Body mass index and waist circumference predict both 10-year nonfatal and fatal cardiovascular disease risk: study conducted in 20,000 Dutch men and women aged 20-65 years

Risk of cardiovascular events after gestational diabetes: a retrospective population study

AIMS

To investigate whether the risk for post-partum cardiovascular diseases (CVD) is driven by gestational diabetes (GDM), by GDM-related risk factors and/or by pre-gestational (Pre-GD) or post-gestational diabetes (Post-GD).

METHODS

Women delivering in Tuscany, Italy in years 2010-2012 (n = 74,720), were identified from certificates of care at delivery and further identified as affected with GDM, Pre-GD or Post-GD through regional administrative databases. Women with GDM, Pre-GD or Post-GD were retrospectively evaluated for risk of post-partum hospitalizations for CVD (myocardial infarction or stroke; n = 728) across years 2013-2021, comparing women with different forms of diabetes to those without diabetes. Risk of CVD was assessed as odds ratio (OR 95% CI), after logistic multivariate models, considering all recorded pre-gestational characteristics as covariates.

RESULTS

The adjusted OR (aOR) for post-partum CVD hospitalizations was not significantly related to GDM itself (aOR: 0.85; 0.64-1.12; p = ns), but increased in women with Pre-GD (aOR: 2.02; 1.09-3.71; p = 0.024) and Post-GD, associated or not to prior GDM (aOR; 4.21; 2.45-7.23 and respectively aOR: 3.80; 2.38-6.05; p < 0.0001 for both). In presence of pre-pregnancy maternal obesity (BMI ≥ 30 kg/m2) the aOR of CVD approximatively doubled (aOR: 1.90; 1.51-2.40); p < 0.0001, independently of GDM and of Post-GD. The adjusted risk of CVD was lower among employed women (aOR: 0.83; 0.70-0.99); p = 0.04 and significantly higher in presence of poorer education levels (aOR: 1.32; 1.11-1.57); p < 0.0001.

CONCLUSION

In this population the risk of post-partum CVD was driven by Pre- and Post-GD, not by GDM alone. Pre-gestational obesity represented a major independent risk factor for post-partum CVD.

Strengths and Limitations of BMI in the Diagnosis of Obesity: What is the Path Forward?

PURPOSE OF REVIEW

This review aims to discuss strengths and limitations of body mass index (BMI) in diagnosing obesity, the use of alternative anthropometric measurements, and potential new technology that may change the future of obesity diagnosis and management.

RECENT FINDINGS

The diagnosis of obesity requires the anthropometric assessment of adiposity. In clinical settings, this should include BMI with confirmation that elevated BMI represents excess adiposity and a measure of fat distribution (i.e., waist circumference (WC), waist to height ratio (WHtR), or WC divided by height0.5 (WHR.5R). Digital anthropometry and bioelectric impedance (BIA) can estimate fat distribution and be feasibly employed in the clinic. In addition, the diagnosis should include a clinical component assessing the presence and severity of weight-related complications. As anthropometric measures used in the diagnosis of obesity, BMI is generally sufficient if confirmed to represent excess adiposity, and there are advantages to the use of WHtR over WC to assess fat distribution. BIA and digital anthropometry have the potential to provide accurate measures of fat mass and distribution in clinical settings. There should also be a clinical evaluation for the presence and severity of obesity complications that can be used to stage the disease.

Neurocircuitry underlying the actions of glucagon-like peptide 1 and peptide YY3-36 in the suppression of food, drug-seeking, and anxiogenesis

Obesity is a critical health condition worldwide that increases the risks of comorbid chronic diseases, but it can be managed with weight loss. However, conventional interventions relying on diet and exercise are inadequate for achieving and maintaining weight loss, thus there is significant market interest for pharmaceutical anti-obesity agents. For decades, receptor agonists for the gut peptide glucagon-like peptide 1 (GLP-1) featured prominently in anti-obesity medications by suppressing appetite and food reward to elicit rapid weight loss. As the neurocircuitry underlying food motivation overlaps with that for drugs of abuse, GLP-1 receptor agonism has also been shown to decrease substance use and relapse, thus its therapeutic potential may extend beyond weight management to treat addictions. However, as prolonged use of anti-obesity drugs may increase the risk of mood-related disorders like anxiety and depression, and individuals taking GLP-1-based medication commonly report feeling demotivated, the long-term safety of such drugs is an ongoing concern. Interestingly, current research now focuses on dual agonist approaches that include GLP-1 receptor agonism to enable synergistic effects on weight loss or associated functions. GLP-1 is secreted from the same intestinal cells as the anorectic gut peptide, Peptide YY3-36 (PYY3-36), thus this review assessed the therapeutic potential and underlying neural circuits targeted by PYY3-36 when administered independently or in combination with GLP-1 to curb the appetite for food or drugs of abuse like opiates, alcohol, and nicotine. Additionally, we also reviewed animal and human studies to assess the impact, if any, for GLP-1 and/or PYY3-36 on mood-related behaviors in relation to anxiety and depression. As dual agonists targeting GLP-1 and PYY3-36 may produce synergistic effects, they can be effective at lower doses and offer an alternative approach for therapeutic benefits while mitigating undesirable side effects.

Association between weight-adjusted-waist index and risk of cardiovascular diseases in United States adults: a cross-sectional study

BACKGROUND

As a new obesity-related index, the weight-adjusted-waist index (WWI) appears to be a good predictor of cardiovascular disease (CVD) in East Asian populations. This study aimed to validate the association between WWI and CVD in United States (US) adults and also evaluate its relationships with the prevalence of specific CVDs.

METHODS

The data were obtained from the 2009-2016 National Health and Nutrition Examination Survey. WWI was calculated as waist circumference divided by the square root of weight, and CVD was ascertained based on self-reported physician diagnoses. Multivariable logistic regression models and subgroup analyses were performed to evaluate the association between WWI and CVD.

RESULTS

A total of 21,040 participants were included. There was a positive linear relationship between WWI and the odds of CVD (P = 0.310). After adjusting for all covariates, each unit of increased WWI was associated with 48% increased risk of CVD (odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.25-1.74). Moreover, compared with the lowest quintile (< 10.3 cm/√kg), the multivariable-adjusted OR was 3.18 (95% CI: 1.80-5.59) in the highest quintile (≥ 11.8 cm/√kg). Besides, positive associations were also found between WWI and increased prevalence of congestive heart failure (OR: 1.47, 95% CI: 1.11-1.96), coronary heart disease (OR: 1.27, 95% CI: 1.01-1.60), angina (OR: 1.44, 95% CI: 1.06-1.96), heart attack (OR: 1.66, 95% CI: 1.29-2.12), and stroke (OR: 1.32, 95% CI: 1.02-1.70). Subgroup analyses showed that stronger associations between WWI and CVD were detected in participants younger than 50 years of age (P < 0.001).

CONCLUSIONS

High levels of WWI were significantly associated with an increased risk of CVD in US adults, particularly in people under 50 years of age. These findings indicate that WWI may be an intervention indicator to reduce the risk of CVD in the general adult population.

BMI category-specific waist circumference thresholds based on cardiovascular disease outcomes and all-cause mortality: Tehran lipid and glucose study (TLGS)

BACKGROUND

Waist circumference (WC), a representative of abdominal visceral fat, is strongly associated with cardiovascular disease (CVD) and its outcomes. We aimed to define body mass index (BMI)-specific WC thresholds as predictors of CVD and all-cause mortality.

METHODS

In this prospective cohort study in the context of the Tehran Lipid and Glucose Study (TLGS), a total of 3344 men and 4068 women were followed up for 18 years. Based on BMI, the participants were categorized into three groups: BMI < 25, 25 < BMI < 30, and BMI > 30. In each BMI category, sex-specific WC thresholds were estimated by the maximum value of Youden's index to predict based on incident CVD events and all-cause mortality prediction.

RESULTS

Overall 667 and 463 CVD events (the incidence rate of 3.1 to 4.5 in men and 1.1 to 2.6 in women per 1,000 person-years within BMI categories) and 438 and 302 mortalities (the incidence rate of 2.1 to 2.7 in men and 1.2 to 1.4 in women per 1,000 person-years within BMI categories) were recorded in men and women, respectively. WC thresholds in the BMI categories of < 25, 25-30, and BMI > 30 kg/m² with regard to CVD events were 82, 95, and 103 cm in men and 82, 89, and 100 cm in women, and regarding all-cause mortality, the respective values were 88, 95, and 103 cm in men and 83, 90, and 99 cm among women.

CONCLUSION

BMI-specific WC thresholds observed here can help to better identify individuals at high risk of developing CVDs.

Challenges in Cardiovascular Evaluation and Management of Obese Patients: JACC State-of-the-Art Review

Many unique clinical challenges accompany the diagnosis and treatment of cardiovascular disease (CVD) in people living with overweight/obesity. Similarly, physicians encounter numerous complicating factors when managing obesity among people with CVD. Diagnostic accuracy in CVD medicine can be hampered by the presence of obesity, and pharmacological treatments or cardiac procedures require careful adjustment to optimize efficacy. The obesity paradox concept remains a source of confusion within the clinical community that may cause important risk factors to go unaddressed, and body mass index is a misleading measure that cannot account for body composition (eg, lean mass). Lifestyle modifications that support weight loss require long-term commitment, but cardiac rehabilitation programs represent a potential opportunity for structured interventions, and bariatric surgery may reduce CVD risk factors in obesity and CVD. This review examines the key issues and considerations for physicians involved in the management of concurrent obesity and CVD.

Moderation of Weight Misperception on the Associations Between Obesity Indices and Estimated Cardiovascular Disease Risk

BACKGROUND

This study aimed to investigate the gender-specific association between weight misperception and estimated cardiovascular disease (CVD) risk and gender-specific moderation of weight misperception in the associations between obesity indices and CVD risk.

METHODS

In 7836 men and 10,299 women aged 40-79 years without CVD history from the 2014-2018 Korea National Health and Nutrition Examination Survey, the risk of 10-year atherosclerotic cardiovascular disease (ASCVD) was calculated using Pooled Cohort Equations. Weight misperception was defined as accurate estimation, overestimation, or underestimation by comparing perceived weight to actual weight category. Obesity indices were BMI and waist circumference (WC).

RESULTS

In fully adjusted models, odds of 10-year ASCVD risk of ≥ 7.5% were lower in men with overestimating weight (odd ratio [95% confidence interval], 0.85 [0.73, 0.99] after adjusting for BMI;0.79 [0.68, 0.92] after adjusting for WC), but higher in women with underestimating weight (1.44 [1.27, 1.63] after adjusting for BMI;1.42 [1.26, 1.61] after adjusting for WC) compared to those with accurate weight estimates. Compared to women with accurate weight estimates, the ASCVD risk associated with obesity indices was higher in those who underestimated weight (ß [95% CI], 0.33 [0.23, 0.43] for BMI;0.16 [0.13, 0.20] for WC), whereas it was lower in those who overestimated weight (-0.15 [-0.28, -0.02] for BMI; -0.07 [-0.11, -0.03] for WC). In men, weight misperception did not moderate the association between obesity indices and the ASCVD risk.

CONCLUSIONS

These findings suggest that weight misperception was associated with estimated CVD risk independently across gender and moderates the association between obesity indices and estimated CVD risk in women.

Obesity and cardiovascular disease: mechanistic insights and management strategies. A joint position paper by the World Heart Federation and World Obesity Federation

The ongoing obesity epidemic represents a global public health crisis that contributes to poor health outcomes, reduced quality of life, and >2.8 million deaths each year. Obesity is relapsing, progressive, and heterogeneous. It is considered a chronic disease by the World Obesity Federation (WOF) and a chronic condition by the World Heart Federation (WHF). People living with overweight/obesity are at greater risk for cardiovascular (CV) morbidity and mortality. Increased adiposity (body fat), particularly visceral/abdominal fat, is linked to CV risk and CV disease (CVD) via multiple direct and indirect pathophysiological mechanisms. The development of CVD is driven, in part, by obesity-related metabolic, endocrinologic, immunologic, structural, humoral, haemodynamic, and functional alterations. The complex multifaceted nature of these mechanisms can be challenging to understand and address in clinical practice. People living with obesity and CVD often have concurrent chronic physical or psychological disorders (multimorbidity) requiring multidisciplinary care pathways and polypharmacy. Evidence indicates that intentional weight loss (particularly when substantial) lowers CVD risk among people with overweight/obesity. Long-term weight loss and maintenance require ongoing commitment from both the individual and those responsible for their care. This position paper, developed by the WOF and the WHF, aims to improve understanding of the direct and indirect links between overweight/obesity and CVD, the key controversies in this area and evidence relating to cardiometabolic outcomes with available weight management options. Finally, an action plan for clinicians provides recommendations to help in identifying and addressing the risks of obesity-related CVD (recognizing resource and support variances between countries).

Predictive ability of six obesity measures to identify 7-year fatal and non-fatal cardiovascular events: A population-based cohort study

Background

Globally, most people die from cardiovascular diseases. We aimed to compare predictive ability of six obesity indices, including body mass index, waist circumference, waist-to-hip ratio, waist-to-height ratio, conicity index, and abdominal volume index, to identify people at risk of fatal and non-fatal cardiovascular events, in a cohort study.

Methods

We studied 5147 participants in a baseline population-based cohort study conducted in northern Iran. The obesity measures were calculated in enrollment phase (2009-2010), and the cardiovascular events were recorded during a 7-year follow-up phase (2010-2017). Receiver operating characteristic (ROC) analyses and Cox hazard regression models were applied, considering the obesity measures as predictors, and the 7-year cardiovascular events as outcomes. Multiple Cox models were adjusted by age, prior history of cardiovascular diseases, chronic kidney diseases, insulin resistance, diabetes mellitus, dyslipidemia, hypertension, and smoking status.

Results

Conicity index showed the highest performance in predicting 7-year fatal and non-fatal cardiovascular events with areas under the ROC curve of 0.77 [95% confidence interval: 0.71-0.82], and 0.63 [0.59-0.68] in men, and 0.80 [0.74-0.87], and 0.65 [0.60-0.71] in women, respectively. In multiple Cox models, the obesity measures had no significant associations with cardiovascular events in women. In men, only waist-to-height ratio was independently associated with 7-year non-fatal cardiovascular events (hazard ratio: 1.19 [95% confidence interval: 1.01-1.38]).

Conclusions

Although waist-to-height ratio had an independent association with 7-year non-fatal cardiovascular events in men, conicity index showed the best ability to predict 7-year fatal and non-fatal cardiovascular events in our study.

The role of body height as a co-factor of excess weight in Switzerland

Object

Excess weight (Body Mass Index [BMI] ≥25.0 kg/m²) is a major health issue worldwide, including in Switzerland. For high‐income countries, little attention has been paid to body height in context of excess weight. The aim of this study is to assess the importance of body height as a co‐factor for excess weight in multiple large nationwide data sets.

Data and methods

In this comparative study, we included the largest nationwide and population‐based studies in the fields of public health, nutrition and economics for Switzerland, as well as data of the medical examination during conscription for the Swiss Armed Forces, which contained information on BMI and, if possible, waist‐to‐height‐ratio (WHtR) and waist‐to‐hip‐ratio (WHR).

Results

The multinomial logistic regressions show that the probability of belonging to the excess weight category (BMI ≥25.0 kg/m²) decreased with increasing height in both sexes inall contemporary data sets. This negative association was shown to be constant, only among conscripts measured in the 1870s the association was positive, when increasing height was associated with a higher BMI. The negative association not only emerge in BMI, but also in WHtR and WHR.

Conclusion

Our results emphasize the importance of body height as a co‐factor of excess weight, suggesting a clear negative association between height and BMI, WHtR and WHR. Evidence indicates that both early‐life environmental exposures and alleles associated with height may contribute to these associations. This knowledge could serve as further starting points for prevention programs in the field of public health.

Dysfunctional adiposity index as a marker of adipose tissue morpho-functional abnormalities and metabolic disorders in apparently healthy subjects

Compared to body mass index, waist circumference (WC), and adiposity measurements, adipose tissue (AT) morpho-functionality evaluations are better predictors of cardiometabolic abnormalities (CA). The present study establishes a dysfunctional adiposity index (DAI) as an early marker of CA based on adipocytes morpho-functional abnormalities. DAI was established in 340 subjects without cardiovascular risk factors selected from a cross-sectional study (n=1600). Then, DAI was calculated in 36 healthy subjects who underwent subcutaneous AT biopsy. The correlation of DAI with adipocyte morphology (size/number) and functionality (adiponectin/leptin ratio) was analyzed. The DAI cut-off point was identified and its independent association with CA was determined in 1418 subjects from the cross-sectional study. The constant parameters to calculate the DAI were [WC/[22.79+[2.68*BMI]]]*[triglycerides (TG, mmol/L)/1.37]*[1.19/high density lipoprotein-cholesterol (HDL-C, mmol/L)] for males, and [WC/[24.02+[2.37*BMI]]]*[TG(mmol/L)/1.32]*[1.43/HDL-C(mmol/L)] for females. DAI correlated with adipocytes mean area, adipocyte number and adiponectin/leptin ratio. DAI ≥1.065 was independently associated with diabetes, non-alcoholic fatty liver disease, subclinical atherosclerosis, and hypertension. The present study highlights that DAI is associated with early CA independently of adiposity and other risk factors. Since DAI is obtained using accessible parameters, it can be easily incorporated into clinical practice for early identification of AT abnormalities in apparently healthy subjects.

Sex-specific associations of body composition measures with cardiac function and structure after 8 years of follow-up

We investigated the prospective associations of body composition with cardiac structure and function and explored effect modification by sex and whether inflammation was a mediator in these associations. Total body (BF), trunk (TF) and leg fat (LF), and total lean mass (LM) were measured at baseline by a whole body DXA scan. Inflammatory biomarkers and echocardiographic measures were determined both at baseline and follow-up in the Hoorn Study (n = 321). We performed linear regression analyses with body composition measures as determinant and left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI) or left atrial volume index (LAVI) at follow-up as outcome. Additionally, we performed mediation analysis using inflammation at follow-up as mediator. The study population was 67.7 ± 5.2 years and 50% were female. After adjustment, BF, TF and LF, and LM were associated with LVMI with regression coefficients of 2.9 (0.8; 5.1)g/m^2.7, 2.3 (0.6; 4.0)g/m^2.7, 2.0 (0.04; 4.0)g/m^2.7 and − 2.9 (− 5.1; − 0.7)g/m^2.7. Body composition measures were not associated with LVEF or LAVI. These associations were not modified by sex or mediated by inflammation. Body composition could play a role in the pathophysiology of LV hypertrophy. Future research should focus on sex differences in regional adiposity in relation with diastolic dysfunction.

Are people with metabolically healthy obesity really healthy? A prospective cohort study of 381,363 UK Biobank participants

AIMS/HYPOTHESIS

People with obesity and a normal metabolic profile are sometimes referred to as having 'metabolically healthy obesity' (MHO). However, whether this group of individuals are actually 'healthy' is uncertain. This study aims to examine the associations of MHO with a wide range of obesity-related outcomes.

METHODS

This is a population-based prospective cohort study of 381,363 UK Biobank participants with a median follow-up of 11.2 years. MHO was defined as having a BMI ≥ 30 kg/m² and at least four of the six metabolically healthy criteria. Outcomes included incident diabetes and incident and fatal atherosclerotic CVD (ASCVD), heart failure (HF) and respiratory diseases.

RESULTS

Compared with people who were not obese at baseline, those with MHO had higher incident HF (HR 1.60; 95% CI 1.45, 1.75) and respiratory disease (HR 1.20; 95% CI 1.16, 1.25) rates, but not higher ASCVD. The associations of MHO were generally weaker for fatal outcomes and only significant for all-cause (HR 1.12; 95% CI 1.04, 1.21) and HF mortality rates (HR 1.44; 95% CI 1.09, 1.89). However, when compared with people who were metabolically healthy without obesity, participants with MHO had higher rates of incident diabetes (HR 4.32; 95% CI 3.83, 4.89), ASCVD (HR 1.18; 95% CI 1.10, 1.27), HF (HR 1.76; 95% CI 1.61, 1.92), respiratory diseases (HR 1.28; 95% CI 1.24, 1.33) and all-cause mortality (HR 1.22; 95% CI 1.14, 1.31). The results with a 5 year landmark analysis were similar.

CONCLUSIONS/INTERPRETATION

Weight management should be recommended to all people with obesity, irrespective of their metabolic status, to lower risk of diabetes, ASCVD, HF and respiratory diseases. The term 'MHO' should be avoided as it is misleading and different strategies for risk stratification should be explored.

Abdominal obesity and risk of CVD: a dose-response meta-analysis of thirty-one prospective studies

This meta-analysis aimed to study the relationship between abdominal obesity and the risk of CVD by waist circumference (WC), waist:hip ratio (WHR) and waist:height ratio (WHtR). We systematically searched PubMed, Embase and Web of Science. Prospective studies that estimated cardiovascular events by WC, WHR and WHtR were included in this study. Pooled relative risks with 95 % CI were calculated using random effects models. A total of thirty-one studies were included in the meta-analysis, including 669 560 participants and 25 214 cases. Compared the highest with the lowest category of WC, WHR and WHtR, the summary risk ratios were 1·43 (95 % CI, 1·30, 1·56, P < 0·001), 1·43 (95 % CI, 1·33, 1·54, P < 0·001) and 1·57 (95 % CI, 1·37, 1·79, P < 0·001), respectively. The linear dose-response analysis revealed that the risk of CVD increased by 3·4 % for each 10 cm increase of WC, and by 3·5 and 6·0 % for each 0·1 unit increase of WHR and WHtR in women, respectively. In men, the risk of CVD increased by 4·0 % for each 10 cm increase of WC, and by 4·0 and 8·6 % for each 0·1 unit increase of WHR and WHtR, respectively. Collectively, abdominal obesity is associated with an increased risk of CVD. WC, WHR and WHtR are good indicators for the prediction of CVD.

Obesity, malnutrition, and trace element deficiency in the coronavirus disease (COVID-19) pandemic: An overview

The world is currently facing the coronavirus disease (COVID-19) pandemic which places great pressure on health care systems and workers, often presents with severe clinical features, and sometimes requires admission into intensive care units. Derangements in nutritional status, both for obesity and malnutrition, are relevant for the clinical outcome in acute illness. Systemic inflammation, immune system impairment, sarcopenia, and preexisting associated conditions, such as respiratory, cardiovascular, and metabolic diseases related to obesity, could act as crucial factors linking nutritional status and the course and outcome of COVID-19. Nevertheless, vitamins and trace elements play an essential role in modulating immune response and inflammatory status. Overall, evaluation of the patient's nutritional status is not negligible for its implications on susceptibility, course, severity, and responsiveness to therapies, in order to perform a tailored nutritional intervention as an integral part of the treatment of patients with COVID-19. The aim of this study was to review the current data on the relevance of nutritional status, including trace elements and vitamin status, in influencing the course and outcome of the disease 3 mo after the World Health Organization's declaration of COVID-19 as a pandemic.

Genetic Determinants of Childhood Obesity

Obesity represents a major health burden to both developed and developing countries. Furthermore, the incidence of obesity is increasing in children. Obesity contributes substantially to mortality in the United States by increasing the risk for type 2 diabetes, cardiovascular-related diseases, and other comorbidities. Despite environmental changes over past decades, including increases in high-calorie foods and sedentary lifestyles, there is very clear evidence of a genetic predisposition to obesity risk. Childhood obesity cases can be categorized in one of two ways: syndromic or non-syndromic. Syndromic obesity includes disorders such as Prader-Willi syndrome, Bardet-Biedl syndrome, and Alström syndrome. Non-syndromic cases of obesity can be further separated into rarer instances of monogenic obesity and much more common forms of polygenic obesity. The advent of genome-wide association studies (GWAS) and next-generation sequencing has driven significant advances in our understanding of the genetic contribution to childhood obesity. Many rare and common genetic variants have been shown to contribute to the heritability in obesity, although the molecular mechanisms underlying most of these variants remain unclear. An important caveat of GWAS efforts is that they do not strictly represent gene target discoveries, rather simply the uncovering of robust genetic signals. One clear example of this is with progress in understanding the key obesity signal harbored within an intronic region of the FTO gene. It has been shown that the non-coding region in which the variant actually resides in fact influences the expression of genes distal to FTO instead, specifically IRX3 and IRX5. Such discoveries suggest that associated non-coding variants can be embedded within or next to one gene, but commonly influence the expression of other, more distal effector genes. Advances in genetics and genomics are therefore contributing to a deeper understanding of childhood obesity, allowing for development of clinical tools and therapeutic agents.

Standardized reporting of co-morbidity outcome after bariatric surgery: low compliance with the ASMBS outcome reporting standards despite ease of use

BACKGROUND

Despite the publication of the American Society for Metabolic and Bariatric Surgery (ASMBS) Outcome Reporting Standards in 2015, there is still a great variety in definitions used for reporting remission of co-morbidities after bariatric surgery. This hampers meaningful comparison of results.

OBJECTIVE

To assess compliance with the ASMBS standards in current literature, and to evaluate use of the standards by applying them in a report on the outcomes of 5 co-morbidities after bariatric surgery.

SETTING

Two clinics of the Dutch Obesity Clinic, location Den Haag and Velp, and three affiliated hospitals: Haaglanden Medical Center in Den Haag, Groene Hart Hospital in Gouda, and Vitalys Clinic in Velp.

METHODS

A systematic search in PubMed was conducted to identify studies using the ASMBS standards. Besides, the standards were applied to a cohort of patients who underwent a primary bariatric procedure between November 2016 and June 2017. Outcomes of co-morbidities were determined at 6 and 12 months after surgery.

RESULTS

Ten previous studies applying ASMBS definitions were identified by the search, including 6 studies using portions of the definitions, and 4 using complete definitions for 3 co-morbidities or in a small population. In this study, the standards were applied to 1064 patients, of whom 796 patients (75%) underwent Roux-en-Y gastric bypass and 268 patients (25%) underwent sleeve gastrectomy. At 12 months, complete remission of diabetes (glycosylated hemoglobin <6%, off medication) was reached in 63%, partial remission (glycosylated hemoglobin 6%-6.4%, off medication) in 7%, and improvement in 28% of patients (n = 232/248, 94%). Complete remission of hypertension (normotensive, off medication) was noted in 8%, partial remission (prehypertensive, off medication) in 23% and improvement in 63% (n = 397/412, 96%). Remission rate for dyslipidemia (normal nonhigh-density lipoprotein, off medication) was 57% and improvement rate was 19% (n = 129/133, 97%). Resolution of gastroesophageal reflux disease (no symptoms, off medication) was observed in 54% (n = 265/265). Obstructive sleep apnea syndrome improved in 90% (n = 157/169, 93%).

CONCLUSIONS

Compliance with the ASMBS standards is low, despite ease of use. Standardized definitions provided by the ASMBS guideline could be used in future research to enable comparison of outcomes of different studies and surgical procedures.

Body shape and pants size as surrogate measures of obesity among males in epidemiologic studies

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Alternative anthropometric indicators reflect overall and abdominal obesity in males.

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Abdominal obesity is predicted using age, pants size, Stunkard’s silhouette & weight.

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Stunkard’s silhouette scale reflects well body mass index recently and in the past.

This study aimed at characterizing anthropometric indicators that can be used as alternatives to measurements for assessing overall obesity over adulthood and abdominal obesity among men. We used data from a population-based case-control study of prostate cancer conducted in Montreal, Canada in 2005–2012. It included men aged ≤ 75 years, 1872 of which were newly diagnosed with prostate cancer, and 1918 others randomly selected from the electoral list. In-person interviews elicited reports of height as well as of weight, pants size and Stunkard’s silhouette at 5 time points over adulthood, i.e., for the ages of 20, 40, 50 and 60 years, if applicable, and at the time of interview. Waist and hip circumferences were measured by interviewers following a validated protocol. Analyses were conducted on the overall sample of 3790 subjects, after having confirmed that results did not differ according to disease status. Stunkard’s silhouette scale proved to be an easy-to-administer tool that reflects well reported body mass index, either recently or decades in the past among adult males. It was discriminatory enough to classify individuals according to commonly-used obesity categories. We observed that a model including age, reported pants size, silhouette and weight can reasonably predict current abdominal obesity. In conclusion, alternative anthropometric indicators can serve as valuable means to assess overall and abdominal obesity when measurements cannot be envisaged in the context of epidemiological studies.

Obesity and cardiovascular disease risk among Africans residing in Europe and Africa: the RODAM study

BACKGROUND

The association between anthropometric variables and cardiovascular disease (CVD) risk among Africans is unclear. We examined the discriminative ability of anthropometric variables and estimate cutoffs for predicting CVD risk among Africans.

METHODS

The Research on Obesity and Diabetes among African Migrants (RODAM) study was a multisite cross-sectional study of Africans in Ghana and Europe. We calculated AHA/ACC Pooled Cohort Equations (PCE) scores for 3661 participants to ascertain CVD risk, and compared a body shape index (ABSI), body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), Relative Fat Mass (RFM), and Waist to Height Ratio (WHtR). Logistic regression and receiver operating curve analyses were performed to derive cutoffs for identifying high predicted CVD risk (PCE score ≥7.5%).

RESULTS

Among men, WC (adjusted Odds Ratio (aOR): 2.25, 95% CI; 1:50-3:37) was strongly associated with CVD risk. Among women, WC (aOR: 1.69, 95% CI: 1:33-2:14) also displayed the strongest association with CVD risk in the BMI-adjusted model but WHR displayed the strongest fit. All variables were superior discriminators of high CVD risk in men (c-statistic range: 0.887-0.891) than women (c-statistic range: 0.677-0.707). The optimal WC cutoff for identifying participants at high CVD risk was 89 cm among men and identified the most cases (64%). Among women, the recommended WC cutoff of 94 cm or WHR cutoff of 0.90 identified the most cases (92%).

CONCLUSIONS

Anthropometric variables were stronger discriminators of high CVD risk in African men than women. Greater WC was associated with high CVD risk in men while WHR and WC were associated with high CVD risk in women.

Study protocol for a multicentre, controlled non-randomised trial: benefits of exercise physiology services for type 2 diabetes (BEST)

INTRODUCTION

Controlled trials support the efficacy of exercise as a treatment modality for chronic conditions, yet effectiveness of real-world Exercise Physiology services is yet to be determined. This study will investigate the efficacy and cost-effectiveness of services provided by Accredited Exercise Physiologists (AEPs) for clients with type 2 diabetes (T2D) in clinical practice.

METHODS AND ANALYSIS

A non-randomised, opportunistic control, longitudinal design trial will be conducted at ten Exercise Physiology Clinics. Participants will be individuals with T2D attending one of the Exercise Physiology Clinics for routine AEP services (exercise prescription and counselling) (intervention) or individuals with T2D not receiving AEP services (usual care) (control). The experimental period will be 6 months with measurements performed at baseline and at 6 months. Primary outcome measures will be glycosylated haemoglobin (HbA1c), resting brachial blood pressure (BP), body mass index, waist circumference, 6 min walk test, grip strength, 30 s sit to stand, Medical Outcomes Short-Form 36-Item Health Survey and Active Australia Questionnaire. Secondary outcomes will be medication usage, out-of-pocket expenses, incidental, billable and non-billable health professional encounters and work missed through ill health. Healthcare utilisation will be measured for 12 months prior to, during and 12 months after trial participation using linked data from Medicare Benefits Schedule and Pharmaceutical Benefits Scheme data.

ETHICS AND DISSEMINATION

The study is a multicentre trial comprising: University of Tasmania, University of New South Wales Lifestyle Clinic, University of Canberra, Baker Heart and Diabetes Institute (covered under the ethics approval of University of Tasmania Health and Medical Ethics Committee H0015266), Deakin University (Approval number: 2016-187), Australian Catholic University (2016-304R), Queensland University of Technology (1600000049), University of South Australia (0000035306), University of Western Australia (RA/4/1/8282) and Canberra Hospital (ETH.8.17.170). The findings of this clinical trial will be communicated via peer-reviewed journal articles, conference presentations, social media and broadcast media.

TRIAL REGISTRATION NUMBER

ACTRN12616000264482.

[Anthropometric measurements of general and central obesity and discriminative capacity on cardiovascular risk: RICARTO study]

INTRODUCTION AND OBJECTIVES

Overweight and obese patients have an increased risk of cardiovascular disease and general mortality. It is not clear which obesity index should be used in the clinic. The objective is to compare the relationship between body mass index (BMI), waist circumference (WC), waist-height ratio (WHR), and conicity index (Conicity-I) with 10-year Framingham cardiovascular risk (CVR).

MATERIAL AND METHODS

Population cross-sectional study in subjects ≥18years, residents in the Toledo (Spain) Health Area. Selection by random sampling. Measurements were made of the BMI, WC, and weight to height ratio with standardised methods. Framingham CVR. Calculation of AUC, and optimal cut-off points.

RESULTS

The study included 1,309 subjects, with mean age of 48.9±15.8years, and 55% women. The response rate was 36.6%. In women, the index that was best associated with CVR in women was the WC with an AUC=0.85 (95%CI: 0.81-0.88). In men it was the I-Conicity, with an AUC=0.81 (95%CI: 0.77-0.84). Cut points for BMI were similar in women (27.08kg/m²) and men (26.99kg/m²). The WC was lower in women (87.75cm) than in men (94.5cm). The WHR was higher in women (0.59) than in men (0.56). The I-Conicity was slightly lower in women (1.25) than in men (1.28). In women, all the ROC curves were closest to each other.

CONCLUSIONS

The central obesity indexes (WC and WHR) discriminated better than the BMI the CVR. In women, all the indices had greater AUCs than in men, except for the I-Conicity.

Improving physical activity, pain and function in patients waiting for hip and knee arthroplasty by combining targeted exercise training with behaviour change counselling: study protocol for a randomised controlled trial

Background

Osteoarthritis often results in prolonged periods of reduced physical activity and is associated with adverse health outcomes, including increased risk of cardiovascular and metabolic diseases. Exercise interventions for patients on the waiting list for arthroplasty can reduce the risk of long-term adverse outcomes by increasing activity levels. However, uptake and ongoing positive rates of physical activity in this population are low and the impact of pre-operative behaviour counselling on exercise is not known.

Method/design

The exercise and behaviour change counselling (ENHANCE) trial is a two-arm assessor-blind randomised controlled trial to assess the effectiveness of a 12-week exercise intervention designed to improve long-term physical activity and functional abilities for people awaiting arthroplasty. Participants on the waiting list for hip and knee arthroplasty are recruited from one clinical site in Australia. After collection of baseline data, participants are randomised to either an intervention or control group. The control group receive usual care, as recommended by evidence-based guidelines. The intervention group receive an individualised programme of exercises and counselling sessions. The 12-week exercise programme integrates multiple elements, including up to five in-person counselling sessions, supported by written materials. Participants are encouraged to seek social support among their friends and self-monitor their physical activity. The primary outcome is physical activity (daily step count and percentage of day spent in sedentary activities). Secondary outcomes include pain ratings, physical function, psychosocial factors and changes in clinical markers linked with potential common chronic diseases (diabetes and cardiovascular disease). All outcomes are assessed at baseline and 26 weeks later and again at 26 weeks post-surgery.

Discussion

This study seeks to address a significant gap in current osteoarthritis management practice by providing evidence for the effectiveness of an exercise programme combined with behaviour counselling for adults waiting for hip and knee arthroplasty. Theory-driven evidence-based strategies that can improve an individual’s exercise self-efficacy and self-management capacity could have a significant impact on the development of secondary chronic disease in this population. Information gained from this study will contribute to the evidence base on the management of adults waiting for hip and knee arthroplasty.

Trial registration

Australian New Zealand Clinical Trials Registry, ACTRN12617000357358. Registered on 8 March 2017.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2808-z) contains supplementary material, which is available to authorized users.

Women, their Offspring and iMproving lifestyle for Better cardiovascular health of both (WOMB project): a protocol of the follow-up of a multicentre randomised controlled trial

INTRODUCTION

Women, their Offspring and iMproving lifestyle for Better cardiovascular health of both (WOMB) project is the follow-up of the LIFEstyle study, a randomised controlled trial in obese infertile women, and investigates the effects of a preconception lifestyle intervention on later health of women (WOMB women) and their children (WOMB kids).

METHODS AND ANALYSIS

Obese infertile women, aged between 18 and 39 years, were recruited in 23 Dutch fertility clinics between June 2009 and June 2012. The 284 women allocated to the intervention group received a 6-month structured lifestyle programme. The 280 women in the control group received infertility care as usual. 4 to 7 years after inclusion in the trial, all women (n=564) and children conceived during the trial (24 months after randomisation) (n=305 singletons and age 3-5 years) will be approached to participate in this follow-up study (starting in 2015). The main focus of outcome will be cardiovascular health, but the dataset comprises a wide range of physical and mental health measures, diet and physical activity measures, child growth and development measures, biological samples and genetic and epigenetic information. The follow-up assessment consists of three stages that take place between 2016 and 2018, and includes (online) questionnaires, accelerometry and physical and behavioural measurements in a mobile research vehicle. A subsample of 100 women and 100 children are planned for cardiac ultrasound measurements.

ETHICS AND DISSEMINATION

The protocol of this follow-up study is approved by the local medical ethics committee (University Medical Centre Groningen). Study findings of the WOMB project will be widely disseminated to the scientific community, healthcare professionals, policy makers, future parents and general public.

TRIAL REGISTRATION NUMBER

The original LIFEstyle study is registered at The Netherlands Trial Registry (number 1530).

Associations between body mass index and mortality or cardiovascular events in a general Korean population

Background/Objectives

The relationship between body mass index (BMI) and mortality remains controversial. Furthermore, the association between BMI and cardiovascular events (CVE) is not conclusive and may differ by ethnicity. We aimed to estimate the associations between the BMI and mortality or cardiovascular disease in a general Korean population.

Subjects/Methods

This study was based on a sample cohort database released by the Korean National Health Insurance Service. We analyzed a total of 415,796 adults older than 30 years of age who had undergone a national health examination at least once from 2002 to 2012. Hazard ratios for death and cardiovascular events were calculated using Cox proportional hazards models.

Results

For both men and women, BMI and overall mortality showed a U-shaped association, with the lowest mortality rate among those with a BMI of 25–27.4 kg/m². Compared with them, subjects with a BMI ≥ 30kg/m², men with a BMI < 25 kg/m², and women with a BMI < 22.5 kg/m² showed significantly higher overall mortality. Additionally, men with a BMI < 22.5 kg/m² and women with a BMI < 20 kg/m² displayed an increased risk of cardiovascular mortality. Unlike the mortality trend, the CVD events trend showed a linearly positive association. The risk of a CVE was the lowest in men with a BMI ranging from 20 to 22.4 kg/m² and in women with a BMI < 20 kg/m².

Conclusions

The BMI showed a U-shaped association with overall mortality, where slightly obese subjects showed the lowest rate of mortality. The CVE exhibited a linear association with the BMI, where the lowest risk was observed for normal weight subjects in a general Korean population.

Obesity and risk of death or dialysis in younger and older patients on specialized pre-dialysis care

Background

Obesity is associated with increased mortality and accelerated decline in kidney function in the general population. Little is known about the effect of obesity in younger and older pre-dialysis patients. The aim of this study was to assess the extent to which obesity is a risk factor for death or progression to dialysis in younger and older patients on specialized pre-dialysis care.

Method

In a multicenter Dutch cohort study, 492 incident pre-dialysis patients (>18y) were included between 2004–2011 and followed until start of dialysis, death or October 2016. We grouped patients into four categories of baseline body mass index (BMI): <20, 20–24 (reference), 25–29, and ≥30 (obesity) kg/m² and stratified patients into two age categories (<65y or ≥65y).

Results

The study population comprised 212 patients younger than 65 years and 280 patients 65 years and older; crude cumulative risk of dialysis and mortality at the end of follow-up were 66% and 4% for patients <65y and 64% and 14%, respectively, for patients ≥65y. Among the <65y patients, the age-sex standardized combined outcome rate was 2.3 times higher in obese than those with normal BMI, corresponding to an excess rate of 35 events/100 patient-years. After multivariable adjustment the hazard ratios (HR) (95% CI) for the combined endpoint by category of increasing BMI were, for patients <65y, 0.92 (0.41–2.09), 1 (reference), 1.76 (1.16–2.68), and 1.81 (1.17–2.81). For patients ≥65y the BMI-specific HRs were 1.73 (0.97–3.08), 1 (reference), 1.25 (0.91–1.71) and 1.30 (0.79–1.90). In the competing risk analysis, taking dialysis as the event of interest and death as a competing event, the BMI-specific multivariable adjusted subdistribution HRs (95% CI) were, for patients <65y, 0.90 (0.38–2.12), 1 (reference), 1.47 (0.96–2.24) and 1.72 (1.15–2.59). For patients ≥65y the BMI-specific SHRs (95% CI) were 1.68 (0.93–3.02), 1 (reference), 1.50 (1.05–2.14) and 1.80 (1.23–2.65).

Conclusion

We found that obesity in younger pre-dialysis patients and being underweight in older pre-dialysis patients are risk factors for starting dialysis and for death, compared with those with a normal BMI.

Obesity paradox in heart failure patients - Female gender characteristics-KAMC-single center experience

Background/Introduction

The correlation between low body mass index (BMI) and congestive heart failure (obesity paradox) has been described in the literature; However, the association between BMI and clinical outcome measures is not well characterized. Little is known about CHF in the Middle Eastern female population; most of the gender-specific information on heart failure comes from higher income “Western” countries.

Objectives

We aimed to identify the correlation between heart failure patients especially those with low BMI and clinical/safety outcome measures with focusing on female patients subgroup characteristics.

Methods

We performed group comparisons of statistically relevant variables using prospectively collected data of HFrEF patients hospitalized over a 12 month period.

Results

The 167 patients (Group I) enrolled by this study with mean age of 59.64 ± 12.9 years, an EF score of 23.96 ± 10.14, 62.9% had ischemic etiology, 12.5% were smoker, 18% had AF, 31.1% had received ICD/CRT-D and an estimated 8.85 ± 9.5 days length of stay (LOS). The low BMI group of patients (Group II) had means age of 58.7 ± 14.5 years, a significant lower EF score of 20.32 ± 8.58, significantly higher 30, 90 days readmission rates and in-house mortality (22%, 36.6% and 17.1% vs 10.2%, 20.4% and 6.6% respectively) and higher rates of CVA, TIA and unexplained syncope (19.5% vs 7.2%). Similarly, female patients with low BMI (Group IV) had lower EF score of 22.0 ± 53, higher 30,90 days readmission rates and in-house mortality (34.4%,43.8% and 25% vs 13.5%,21.6% and 5.4% respectively) and higher rates of CVA, TIA and unexplained syncope(10% vs 0%).

Conclusion

Our findings showed that heart failure patients with low BMI had poor adverse clinical outcome measures (poor EF, recurrent readmission, mortality and composite rates of CVA, TIA and unexplained syncope) which reflect the effect of obesity paradox in those patients with HFrEF. Female patient subgroup showed similar characteristic findings which also might reflect the value of gender-specific BMI related clinical outcomes.

The effect of ongoing feedback on physical activity levels following an exercise intervention in older adults: a randomised controlled trial protocol

Background

Physical inactivity ranks as a major contributing factor in the development and progression of chronic disease. Lifestyle interventions reduce the progression of chronic disease, however, compliance decreases over time and health effects only persist as long as the new lifestyle is maintained. Telephone counselling (TC) is an effective way to provide individuals with ongoing support to maintain lifestyle changes. Remote physical activity monitoring and feedback (RAMF) via interactive technologies such as activity trackers and smartphones may be a cost-effective alternative to TC, however, this comparison has not been made. This study, therefore, aims to determine the effect of ongoing feedback (TC vs. RAMF) on the maintenance of physical activity following a 12-week individualised lifestyle program, and the effect of this on health risk factors and health services usage.

Methods and design

A randomised controlled trial with a parallel groups design. A total of 150 adults (≥60 years) who participate in a 12-week face-to-face individualised lifestyle program will be randomised to twelve months of RAMF (n = 50), TC (n = 50), or usual care (n = 50). Participants randomised to RAMF will use a smartphone activity tracker app, synced to a wrist worn activity tracker, to provide them with automated feedback regarding compliance to prescribed activity targets. Telephone counselling involves a follow-up phone call every fortnight for the first three months and a monthly call for the remaining nine months of the follow-up period.

The primary outcome measures are physical activity compliance (accelerometry and Active Australia survey). Secondary outcome measures include cardiorespiratory fitness, muscle strength, dynamic balance, quality of life, blood pressure, body composition, and health services usage. Measures will be made before and after the individualised lifestyle program, and at three, six and twelve months during the intervention.

Discussion

The results of this study will help to determine the efficacy of RAMF devices on compliance to prescribed physical activity compared to the current gold standard of TC. If the remote monitoring proves effective, it may provide a cost efficient alternative method of assisting maintenance of behaviour change from lifestyle interventions.

Trial registration

ACTRN12615001104549. Retrospectively Registered 20/10/2015.

Comparison of body mass index with abdominal obesity for identifying elevated blood pressure in children and adolescents: The SNEC study

Body mass index (BMI) and waist circumference (WC) are two common ways to measure obesity. There is a debate, however, about which of these two measures are more closely associated with elevated blood pressure (BP). The aim of this study is to investigate the prevalence of obesity and whether BMI and WC is better associated with elevated BP in children and adolescents. A representative sample of 8613 Chinese youth aged 7-17 years from seven cities in Northeastern China was selected and measurements of height, weight, WC, BP were taken from 2012 to 2013. The average age of the children was 11.3±2.3years. The prevalence of overweight/obese and abdominal obesity in the subjects was 35% and 44.8%, respectively. We found that both BMI and WC were significantly associated with elevated BP. An increase of 1kgm^-2 in BMI was associated with a 1.10 (1.08-1.12, 95% CI) increased risk of an elevated BP diagnosis in boys, and a 1.14 (1.11-1.16, 95% CI) increased risk in girls. Meanwhile, a 1cm increase in WC correlated with a 1.03 (1.02-1.04, 95% CI) and a 1.05 (1.04-1.06, 95% CI) increased risk of higher BP in boys and girls, respectively. Compared to the normal-weight youth, subjects with elevated BMI (BMI>85th) had higher risk of elevated BP (OR: 2.42, 95% CI: 2.13-2.75) than that of in elevated WC participants (OR: 2.00, 95% CI: 1.77-2.27). Therefore, BMI may associate better with elevated BP than WC in Chinese youth in our Seven Northeastern Cities study.

Serum γ-glutamyltranspeptidase and oxidative stress in subjectively healthy women: an association with menopausal stages

BACKGROUND

Gamma-glutamyltransferase (γ-GT) is used as a marker of alcohol-related pathology, while γ-GT is recently considered to be an oxidative stress marker.

AIM

The present study aimed to investigate the correlation between the oxidative status and γ-GT levels, in association with menopausal stages.

METHODS

In total, 252 women, who were subjectively healthy, were divided into three groups: premenopausal, perimenopausal, and postmenopausal. The circulating oxidative status was evaluated by the diacron-reactive oxygen metabolite (d-ROM) test. In addition to serum γ-GT, routine blood investigations, including lipid, glucose, and inflammatory parameters, were performed.

RESULTS

The median γ-GT level was 17 U/L and the mean d-ROM level was 335 Carr U in all subjects. On multiple regression analysis, independent significant positive correlations were observed between d-ROM and high-sensitivity CRP levels in three groups, while there was a significant positive correlation between d-ROM and γ-GT levels only in the premenopausal group but not in the perimenopausal and postmenopausal groups.

DISCUSSION

The significant relationship between d-ROM and γ-GT at active estrogen stage may indicate a different oxidative stress condition by memopausal stage. The reasons of this relationship should be further explored.

CONCLUSION

A positive relationship between d-ROM and γ-GT levels, both as known as oxidative stress-related markers, could exist in premenopausal women.

Correlation of adiposity indices with cardiovascular disease risk factors in healthy adults of Singapore: a cross-sectional study

Background

Obesity has long been highlighted for its association with increased incidence of cardiovascular disease (CVD). Nonetheless, the best adiposity indices to evaluate the CVD risk factors remain contentious and few studies have been performed in Asian populations. In the present study, we compared the association strength of percent body fat (PBF) to indirect anthropometric measures of general adiposity (body mass index (BMI) and body adiposity index (BAI)) and central adiposity (waist circumference (WC), and waist-to-hip ratio (WHR)) for the prediction of CVD risk factors in healthy men and women living in Singapore.

Methods

A total of 125 individuals (63 men and 62 women) took part in this study. PBF was measured by using three different techniques, including bioelectrical impedance analysis (BIA), BOD POD, and dual-energy X-ray absorptiometry (DEXA). Anthropometric measurements (WC, hip circumference (HC), height, and weight), fasting blood glucose (FBG), fasting serum insulin (FSI), and lipid profiles were determined according to standard protocols. Correlations of anthropometric measurements and PBF with CVD risk factors were compared.

Results

Irrespective of the measuring techniques, PBF showed strong positive correlations with FSI, HOMA-IR, TC/HDL, TG/HDL, and LDL/HDL in both genders. While PBF was highly correlated with FBG, SBP, and DBP in females, no significant relationships were observed in males. Amongst the five anthropometric measures of adiposity, BAI was the best predictor for CVD risk factors in female participants (r = 0.593 for HOMA-IR, r = 0.542 for TG/HDL, r = 0.474 for SBP, and r = 0.448 for DBP). For males, the combination of WC (r = 0.629 for HOMA-IR, and r = 0.446 for TG/HDL) and WHR (r = 0.352 for SBP, and r = 0.366 for DBP) had the best correlation with CVD risk factors.

Conclusion

Measurement of PBF does not outperform the simple anthropometric measurements of obesity, i.e. BAI, WC, and WHR, in the prediction of CVD risk factors in healthy Asian adults. While measures of central adiposity (WC and WHR) tend to show stronger associations with CVD risk factors in males, measures of general adiposity (BAI) seems to be the best predictor in females. The gender differences in the association between adiposity indices and CVD risk factors may relate to different body fat distribution in males and females living in Singapore. These results may find further clinical utility to identify patients with CVD risk factors in a more efficient way.

Electronic supplementary material

The online version of this article (doi:10.1186/s40608-016-0114-4) contains supplementary material, which is available to authorized users.

Conicity Index and Waist-to-Hip Ratio Are Superior Obesity Indices in Predicting 10-Year Cardiovascular Risk Among Men and Women

BACKGROUND

Central obesity has been recognized as a main risk factor for cardiovascular (CV) events. Three popular central obesity indices are waist circumference, waist-to-hip ratio (WHR), and waist-to-height ratio; abdominal volume index and conicity index are 2 recent novel obesity indices. The main aim of this study is to determine the performance of these indices to best predict 10-year CV events.

HYPOTHESIS

Some obesity indices can be used to predict cardiovascular risk.

METHODS

In total, 3199 subjects (age range, 40-79 years) were enrolled in this cross-sectional study. The American College of Cardiology/American Heart Association and Framingham risk score tools were used to estimate the 10-year CV events. Receiver operating characteristic curve analysis was used to determine the optimal discriminator(s) among the central obesity measures in the estimation of a 10-year risk of CV events ≥7.5%, ≥10%, and ≥20% separately.

RESULTS

Among the 5 central obesity indices, conicity index showed the most discriminatory power in estimation of a 10-year CV risk. In men, based on the American College of Cardiology/American Heart Association tool, the areas under the curve (AUCs) were from 0.671 to 0.682 based on the 3 above thresholds, whereas with the Framingham tool, AUCs were from 0.651 to 0.659. In women, all AUCs were >0.7. Our results also showed WHR to be an almost comparable discriminator of CV disease risk in the Iranian study population.

CONCLUSION

Conicity index and WHR had a more discriminatory accuracy for 10-year CV events compared with the other obesity indices.

Body mass index and anxiety/depression as mediators of the effects of child sexual and physical abuse on physical health disorders in women

The relation between childhood sexual abuse (CSA) and physical health disorders in adulthood, and what factors may serve as mediators, remains poorly understood. Using data from the 2007 Adult Psychiatric Morbidity Survey (N=3,486), we tested whether CSA was associated with physical health disorders in adult women and if mediated effects via body mass index (BMI), anxiety/depression, alcohol dependence, and smoking were present. Compared to women with no CSA, women who had experienced CSA involving intercourse had more than twice the odds of being obese, more than 3 times the odds of experiencing mental health disorders, more than 4 times the odds of being alcohol dependent, more than 5 times the odds of being drug dependent, and more than 6 times the odds of attempting suicide. Those experiencing both CSA and child physical abuse (CPA) were on average over 11kg heavier than those with neither CSA nor CPA. After controlling for demographics, CPA, and childhood bullying, CSA was associated with the majority of physical health disorders studied (typically 50-100% increases in odds). Evidence was found consistent with mediation by BMI (typically accounting for 5-20% increases in odds) and anxiety/depression (typically accounting for 8-40% increases in odds), in a dose-response manner, for the majority of physical health disorders. Bidirectional relations among these mediators and physical health disorders, and residual confounding, may have led to overestimation of mediation through BMI and anxiety/depression and underestimation of mediation through alcohol/smoking. Relations between both CPA and childhood bullying and physical health disorders in adulthood were also found. Longitudinal studies employing more sensitive measures of potential mediators are now required.

Estimating population attributable fractions to quantify the health burden of obesity

PURPOSE

Obesity is a highly prevalent condition in the United States and elsewhere and is associated with increased mortality and morbidity. Here, we discuss some issues involved in quantifying the health burden of obesity using population attributable fraction (PAF) estimates and provide examples.

METHODS

We searched PubMed for articles reporting attributable fraction estimates for obesity. We reviewed eligible articles to identify methodological concerns and tabulated illustrative examples of PAF estimates for obesity relative to cancer, diabetes, cardiovascular disease, and all-cause mortality.

RESULTS

There is considerable variability among studies regarding the methods used for PAF calculation and the selection of appropriate counterfactuals. The reported estimates ranged from 5% to 15% for all-cause mortality, -0.2% to 8% for all-cancer incidence, 7% to 44% for cardiovascular disease incidence, and 3% to 83% for diabetes incidence.

CONCLUSIONS

To evaluate a given estimate, it is important to consider whether the exposure and outcome were defined similarly for the PAF and for the relative risks, whether the relative risks were suitable for the population at hand, and whether PAF was calculated using correct methods. Strong causal assumptions are not necessarily warranted. In general, PAFs for obesity may be best considered as indicators of association.

Anthropometric measurements of general and central obesity and the prediction of cardiovascular disease risk in women: a cross-sectional study

OBJECTIVES

It is important to ascertain which anthropometric measurements of obesity, general or central, are better predictors of cardiovascular disease (CVD) risk in women. 10-year CVD risk was calculated from the Framingham risk score model, SCORE risk chart for high-risk regions, general CVD and simplified general CVD risk score models. Increase in CVD risk associated with 1 SD increment in each anthropometric measurement above the mean was calculated, and the diagnostic utility of obesity measures in identifying participants with increased likelihood of being above the treatment threshold was assessed.

DESIGN

Cross-sectional data from the National Heart Foundation Risk Factor Prevalence Study.

SETTING

Population-based survey in Australia.

PARTICIPANTS

4487 women aged 20-69 years without heart disease, diabetes or stroke.

OUTCOME MEASURES

Anthropometric obesity measures that demonstrated the greatest increase in CVD risk as a result of incremental change, 1 SD above the mean, and obesity measures that had the greatest diagnostic utility in identifying participants above the respective treatment thresholds of various risk score models.

RESULTS

Waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-stature ratio had larger effects on increased CVD risk compared with body mass index (BMI). These central obesity measures also had higher sensitivity and specificity in identifying women above and below the 20% treatment threshold than BMI. Central obesity measures also recorded better correlations with CVD risk compared with general obesity measures. WC and WHR were found to be significant and independent predictors of CVD risk, as indicated by the high area under the receiver operating characteristic curves (>0.76), after controlling for BMI in the simplified general CVD risk score model.

CONCLUSIONS

Central obesity measures are better predictors of CVD risk compared with general obesity measures in women. It is equally important to maintain a healthy weight and to prevent central obesity concurrently.

Cardiometabolic risk factors and obesity: does it matter whether BMI or waist circumference is the index of obesity?

BACKGROUND

It has been suggested that the cardiometabolic risk associated with excess adiposity is particularly related to central obesity.

OBJECTIVE

The objective was to compare the associations between cardiometabolic risk of apparently healthy individuals and measures of central obesity [waist circumference (WC)] and overall obesity [body mass index (BMI)].

DESIGN

In this cross-sectional, observational study, 492 subjects (306 women and 303 non-Hispanic whites) were classified by BMI (in kg/m²) as normal weight (BMI <25) or overweight/obese (BMI = 25.0-34.9) and as having an abnormal WC (≥80 cm in women and ≥94 cm in men) or a normal WC (<80 cm in women and <94 cm in men). Measurements were also made of the cardiometabolic risk factors age, systolic blood pressure (SBP), and fasting plasma glucose (FPG), triglyceride, and high-density lipoprotein (HDL)-cholesterol concentrations. Associations among cardiometabolic risk factors and BMI and WC were evaluated with Pearson correlations.

RESULTS

There was a considerable overlap in the normal and abnormal categories of BMI and WC, and ~81% of the subjects had both an abnormal BMI and WC. In women, BMI and WC correlated with SBP (r = 0.30 and 0.19, respectively), FPG (r = 0.25 and 0.22, respectively), triglycerides (r = 0.17 and 0.20, respectively), and HDL cholesterol (r = -0.23 and -0.20, respectively) (P < 0.01 for all). In men, BMI and WC also correlated with SBP (r = 0.22 and 0.22, respectively), FPG (r = 0.22 and 0.25, respectively), triglycerides (r = 0.21 and 0.18, respectively), and HDL cholesterol (r = -0.20 and -0.13, respectively) [P < 0.05 for all, except for the association of WC with HDL cholesterol (P = 0.08)].

CONCLUSIONS

Most individuals with an abnormal BMI also have an abnormal WC. Both indexes of excess adiposity are positively associated with SBP, FPG, and triglycerides and inversely associated with HDL cholesterol.

The obesity paradox in patients with acute coronary syndrome: results from the Gulf RACE-2 study

We investigated the association between in-hospital and peri-hospital mortality and body mass index (BMI)/waist circumference (WC) in a prospective acute coronary syndrome (ACS) registry in the Arabian Gulf. No significant associations with in-hospital mortality were found. Normal BMI had highest peri-hospital mortality, notably those with high WC. In logistic regression of mortality on obesity measures and potential confounders, the effects of obesity measures were no longer significant. In-hospital death increased by 5% with age and decreased by 42% in males. Mortality increased 3.7-fold with ST-elevation myocardial infarction (STEMI) and 3.0-fold with heart failure (HF) but decreased by 33% with dyslipidemia. Peri-hospital death increased by 4% with age and decreased by 30% in males. Mortality increased 2.8-fold with STEMI and 2.4-fold with HF. In- and peri-hospital mortality in ACS is significantly associated with age, gender, STEMI, HF, and dyslipidemia but not obesity measures.

The relation of body mass index and abdominal adiposity with dyslipidemia in 27 general populations of the WHO MONICA Project

BACKGROUND AND AIMS

The association between adiposity measures and dyslipidemia has seldom been assessed in a multipopulational setting.

METHODS AND RESULTS

27 populations from Europe, Australia, New Zealand and Canada (WHO MONICA project) using health surveys conducted between 1990 and 1997 in adults aged 35-64 years (n = 40,480). Dyslipidemia was defined as the total/HDL cholesterol ratio >6 (men) and >5 (women). Overall prevalence of dyslipidemia was 25% in men and 23% in women. Logistic regression showed that dyslipidemia was strongly associated with body mass index (BMI) in men and with waist circumference (WC) in women, after adjusting for region, age and smoking. Among normal-weight men and women (BMI<25 kg/m(2)), an increase in the odds for being dyslipidemic was observed between lowest and highest WC quartiles (OR = 3.6, p < 0.001). Among obese men (BMI ≥ 30), the corresponding increase was smaller (OR = 1.2, p = 0.036). A similar weakening was observed among women. Classification tree analysis was performed to assign subjects into classes of risk for dyslipidemia. BMI thresholds (25.4 and 29.2 kg/m(2)) in men and WC thresholds (81.7 and 92.6 cm) in women came out at first stages. High WC (>84.8 cm) in normal-weight men, menopause in women and regular smoking further defined subgroups at increased risk.

CONCLUSION

standard categories of BMI and WC, or their combinations, do not lead to optimal risk stratification for dyslipidemia in middle-age adults. Sex-specific adaptations are necessary, in particular by taking into account abdominal obesity in normal-weight men, post-menopausal age in women and regular smoking in both sexes.

A primary estimation of the cardiometabolic risk by using artificial neural networks

Estimation of the cardiometabolic risk (CMR) has a leading role in the early prevention of atherosclerosis and cardiovascular diseases. The CMR estimation can be separated into two parts: primary estimation (PE-CMR) that includes easily-obtained, non-invasive and low-cost diagnostic methods and secondary estimation (SE-CMR) involving complex, invasive and/or expensive diagnostic methods. This paper presents a PE-CMR solution based on artificial neural networks (ANN) as it would be of great interest to develop a procedure for PE-CMR that would save time and money by extracting the persons with potentially higher CMR and conducting complete SE-CMR tests only on them. ANN inputs are values obtained by using PE-CMR methods, i.e. primary risk factors: gender, age, waist-to-height ratio, body mass index, systolic and diastolic blood pressures. ANN output is cmr-coefficient obtained from the number of disturbances in biochemical indicators, i.e. secondary risk factors: HDL-, LDL- and total cholesterol, triglycerides, glycemia, fibrinogen and uric acid. ANN training and testing are done by dataset that includes 1281 persons. The accuracy of our solution is 82.76%.

Effect of Lactobacillus gasseri BNR17 on Overweight and Obese Adults: A Randomized, Double-Blind Clinical Trial

Background

Lactobacillus gasseri BNR17 is a type of probiotic strain isolated from human breast milk. A study was reported regarding the fact that BNR17 was an inhibitor of obesity and diabetic activities in the human body through previous animal experiments. This study was furthered to investigate the effect of BNR17, a probiotic strain isolated from human breast milk, on obese and overweight adults.

Methods

Sixty-two obese volunteers aged 19 to 60 with body mass index ≥ 23 kg/m² and fasting blood sugar ≥ 100 mg/dL participated in a placebo controlled, randomized, and double-blind trial. For 12 weeks, 57 participants were given either placebo or BNR17 and were tested by measuring body fat, body weight, various biochemical parameters, vital signs, and computed tomography at the start of the study and at weeks 4, 8, and 12. The subjects assumed usual daily activities without having to make behavioral or dietary modifications during the course of the study.

Results

At the 12th week, a slight reduction in body weight was noted in the BNR17 group, but there were no significant weight changes between groups. Decrease of waist and hip circumferences in the BNR17 group was more pronounced than those in the placebo group. The two groups had no special or severe adverse reactions.

Conclusion

Despite there being no change in behavior or diet, administration of only the supplement of BNR17 reduced weight and waist and hip circumference. However, there were no significant differences between the two groups. These findings warrant a subsequent longer-term prospective clinical investigation with a large population.

Screening South Asians for type 2 diabetes and prediabetes: (1) comparing oral glucose tolerance and haemoglobin A1c test results and (2) comparing the two sets of metabolic profiles of individuals diagnosed with these two tests

BACKGROUND

The glycated haemoglobin A1c (HbA1c) level may be used for screening for type 2 diabetes and prediabetes instead of a more burdensome oral glucose tolerance test (OGTT). However, among the high-risk South Asian population, little is known about the overlap of the methods or about the metabolic profiles of those disconcordantly diagnosed.

METHODS

We included 944 South Asians (18-60 years old), whom we screened with the HbA1c level and the OGTT in The Hague, the Netherlands. We calculated the area under the receiver-operator characteristic curve (AUROC) with a 95% confidence interval of HbA1c using the American Diabetes Association classifications, and determined the sensitivity and specificity with 95% confidence intervals at different thresholds. Moreover, we studied differences in metabolic characteristics between those identified by HbA1c and by the OGTT alone.

RESULTS

The overlap between HbA1c and OGTT classifications was partial, both for diabetes and prediabetes. The AUROC of HbA1c for OGTT defined diabetes was 0.86 (0.79-0.93). The sensitivity was 0.46 (0.29-0.63); the specificity 0.98 (0.98-0.99). For prediabetes, the AUROC was 0.73 (0.69-0.77). Each of the 31 individuals with diabetes and 353 with prediabetes identified with the HbA1c level had a high body mass index, large waist circumference, high blood pressure, and low insulin sensitivity, all of which were similar to the values shown by those among the 19 with diabetes or 62 with prediabetes who only met the OGTT criteria, but not the HbA1c criteria.

CONCLUSIONS

The HbA1c level identified a partially different group than the OGTT did. However, both those identified with the HbA1c level and those identified with the OGTT alone were at increased metabolic risk.

TRIAL REGISTRATION

Dutch Trial Register: NTR1499.

Waist circumference a good indicator of future risk for type 2 diabetes and cardiovascular disease

Background

Abdominal obesity is a more important risk factor than overall obesity in predicting the development of type 2 diabetes and cardiovascular disease. From a preventive and public health point of view it is crucial that risk factors are identified at an early stage, in order to change and modify behaviour and lifestyle in high risk individuals.

Methods

Data from a community based study was used to assess the risk for type 2 diabetes, cardiovascular disease and prevalence of metabolic syndrome in middle-aged men. In order to identify those with increased risk for type 2 diabetes and/or cardiovascular disease sensitivity and specificity analysis were performed, including calculation of positive and negative predictive values, and corresponding 95% CI for eleven different cut-off points, with 1 cm intervals (92 to 102 cm), for waist circumference.

Results

A waist circumference ≥94 cm in middle-aged men, identified those with increased risk for type 2 diabetes and/or for cardiovascular disease with a sensitivity of 84.4% (95% CI 76.4% to 90.0%), and a specificity of 78.2% (95% CI 68.4% to 85.5%). The positive predictive value was 82.9% (95% CI 74.8% to 88.8%), and negative predictive value 80.0%, respectively (95% CI 70.3% to 87.1%).

Conclusions

Measurement of waist circumference in middle-aged men is a reliable test to identify individuals at increased risk for type 2 diabetes and cardiovascular disease. This measurement should be used more frequently in daily practice in primary care in order to identify individuals at risk and when planning health counselling and interventions.

Do obesity and parental history of myocardial infarction improve cardiovascular risk prediction?

BACKGROUND

In clinical practice, individuals at increased risk of cardiovascular diseases (CVD) are identified on the basis of age, sex, smoking, blood pressure, and serum total and high-density lipoprotein cholesterol. We examined whether CVD risk prediction improved when obesity (body mass index ≥30 kg/m(2)) and premature (<70 years) parental myocardial infarction (MI) were added to the classical risk factor model.

METHODS

Risk factors were measured in 1993-97 in 12,818 participants (53% female) aged 35-65 in the Dutch MORGEN project. Cases of fatal and nonfatal CVD during 10 years of follow up were identified through record linkage. Classical risk factor equations, obtained by Cox proportional hazard analysis, were extended with obesity, paternal MI, and maternal MI. We calculated the net reclassification index (NRI), a measure for correct reclassification of subjects, to check improvement in risk prediction using 5 and 10% increments in absolute CVD risk.

RESULTS

A CVD event occurred in 280 men and 140 women. Obesity and maternal MI were positively and significantly related to total CVD after adjustment for classical risk factors (both hazard ratios ∼1.5). Adding obesity and parental MI to CVD risk prediction yielded a significant NRI of 4.5% in men and a non-significant NRI of 2.6% in women when 5% risk categories were used. For 10% categories, the NRIs were slightly larger (5.5% and 3.3%, respectively). The improvements in risk prediction were mainly due to obesity.

CONCLUSION

Modest improvements in CVD risk prediction can be obtained when obesity and, to a lesser extent, parental MI are added to the risk function.

Obesity and mortality risk among younger dialysis patients

BACKGROUND AND OBJECTIVES

Many studies show that obesity in dialysis patients is not strongly associated with mortality but not whether this modest association is constant over age. This study investigated the extent to which the relation of body mass index (BMI) and mortality differs between younger and older dialysis patients.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Adult dialysis patients were prospectively followed from their first dialysis treatment for 7 years or until death or transplantation. Patients were stratified by age (<65 or ≥65 years) and baseline BMI (<20, 20-24 [reference], 25-29, and ≥30 kg/m(2)).

RESULTS

The study sample included 984 patients younger than 65 years and 765 patients 65 years or older; cumulative survival proportions at end of follow-up were 50% and 16%. Age-standardized mortality rate was 1.7 times higher in obese younger patients than those with normal BMI, corresponding to an excess rate of 5.2 deaths/100 patient-years. Mortality rates were almost equal between obese older patients and those with normal BMI. Excess rates of younger and older patients with low compared with normal BMI were 8.7 and 1.1 deaths/100 patient-years. After adjustment for age, sex, smoking, comorbidity, and treatment modality, hazard ratios by increasing BMI were 2.00, 1, 0.95, and 1.57 for younger patients and 1.07, 1, 0.88, and 0.91 for older patients, implying that obesity is a 1.7-fold (95% confidence interval, 1.1- to 2.9-fold) stronger risk factor in younger than older patients.

CONCLUSIONS

In contrast to older dialysis patients, younger patients with low or very high BMI had a substantially elevated risk for death.

Paternal and maternal history of myocardial infarction and cardiovascular diseases incidence in a Dutch cohort of middle-aged persons

BACKGROUND

A positive parental history of myocardial infarction (MI) is an independent risk factor for cardiovascular diseases (CVD). However, different definitions of parental history have been used. We evaluated the impact of parental gender and age of onset of MI on CVD incidence.

METHODS

Baseline data were collected between 1993 and 1997 in 10,524 respondents aged 40-65 years. CVD events were obtained from the National Hospital Discharge Register and Statistics Netherlands. We used proportional hazard models to calculate hazard ratios (HR) and 95% confidence intervals (CI) for CVD incidence and adjusted for lifestyle and biological risk factors.

RESULTS

At baseline, 36% had a parental history of MI. During 10-year follow-up, 914 CVD events occurred. The age and gender adjusted HR was 1.3 (95% CI 1.1-1.5) for those with a paternal MI, 1.5 (1.2-1.8) for those with a maternal MI and 1.6 (1.2-2.2) for those with both parents with an MI. With decreasing parental age of MI, HR increased from 1.2 (1.0-1.6) for age ≥70 years to 1.5 (1.2-1.8) for age <60 years for a paternal MI and from 1.1 (0.9-1.5) to 2.2 (1.6-3.0) for a maternal MI. The impact of having a mother with MI before age 60 significantly differed in women [(2.9 (1.8-4.6)] and men [1.5 (0.9-2.6)]. Adjustment only slightly influenced HRs for maternal MI.

CONCLUSIONS

Respondents with a parental history of MI have an increased CVD incidence, in particular with parental onset of MI before age 70. A maternal history of MI before age 60 was the strongest predictor of CVD incidence.

Metabolically healthy and unhealthy obesity phenotypes in the general population: the FIN-D2D Survey

BACKGROUND

The aim of this work was to examine the prevalence of different metabolical phenotypes of obesity, and to analyze, by using different risk scores, how the metabolic syndrome (MetS) definition discriminates between unhealthy and healthy metabolic phenotypes in different obesity classes.

METHODS

The Finnish type 2 diabetes (FIN-D2D) survey, a part of the larger implementation study, was carried out in 2007. The present cross-sectional analysis comprises 2,849 individuals aged 45-74 years. The MetS was defined with the new Harmonization definition. Cardiovascular risk was estimated with the Framingham and SCORE risk scores. Diabetes risk was assessed with the FINDRISK score. Non-alcoholic fatty liver disease (NAFLD) was estimated with the NAFLD score. Participants with and without MetS were classified in different weight categories and analysis of regression models were used to test the linear trend between body mass index (BMI) and various characteristics in individuals with and without MetS; and interaction between BMI and MetS.

RESULTS

A metabolically healthy but obese phenotype was observed in 9.2% of obese men and in 16.4% of obese women. The MetS-BMI interaction was significant for fasting glucose, 2-hour plasma glucose, fasting plasma insulin and insulin resistance (HOMA-IR)(p < 0.001 for all). The prevalence of total diabetes (detected prior to or during survey) was 37.0% in obese individuals with MetS and 4.3% in obese individuals without MetS (p < 0.001). MetS-BMI interaction was significant (p < 0.001) also for the Framingham 10 year CVD risk score, NAFLD score and estimated liver fat %, indicating greater effect of increasing BMI in participants with MetS compared to participants without MetS. The metabolically healthy but obese individuals had lower 2-hour postload glucose levels (p = 0.0030), lower NAFLD scores (p < 0.001) and lower CVD risk scores (Framingham, p < 0.001; SCORE, p = 0.002) than normal weight individuals with MetS.

CONCLUSIONS

Undetected Type 2 diabetes was more prevalent among those with MetS irrespective of the BMI class and increasing BMI had a significantly greater effect on estimates of liver fat and future CVD risk among those with MetS compared with participants without MetS. A healthy obese phenotype was associated with a better metabolic profile than observed in normal weight individuals with MetS.