towards development of hypertension. Physical inactivity was also found to be associated with high BMI levels.

CONCLUSION

In the present study, hypertension, high BMI levels, MS and abdominal obesity have been found to be high among the studied population. The status of the population with respect to these abnormalities implicates susceptibility of the community towards various common disorders. The prevention and treatment intervention programs should be implemented taking into consideration age and gender.

Preferred women's waist-to-hip ratio variation over the last 2,500 years

The ratio between the body circumference at the waist and the hips (or WHR) is a secondary sexual trait that is unique to humans and is well known to influence men’s mate preferences. Because a woman's WHR also provides information about her age, health and fertility, men's preference concerning this physical feature may possibly be a cognitive adaptation selected in the human lineage. However, it is unclear whether the preferred WHR in western countries reflects a universal ideal, as geographic variation in non-western areas has been found, and discordances about its temporal consistency remain in the literature. We analyzed the WHR of women considered as ideally beautiful who were depicted in western artworks from 500 BCE to the present. These vestiges of the past feminine ideal were then compared to more recent symbols of beauty: Playboy models and winners of several Miss pageants from 1920 to 2014. We found that the ideal WHR has changed over time in western societies: it was constant during almost a millennium in antiquity (from 500 BCE to 400 CE) and has decreased from the 15^th century to the present. Then, based on Playboy models and Miss pageants winners, this decrease appears to slow down or even reverse during the second half of the 20^th century. The universality of an ideal WHR is thus challenged, and historical changes in western societies could have caused these variations in men’s preferences. The potential adaptive explanations for these results are discussed.

Relationship of Social and Lifestyle Factors with Central Fat Distribution Expressed by the Aggregate Fat Distribution Index

Abdominal obesity is caused by several factors and the explanation of the level of its variability also depends on anthropometric indexes applied for its assessment. The aim was to determine the degree of explanation of the abdominal adiposity variation, presented by the aggregate fat distribution index (AFDI), through the socio-economic status and lifestyle. Subjects and methods: A cross-sectional population-based study was conducted on a sample of 259 healthy working males aged 20-30 from the city of Cracow, Poland. A full model was created using a stepwise backward regression with the social and lifestyle data as independent variables and the AFDI as a dependent variable. The AFDI was created by unitarization applied to selected characteristics of fat distribution which were transformed into [0,1] interval (without measurement unit) and then added and averaged to form a composite index. The highest autonomous influence on AFDI is ascribed to age (b = 0.2456 p = 0.000), level of motor fitness b=−0.2392 p=0.000), leisure time physical activity (b=−0.1353 p=0.000) and being born in a rural area (b=0.1300 p=0.000). The variables explain 17% (R2=0.1667) of the variation of the central fat distribution. Variation of the abdominal adiposity was explained with the use of AFDI at the level close to the commonly applied indexes.

Educational attainment and obesity: a systematic review

Although previous systematic reviews considered the relationship between socioeconomic status and obesity, almost 200 peer-reviewed articles have been published since the last review on that topic, and this paper focuses specifically on education, which has different implications. The authors systematically review the peer-reviewed literature from around the world considering the association between educational attainment and obesity. Databases from public health and medicine, education, psychology, economics, and other social sciences were searched, and articles published in English, French, Portuguese and Spanish were included. This paper includes 289 articles that report on 410 populations in 91 countries. The relationship between educational attainment and obesity was modified by both gender and the country's economic development level: an inverse association was more common in studies of higher-income countries and a positive association was more common in lower-income countries, with stronger social patterning among women. Relatively few studies reported on lower-income countries, controlled for a comprehensive set of potential confounding variables and/or attempted to assess causality through the use of quasi-experimental designs. Future research should address these gaps to understand if the relationship between educational attainment and obesity may be causal, thus supporting education policy as a tool for obesity prevention.

Active transport, physical activity, and body weight in adults: a systematic review

CONTEXT

Physical activity has various health benefits. Active transport can contribute to total physical activity and thus affect body weight because of increased energy expenditure. This review summarizes published evidence on associations of active transport, general physical activity, and body weight in adults.

EVIDENCE ACQUISITION

A systematic review of the literature was conducted in October 2010 using eight databases. A total of 14,216 references were screened; full texts were retrieved for 95 articles. Forty-six articles (36 unique studies) were included: 20 (17) from Europe; 18 (13) from North America, Australia, and New Zealand; and eight (six) from other countries. Analyses of the retrieved papers were carried out between November 2010 and March 2011.

EVIDENCE SYNTHESIS

Of 15 studies assessing active transport and physical activity, five found associations in the expected direction (more active transport associated with more physical activity) for all or most variables studied, nine found some associations, and one reported no associations. Of 30 studies assessing active transport and body weight, 13 reported associations in the expected direction (more active transport associated with lower body weight) for all or most variables studied, 12 found some associations, two presented some associations in the expected and some in the opposite direction, and three reported no associations.

CONCLUSIONS

There is limited evidence that active transport is associated with more physical activity as well as lower body weight in adults. However, study heterogeneity, predominantly cross-sectional designs, and crude measures for active transport and physical activity impede quantitative conclusions.

The Influence of Zygosity and Chorion Type on Fat Distribution in Young Adult Twins Consequences for Twin Studies

An adverse intra-uterine environment has been associated with abdominal fat distribution in singletons. Twins often have a low birth weight and a short gestation. Therefore, they may have an increased risk to develop abdominal obesity. Furthermore, monozygotic monochorionic twins (MZ MC) have a larger intra-pair birth weight difference compared to monozygotic dichorionic twins (MZ DC). If adult anthropometry is programmed in utero, this may affect the intra-pair correlations in adulthood and, consequently, also the results from the classic twin method to estimate genetic and environmental influences. In the present study, we compared the absolute values, the intra-pair differences, and the intra-pair correlations of body mass, height, BMI, and abdominal fat distribution of 424 MZ MC, MZ DC and dizygotic (DZ) twin pairs (aged 18–34 yrs). DZ, MZ DC and MZ MC twins did not differ for most anthropometric characteristics. Only MZ women tended (p = 0.03) to accumulate more abdominal fat compared to DZ twins. Overall, the contribution of zygosity and chorion type to adult anthropometry was rather low (≤ 1.7%). Although the intra-pair birth weight difference of MZ MC pairs (10.5% in men, 12.3% in women) was significantly larger compared to that of MZ DC pairs (6.9% and 9.2% resp.), the intra-pair differences in adult anthropometry were similar for both MZ twin types. Also the intra-pair correlations of MZ MC and MZ DC pairs were strikingly alike, suggesting no significant influence of the prenatal environment on adult concordance. In conclusion, the substantial difference in the prenatal environment of MZ MC and MZ DC twins did not result in a difference in intra-pair concordance of adult anthropometry and fat distribution. Therefore, we suggest that the chorion type of MZ twins does not bias the twin design and the estimation of the genetic contribution to adult anthropometry.

Age standardization in mapping adult overweight and obesity trends in the WHO European Region

This study aims to improve comparability of available data within the World Health Organization (WHO) European Region taking into account differences related to the aging of the population. Surveys were included if they were conducted on adults aged 25-64 years between 1985 and 2010 in the WHO European Region. Overweight/obesity prevalences were adjusted to the European standard population aged 25-64. Data were entered for each of the 5-year categories between 1981 and 2010. Measured height and weight data were available for males in 16 and females in 24 of the 53 countries. The 50-64-year-olds had higher prevalence of overweight and obesity as compared to the 25-49-year-olds. This pattern occurs in every country, by male and female, in almost all surveys. Age-standardized overweight prevalence was higher among males than females in all countries. Trend data showed increases in most countries. Age-standardized maps were based on self-reported data because of insufficient availability of measured data. Results showed more countries with available data as well as the higher category of obesity in the later surveys. Measured values are needed and age adjustment is important in documenting emerging overweight and obesity trends, independent of demographic changes, in the WHO European Region.

Trends in waist circumference and central obesity in adults, northern iran

OBJECTIVES

The main aim of this study is to determine the central obesity trends during the period from 2006 to 2010 among 15-65 years old people in Northern Iran.

METHODS

This was a population-based cross-sectional study conducted on 6466 subjects who had been chosen by a multi stage cluster random sampling within five steps. The subjects were randomly chosen from 325 clusters and each cluster included 20 cases. Central obesity was defined as waist circumference ³102 cm and ³88 cm in men and women, respectively.

RESULTS

Compared to 2010, the mean waist circumference in 2006 changed from 87.2 cm to 88.1 cm in men (p=0.237), and from 90.3 cm to 88.6 cm in women (p=0.045). The comparison between 2006 and 2010 revealed that the prevalence of central obesity slightly decreased, 6.8% and 2.4% in urban women and men, respectively. Generally, the mean of waist circumference significantly decreased in urban women (by 0.069 cm in each year; p=0.020); however, the decrease of waist circumference in urban men was not significant (0.006 cm decrease each year; p=0.915).

CONCLUSION

The prevalence of central obesity declined among both males and females in the urban area; however, there was an attenuated increasing trend in the rural area. The disparity of trends between the two regions should be considered for further study.

Methodological problem with comparing increases in different measures of body weight

Background

A number of studies have compared proportional increases over time in waist circumference (WC) and body mass index (BMI). However this method is flawed. Here, we explain why comparisons of WC and BMI must take into account the relationship between them. We used data from two cross-sectional US surveys (NHANES 1988-94 and 2005-06), and calculated the percentage change in the average BMI and the average WC between the two surveys, comparing the results with a regression analysis of changes in WC relative to BMI.

Findings

The crude percentage change in BMI (5.8%) was marginally greater than for WC (5.1%). But these percentages cannot be directly compared, as the relationship between the measures is described by a regression equation with an intercept term that does not equal zero. The coefficient of time from the regression equation will determine whether or not WC is on average larger for a given BMI at the second compared with the first time point.

Conclusion

Differences in the percentage change in WC and the percentage change in BMI cannot be usefully directly compared. Comparisons of increases in the two measures must account for the relationship between them as described by the regression equation.

Waist-to-height ratio as a predictor of serum testosterone in ageing men with symptoms of androgen deficiency

The decline in serum testosterone in ageing men may be mediated in part by obesity; however, it is uncertain which measure of adiposity is most closely associated with testosterone levels. We have examined the relationships of age, adiposity and testosterone levels in ageing men with symptoms consistent with hypoandrogenism but who were otherwise in good health. We conducted a cross-sectional study of non-smoking men aged ≥ 54 years recruited from the community and who were free of cancer or serious medical illness. Height (Ht), weight and waist circumference (WC) were measured, and body mass index (BMI) and waist-to-height (WHt) ratio were calculated. Two morning blood samples were collected for measurement of total testosterone (TT), sex hormone binding globulin (SHBG) and luteinizing hormone (LH). Free testosterone (cFT) was calculated. Multivariate linear regression analysis was performed to assess their relationship with measures of adiposity. Two hundred and seven men aged 54-86 years were studied. On univariate analysis WHt ratio was more strongly correlated with TT and cFT than either WC or BMI. Furthermore, in models of TT and cFT, the addition of Ht to WC resulted in an increase in the magnitude of the regression coefficients for both WC (inverse correlate) and Ht (positive correlate), with the contributions of both WC and Ht both being significant (P<0.05 for all). In conclusion, WHt ratio is the best anthropometric predictor of both TT and cFT in this group of healthy but symptomatic ageing men.

Comparing trends in BMI and waist circumference

The nature of excess body weight may be changing over time to one of greater central adiposity. The aim of this study is to determine whether BMI and waist circumference (WC) are increasing proportionately among population subgroups and the range of bodyweight, and to examine the public health implications of the findings. Our data are from two cross-sectional surveys (the US National Health and Nutrition Examination Studies (NHANES) in 1988-1994 (NHANES III) and 2005-2006), from which we have used samples of 15,349 and 4,176 participants aged ≥20 years. Between 1988-1994 and 2005-2006 BMI increased by an average of 1.8 kg/m² and WC by 4.7 cm (adjusted for sex, age, race-ethnicity, and education). The increase in WC was more than could be attributed simply to increases in BMI. This independent increase in WC (of on average, 0.9 cm) was consistent across the different BMI categories, sexes, education levels, and race-ethnicity groups. It occurred in younger but not older age groups. Overall in each BMI category, the prevalence of low-risk WC decreased and the prevalence of increased-risk or substantially increased-risk WC increased. These results suggest that the adverse health consequences associated with obesity may be increasingly underestimated by trends in BMI alone. Since WC is closely linked to adverse cardiovascular outcomes, it is important to know the prevailing trends in both of these parameters.

Body mass index, waist-to-hip ratio and waist/height in adult population from Backa and Banat - the Republic of Serbia

BACKGROUND

Nutritional status is vital in the assessment of physical fitness and health status of populations.

AIM

This study aimed to describe relationships between BMI, waist-to-hip ratio (WHR) and waist/height (W/Ht) and factors such as education, residence, origin and ethnic belonging among adults in Backa and Banat.

SUBJECTS AND METHODS

The study was conducted in 47 villages in the north of Serbia. The tested group consisted of 4247 individuals, aged 20+.

RESULTS

The problem of overweight and obesity was more common among men (66%) than women (49.71%). In the group with normal BMI, the majority of men and women were characterized by normal WHR and W/Ht values, but among them there were also groups with incorrect WHR (males >or= 0.95, females >or= 0.8) and W/Ht (>or= 0.5). Socio-demographic factors had a little impact on BMI, WHR and W/Ht in men in certain age groups while their impact was higher in women. These factors, especially education and origin, had a significant impact on nutritional status in young and middle-aged women, whereas they were not significant in older female participants (> 60).

CONCLUSION

Despite the fact that this part of the country has undergone intensive social changes since the last decade of 20th century, the nutritional status of the population has not significantly changed.

An examination of the association of selected toxic metals with total and central obesity indices: NHANES 99-02

It is conceivable that toxic metals contribute to obesity by influencing various aspects of metabolism, such as by substituting for essential micronutrients and vital metals, or by inducing oxidative stress. Deficiency of the essential metal zinc decreases adiposity in humans and rodent models, whereas deficiencies of chromium, copper, iron, and magnesium increases adiposity. This study utilized the NHANES 99-02 data to explore the association between waist circumference and body mass index with the body burdens of selected toxic metals (barium, cadmium, cobalt, cesium, molybdenum, lead, antimony, thallium, and tungsten). Some of the associations were significant direct relationships (barium and thallium), and some of the associations were significant inverse relationships (cadmium, cobalt, cesium, and lead). Molybdenum, antimony, and tungsten had mostly insignificant associations with waist circumference and body mass index. This is novel result for most of the toxic metals studied, and a surprising result for lead because high stored lead levels have been shown to correlate with higher rates of diabetes, and obesity may be a key risk factor for developing diabetes. These associations suggest the possibility that environmental exposure to metals may contribute to variations in human weight gain/loss. Future research, such as prospective studies rather than the cross-sectional studies presented here, is warranted to confirm these findings.

Follow-ups of the Cardiovascular Risk in Young Finns Study in 2001 and 2007: levels and 6-year changes in risk factors

OBJECTIVES

To examine cardiovascular risk factor levels in 2007 and their 6-year changes between 2001 and 2007 using the data collected in the follow-ups of the Cardiovascular Risk in Young Finns Study.

DESIGN

Population-based follow-up study.

SUBJECTS

A total of 2204 healthy Finnish adults aged 30-45 years (1210 women; 994 men).

MAIN OUTCOME MEASURES

Levels in 2007 and changes between 2001 and 2007 of lipids, insulin, glucose, blood pressure, smoking, body mass index, alcohol consumption, waist and hip circumferences.

RESULTS

The mean serum total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol and triglyceride concentrations in 30- to 45-year-old adults were 5.05, 3.09, 1.34 and 1.40 mmol L(-1), respectively. Significant changes (P < 0.05) between 2001 and 2007 in 30- to 39-year-old subjects included a decrease in total cholesterol (-6.6% in men, -5.8% in women), LDL-cholesterol (-10.2% and -11.6%) and an increase in diastolic blood pressure (3.5% and 3.9%). Waist circumference (1.8% and 5.5%) and systolic blood pressure increased in 36-39 year olds (2.3% and 2.3%). HDL-cholesterol increased in 30- to 33-year-old women (5.8%) Glucose levels increased in 30- to 39-year-old women (3.7%) and 36- to 39-year-old men (3.6%). Smoking prevalence decreased in 36- to 39-year-old men from 29.8% to 22.2%.

CONCLUSIONS

The 6-year changes in total cholesterol, LDL-cholesterol and HDL-cholesterol in young Finns were favourable between 2001 and 2007. However, waist circumference, glucose and blood pressure levels increased. Therefore, continuous efforts are still needed in fighting against cardiovascular risk factors.

Fat free mass and obesity in relation to educational level

BACKGROUND

The aim of the study was to describe the body composition of Finnish adults, especially by education, and to investigate whether fat-free mass (FFM) can explain educational gradients relating to body mass index (BMI) and waist-to-hip ratio (WHR).

METHODS

Data for this cross-sectional study were based on data collected in 2000-2001 for the Health 2000 Survey. Of the nationally representative sample of 8,028 Finnish men and women aged 30 years and older, 6,300 (78.5%) were included in the study. Body composition measurements were carried out in the health examination, where FFM was assessed with eight-polar bioelectrical impedance analysis. Questions on education were included in the health interview.

RESULTS

The mean FFM varied by education in older (>or= 65 y.) men only. In the middle-aged group (30-64 y.), highly educated men were less likely to belong to the lowest quintile of FFM (OR 0.67, 95%CI 0.48-0.93) compared with the least educated subjects. The level of education was inversely associated with the prevalence of high BMI and WHR in middle-aged men. In women, the respective associations were found both in middle-aged women and their older counterparts. Adjustment for FFM slightly strengthened the associations of education with BMI and WHR.

CONCLUSIONS

The association between education and FFM is weak. Educational gradients of high BMI and high WHR cannot be explained by FFM.

Obesity and cardiometabolic risk factors in a representative population of Iranian adolescents and adults in comparison to a Western population: the Isfahan Healthy Heart Programme

Objective

The aim of the present study was to develop reference data for the Iranian population for anthropometric values and cardiometabolic data in comparison with those in Americans, as representative of a Western population.

Design

The present cross-sectional survey, conducted as part of the baseline survey of a community-based interventional study (the Isfahan Healthy Heart Programme), used a two-stage clustering design and was conducted in 12 600 randomly selected adults (≥19 years of age) and 2000 adolescents (aged 11–18 years) living in three cities in the central part of Iran. For comparison with a Western population, comparable data for Americans were derived from the data sets of the Second and Third National Health and Nutrition Examination Surveys (NHANES II and NHANES III).

Results

Iranian women had significantly higher mean BMI, waist circumference (WC), hip circumference (HC) and waist:hip ratio (WHR) than Iranian men and American women; but the mean BMI of Iranian men was lower than that of American men. The mean serum TAG level of Iranian men was significantly higher than that of Iranian women, whereas the mean serum total cholesterol (TC), LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C) levels were significantly higher in Iranian women than in men. The Iranian population had lower mean TC, LDL-C and TAG levels than the Americans, but such difference was not documented for HDL-C. Iranian adolescents had significantly lower mean BMI and higher mean TAG than did American adolescents.

Conclusions

Our findings provide serious evidence for health professionals and policy makers about the very high prevalence of generalized and abdominal obesity in Iran. Controlling this emerging health problem, notably in women, should become a national priority in Iran and necessitates comprehensive public health programmes.

Waist circumference in relation to body perception reported by Finnish adolescent girls and their mothers

AIM

To study how waist circumference (WC) relates to body perception in adolescent girls and to maternal perception of the girl's body size.

METHODS

Three hundred and four girls, 11-18 years, were measured for height, weight and WC. 294 girls provided self-report data on weight, height and body image before anthropometric measurements. Paired data from 237 girls and mothers on perception of the girls' body size were collected.

RESULTS

In girls, self-reported weight indicated awareness of actual body size. The girls' body perception showed an overestimation of body size relative to international reference values for body mass index (BMI) (p < 0.05), but not for WC. Girls' body perception exceeded that of their mothers (p < 0.05). Maternal perception agreed better than the girls' perception with international reference values for BMI (p < 0.05). No significant difference between mothers and girls were found concerning agreement of body perception with international reference values for WC.

CONCLUSION

WC rather than BMI agrees with perception of body size, possibly due to its relation to abdominal fat at different ages. For effective prevention and treatment programmes for weight-related health problems among adolescent girls, we recommend measuring WC to diminish the discrepancy between measured and perceived body size.

Mapping geographical variation in obesity in Finland

BACKGROUND

The prevalence of obesity varies across countries. However, less is known about the geographical, within-country variation. This study investigated and visualized the geographical differences in general obesity defined by body mass index (BMI) and in abdominal obesity defined by waist circumference and waist-to-hip ratio (WHR) in Finland.

SUBJECTS AND METHODS

Data for the study consisted of three large population surveys: Health 2000 Survey with a nationally representative sample together with the National FINRISK Study conducted in five areas in 1997 and six areas in 2002. Altogether, 17 816 men and women aged 30-64 years participated in the surveys. In each survey, subjects' weight, height and circumferences of waist and hip were measured. The geographical pattern of mean anthropometric values and obesity prevalence were studied applying a Bayesian hierarchical approach and Geographical Information Systems.

RESULTS

Both in men and women, the prevalence of obesity (BMI >/= 30 kg m(-2)) varied little across geographical areas, but it was smaller in cities compared with other areas across the country. In men, the prevalence of abdominal obesity defined both by waist circumference and WHR was higher in western Finland compared with southern and northern Finland. Also in women, the prevalence of abdominal obesity was highest in western Finland, especially as defined by waist circumference.

CONCLUSIONS

Geographical variation in BMI was different and less prominent than in waist circumference and WHR. Abdominal obesity was surprisingly high in western Finland, the area seldom investigated. Mapping obesity gives a useful tool for professionals working in the field of health promotion.

Changes in physical activity behavior and the development of body mass index during the last 30 years in Norway

Body mass index (BMI; kg/m(2)) has increased markedly in the last decades. We hypothesized that highly physically active persons both at work and at leisure would be resistant to weight gain. The hypothesis was tested by analyzing Norwegian cross-sectional data collected in the period 1972-2002. Participants were 214,449 men and 206,136 women (aged 20-70 years). During the last 30 years in men and the last 15 years in women, a systematic larger BMI increase per year was observed in the sedentary [regression coefficients (SE) in men 0.060 (0.004) kg/m(2) and women 0.137 (0.012) kg/m(2)] compared with highly physically active groups [regression coefficients (SE) in men 0.036 (0.00 4) kg/m(2), and in women -0.001 (0.039) kg/m(2)]. Analyses were robust to adjustments for age, smoking and education. There was a larger absolute net increase in the prevalence of obesity among the sedentary compared with persons performing light, moderate or heavy physical activity (PA) at leisure. PA level in women both at work and in leisure was not associated with weight gain during the last decades. This association was less evident among men. Men and women who were lightly, moderately or highly active at leisure were less likely to be obese compared with those who were sedentary.

Assessing body composition with DXA and bioimpedance: effects of obesity, physical activity, and age

OBJECTIVE

This study evaluated to what extent dual-energy X-ray absorptiometry (DXA) and two types of bioimpedance analysis (BIA) yield similar results for body fat mass (FM) in men and women with different levels of obesity and physical activity (PA).

METHODS AND PROCEDURES

The study population consisted of 37-81-year-old Finnish people (82 men and 86 women). FM% was estimated using DXA (GE Lunar Prodigy) and two BIA devices (InBody (720) and Tanita BC 418 MA). Subjects were divided into normal, overweight, and obese groups on the basis of clinical cutoff points of BMI, and into low PA (LPA) and high PA (HPA) groups. Agreement between the devices was calculated by using the Bland-Altman analysis.

RESULTS

Compared to DXA, both BIA devices provided on average 2-6% lower values for FM% in normal BMI men, in women in all BMI categories, and in both genders in both HPA and LPA groups. In obese men, the differences were smaller. The two BIA devices provided similar means for groups. Differences between the two BIA devices with increasing FM% were a result of the InBody (720) not including age in their algorithm for estimating body composition.

DISCUSSION

BIA methods provided systematically lower values for FM than DXA. However, the differences depend on gender and body weight status pointing out the importance of considering these when identifying people with excess FM.

Smaller hip circumference is associated with dyslipidemia and the metabolic syndrome in obese women

BACKGROUND

There is great need for simple anthropometric measures that predict risk. The authors explored the relationship between body composition measures and features of the metabolic syndrome (MtS) in women aged between 20 and 50 years with class I obesity.

METHODS

This is a cross-sectional study of 49 obese (BMI 30-35) women recruited into a weight management randomized trial. An analysis was conducted of the baseline weight, anthropometric measures, skin-fold thickness, bioelectrical impedance, whole body dual-energy x-ray absorptiometry (DEXA), and their relationships with the features of the MtS.

RESULTS

All women but one (n=48) had a population risk waist circumference of >88 cm. 16 of the 49 (33%) fulfilled the criteria of the metabolic syndrome. Simple anthropometric measures provided the strongest correlations with the presence of the MtS. Cut-off values were selected using receiver operator characteristics. Waist circumference of >100 cm and hip circumference <115cm was associated with odds ratios of 5.2 (95% CI, 1.4-20) and 12.3 (95% CI, 3.0-51) respectively for the MtS. Regional DEXA analysis showed that lower leg fat mass rather than fat-free mass was associated with the MtS. The dyslipidemia of the MtS was associated with a lower leg fat mass, while higher HbAlc levels and HOMA, an indirect measure of insulin resistance, were seen with increased trunk fat. Percentage fat as measured by skin-fold thickness and bioelectrical impedance were not related to any features. Women with the metabolic syndrome were found to have lower bone mineral content as measured by DEXA.

CONCLUSION

Weight distribution is highly predictive of metabolic risk. Smaller hip and larger waist circumference provided independent effect. BMI adjusted anthropometric measures may be of value.

Waist circumference values are increasing beyond those expected from BMI increases

OBJECTIVE

The objective of this investigation was to examine the relationship between BMI and waist circumference (WC) by gender and race subgroups from U.S. population-based data from 1959 to 2004 and to investigate the trend in WC over calendar time.

RESEARCH METHODS AND PROCEDURES

Demographic and anthropometric cross-sectional data on 30,730 participants 18 to 79 years old across five national surveys were included. We regressed WC on BMI while controlling for age in each time period for blacks and whites by gender.

RESULTS

The relationship between BMI and WC as characterized by the slope of the linear regression of WC on BMI does not seem to be changing significantly over time. A small (range, 0.08 to 0.27 cm/yr) increase in WC over time was observed.

DISCUSSION

The implications of these findings for public health and for understanding any extant changes in the BMI-mortality rate relationship remain to be elucidated.

Fifteen-year changes in body mass index and waist circumference in Finnish adults

BACKGROUND

Obesity is an increasing health problem. Data on long-term obesity trends are most often based on the measurement of body mass index (BMI). Abdominal obesity, assessed by waist circumference may, however, be more closely related to health risks than overall obesity. The aim of this study was to investigate 15-year changes in general and abdominal obesity among adults in Finland, and furthermore, to assess whether obesity trends differ between educational groups.

DESIGN

Four cross-sectional population surveys conducted at 5-year intervals between 1987 and 2002.

METHODS

Altogether, 9025 men and 9950 women aged 25-64 years participated in these surveys. The weight, height, and waist circumferences of the participants were measured using a standardized protocol.

RESULTS

Mean waist circumference increased by 2.7 cm in men and 4.3 cm in women in 15 years. Whereas the distribution of BMI values did not change much, a remarkable shift towards higher waist circumference values was observed in 15 years. In both sexes, mean and high values of waist circumference increased in all educational groups. However, the values remained highest among the subjects with the lowest education.

CONCLUSIONS

These results indicate that adverse changes in body shape have taken place from the late 1980s to the early 2000s. Given that one in five Finnish adults is defined as obese based on BMI, there is an even larger group of individuals at risk of obesity-related metabolic disorders because of abdominal obesity, particularly among low-educated individuals.

The minor allele of the PPARγ2 Pro12Ala polymorphism is associated with lower postprandial TAG and insulin levels in non-obese healthy men

The PPARγ Pro12Ala polymorphism has been associated in several studies with a decreased risk of obesity, type 2 diabetes and insulin resistance. Weak hints are available about the influence of PPARγ Pro12Ala on postprandial metabolism. In 708 men, aged 45 to 65 years the PPARγ2 Pro12Ala genotypes were determined and postprandial TAG, insulin, glucose and NEFA after a standardized mixed fat meal and insulin and glucose after a glucose load (oral glucose tolerance test; OGTT) were assessed. Using the total sample, we did not find a significant impact of the genotype on the postprandial metabolism. In the subgroup with BMI < 30 kg/m2, fasting and postprandial TAG and insulin levels as well as homeostasis model assessment of insulin resistance (HOMA) were significantly lower in the Ala12Ala group than in the Pro12Pro group after the mixed meal. In contrast, the groups did not differ in insulin levels and HOMA after the OGTT. To investigate if differences between a fat-containing meal and OGTT are caused by adiponectin, we examined a BMI- and age-matched subgroup. No differences were found between the genotypic groups. The effects of the PPARγ2 polymorphism on insulin sensitivity are mediated by affluent dietary fat. We did not find evidence that adiponectin as a fatty-acid-dependent adipocyte factor is a causative factor for this phenomenon.

Impact of Obesity on Outcome and Changes in Quality of Life After Coronary Artery Bypass Grafting

BACKGROUND

An increasing proportion of patients undergoing coronary artery bypass grafting (CABG) are obese and are thought to carry a higher mortality and morbidity in association with surgery, but data on whether health-related quality of life (QOL) improves similarly after CABG in obese and non-obese patients are limited. We assessed in detail the effect of obesity on changes in health-related QOL (RAND-36 Health Survey) during the first year following CABG.

METHODS

Comprehensive data on 508 CABG patients were prospectively collected. One hundred patients (19.7%) were categorized as obese (body mass index >or= 30 kg/m(2)). The RAND-36 Health Survey was used as an indicator of quality of life. Assessments were made preoperatively and repeated 12 months later.

RESULTS

The obese group fared significantly worse than the non-obese group with regard to the likelihood of superficial wound infection (19.0% versus 7.1%, P < 0.001), impaired renal function (31.7% versus 14.4%, P = 0.01), and required on average 2 days longer in hospital (P < 0.05). The incidence of mediastinitis was not significantly higher among the obese patients (2.0% versus 1.2%, P = 0.55), and they less frequently needed postoperative red cell transfusions (29.0% versus 44.9%, P = 0.004). The obese improved significantly (P < 0.001) in 7, and the non-obese (P < 0.001) in all 8 RAND-36 dimensions. Physical Component Summary and Mental Component Summary scores on the RAND-36 improved significantly (P < 0.001) in obese as well as in non-obese patients.

CONCLUSIONS

Although obese patients differ from non-obese patients in that they had inferior QOL before and in the year following CABG, they gain a similar improvement in QOL 1 year after surgery compared with non-obese patients. Excluding superficial wound infection, transient impaired renal function, and slightly longer hospital stay, obesity does not significantly increase the risk of other adverse outcomes during the first year following CABG.

Socio-economic status and abdominal obesity among Finnish adults from 1992 to 2002

OBJECTIVE

To examine 10-year changes in waist circumference (WC) and identify socio-economic groups having higher WC than expected by their body mass index (BMI).

DESIGN

Population based cross-sectional surveys carried out in four regions of Finland in 1992, 1997 and 2002.

SUBJECTS

A total of 9026 women and 8173 men, aged 25-64 years.

MEASUREMENTS

Waist circumference, BMI, socio-economic indicators (education, household income, employment status, marital status) and health behaviors (smoking, alcohol use, physical activity).

RESULTS

In 2002, women had about 2.7 cm and men about 1.0 cm higher WC than subjects 10 years previously. Waist circumference increased more than BMI among women, especially among unemployed women. Higher WC among non-employed women was not explained by socio-economic indicators or health behaviors. Among men, smaller WC was associated with lower socio-economic status. However, associations partly disappeared after adjustment for health behaviors including physical activity at work.

CONCLUSION

Socio-economic patterning of WC is divergent and gender-specific. More attention should be paid to increasing waistlines among women.

Does body mass index reflect adequately the body fat content in perimenopausal women?

OBJECTIVE

To test whether BMI cut-off points for obesity, reflect adequately the actual obesity status, in a sample of perimenopausal women. For study's purposes, a new bioelectrical impedance analysis (BIA) equation was estimated.

METHODS

115 Greek, middle-aged women were tested. Body composition was estimated by dual X-ray absorptiometry and BIA method. Waist (WC) and hip circumference (HC) and skinfolds were also measured.

RESULTS

The BIA equation predicted fat free mass (FFM) from height, weight, age and resistance (R(2)=0.88, S.E.E.=1.89 kg). The bias was not significant and the limits of agreement +/-3.6 kg. BMI, FFM, body fat percentage (BF%), waist-to-hip ratio (WHR), WC and HC did not differ between pre (N=37) and postmenopausal (N=48) women (at p=0.05). Both BF% and BMI correlated with WHR and WC (r(BF%-WHR)=0.287, p=0.009; r(BMI-WHR)=0.355, p=0.001 and r(BF%-WC)=0.72, p<0.0001; r(BMI-WC)=0.81, p<0.0001). The mean values for BF%, WC and WHR for women with normal BMI were 36.15% (+/-4.19), 72.53 cm (+/-3.64) and 0.749 (+/-0.05), whereas values for overweight women were 41.42% (+/-3.16), 83.06 cm (+/-7.55) and 0.787 (+/-0.05) and for obese these were 47.40% (+/-3.67), 95.10 cm (+/-8.52) and 0.814 (+/-0.05), respectively.

CONCLUSION

The body composition analysis of the study sample revealed undesirably high BF%, even in subjects with BMI below 25, in whom BMI did not reflect the body fat content. However, BF was mainly distributed at the lower part of the body. Whether BMI or BF% is a more sensitive index for obesity related diseases, in perimenopausal period, remains to be defined.

Determining lifestyle correlates of body mass index using multilevel analyses: the Tromsø Study, 1979-2001

Increases in overweight and obesity have been observed globally in both developed and developing countries. The authors assessed the relation between lifestyle factors and body mass index (BMI) (weight (kg)/height (m)2) in a population-based longitudinal study, using BMI and its subsequent change as responses in a multilevel model. The authors included 11,115 men and women aged 20-61 years at baseline who were living in the municipality of Tromsø, Norway, and who participated in three or four consecutive health surveys between 1979-1980 and 2001. Baseline age, physical activity at work, coffee consumption, and desired BMI (i.e., the BMI that the subjects reported they would like to have) were positively associated with baseline BMI, whereas height, alcohol consumption, leisure-time physical activity, and level of education were inversely associated. Most relations were found to be stronger in women than in men. Clinically relevant effect sizes were observed for most of the significant associations, especially in women. For instance, on an ordinal scale, a one-category increase in educational level would decrease the mean baseline BMI among women by 0.30 kg/m2. Significant associations between several lifestyle factors and subsequent BMI change revealed that observed baseline associations were strengthened over time, especially in women.

Obesity in 70-year-old Swedes: secular changes over 30 years

OBJECTIVE

Secular increases in obesity have been widely reported in middle-aged adults, but less is known about such trends among the elderly. The primary purpose of this paper is to document the most recent wave of the obesity epidemic in population-based samples of 70-y-old men and women from Göteborg. Additionally, we will investigate the influences of physical activity, smoking and education on these secular trends.

POPULATIONS AND METHODS

Five population-based samples of 3702 70-y-olds (1669 men and 2033 women) in Göteborg, Sweden, born between 1901 and 1930, were examined in the Gerontological and Geriatric Population Studies (H70) between 1971 and 2000. Cohort differences in anthropometric measures were the main outcomes studied. Physical activity, smoking habits and education were assessed by comparable methods in all cohorts. Subsamples of the women in the latest two cohorts (birth years 1922 and 1930) were also part of the Prospective Population Study of Women in Göteborg. In these women, it was possible to examine body mass index (BMI) and waist-to-hip circumference ratio (WHR) longitudinally since 1968.

RESULTS AND CONCLUSIONS

Significant upward trends were found for height, weight, BMI, waist circumference (WC), WHR, prevalence of overweight (BMI> or =25 kg/m(2)) and obesity (BMI> or =30 kg/m(2)) across cohorts in both sexes. In 2000, 20% of the 70-y-old men born in 1930 were obese, and the largest increment (almost doubling) had occurred between the early 1980s and the early 1990s. In 70-y-old women the prevalence of obesity was 24% in 2000, a 50% increase compared to the cohort born 8 y earlier. BMI increased over time in all physical activity, smoking and education groups, with the exception of never-smoking men. Although 70-y-old women in 2000 were heavier than cohorts examined 8 y previously, data from the women studied longitudinally revealed that these differences were already present in earlier adulthood. In conclusion, the elderly population is very much part of the obesity epidemic, although secular trends in BMI were detected slightly earlier in men than in women. The health implications of these secular trends should be focused on in future gerontological research.

Which anthropometric measurements is most closely related to elevated blood pressure?

BACKGROUND

Epidemiological studies find a progressive increase in the prevalence of elevated blood pressure with increasing adipose tissue. But there is no common opinion about which effectiveness of the anthropometric measurement tools indicating general or android obesity are most important to follow up in patients with elevated blood pressures.

OBJECTIVES

To identify which anthropometric measurements are most closely related to blood pressure elevation.

METHODS

A cross-sectional descriptive study of 1727 subjects [894 (50.6%) men and 833 (48.2%) women, aged 18-65 years old] was held in Edirne, Turkey. Each subject's weight, height, waist and hip circumference, triceps skin fold and blood pressures was measured; waist to hip ratio and body mass index were calculated. The relations between blood pressure and different anthropometric variables in both genders were investigated in linear regression models.

RESULTS

The mean systolic and diastolic blood pressures were 123.49 +/- 17.60 and 78.79 +/- 10.37 mmHg. According to body mass index 23.7% of the subjects were obese (.29.9 kg/m(2)). When waist circumference cut-off points were compared with waist to hip ratio the android obesity ratio was doubled (32.3% versus 16.6%). 119 subjects (6.8%) were not obese according to body mass index but nonetheless had waist circumference measurements above the cut-off points suggesting a high cardiovascular risk. In the linear regression models waist circumference was found to be an independent risk factor for blood pressure in men; however body mass was more important index and waist circumference somewhat less so for women.

CONCLUSION

In primary care waist circumference should be a useful tool screening for and following android obesity in patients with elevated blood pressure.

Prevalence of weight cycling and its relation to health indicators in Finland

OBJECTIVE

This study was performed to identify weight cyclers and to assess the prevalence of weight cycling and its relation to health indicators in Finnish adults.

RESEARCH METHODS AND PROCEDURES

Data for the study consisted of 3320 men and 3540 women (25 to 64 years of age). The subjects went through a health examination, and data on intentional weight losses and regains during the last 10 years were collected by a questionnaire. The subjects were divided into five groups: severe weight cyclers (weight loss >/= 5 kg at least three times with regain), mild weight cyclers (weight loss >/= 5 kg one to two times and regain), successful dieters (weight loss >/= 5 kg with no regain), nonobese nondieters, and obese nondieters.

RESULTS

Approximately 7% of men and 10% of women were defined as severe weight cyclers, and an additional 11% and 19% were defined as mild weight cyclers, respectively. In men, 20% of severe weight cyclers and 15% of obese nondieters perceived their health as poor, whereas in other groups, these proportions were <10%. In both sexes, severe weight cyclers seemed to have visited a doctor more frequently than nonobese nondieters. Severe weight cyclers were also more likely to use some medication compared with other groups.

DISCUSSION

Weight cycling is more common in women than in men, and it seems to be associated with more regular visits to a doctor and poor self-perceived health. However, because of the cross-sectional design of the study, causal conclusions cannot be drawn.

Waist circumference and testosterone levels in community dwelling men. The Tromsø study

To examine the relationship of total and free testosterone and sex hormone-binding globulin (SHBG) with central obesity in men, we studied 1548 men aged 25-84 years that took part in the 1994--1995 survey of the Tromsø study. Total testosterone and SHBG were measured by immuno-assay and the free testosterone fraction was calculated. These measurements were analyzed in relation to anthropometric data and lifestyle factors. The age-adjusted correlation between waist circumference (WC) and total testosterone was -0.34 (p < 0.001), between WC and free testosterone -0.09 (p < 0.001) and, between WC and SHBG -0.44 (p < 0.001). Adjusting for BMI and lifestyle factors weakened, but did not eliminate these associations. All hormone and SHBG associations were stronger for WC than for waist-hip ratio or BMI. In age- and BMI-adjusted analyses men with a WC > or = 102 cm had significantly lower levels of total testosterone and SHBG compared to men with an optimal WC, defined as < 94 cm (12.3 vs. 13.9 nmol/l; p < 0.01 and 48.5 vs. 55.1 nmol/l; p < 0.001, respectively). The lowest levels of total and free testosterone were observed in men with relatively high WC despite relatively low overall obesity (BMI), suggesting that WC should be the preferred anthropometric measurement in predicting endogenous testosterone levels.

Body composition in the SOS (Swedish Obese Subjects) reference study

OBJECTIVE

The primary objective was to establish population-based, sex- and age-specific reference data with respect to body composition variables. Secondary objectives were to relate body mass index (BMI) to anthropometric measurements reflecting central adiposity and to body fat (BF). Another objective was to examine if secular changes in adipose tissue distribution occurred during the sampling period, 1994-1999.

DESIGN

Sex- and age-specific data on anthropometric measurements and body composition were cross-sectionally collected in the reference study of Swedish Obese Subjects.

SUBJECTS

In total, 1135 randomly selected subjects (524 men and 611 women), aged 37-61 y, BMI 17.6-45.4 kg/m(2).

MEASUREMENTS

Measures of body fatness and fat distribution (by dual energy X-ray absorptiometry and anthropometry) were collected.

RESULTS

At BMI 25 kg/m(2), relative (absolute) BF mass was 24% (19 kg) in men vs 36% (25 kg) in women, waist circumference was 90 vs 85 cm, and sagittal trunk diameter was 21 vs 19 cm. BF and measures of centralized adipose tissue distribution increased with age in both sexes (P<0.01). In women, waist circumference and sagittal diameter increased (P<0.01) over the sampling period while BMI did not.

CONCLUSIONS

Sex- and age-specific reference data on body composition are reported from a randomly selected sample of Swedish men and women. At given BMIs, women had more BF but smaller waist circumference than men. Secular increases in indices of central obesity were found in women but not in men.

Time trends (1993–1997) and seasonal variation in body mass index and waist circumference in the Netherlands

OBJECTIVE

To compare the time trend and seasonal variation in body mass index (BMI) and waist circumference.

DESIGN

Continuous monitoring health survey carried out between 1 June 1993 and 31 May 1997.

SUBJECTS

A total of 8,186 men and 9,638 women aged 20-59 y from three towns in the Netherlands.

MEASUREMENTS

BMI and waist circumference. Obesity was defined as BMI > or =30 kg/m(2), abdominal obesity as waist circumference > or =102 cm for men and > or =88 cm for women.

RESULTS

Levels of BMI and waist circumference increased between 1 June 1993 and 31 May 1997. Among women, the time trend in abdominal obesity was stronger than that in obesity. Further, levels of BMI and waist circumference were higher in winter than in summer seasons. The seasonal variation was larger for abdominal obesity than for obesity, among both men and women.

CONCLUSIONS

The time trend in women and the seasonal differences in both men and women were stronger for abdominal obesity than for obesity. Surveys on BMI and waist circumference are only comparable if season is taken into account. Furthermore, the waist circumference is a more sensitive indicator of variations in lifestyle and body composition than is body mass index.

Trends in waist circumference among U.S. adults

OBJECTIVE

Waist circumference has been proposed as a measure of obesity or as an adjunct to other anthropometric measures to determine obesity. Our objective was to examine temporal trends in waist circumference among adults in the U.S.

RESEARCH METHODS AND PROCEDURES

We used data from 15,454 participants >/=20 years old in National Health and Nutrition Examination Survey (NHANES) III (1988 to 1994) and 4024 participants >/=20 years old from National Health and Nutrition Examination Survey 1999 to 2000.

RESULTS

The unadjusted waist circumference increased from 95.3 (age-adjusted, 96.0 cm) to 98.6 (age-adjusted, 98.9 cm) cm among men and from 88.7 (age-adjusted 88.9 cm) to 92.2 (age-adjusted 92.1 cm) cm among women. The percentiles from the two surveys suggest that much of the waist circumference distribution has shifted. Statistically significant increases occurred among all age groups and racial or ethnic groups except men 30 to 59 years old, women 40 to 59 and >/=70 years old, and women who were Mexican American or of "other" race or ethnicity.

DISCUSSION

These results demonstrate the rapid increase in obesity, especially abdominal obesity, among U.S. adults. Unless measures are taken to slow the increase in or reverse the course of the obesity epidemic, the burden of obesity-associated morbidity and mortality in the U.S. can be expected to increase substantially in future years.

Predictors of abdominal obesity among 31-y-old men and women born in Northern Finland in 1966

OBJECTIVE

To find predictors of abdominal obesity (defined by >90th percentile of waist/hip ratio (WHR)) and related factors among 31-y-old men and women.

DESIGN

Longitudinal study of the northern Finland birth cohort of 1966 with measurements obtained at birth, 14 and 31 y.

SUBJECTS

A total of 2841 men and 2930 women with data on WHR at 31 y.

RESULTS

The most important predictor of abdominal obesity among the 31-y-old men was a high body mass index (BMI), those with normal weight at 14 y who were obese at 31 y having an especially high risk of abdominal obesity at 31 y. Abdominal obesity was independently associated with current weight status, small size for gestational age, a high intake of alcohol at 31 y, physical inactivity at 31 y, unhealthy diet in the sense of infrequent consumption of fiber-rich foods and frequent consumption of sausages, and a low level of occupational training. Physical inactivity and minimal vocational training also tended to be associated with abdominal obesity among women. The analyses were controlled for maternal age and BMI, and also for hormonal contraception and parity among women.

CONCLUSIONS

Some aspects of risk of adult abdominal obesity were evident during adolescence, and good advice is needed then, and in early adulthood, in order to reduce the risk of abdominal obesity in their thirties. Those who are small for gestational age are vulnerable to the development of abdominal obesity. Successful weight control from adolescence to adulthood, and healthy eating, alcohol drinking and exercise habits are important for avoiding abdominal accumulation of body fat.

Dietary changes in Finland—success stories and future challenges

The paper describes dietary changes and related nutrition policies and interventions in Finland since the 1960s. Dietary changes are interpreted from the lifestyle perspective, in which food consumption patterns are assumed to be formed by the interplay of individual choices and structural chances, such as socioeconomic and cultural conditions. Finland can demonstrate a success story when it comes to decreased use of dairy fats and increased use of vegetables and fruit. However, the prevalence of overweight has increased. Nutrition policies and interventions together with sociocultural factors have supported the shift towards healthy nutrition. The same factors have promoted overweight, as well.

Selected Physical Characteristics of Medical Students

The purpose of this study was to measure selected anthropometrical characteristics, motor abilities and cardiorespiratory functions of medical students. Eighty-seven students were involved in this investigation. The students were categorized into five groups: (1) recrea-tional, doing sport activities irregularly, (2) basketball and (3) handball players, having training at least two times per week, as well as men (4) and women (5) students entering medical school. In all groups the mean body mass index and waist-to-hip ratio were at the upper level of the normal range, while body fat percentage was similar to standards for sedentary subjects. Better motor performances were obtained from the basketball and handball players than from the other groups. Static strength for the sample was somewhat above the normal sedentary level. The resting blood pressure and heart rate for most subjects were in the normal. Cardiovascular risk factors were found in six students. Their systolic blood pressure was above 140 mm Hg. There were no subjects identified with low blood pressure. The heart rate was elevated for three students from the recreational group, and in the women. Bradycardia did not occur. The vital capacity and the ability to hold one's breath was at the upper level of the normal range. The present results emphasis the need to improve the students prevention oriented life style through participation in exercising.

Prospective study of the association of changes in dietary intake, physical activity, alcohol consumption, and smoking with 9-y gain in waist circumference among 16 587 US men

BACKGROUND

Although it is known that abdominal obesity increases the risk of chronic diseases, prospective data examining the relation between lifestyle factors and the accumulation of abdominal adipose tissue are sparse.

OBJECTIVE

The objective of the study was to determine the associations of changes in diet, physical activity, alcohol consumption, and smoking with 9-y waist gain among US men.

DESIGN

A prospective cohort comprised 16 587 US men aged 40-75 y at baseline in 1986. Data on lifestyle factors were provided periodically with the use of self-reported questionnaires, and participants measured and reported their waist circumference in 1987 and 1996.

RESULTS

In multivariate analyses, a 2% increment in energy intake from trans fats that were isocalorically substituted for either polyunsaturated fats or carbohydrates was significantly associated with a 0.77-cm waist gain over 9 y (P < 0.001 for each comparison). An increase of 12 g total fiber/d was associated with a 0.63-cm decrease in waist circumference (P < 0.001), whereas smoking cessation and a 20-h/wk increase in television watching were associated with a 1.98-cm and 0.59-cm waist gain, respectively (P < 0.001). Increases of 25 metabolic equivalent tasks (METs) * h/wk in vigorous physical activity and of >/= 0.5 h/wk in weight training were associated with 0.38-cm and 0.91-cm decreases in waist circumference, respectively (P < 0.001 for each comparison). These associations remained significant after further adjustment for concurrent change in body mass index. Changes in total fat and alcohol consumption and in walking volume were not significantly related to waist gain.

CONCLUSIONS

Waist gain may be modulated by changes in trans fat and fiber consumption, smoking cessation, and physical activity.

Occupational, commuting, and leisure-time physical activity in relation to risk for Type 2 diabetes in middle-aged Finnish men and women

AIM/HYPOTHESIS

Leisure-time physical activity can reduce the risk of Type 2 diabetes, but the potential effect of different types of physical activity is still uncertain. This study is to examine the relationship of occupational, commuting and leisure-time physical activity with the incidence of Type 2 diabetes.

METHODS

We prospectively followed 6898 Finnish men and 7392 women of 35 to 64 years of age without a history of stroke, coronary heart disease, or diabetes at baseline. Hazards ratios of incidence of Type 2 diabetes were estimated by levels of occupational, commuting, and leisure-time physical activity.

RESULTS

During a mean follow-up of 12 years, there were 373 incident cases of Type 2 diabetes. In both men and women combined, the hazards ratios of diabetes associated with light, moderate and active work were 1.00, 0.70 and 0.74 (p=0.020 for trend) after adjustment for confounding factors (age, study year, sex, systolic blood pressure, smoking, education, the two other types of physical activity and BMI). The multivariate-adjusted hazards ratios of diabetes with none, 1 to 29, and more than 30 min of walking or cycling to and from work were 1.00, 0.96, and 0.64 (p=0.048 for trend). The multivariate-adjusted hazards ratios of diabetes for low, moderate, high levels of leisure-time physical activity were 1.00, 0.67, and 0.61 (p=0.001 for trend); after additional adjustment for BMI, the hazards ratio was no longer significant.

CONCLUSIONS/INTERPRETATION

Moderate and high occupational, commuting or leisure-time physical activity independently and significantly reduces risk of Type 2 diabetes among the middle-aged general population.