Does the relationship between waist circumference, morbidity and mortality depend on measurement protocol for waist circumference?

Adult obesity diagnostic tool: A narrative review

Obesity is a complex chronic metabolic disorder characterized by abnormalities in lipid metabolism. Obesity is not only associated with various chronic diseases but also has negative effects on physiological functions such as the cardiovascular, endocrine and immune systems. As a global health problem, the incidence and prevalence of obesity have increased significantly in recent years. Therefore, understanding assessment methods and measurement indicators for obesity is critical for early screening and effective disease control. Current methods for measuring obesity in adult include density calculation, anthropometric measurements, bioelectrical impedance analysis, dual-energy X-ray absorptiometry, computerized imaging, etc. Measurement indicators mainly include weight, hip circumference, waist circumference, neck circumference, skinfold thickness, etc. This paper provides a comprehensive review of the literature to date, summarizes and analyzes various assessment methods and measurement indicators for adult obesity, and provides insights and guidance for the innovation of obesity assessment indicators.

The association between waist circumference and adult asthma attack using nationally representative samples

AIMS

This study aims to explore the relationship between waist circumference and asthma attack in adults.

METHODS

In this cross-sectional study, we analysed data from 5,530 U.S. adults diagnosed with asthma. Participants were categorized into two groups based on their experience of asthma attacks: with or without asthma attacks. We employed adjusted weighted logistic regression models, weighted restricted cubic splines, subgroup and sensitivity analyses to assess the association between waist circumference and asthma attack.

RESULTS

The median age of all participants was 43 years, and the median waist circumference was 98.9 cm, with a median BMI was 28.50 kg/m2. Participants in the asthma attack group had significantly higher waist circumferences than those in the non-attack group (P < 0.001). After full adjustment for body mass index-defined obesity, age, gender, race, education levels, poverty income ratio levels, smoking status, and metabolic syndrome, every 5 cm increase in waist circumference exhibited a 1.06 times higher likelihood of asthma attack probability. The weighted restricted cubic spline analysis demonstrated an increased risk of asthma attacks with rising waist circumference. Subgroup analyses confirmed this relationship across various groups differentiated by gender, age, and smoking status. When applying a stricter definition of asthma attack, the weighted logistic regression models showed robust association between waist circumference and asthma attack.

CONCLUSION

Waist circumference is an independent predictor of asthma attacks. Our findings underscore the importance of waist circumference measurement in evaluating the risk of asthma attacks.

Association between abdominal adiposity and clinical outcomes in patients with acute ischemic stroke

BACKGROUND

It is unclear whether abdominal adiposity has an additional effect on post-stroke outcomes. This study aimed to determine whether waist circumference (WC) is independently associated with clinical outcomes after acute ischemic stroke.

METHODS

We enrolled patients with acute ischemic stroke from a multicenter hospital-based stroke registry in Fukuoka, Japan. We measured WC on admission and categorized patients into four groups (Q1-Q4) according to the quartiles in females and males. The clinical outcomes were poor functional outcome (modified Rankin scale score 2-6) and death from any cause. Logistic regression analysis was performed to estimate the odds ratio and 95% confidence interval of the outcomes of interest after adjusting for potential confounding factors, including body mass index (BMI).

RESULTS

A total of 11,989 patients (70.3±12.2 years, females: 36.1%) were included in the analysis. The risk of poor functional outcome significantly decreased for Q2-Q4 (vs. Q1) at discharge and Q2-Q3 (vs. Q1) at 3 months, even after adjusting for potential confounders, including BMI. In contrast, adjustment of BMI eliminated the significant association between WC and all-cause death at discharge and 3 months. The association between high WC and favorable functional outcome was not affected by fasting insulin levels or homeostatic model assessment for insulin resistance and was only found in patients without diabetes (P = 0.02 for heterogeneity).

CONCLUSIONS

These findings suggest that abdominal adiposity has an additional impact on post-stroke functional outcome, independent of body weight and insulin action.

Revisiting Waist Circumference: A Hypertension Risk Factor that Requires a More In-depth Understanding

As a major cause of various cardiovascular diseases, the prevalence of hypertension has been increasing in the past 30 years, leading to significant socioeconomic and health burdens. Obesity is one of the major risk factors for hypertension. Body mass index (BMI) is the most used anthropometric index to measure obesity in clinical practice and to assess the risk of obesity-related diseases. However, obesity is a heterogeneous disease, and the accumulation of fat in different body regions leads to differences in cardiovascular and metabolic risks. BMI only reflects the overall obesity but does not consider the distribution of fat and muscle mass. The limitation of BMI makes it insufficient to assess the risk of hypertension attributed to obesity. In addition, waist circumference is an easily obtainable anthropometric index to evaluate abdominal fat distribution. High waist circumference is an independent risk factor for various cardiovascular diseases and all-cause mortality regardless of BMI. Preliminary data indicate that waist circumference is significantly associated with the risk of hypertension at different BMI levels. However, routine measurement of waist circumference is currently not required in current clinical guidelines or is only recommended for obese populations, indicating an insufficient understanding of waist circumference. In this review, we summarize the measurement methods and diagnostic thresholds of waist circumference for abdominal obesity, the trend of central obesity prevalence, the superiority of waist circumference over other anthropometric indices, and recent cross-sectional and longitudinal studies on the association between obesity and hypertension.

Muscular Adaptations to Concurrent Resistance Training and High-Intensity Interval Training in Adults with Type 2 Diabetes: A Pilot Study

This pilot study aimed to compare the effects of eight weeks of concurrent resistance training (RT) and high-intensity interval training (HIIT) vs. RT alone on muscle performance, mass and quality in adults with type 2 diabetes (T2DM). Twelve T2DM adults were randomly allocated to the RT + HIIT (n = 5) or RT (n = 7) group. Before and after training, maximal oxygen uptake (VO2max), muscle strength and power were evaluated by calorimetry, dynamometry and one-repetition maximum (1RM) test. Quadriceps muscle volume was determined by MRI, and muscle quality was estimated. After RT, VO2max (+12%), knee muscle power (+20%), quadriceps muscle volume (+5.9%) and quality (leg extension, +65.4%; leg step-up, +223%) and 1RM at leg extension (+66.4%), leg step-up (+267%), lat pulldown (+60.9%) and chest press (+61.2%) significantly increased. The RT + HIIT group improved on VO2max (+27%), muscle volume (+6%), muscle power (+9%) and 1RM at lat pulldown (+47%). No other differences were detected. Among groups, changes in muscle quality at leg step-up and leg extension and VO2max were significantly different. The combination of RT and HIIT effectively improves muscle function and size and increases cardiorespiratory fitness in adults with T2DM. However, HIIT combined with RT may interfere with the development of muscle quality.

Body mass index combined with (waist + hip)/height accurately screened for normal-weight obesity in Chinese young adults

OBJECTIVES

Only a few studies have explored the prevalence of normal-weight obesity in young adults or the development of a simple evaluation index for body fat percentage. Therefore, this study aimed to examine the prevalence of normal-weight obesity in young Chinese adults and use anthropometric measurements to develop an evaluation index.

METHODS

In total, 1322 college students participated in the study and were divided into the normal-weight lean, normal-weight obese, and overweight and obese groups based on their body mass index and body fat percentage. The differences in body composition, circumference, and circumference ratio among these three groups were examined.

RESULTS

When exploring the correlation between the circumference ratio and body fat percentage, the circumference ratio was suitable for early screening of abnormal body fat percentage, and the cutoff value was calculated. Body composition and circumference were significantly different among the three groups: (waist + hip)-to-height, hip-to-height, and waist-to-height ratios were strongly correlated with body fat percentage.

CONCLUSIONS

(Waist + hip)-to-height ratio can be used as a simple evaluation index for indicating abnormal body fat percentage when higher than 1.032 in male and 1.047 in female individuals. Downregulating the normal upper limit for body mass index to 24.4 and 23.8 kg/m² in male and female individuals, respectively, is recommended. Body mass index combined with (waist + hip)-to-height ratio allowed for more accurate screening of normal-weight obesity as an easy and cost-free evaluation measure for abnormal body fat percentage.

Association between obesity indicators and cardiometabolic disease in Chinese adults

BACKGROUND

Obesity is an established risk factor for cardiometabolic disease. Different measurements of obesity with cardiometabolic disease have been compared in recent studies in Western countries. However, obesity-related criteria for the Chinese population differ from the standard World Health Organization guidelines, and similar research in Chinese adults is limited.

MEASURES

Data were obtained from a comprehensive intervention project involving a community population with cardiovascular and cerebrovascular risk factors in Shenzhen in 2015. A total of 4,000 participants (1,605 men and 2,395 women) with a mean age of 56.01±9.78 years were included in this study. Categorical data are reported as percentages, and continuous data are reported as mean ± standard deviation. Logistic regression analyses were conducted to examine the associations of body mass index (BMI), waist circumference (WC), and neck circumference (NC) with hypertension, diabetes, and dyslipidemia among Chinese adults.

RESULTS

The participants had a mean BMI of 24.25±3.33 kg/m2, mean NC of 33.59±4.16 cm, and mean WC of 82.44±9.84 cm (men: 85.46±9.10 cm, women: 80.40±9.81 cm). Blood pressure, plasma glucose, and lipid levels in the BMI, WC, and NC groups were statistically significant (p < 0.05). BMI, WC, and NC were positively correlated with systolic blood pressure, diastolic blood pressure, fasting plasma glucose, total cholesterol, and triglyceride and negatively correlated with low-density lipoprotein cholesterol (p < 0.05), while the risk of hypertension, diabetes, and dyslipidemia increased with an increase in BMI, WC, and NC (p < 0.05). One SD of BMI, WC, and NC resulted in an increase of 41%, 22%, and 31% risk of hypertension; 45%, 34%, and 47% risk of diabetes; and 37%, 32%, and 23% risk of dyslipidemia, respectively.

CONCLUSIONS

Compared to BMI and NC, WC was more strongly associated with cardiometabolic diseases in Chinese adults.

Outdoor gyms and physical function: A cross-sectional comparative study between active and sedentary older adults

Outdoor gyms (OG) are public places designed for physical activity, especially for older adults. This is a cross-sectional study that aimed to compare morphofunctional characteristics of sedentary and active older adults regarding OG. The participants consisted of 194 older people divided into three groups: sedentary (n = 76, mean age = 70.5 ± 6.4 years, 38.7% male); OG + walking (n = 86; mean age = 69 ± 6.1 years; male 50.6%); and OG (n = 32; mean age = 70.3 ± 8.3 years; male 56.3%). Socioeconomic and morphofunctional characteristics, anthropometric measurements, body composition, and functional tests were collected. For comparison among groups ANOVA, for categorical variables the chi-square test or Fisher's exact test, and to verify factors related to gait speed logistic regression were used. We found that sedentary older adults had lower educational level and lower prevalence of polypharmacy. OG + walking participants had lower waist circumference and fat percentage, and better gait speed. Older people in the OG + walking were less likely to show gait difficulty (i.e., <1.0 m/s) in reference to the sedentary group. In addition, strength and better performance on the Timed Up and Go were also associated with gait speed >1 m/s. It is understood that the higher volume of physical activity performed by OG + walking may be one of the reasons why they obtained better indicators in health aspects. The findings, especially regarding the characterization of profiles of older adults who use OG, leads to the definition of public policies aimed at the real needs of this public.

Influence of Waist Circumference Measurement Site on Visceral Fat and Metabolic Risk in Youth

Although the rate of childhood obesity seems to have plateaued in recent years, the prevalence of obesity among children and adolescents remains high. Childhood obesity is a major public health concern as overweight and obese youth suffer from many co-morbid conditions once considered exclusive to adults. It is now well demonstrated that abdominal obesity as measured by waist circumference (WC) is an independent risk factor for cardiovascular disease and metabolic dysfunction in youth. Despite the strong associations between WC and cardiometabolic risk factors, there is no consensus regarding the optimal WC measurement sites to assess abdominal obesity and obesity-related health risk in children and adolescents. Currently, the WC measurement site that provides the best reflections of visceral fat and the best correlations with cardiometabolic risk factors is unclear. The purpose of this review is to explore whether WC measurement sites influence the relationships between WC, visceral fat, and cardiometabolic risk factors in children and adolescents.

Combined body mass index and abdominal obesity, lifestyle and health in a Norwegian adult population: a cross-sectional study

Aim

This study aimed to determine the prevalence of combined body mass index and waist circumference (BMI-WC) disease risk categories in a Norwegian adult population aged 18–51 years and describe selected health indicators (lifestyle factors, medical conditions, self-perceived health and high sensitive serum C-reactive protein (hs-CRP)) within these categories.

Subjects and methods

A sample of 1318 adults (aged 18–51 years) answered a comprehensive questionnaire covering lifestyle factors, medical conditions, self-perceived health and background variables in the population-based cross-sectional Telemark study, Norway, 2014–2015. BMI, WC and hs-CRP were determined as part of a broader medical examination. Four combined BMI-WC risk categories were constructed, based on recommendations provided by the US National Institutes of Health (NIH), and associations with health indicators examined using multiple logistic regression analyses.

Results

More than half of the participants represented combined BMI-WC categories with elevated disease risk (27% with increased risk, 11% with high risk and 19% with very high risk). Unfavourable health indicators (low physical activity, cardiovascular disease (CVD) history, physician-diagnosed high blood pressure and diabetes, lowered self-perceived health and elevated hs-CRP) increased in line with BMI-WC disease risk. Associations were observed independent of gender, age, education level and residential area.

Conclusion

The findings highlight the importance of using both BMI categories and WC for personalised assessment of obesity-related risk and need for follow-up. The findings are considered relevant to public health intervention programmes targeting adults with overweight and obesity. Follow-up studies are warranted to study morbidity development in the BMI-WC risk categories.

Accuracy of Waist Circumference Measurement using the WHO versus NIH Protocol in Predicting Visceral Adiposity Using Bioelectrical Impedance Analysis among Overweight and Obese Adult Filipinos in a Tertiary Hospital

Objectives

The study aimed to compare the performance of weight circumference (WC) measurement using the World Health Organization (WHO) versus National Institutes of Health (NIH) protocol in identifying visceral adiposity, and to determine the association of WC with cardiometabolic risk factors among overweight and obese adult Filipinos.

Methodology

A retrospective study involving 221 subjects (99 males, 122 females) evaluated at an outpatient weight intervention center of a tertiary hospital. The WC was measured at the superior border of the iliac crest (WC-NIH) and midway between the lowest rib and the iliac crest (WC-WHO) for each patient. Using visceral fat rating (VF) derived via bioelectrical impedance analysis (BIA) as reference standard, diagnostic accuracy tests for both protocols (using cut-offs of ≥90 cm in males and ≥80 cm in females) were done. Cardiometabolic parameters were also obtained, and binary logistic regression was performed to determine associations with WC.

Results

Among males, WC-WHO had 96% sensitivity (95% CI 88.8%-99.2%) and 25% specificity (95% CI 9.77%-46.7%) while WC-NIH had 94.7% sensitivity (95% CI 86.9%-98.5%) and 29.2% specificity (95% CI 12.6%-51.1%) to predict high VF >12. Among females, WC-WHO had 100% sensitivity (95% CI 90%-100%) and 24.1% specificity (95% CI 15.6%-34.5%) while WC-NIH had 100% sensitivity (95% CI 90%-100%) and 4.6% specificity (95% CI 1.3%-11.4%). Prevalence of high VF was significantly greater among males – 75.8% (95% CI 66.1%-83.8%) vs. 28.7% (95% CI 20.9%-37.6%) in females (p<0.001). Among females, WC-NIH tended to have higher measurements than WC-WHO by an average of 4.67 cm. Females with WC-WHO measurements of at least 80 cm were approximately four times more likely to have low (<50 mg/dL) HDL levels (cOR 3.82, p=<0.05), even after adjusting for age (aOR 3.83, p=<0.05).

Conclusion

WC measurement using the WHO and NIH protocols were both highly sensitive but had low specificity in predicting high VF estimated via BIA among overweight and obese adult Filipinos in this study. WC-NIH measurements tended to be higher among the females, which may affect classification of central obesity when using this protocol. WC ≥80 cm measured using the WHO protocol was associated with low HDL levels among female subjects. Prospective studies conducted among the general Filipino population are recommended to verify these findings.

Obesity and CKD in Sub-Saharan Africa: A Narrative Review

Obesity is a major public health problem in the developed world, where it has reached an epidemic status over the last few decades. In parallel with this, the prevalence of chronic kidney disease (CKD) has increased. Although obesity is a risk factor for hypertension and diabetes, it is also independently associated with the development and progression of CKD. Two-third of patients with CKD worldwide will be residents of developing countries by the year 2030. Risk factors for CKD are prevalent in the sub-Saharan Africa region; this review discusses the available data regarding the relationship between obesity and CKD. The prevalence of CKD appears to correlate with increasing adiposity in sub-Saharan Africa; however, limited data are currently available, and the analysis of this association is further complicated by a variety of parameters used to define obesity. (eg, body mass index vs waist circumference). Longer, large-scale studies are needed to inform the prevalence and kidney implications of obesity in sub-Saharan Africa.

Regional variation in growth status. The Peruvian health and optimist growth study

OBJECTIVE

This study aims to (1) investigate differences in weight, body mass index (BMI), and waist circumference (WC) among Peruvian children and adolescents living in three areas located at different altitudes; (2) compare age- and sex-specific height, weight, and BMI within each site with US reference data.

METHODS

We sampled 8753 subjects (4130 boys), aged 4 to 17 years from sea level, rainforest, and high-altitude. Height, weight, and WC were measured and BMI was calculated. Analysis of variance was used to compare variables across geographic regions, and the Hoff and Blackburn procedure was used to compare the Peruvian results with US reference data.

RESULTS

Participants living at sea level were taller, heavier, had greater BMI and WC relative to those living at high-altitude and in the rainforest. Peruvian schoolchildren of both sexes from the three geographical areas were shorter and lighter than their American peers. Boys and girls living in the rainforest and at high-altitude had lower BMI, whereas WC values of American schoolchildren are higher than those of the Peruvian children by age and gender.

CONCLUSIONS

Peruvians living at different altitudes differ in their growth indicators (height, weight, BMI, and WC), with significant differences between those living at sea level relative to their peers from other regions. Further, Peruvian schoolchildren of both sexes from the three geographical areas significantly differ from their US counterparts.

Anthropometric Indices and Age at Natural Menopause: A 15-Year Follow-up Population-Based Study

BACKGROUND

Following menopause, the risk of many diseases is increased, and this situation may be due to changes in anthropometric indices (AI), while the association between adiposity and age at natural menopause (ANM) is not clear yet.

OBJECTIVES

This longitudinal study was conducted to investigate the ability of AI in predicting ANM.

METHODS

For this purpose, a total of 3,876 women aged > 20 years old from participants of the Tehran lipid and glucose study (TLGS) met our eligibility criteria. The association between ANM and various AIs was assessed using the Accelerated Failure Time (AFT) model, and time ratio (TR) with 95% confidence intervals was reported in this longitudinal study.

RESULTS

The median [interquartile range (IQR) 25 - 75] of the survival time was 12.5 (7.9 - 15.8) years. At the end of the follow-up, 1,479 (38.2%) of the participants reached menopause. The median time to natural menopause was decreased by about 2% with one standard deviation (SD) increase of both a body shape index (ABSI) (time ratio (TR): 0.98, 95% CI: 0.97, 0.99) and lipid accumulation product (LAP) (TR: 0.98, 95% CI: 0.98, 0.99) z-scores; and this time was increased by about 1% (TR: 1.01, 95% CI: 1.00, 1.02) with one SD increase in body mass index (BMI) z-score.

CONCLUSIONS

The ABSI, LAP, and BMI were the most useful AIs for identification of the time to menopause onset, and ABSI and LAP were inversely associated with the ANM. Also, the BMI was directly associated with the ANM.

Validity of Self-reported Height, Weight, Body Mass Index, and Waist Circumference in Iranian Adults

Context:

The validity of self-reported anthropometric indices has been examined in previous studies in different populations.

Aims:

The aim of our study was to evaluate the validity of self-reported height, weight, body mass index (BMI), and waist circumference (WC) for the first time in middle-age staffs of Isfahan University of Medical Sciences.

Settings and Design:

In this cross-sectional study, a total of 171 men and women were selected from staffs of Isfahan University of Medical Sciences, Isfahan, Iran.

Methods and Materials:

Technician- and self-reported measurements of height, weight, and WC were collected from all participants. BMI was calculated by dividing weight in kg by height in meters squared. Overweight and obesity were defined as BMI ≥25-<29.9 and ≥30 kg/m², respectively. Abdominal obesity was defined as WC ≥94 and ≥80 cm in men and women, respectively.

Statistical Analysis:

Independent t-test, chi-square, Pearson and intraclass correlation coefficients (ICCs), as well as Kappa measurements, were used.

Results:

Fifty and 19 percentages of the study population were overweight and obese, respectively. Self-reported height (r = 0.83, P < 0.001, ICC =0.89, 95% confidence interval (CI): 0.85–0.92), weight (r = 0.95, P < 0.001, ICC = 0.979, 95% CI: 0.971–0.98), BMI (r = 0.70, P < 0.001, ICC = 0.81, 95% CI: 0.74–0.86), and WC (r = 0.60, P < 0.001, ICC = 0.71, 95% CI: 0.51–0.81) were highly correlated with actually measured ones. Approximately 80% and 65% of individuals who were defined as overweight and obese, respectively, based on actually measured data were correctly diagnosed as overweight and obese, respectively, based on self-reported data. The Kappa coefficients for different categories of weight situation and abdominal obesity were 0.59 and 0.32, respectively. Fifty-seven percent of participants who were diagnosed with abdominal obesity based on actually measured data were correctly diagnosed with abdominal obesity based on self-reported data. Also, approximately 48% and 69% of men and women, respectively, who were diagnosed with abdominal obesity based on actually measured data were correctly diagnosed with abdominal obesity based on self-reported ones.

Conclusions:

We found that self-reported data of anthropometric measures are reasonable in middle-age staff of Isfahan University of Medical Sciences. Nevertheless, self-reported data on WC should be cautiously relined on, in particular, among men.

Utilizing Participatory Research to Engage Underserved Populations to Improve Health-Related Outcomes in Delaware

Cooperative Extension is a community outreach program. Despite its large reach, there is a need for the evaluation of changes in health-related outcomes for individuals engaged with Cooperative Extension. A team-based challenge was developed using community-engaged participatory research integrated with Cooperative Extension to encourage healthy eating and physical activity behaviors through Cooperative Extension programming. Thus, the primary purpose of this secondary analysis was to (1) evaluate changes in anthropometric outcomes and (2) evaluate changes in health behavior outcomes. Associations of anthropometric changes and health behavior changes with engagement in the three-month team-based challenge were explored. Anthropometrics were measured using standard procedures, and intake of fruits and vegetables and physical activity were self-reported. Of the 145 participants in the community-engaged participatory research portion of the study, 52.4% (n = 76) had complete anthropometrics before and after the team-based challenge and were included in this study. At 3 months, there was a significant reduction in body mass index (-0.3 kg/m2, p = 0.024) and no significant change in waist circumference (p = 0.781). Fruit and vegetable intake significantly increased (+0.44 servings/day, p = 0.018). Physical activity did not significantly change based on (1) the number of days 30 or more minutes of physical activity was conducted (p = 0.765) and (2) Godin Leisure-Time Exercise Questionnaire scores (p = 0.612). Changes in anthropometrics and health behaviors were not associated with engagement in the team-based challenge. Using community-engaged participatory research with community outreach programs, such as Cooperative Extension, can improve health-related outcomes in underserved populations. However, despite a participatory approach, changes in anthropometrics and health behaviors were not associated with engagement in the developed team-based challenge.

Anthropometric Indicators as a Tool for Diagnosis of Obesity and Other Health Risk Factors: A Literature Review

Obesity is characterized by the accumulation of an excessive amount of fat mass (FM) in the adipose tissue, subcutaneous, or inside certain organs. The risk does not lie so much in the amount of fat accumulated as in its distribution. Abdominal obesity (central or visceral) is an important risk factor for cardiovascular diseases, diabetes, and cancer, having an important role in the so-called metabolic syndrome. Therefore, it is necessary to prevent, detect, and appropriately treat obesity. The diagnosis is based on anthropometric indices that have been associated with adiposity and its distribution. Indices themselves, or a combination of some of them, conform to a big picture with different values to establish risk. Anthropometric indices can be used for risk identification, intervention, or impact evaluation on nutritional status or health; therefore, they will be called anthropometric health indicators (AHIs). We have found 17 AHIs that can be obtained or estimated from 3D human shapes, being a noninvasive alternative compared to X-ray-based systems, and more accessible than high-cost equipment. A literature review has been conducted to analyze the following information for each indicator: definition; main calculation or obtaining methods used; health aspects associated with the indicator (among others, obesity, metabolic syndrome, or diabetes); criteria to classify the population by means of percentiles or cutoff points, and based on variables such as sex, age, ethnicity, or geographic area, and limitations.

Performance of waist-to-height ratio as a screening tool for identifying cardiometabolic risk in children: a meta-analysis

OBJECTIVE

To provide the latest evidence of performance and robustness of waist-to-height ratio (WHtR) in discriminating clusters of cardiometabolic risk factors (CMRs) and promote WHtR in routine primary health care practice in children, a meta-analysis was used.

METHODS

Searches was performed in eight databases from inception to July 03, 2020. Inclusion criteria were: (1) observational study, (2) children and adolescents, (3) provided WHtR measurements, (4) had CMRs as outcomes, and (5) diagnostic studies. Exclusion criteria were: (1) non-original articles, (2) unable to extract 2 × 2 contingency tables, (3) not in English or Chinese language, (4) populations comprising clinical patients, or (5) duplicate articles. WHtR cutoff points, 2 × 2 contingency tables were extracted from published reports. Outcomes included: CMR clusters of at least three CMRs (CMR₃), two (CMR₂), one (CMR₁), and CMR components. Bivariate mixed-effects models were performed to estimate the summarised area under the curves (AUSROC) with 95% CIs and related indexes. We conducted subgroup analyses by sex and East Asian ethnicity.

RESULTS

Fifty-three observational studies were included. The AUSROC reached 0.91 (95% CI: 0.88-0.93), 0.85 (95% CI: 0.81, 0.88) and 0.75 (95% CI: 0.71, 0.79) for CMR₃, CMR₂, and CMR₁, respectively. The pooled sensitivity and specificity for CMR₃ reached 0.84 and exceeded 0.75 for CMR₂. For CMR₁, the sensitivity achieved 0.55 with 0.84 for specificity. We had similar findings for our subgroup and sensitivity analyses.

CONCLUSIONS

WHtR shows good and robust performance in identifying CMRs clustering across racial populations, suggesting its promising utility in public health practice globally.

Feasibility and acceptability of a culturally tailored physical activity intervention for Arab-Australian women

BACKGROUND

Despite being one of the largest migrant groups in Australia, few physical activity interventions exist for Arab-Australians. The primary aim of this study was to test the feasibility and acceptability of a 12-week culturally tailored physical activity intervention for Arab-Australian women.

METHODS

This study used a single-group pretest-posttest design, and was informed by extensive formative research and consultation involving the Arab-Australian community. Participants were insufficiently active Arab-Australian women aged 35-64 with no current illness or injury that would limit physical activity participation. The intervention comprised 6 face-to-face physical activity and education sessions over 12 weeks. The intervention was conducted at 2 separate intervention sites in Western Sydney, Australia. Feasibility outcomes included recruitment, session attendance, and retention. The acceptability of the intervention was assessed through a process evaluation questionnaire completed post-intervention. Accelerometers and the short-form International Physical Activity Questionnaire were used to measure physical activity at baseline and post-intervention. Descriptive statistics were used for feasibility and acceptability outcomes, and changes in physical activity were examined using Wilcoxon signed-rank tests.

RESULTS

Of the 53 women who were contacted or expressed interest, 22 were eligible and enrolled in the study. Participants were primarily recruited through direct contact by Arab-Australian community workers and by word-of-mouth. Average session attendance was 63% and the retention rate post-intervention was 68%. The culturally-related intervention components, such as the appropriateness of content, and women-only setting, were rated highly favourably (4.33 to 4.87/5). General intervention elements, such as the face-to-face delivery, knowledge and approachability of facilitators, and session structure, were also rated favourably (4.33 to 4.93/5), and the lowest scored item was the intervention session frequency (3.2/5). There were no statistically significant changes in physical activity post-intervention.

CONCLUSIONS

The findings from this study highlighted factors related to recruitment and delivery that need to be considered when developing physical activity interventions for Arab-Australian women. Further research is required using a larger sample and a randomised controlled trial design to examine the longer-term impact on physical activity, and to also examine ways of increasing intervention engagement and retention among Arab-Australian women.

TRIAL REGISTRATION

ANZCTR, ACTRN12618001392257. Registered 20 August 2018, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375636 .

Using anthropometric measures to screen for obstructive sleep apnea in the Sleep Heart Health Study cohort

STUDY OBJECTIVES

To evaluate predictions of moderate-to-severe-obstructive sleep apnea (MS-OSA) by the neck circumference height ratio (NHR) and waist circumference height ratio (WHR) and compare to the derived STOP-Bang Questionnaire (dSBQ) prediction.

METHODS

Included were 6,167 participants from the Sleep Heart Health Study (SHHS) baseline evaluation who completed polysomnograms, had anthropometric measurements, and data to compute proxy dSBQ item answers. The sample was divided randomly into derivation (n = 2,035) and validation (n = 4,132) subsets. The derivation sample was used to estimate the NHR and WHR cut points to detect MS-OSA; the validation sample was used to evaluate sensitivity (SN) and specificity (SP).

RESULTS

Mean age was 63.1 years, and 47.2% were male for the overall sample. In the derivation sample, a cut point ≥ 0.21 for NHR yielded a SN of 92.0% and SP of 25.0%; a cut point ≥ 0.52 for WHR yielded a SN of 91.2% and SP of 25.0% for MS-OSA. Using the validation sample, the NHR, WHR, and dSBQ areas under the receiver operator curves (AUCs) were 69.8%, 65.2%, and 70.5% respectively for MS-OSA. There was no statistical difference with listwise comparison of the NHR and dSBQ AUCs (p = 0.997); however, there was a significant difference between the WHR and dSBQ AUCs (p = 0.015) for MS-OSA.

CONCLUSIONS

The NHR is a viable OSA screening tool comparable to the dSBQ, independent of witnessed apneas and BMI, that can be used for different body types.

Dancing With Health: Quality of Life and Physical Improvements From an EU Collaborative Dance Programme With Women Following Breast Cancer Treatment

Background: Women's health has received renewed attention in the last few years including health rehabilitation options for women affected by breast cancer. Dancing has often been regarded as one attractive option for supporting women's well-being and health, but research with women recovering from breast cancer is still in its infancy. Dancing with Health is multi-site pilot study that aimed to evaluate a dance programme for women in recovery from breast cancer across five European countries.

Methods: A standardized 32 h dance protocol introduced a range of Latin American dances presented within a sports and exercise framework with influences from dance movement therapy. Fifty-four women (M age 53.51; SD 7.99) participated in the study who had a breast cancer diagnosis <3 years, chemotherapy >6 weeks, no indication of metastasis, or scheduled surgery/chemotherapy/radiation treatment for the duration of the intervention. Primary outcome data was collected for anthropometric and fitness measures next to cancer-related quality of life. T-tests and Wilcoxon signed ranked tests were used to establish differences pre and post intervention. Cohen's d was also calculated to determine the effect size of the intervention.

Results: Statistically significant changes were found for: (i) weight, right and left forearm circumference and hip; (ii) 6 min walking, right and left handgrip, sit-to-stand and sit-and-reach; (iii) the EORTC-QLQ C30 summary score as well as the subscales of emotional and social functioning and symptoms. In all cases the direction of change was positive, while Cohen's d calculated showed that the effect of the intervention for these parameters ranged from intermediate to large.

Conclusion: Changes on the above anthropometric, fitness and quality of life measures suggest that the intervention was of value to the participating women recovering from breast cancer. Results also advocate collaborative efforts across countries to further research.

Prevalence of Type 2 Diabetes and Its Association with Added Sugar Intake in Citizens and Refugees Aged 40 or Older in the Gaza Strip, Palestine

BACKGROUND

Little is known about the prevalence and risk factors of diabetes among Gaza Palestinians, 64% of whom are refugees with exceeded sugar intake. We aimed to estimate the prevalence of type 2 diabetes (T2D) and its association with added sugar intake among residents, with regular visits to primary healthcare centers (PHCs) across Gaza.

METHODS

From October to December of 2019, a cross-sectional survey was conducted among 1000 citizens and refugees in nine PHCs selected from the five governorates of the Gaza Strip. Information on dietary intake, medical history, and other risk factors was collected by trained health workers, using structured questionnaires. Anthropometry and biochemical data were extracted from the PHC medical record system.

RESULTS

Overall, the prevalence of diagnosed T2D and undiagnosed T2D were 45.2% and 16.8%, respectively, in adults aged 42 to 74 years, with the differences among citizens and refugees (diagnosed: 46.2% vs. 43.8%; undiagnosed: 15.7% vs. 18.2%). The uncontrolled glycaemic rate was 41.9% and 36.8% for diagnosed patients in citizens and refugees, respectively. Among those without a clinical diagnosis of T2D, after multivariable adjustment, daily added sugar intake was positively associated with fasting glucose and the risk of undiagnosed T2D (odds ratio, 95% CI, highest vs. lowest intake, was 2.71 (1.12-6.54) (pfor trend < 0.001). In stratified analysis, the associations between added sugar intake and the risk of undiagnosed T2D tend to be stronger among refugees or those with higher body mass index.

CONCLUSIONS

Among Palestinian adults, both citizens and refugees are affected by T2D. Added sugar intake is associated with the risk of undiagnosed T2D.

Wand Stretching Exercise Decreases Abdominal Obesity Among Adults With High Body Mass Index Without Altering Fat Oxidation

Rationale

We designed a wand-based muscle stretching (WE) exercise program, which has become increasingly popular in physical therapy and has been used for elderly patients with adhesive capsulitis. However, studies regarding the effects of WE training on abdominal obesity and measures of cardiovascular risk factors among overweight/obese adults aged ≥55 years are rare.

Purpose

The objective of this study is to evaluate the effects of a 15-week wand stretching exercise program on waist circumference and cardiovascular risk factors in sedentary adults aged 55–70 years.

Methods

A total of 124 participants were randomly assigned to either participate in wand stretching exercise (WE) over a 15-week period or a control group (n = 62 each). Sixty participants in the WE group (26 overweight and 34 obese) and 51 in the control group (29 overweight and 22 obese) completed the study. The WE program included wand-assisted muscle stretching exercise on both the upper body and lower body for 40 min per day, 5 days per week, whereas the control group maintained their sedentary lifestyle.

Results

No significant improvements were observed in plasma glucose, insulin, and the homeostatic model assessment of insulin resistance (HOMA-IR) after exercise training. Compared with the control group, the WE group had more significant reductions in waist circumference among participants with a body mass index (BMI) < 25 kg/m² (−2.6 cm, 95% CI: −4.19 to −0.97 cm, d = 0.48) and BMI > 25 kg/m² (−2.5 cm, 95% CI: −4.1 to −0.9 cm, d = 0.59) (both P < 0.01). Furthermore, within groups, a significant increase in % fat free mass was observed after WE training. The basal metabolic rate was slightly increased, but the fat oxidation rate remained unaltered in the WE group. Improvements in low-density lipoprotein cholesterol to high-density lipoprotein cholesterol were minimal after WE. Significant reductions in high-sensitivity C-reactive protein were observed after WE only for participants with a BMI <25 kg/m².

Conclusion

The results suggest redistribution of a carbon source from the abdominal region to challenged skeletal muscle, following prolonged WE training. This abdominal fat reducing outcome of the WE is unlikely to be associated with fatty acid oxidation.

Nonexercise Equations for Determining Change in Cardiorespiratory Fitness

PURPOSE

This study aimed to determine whether change in estimated cardiorespiratory fitness (eCRF) is associated with change in measured cardiorespiratory fitness (mCRF) independent of exercise amount and intensity over 24 wk.

METHODS

Participants were 163 sedentary adults with abdominal obesity (mean ± SD waist circumference, 109.9 ± 11.5 cm) randomly assigned to (i) no-exercise control (n = 42); (ii) low-amount, low-intensity exercise (LALI; n = 39); (iii) high-amount, low-intensity exercise (HALI; n = 51); and (iv) high-amount, high-intensity exercise (HAHI; n = 31). mCRF was measured using a maximal treadmill test at baseline, 8, 16, and 24 wk. eCRF was calculated using a published nonexercise equation with the following variables: sex, age, waist circumference, resting heart rate, and self-selected physical activity.

RESULTS

Participants attended 115 of 120 exercise sessions prescribed (96.0% ± 4.0% adherence). eCRF change from baseline to 8, 16, and 24 wk was not different from mCRF change for control, LALI, or HALI (P = 0.03). In HAHI, eCRF change was significantly greater than mCRF change at all time points (P < 0.001). Further analysis revealed that change in eCRF systematically overestimated and underestimated small and large changes in mCRF, respectively, in all groups (P < 0.001).

CONCLUSIONS

eCRF change was associated with mCRF change at 24 wk independent of exercise amount but not intensity. Systematic variation between eCRF and mCRF highlights a possible limitation when using eCRF to follow change in mCRF, specifically that eCRF does not capture the individual variability of the mCRF response.

Clinical Leadership and Management Perceptions of Inpatients with Obesity: An Interpretative Phenomenological Analysis

While obesity is recognized as a key global public health issue, there has been no research to date on the perceptions of care for people with this condition held by individuals in positions of organizational power. The aim of this study was therefore to describe the perceptions and experiences of clinical leaders and managers of providing care to inpatients with obesity at a metropolitan public health service. This study applied an interpretative phenomenological analysis (IPA) approach to qualitative research, conducting interviews with 17 participants. Their perceptions of care for inpatients with obesity encompassed both their personal understanding as an individual, and their observations about the organizational, patient and carer perspectives. Three overall themes were identified: (1) the problem of inpatients with obesity, (2) inpatients with obesity as sources of risk and (3) personal and professional perceptions of inpatients with obesity. While clinical leaders and managers were aware of the potential impact of stigma and weight bias on care given to this cohort, elements of implicit bias, stereotyping, "othering" and ambivalence were frequently present in the data. Ongoing efforts to improve care for patients with obesity must therefore include efforts to address perceptions and attitudes at all organisational levels of the workforce.

Waist circumference does not improve established cardiovascular disease risk prediction modeling

Despite considerable evidence demonstrating that waist circumference (WC) is independently associated with cardiovascular disease (CVD) and/or all-cause mortality, whether the addition of WC improves risk prediction models is unclear. The objective was to evaluate the improvement in risk prediction with the addition of WC, alone or in combination with BMI, to the Framingham Risk Score (FRS) and a population specific model. 34,377 men and 9,477 women aged 20 to 79 years who completed a baseline examination at the Cooper Clinic (Dallas, TX) during 1977–2003 and enrolled in the Aerobics Center Longitudinal Study (ACLS). WC was measured at the level of the umbilicus and expressed as a continuous variable. Deaths among participants were identified using the National Center for Health Statistics National Death Index. A total of 728 fatal cardiovascular disease (CVD) events occurred over a mean follow-up period of 13.1 ± 7.5 years. WC was significantly higher in CVD decedents (P = .002). The FRS C-statistic for fatal CVD in men was 0.836 (0.816–0.855) and 0.883 (0.851–0.915) in women. The addition of WC did not improve the C-statistic in men (0.831 (0.809–0.853)) or women (0.883 (0.850–0.916)). Similar findings were observed for non-fatal CVD and all-cause mortality, and when WC was added to a population specific model. Upon adding WC, the net-reclassification index was 0.024 with an integrated discrimination improvement of -0.0004. The addition of WC, alone or in combination with BMI, did not substantively improve risk prediction for CVD or all-cause mortality compared to the Framingham Risk Score or a population specific model.

Waist circumference percentiles for Hispanic-American children and comparison with other international references

INTRODUCTION

Waist circumference (WC) constitutes an indirect measurement of central obesity in children and adolescents.

OBJECTIVE

To provide percentiles of WC for Hispanic-American children and adolescents, and compare them with other international references.

MATERIALS AND METHODS

The sample comprised 13 289 healthy children between 6 and 18 years coming from public schools of middle and low socioeconomic levels in different parts of Argentina, Cuba, Spain, Mexico, and Venezuela. The LMS method to calculate WC percentiles was applied. Sex and age differences were assessed using Student's t test and ANOVA (SPSS v.21.0). Comparisons were established with references from the United States, Colombia, India, China, Australia, Kuwait, Germany, Tunisia, Greece, and Portugal.

RESULTS

WC increases with age in both sexes. Boys show higher WC in P3, P50, and P97. Comparison of 50th and 90th percentiles among populations from diverse sociocultural and geographical contexts shows high variability, not all justified by the measurement method.

DISCUSSION AND CONCLUSIONS

Specific WC percentiles for sex and age, and P90 cut-off points are provided; these values are potentially useful to assess central obesity in Hispanic-American adolescent children.

Negative Energy Balance Induced by Exercise or Diet: Effects on Visceral Adipose Tissue and Liver Fat

The indisputable association between visceral adipose tissue (VAT) and cardiometabolic risk makes it a primary target for lifestyle-based strategies designed to prevent or manage health risk. Substantive evidence also confirms that liver fat (LF) is positively associated with increased health risk and that reduction is associated with an improved metabolic profile. The independent associations between reductions in VAT, LF, and cardiometabolic risk is less clear. In this narrative review, we summarize the evidence indicating whether a negative energy balance induced by either an increase in energy expenditure (aerobic exercise) or a decrease in energy intake (hypocaloric diet) are effective strategies for reducing both VAT and LF. Consideration will be given to whether a dose-response relationship exists between the negative energy balance induced by exercise or diet and reduction in either VAT or LF. We conclude with recommendations that will help fill gaps in knowledge with respect to lifestyle-based strategies designed to reduce VAT and LF.

The association between anthropometric measures of adiposity and the progression of carotid atherosclerosis

Background

Few reports are available on the contribution of general and abdominal obesity to the progression of carotid atherosclerosis in late adulthood. This study investigated the impact of four simple anthropometric measures of general and abdominal obesity on the progression of carotid atherosclerosis and the extent to which the association between adiposity and the progression of plaque burden is mediated by cardiometabolic markers.

Methods

Four thousand three hundred forty-five adults (median age 60) from the population-based Tromsø Study were followed over 7 years from the first carotid ultrasound screening to the next. The progression of carotid atherosclerosis was measured in three ways: incidence of plaques in previously plaque-free participants; change in the number of plaques; and total plaque area (TPA). We used generalised linear models to investigate the association between each adiposity measure – body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) – and each outcome. Models were adjusted for potential confounders (age, sex, smoking, education, physical activity). The pathways through which any associations observed might operate were investigated by further adjusting for cardiometabolic mediators (systolic blood pressure, cholesterol, and HbA1c).

Results

There was little evidence that adiposity was related to the formation of new plaques during follow-up. However, abdominal adiposity was associated with TPA progression. WHtR showed the largest effect size (mean change in TPA per one standard deviation (SD) increase in WHtR of 0.665 mm², 95% confidence interval 0.198, 1.133) while BMI showed the smallest. Effect sizes were substantially reduced after the adjustment for potential mediators.

Conclusions

Abdominal obesity indirectly measured with WC seems more strongly associated with the progression of TPA than general obesity. These associations appear to be largely mediated by known cardiometabolic markers.

Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity

Despite decades of unequivocal evidence that waist circumference provides both independent and additive information to BMI for predicting morbidity and risk of death, this measurement is not routinely obtained in clinical practice. This Consensus Statement proposes that measurements of waist circumference afford practitioners with an important opportunity to improve the management and health of patients. We argue that BMI alone is not sufficient to properly assess or manage the cardiometabolic risk associated with increased adiposity in adults and provide a thorough review of the evidence that will empower health practitioners and professional societies to routinely include waist circumference in the evaluation and management of patients with overweight or obesity. We recommend that decreases in waist circumference are a critically important treatment target for reducing adverse health risks for both men and women. Moreover, we describe evidence that clinically relevant reductions in waist circumference can be achieved by routine, moderate-intensity exercise and/or dietary interventions. We identify gaps in the knowledge, including the refinement of waist circumference threshold values for a given BMI category, to optimize obesity risk stratification across age, sex and ethnicity. We recommend that health professionals are trained to properly perform this simple measurement and consider it as an important 'vital sign' in clinical practice.

Association of wrist circumference with cardio-metabolic risk factors: a systematic review and meta-analysis

BACKGROUND AND AIMS

The association of Wrist Circumference (WrC) with cardio-metabolic risk factors is still contradictory. We aimed to systematically review the association of WrC with cardio-metabolic diseases among the general populations.

METHODS

We systematically searched electronic databases such as PubMed/Medline, Web of Sciences, and Scopus without language restriction until March 2017. Observational studies that examined the association of WrC with any cardio-metabolic risk factors were included. Pooled association of WrC with metabolic syndrome (MetS) was estimated using a random-effect model, and heterogeneity among studies was assessed by I² index and Q test.

RESULTS

A total of 14 papers including cohort study (n = 9), cross-sectional study (n = 4), and case-control study (n = 1) met the criteria and included. The eligible papers have been examined the association of WrC with any cardiovascular disorders (n = 8), metabolic syndrome (n = 4), insulin resistance (IR) (n = 5), diabetes mellitus (n = 2), impaired glucose tolerance (n = 1), cardio-metabolic risk factors (n = 2) and obesity/overweight (n = 1). In the whole population (both adults and pediatric population), high WrC increased the risk of MetS by 33% (Pooled OR = 1.33; 95% CI 1.20, 1.48; I² = 60.2%, p = 0.04), while the pooled OR in adult populations was 1.27 (95% CI 1.15-1.41; I²: 32.8%, p = 0.21). Qualitative synthesis showed that associations of WrC with other cardio-metabolic risk factors are conflicting.

CONCLUSION

High WrC increased the risk of MetS and other cardio-metabolic risk factors. However, due to limited studies, particularly in children, results should be declared with great caution. Further cohort studies are needed to clarify whether WrC is a suitable anthropometric index to predict cardio-metabolic disorders in adult and children populations in different societies.

LEVEL OF EVIDENCE

Level 1, systematic review and meta-analysis.

Measurement of Visceral Fat, Abdominal Circumference and Waist-hip Ratio to Predict Health Risk in Males and Females

BACKGROUND AND OBJECTIVE

Obesity is a risk factor for a broad range of diseases. This study aimed to estimate association between selected variables (visceral fat, abdominal circumference and waist-hip ratio) and health risk in between male and female.

MATERIALS AND METHODS

The university student based cross-sectional study was conducted among male and female students. The anthropometric measurements were taken through the auto-calibrated digital scale. Bioelectrical impedance analyzer device was used to determine visceral fat area, abdominal circumference and waist-hip ratio. Independent t-test and Pearson Chi-Square was used for statistical analysis. To see the association among the all three variables, scatter plots were also drawn.

RESULTS

The results showed that 28.3% male and 9.4% female at risk for visceral fat, for the abdominal circumference 16.9% male and 6% female at risk and for waist-hip ratio 27.5% male and 6% female fell under risk category. There was a significant relationship among all variable for male and female.

CONCLUSION

Findings suggested that visceral fat area, abdominal circumference and waist-hip ratio were strong predictors of health risk. Male were more prone to health risk than female participants.

Relationship Between Metabolic Syndrome and the Brazilian Workers' Food Program in Male and Female Manufacturing Workers

INTRODUCTION

Several studies have reported increased cardiometabolic risk among workers assisted by food assistance public policies. The aim of this study was to estimate the prevalence of metabolic syndrome (MetS) and its individual components among manufacturing workers and their relationship to the Brazilian Workers' Food Program (WFP).

METHODS

It was a prospective, cross-sectional, two-stage survey comparative of manufacturing workers from companies adherent and non-adherent to the WFP stratified by sector of activity and company size. The workers were interviewed in the workplace, and data on waist circumference (WC), blood pressure, and 12-hours fasting blood glucose (FBG), serum triglycerides (TG), and total and HDL-cholesterol were obtained. Mixed effects multilevel regression was used to compare WFP and non-WFP groups separately in each sex. All subjects gave written informed consent.

RESULTS

The survey included 332 workers from 16 WFP companies and 344 workers from 17 non-WFP companies. The general prevalence of MetS, according to IDF/AHA/NHLBI criteria, was high but not statistically different between sexes (39.8% in females versus 28.5% for males, p=0.16). Statistically significant differences were found between sexes in the prevalence of individual components: WC (77.8% in females versus 38.3% in males, p=0.002), TG (27.3% in females versus 40.8% in males, p=0.07), and HDL-C (52.2% in females versus 43.1% in males, p=0.05). Among males, MetS prevalence was significantly higher in the WFP group (33.0% versus 23.9%, p=0.008), and, in the individual components, the WFP group had higher prevalence of increased WC (47.0% versus 29.4%, p<0.001) and elevated FBG (8.9% versus 6.3%, p<0.001), as well as greater average levels of TG, HDL-C and FBG. Among female workers, no statistically significant differences between groups were observed in MetS prevalence and its individual components, but WFP female worker presented lower systolic and diastolic blood pressure.

CONCLUSION

In a low-income population, male manufacturing workers participating in a food assistance program are at increased risk of MetS, an effect that was not identified among female workers.

External validation of the relative fat mass (RFM) index in adults from north-west Mexico using different reference methods

Background

Analysis of body composition is becoming increasingly important for the assessment, understanding and monitoring of multiple health issues. The body mass index (BMI) has been questioned as a tool to estimate whole-body fat percentage (FM%). Recently, a simple equation described as relative fat mass (RFM) was proposed by Woolcott & Bergman. This equation estimates FM% using two anthropometric measurements: height and waist circumference (WC). The authors state that due to its simplicity and better performance than BMI, RFM could be used in daily clinical practice as a tool for the evaluation of body composition. The aim of this study was to externally validate the equation of Woolcott & Bergman to estimate FM% among adults from north-west Mexico compared with Dual-energy X-ray absorptiometry (DXA) as an alternative to BMI and secondly, to make the same comparison using air displacement plethysmography (ADP), Bioelectrical Impedance Analysis (BIA) and a 4-compartment model (4C model).

Methods

Weight, height and WC were measured following standard procedures. The RFM index was calculated for each of the 61 participating subjects (29 females and 32 males, ages 20–37 years). The RFM was then regressed against each of the four body composition methods for estimating FM%.

Results

Compared with BMI, RFM was a better predictor of FM% determined by each of the body composition methods. In terms of precision the best equation was RFM regressed against DXA (y = 1.12 + 0.99 x; R² = 0.84 p<0.001). Accuracy (represented by the closeness to the zero-intercept) was 1.12 (95% CI: -2.44, to 4.68) and thus, not significantly different from zero. For the rest of the methods, precision in the prediction of FM% was improved compared to BMI, with significant increases in the R² and reduction of the root mean squared error (RMSE). However, the intercepts of each regression did not show accuracy since they were different from zero, for ADP: -9.95 (95%CI: -15.7 to -4.14), for BIA: -12.6 (95%CI: -17.5 to -7.74) and for the 4C model: -13.6 (95%CI: -18.6 to -8.60). Irrespectively, FM% measured by each of the body composition methods was higher for DXA than the other three methods (p<0.001).

Conclusions

This external validation proved that the performance of the RFM equation used in this study to estimate FM% was more consistent than BMI in this Mexican population, showing a stronger correlation with DXA than with the other body composition methods.

Waist-height ratio: How well does it predict glucose intolerance and systemic hypertension?

AIM

The aim of this study is to assess whether WHtR is a better predictor of glucose intolerance and systemic hypertension than some other obesity indices.

METHODS

This is a cross-sectional observational study among four hundred (4 0 0) participants in a Northern Nigerian population. Four (4) participants were eventually excluded due to incomplete data, therefore data from three hundred and ninety six (3 9 6) participants were used in the final analysis. The study assessed whether WHtR is a better predictor of glucose intolerance and systemic hypertension compared to some other obesity indices. Participants were recruited after due consent, then bio-data, blood pressure levels, and some anthropometric measurements were obtained. Subsequently, plasma glucose levels (fasting [FPG] and 2-hour post 75 g glucose load [2HrPPG]) were measured. Data was entered into Microsoft Excel, then analyzed using IBM SPSS version 23.

RESULTS

Data from three hundred and ninety six (3 9 6) participants (4 excluded due to incomplete details) were analyzed. Logistic regression of obesity indices showed that WHtR was the best predictor of glucose intolerance with odds ratio (OD) of 20.74 (CI 2.80-155, p < 0.001), followed by WC with OD of 1.89 (CI 1.83-3.94, p < 0.001), then WHR with OD of 1.69 (CI 1.06-8.22, p = 0.009). The least but significant predictor of glucose intolerance was BMI with odds ratio of 1.12 (CI 1.06-3.18, p < 0.001). Furthermore, logistic regression of obesity indices showed that WHtR was the strongest predictor of systemic hypertension with OD of 2.32 (CI 4.85-14.96, p < 0.001), followed by BMI (OD 1.99, CI 1.96-2.05, p = 0.031), then WC (OD 1.95, CI 1.90-1.99, p = 0.020). The weakest predictor of systemic hypertension was WHR (OD 1.26, CI 0.04-1.88, p = 0.181).

CONCLUSION

WHtR had the highest predictive power for both glucose intolerance and systemic hypertension compared to BMI, WC, and WHR.

Changes in weight and body composition across five years at university: A prospective observational study

Objectives

The transition from high school to college or university has been shown to be a critical period for weight and fat gain. To date, no European data on weight and fat gain over the full trajectory of college or university are available. Therefore, the purpose of the present study was to investigate weight and fat gain among Belgian university students from freshman through senior year of university.

Methods

In this prospective observational study, a total of 340 university students were measured six times, i.e. at baseline (start of the first academic year) and at the start of the second semester of the first, second, third, fourth and fifth academic year. Objective measurements included body weight, height, body mass index (BMI), fat%, fat mass, fat free mass and waist circumference. Multilevel modelling was used to assess anthropometric changes over time according to sex.

Results

From freshman through senior year of university, individual weight changes ranged from -5.2 to +15.7kg, and respectively 77.4% and 69.3% of students showed increases in BMI and fat%. Stronger increases in weight and BMI were found for males (5.7kg; 1.6kg/m²; both p<0.001) than females (2.2kg; 0.8kg/m²; both p<0.001) over the 4.5 year measuring period. Similarly, waist circumference increased more in males (4.7cm; p<0.001) than in females (1.0cm; p<0.001). In contrast, females (2.5%; p<0.001) showed a higher increase in fat% than males (1.0%; p = 0.019). Across sexes, the highest weight and fat gains were found during the first semester and during the final year of university.

Conclusions

Belgian university students gain a significant amount of body weight and body fat from freshman through senior year of university. Similar to the first semester, more pronounced increases in weight and fat were observed during the final year of university. Interventions aiming at preventing weight gain at university should not only focus on freshmen but also on senior students.

Association of Obesity With Septic Complications After Major Abdominal Surgery: A Secondary Analysis of the RELIEF Randomized Clinical Trial

IMPORTANCE

Body mass index (BMI) has been the most common obesity measure to assess perioperative risk; however, cardiometabolic risk is associated with the burden of visceral fat. Definitive evidence on the association of visceral fat measures, such as waist circumference and waist-to-hip ratio (WHR), with postoperative complications is lacking.

OBJECTIVE

To compare the value of waist circumference with the value WHR and BMI in predicting adverse outcomes, including major septic complications and persistent disability, following major abdominal surgery.

DESIGN, SETTING, AND PARTICIPANTS

This planned secondary analysis of the Restrictive vs Liberal Fluid Therapy for Major Abdominal Surgery (RELIEF) randomized clinical trial took place at 47 centers in 7 countries between October 2013 and September 2016, with 90-day follow-up. A total of 2954 adult RELIEF participants were coenrolled in this secondary analysis. Data analysis took place from December 2018 to September 2019.

EXPOSURES

Waist circumference, WHR, and BMI measurements.

MAIN OUTCOMES AND MEASURES

The primary outcomes were 30-day major septic complications and 90-day persistent disability or death.

RESULTS

Of 2954 eligible participants, 2755 were included (mean [SD] age, 65.9 [12.9] years; 1426 [51.8%] men) in the final analysis. A total of 564 participants (20.6%) experienced at least 1 major septic complication within 30 days after surgery (sepsis, 265 [9.7%]; surgical site infection, 409 [14.9%]; anastomotic leak, 78 [2.8%]; pneumonia, 104 [3.8%]). Waist circumference had a statistically significantly larger odds ratio (OR) and discrimination indices as well as a smaller prediction error than WHR or BMI for 30-day major septic complications or death (waist circumference: OR, 1.44; 95% CI, 1.28-1.62; P < .001; area under the receiver operating characteristic curve, 0.641; net reclassification index, 0.266; integrated discrimination improvement [score × 104], 152.98; Brier score, 0.162; WHR: OR, 1.15; 95% CI, 1.03-1.28; P = .01; area under the receiver operating characteristic curve, 0.621; net classification index, 0.199; integrated discrimination improvement [score × 104], 28.47; Brier score, 0.164; BMI: OR, 1.33; 95% CI, 1.17-1.50; P < .001; area under the receiver operating characteristic curve, 0.629; net reclassification index, 0.205; integrated discrimination improvement [score × 104], 85.61; Brier score, 0.163) but not for any other outcomes.

CONCLUSIONS AND RELEVANCE

In this secondary analysis of the RELIEF randomized clinical trial, waist circumference was observed to be superior to other adiposity indices in predicting 30-day major septic complications alone or in conjunction with death following elective major abdominal surgery. Findings suggest that waist circumference is a useful adiposity measure that should be incorporated in preoperative risk assessment for such complications.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT01424150.

Alternative waist-to-height ratios associated with risk biomarkers in youth with diabetes: comparative models in the SEARCH for Diabetes in Youth Study

BACKGROUND/OBJECTIVES

The waist-to-height ratio (WHtR) estimates cardiometabolic risk in youth without need for growth charts by sex and age. Questions remain about whether waist circumference measured per protocol of the National Health and Nutrition Examination Survey (WNHAHtR) or World Health Organization (WWHOHtR) can better predict blood pressures and lipid parameters in youth.

PARTICIPANTS/METHODS

WHtR was measured under both anthropometric protocols among participants in the SEARCH Study, who were recently diagnosed with diabetes (ages 5-19 years; N = 2 773). Biomarkers were documented concurrently with baseline anthropometry and again ~7 years later (ages 10-30 years; N = 1 712). For prediction of continuous biomarker outcomes, baseline WNHAHtR or WWHOHtR entered semiparametric regression models employing restricted cubic splines. To predict binary biomarkers (high-risk group defined as the most adverse quartile) linear WNHAHtR or WWHOHtR terms entered logistic models. Model covariates included demographic characteristics, pertinent medication use, and (for prospective predictions) the follow-up time since baseline. We used measures of model fit, including the adjusted-R2 and the area under the receiver operator curves (AUC) to compare WNHAHtR and WWHOHtR.

RESULTS

For the concurrent biomarkers, the proportion of variation in each outcome explained by full regression models ranged from 23 to 46%; for the prospective biomarkers, the proportions varied from 11 to 30%. Nonlinear relationships were recognized with the lipid outcomes, both at baseline and at follow-up. In full logistic models, the AUCs ranged from 0.75 (diastolic pressure) to 0.85 (systolic pressure) at baseline, and from 0.69 (triglycerides) to 0.78 (systolic pressure) at the prospective follow-up. To predict baseline elevations of the triglycerides/HDL cholesterol ratio, the AUC was 0.816 for WWHOHtR compared with 0.810 for WNHAHtR (p = 0.003), but otherwise comparisons between alternative WHtR protocols were not significantly different.

CONCLUSIONS

Among youth with recently diagnosed diabetes, measurements of WHtR by either waist circumference protocol similarly helped estimate current and prospective cardiometabolic risk biomarkers.

Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: a position statement

Findings from epidemiological studies over the past 30 years have shown that visceral adipose tissue, accurately measured by CT or MRI, is an independent risk marker of cardiovascular and metabolic morbidity and mortality. Emerging evidence also suggests that ectopic fat deposition, including hepatic and epicardial fat, might contribute to increased atherosclerosis and cardiometabolic risk. This joint position statement from the International Atherosclerosis Society and the International Chair on Cardiometabolic Risk Working Group on Visceral Obesity summarises the evidence for visceral adiposity and ectopic fat as emerging risk factors for type 2 diabetes, atherosclerosis, and cardiovascular disease, with a focus on practical recommendations for health professionals and future directions for research and clinical practice. We discuss the measurement of visceral and ectopic fat, pathophysiology and contribution to adverse health outcomes, response to treatment, and lessons from a public health programme targeting visceral and ectopic fat. We identify knowledge gaps and note the need to develop simple, clinically applicable tools to be able to monitor changes in visceral and ectopic fat over time. Finally, we recognise the need for public health messaging to focus on visceral and ectopic fat in addition to excess bodyweight to better combat the growing epidemic of obesity worldwide.

The association of wrist circumference with hypertension in northeastern Chinese residents in comparison with other anthropometric obesity indices

Background

Wrist circumference (WrC) is an easily obtained measure in estimating the body frame and regional fat distribution, and has increasingly used as an obesity index. The aim of our study is to estimate the association of WrC with elevated blood pressure (BP) among northeastern Chinese community-dwelling residents, and compare the strength of this association to other anthropometric obesity indices.

Methods

A total of 2,331 adult participants (761 male participants, and 1,570 female participants) were included. WrC and other five generally used obesity indices, including body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and neck circumference (NC) were measured. Hypertension was defined as systolic blood pressure (SBP)/diastolic blood pressure (DBP) ≥140/90 mmHg or anti-hypertensive medication use. Multivariable linear and logistic regression models were performed to identify associations of BP and hypertension with per standard deviation (SD) increase of obesity indices. Areas under receiver operative characteristic curves (AUC) were calculated to compare the predicting capacity of WrC and other obesity indices on hypertension.

Results

All of the six obesity indices were positively associated with both SBP and DBP after adjustment for age and gender (P-values of associations of SBP with obesity indices were 0.043 for WrC, and <0.001 for other five indices; P-values of associations of DBP with obesity indices were 0.011 for WrC, 0.031 for WHR, and <0.001 for other four indices), while the association between SBP and WrC showed no statistically significant after further adjusted for life-style and metabolic risk factors (P-value was 0.062). The increases of both SBP and DBP per SD increase of BMI were the largest. The positive associations of five obesity indices but WHR with hypertension were observed after adjustment for all risk factors (P-values were 0.024 for WrC, 0.064 for WHR and <0.001 for other four indices). However, the odd ratios (OR) of WrC was the smallest, while BMI was the largest. Consistently, the AUC of BMI was the largest and statistically larger than that observed for WrC (P-value <0.001).

Conclusions

WrC was associated with hypertension among northeastern Chinese populations. However, the association was not stronger than the other generally used indices, particularly BMI.

The beneficial effects of brown adipose tissue transplantation

Obesity is a disease that results from an imbalance between energy intake and energy expenditure. Brown adipose tissue (BAT) is a potential therapeutic target to improve the comorbidities associated with obesity due to its inherent thermogenic capacity and its ability to improve glucose metabolism. Multiple studies have shown that activation of BAT using either pharmacological treatments or cold exposure had an acute effect to increase metabolic function and reduce adiposity. Recent preclinical investigations have explored whether increasing BAT mass or activation through transplantation models could improve glucose metabolism and metabolic health. Successful BAT transplantation models have shown improvements in glucose metabolism and insulin sensitivity, as well as reductions in body mass and decreased adiposity in recipients. BAT transplantation may confer its beneficial effects through several different mechanisms, including endocrine effects via the release of 'batokines'. More recent studies have demonstrated that beige and brown adipocytes isolated from human progenitor cells and transplanted into mouse models result in metabolic improvements similar to transplantation of whole BAT; this could represent a clinically translatable model. In this review we will discuss the impetus for both early and recent investigations utilizing BAT transplantation models, the outcomes of these studies, and review the mechanisms associated with the beneficial effects of BAT transplant to confer improvements in metabolic health.

Associations between self-reported and objectively measured physical activity and overweight/obesity among adults in Kota Bharu and Penang, Malaysia

BACKGROUND

For the past decades, Malaysia has seen an increased prevalence of overweight and obesity which leads to significant health threats. Physical activity is beneficial in maintaining healthy body weight. The objective of this study was to measure physical activity of adults in Malaysia using objective measurement (accelerometer) and self-reported methods, as well as to determine their associations with (body mass index (BMI) and waist circumference (WC) measurements.

METHODS

Four-hundred and ninety Malaysian adults (n = 490) aged 20 to 65 years old participated in this cross-sectional study. Their body weight, height, and WC measurements were measured according to standard procedures. Physical activity was assessed objectively with accelerometers for five to seven consecutive days. The International Physical Activity Questionnaire (IPAQ) was used to estimate the amount of time spent on various domains of physical activity. Mixed models were used to determine the associations between physical activity variables and both BMI and WC.

RESULTS

The mean value of objectively measured moderate-to-vigorous physical activity (MVPA) was 13.5 min per day, in which male participants recorded a significantly higher amount of time compared to females. On the other hand, the mean self-reported total physical activity was 380 min per week; male participants reported a significantly higher amount of time on physical activity in the occupation/work and leisure/recreation domains while female participants spent significantly more time in the domestic/household chores domain. We also observed that the mean values of objectively measured total MVPA, self-reported time spent on walking for leisure/recreation, and total time amount of time spent on MVPA for leisure/recreation were significantly higher among participants with BMI of less than 25 kg/m2. The final statistical model yielded a significant negative association between objectively measured total MVPA and BMI, but not with WC measurement. No significant association was reported between self-reported total physical activity with BMI and WC measurement.

CONCLUSIONS

Objectively measured MVPA was inversely associated with BMI, but not WC measurement. No significant association was observed between self-reported total physical activity and physical activity time measures across domains with both BMI and WC measurement.

Dietary intakes and obesity of Malaysian adults

BACKGROUND/OBJECTIVES

Over the past few decades, Malaysia has been experiencing an increased prevalence of overweight and obesity that threatens the health of Malaysians. Poor dietary intake is one of the major contributors to the development of obesity and many non-communicable diseases. The dietary intakes of adults in Malaysia were assessed to determine the association between the dietary intake variables and the body mass index (BMI) and waist circumference (WC) measurements. This study examined whether the dietary intake achieved the recommended nutritional guidelines and compared the intakes between both sexes.

SUBJECTS/METHODS

The height, weight, and WC of four-hundred-and-ninety adults (n = 490) in Malaysia were measured using standard procedures. The three-day 24-hour dietary recalls were conducted on 422 out of the 490 adults and their dietary intakes were evaluated in detail. The selected dietary intake variables were used to determine the associations with the obesity indicators.

RESULTS

Among the participants, 52.8% were overweight or obese. After data analysis, the mean energy intake was 1,550 kcal/day, in which male participants had a significantly higher energy and macronutrients intake than females. Protein consumption and its percentage of energy contribution exceeded the recommended range. The consumption of fruits, vegetables, and milk and milk products were lower than the recommended number of servings for a healthy diet. The male participants consumed significantly more servings of carbohydrate-based foods, meat, and fats, oils, and sweets than females. Among the selected dietary intake variables, only the carbohydrate intake was negatively associated with the BMI (Estimate b = −0.008) and WC measurements (Estimate b = −0.019) after adjusting for covariates.

CONCLUSIONS

This study evaluated the dietary intakes of a sample of Malaysian adults and its association with the obesity indicators. The results highlight the need for improvements and modifications of the dietary intake of Malaysians to reduce the overweight and obesity rates.

Clinically relevant body composition methods for obese pediatric patients

BACKGROUND

There is no gold standard in body composition measurement in pediatric patients with obesity. Therefore, the aim of this study was to investigate if there are any differences between two bioelectrical impedance analysis techniques performed in children and adolescents with obesity.

METHODS

Data were collected at the Department of Pediatrics and Adolescent Medicine in Vienna from September 2015 to May 2017. Body composition measurement was performed with TANITA scale and BIA-BIACORPUS.

RESULTS

In total, 38 children and adolescents (age: 10-18 years, BMI: 25-54 kg/m2) were included. Boys had significantly increased fat free mass (TANITA p = 0.019, BIA p = 0.003), total body water (TANITA p = 0.020, BIA p = 0.005), and basal metabolic rate (TANITA p = 0.002, BIA p = 0.029). Girls had significantly increased body fat percentage with BIA (BIA p = 0.001). No significant gender differences of core abdominal area have been determined. TANITA overestimated body fat percentage (p < 0.001), fat mass (p = 0.002), and basal metabolic rate (p < 0.001) compared to BIA. TANITA underestimated fat free mass (p = 0.002) in comparison to BIA. The Bland Altman plot demonstrated a low agreement between the body composition methods.

CONCLUSIONS

Low agreement between TANITA scale and BIA-BIACORPUS has been observed. Body composition measurement should always be performed by the same devices to obtain comparable results. At clinical routine due to its feasibility, safety, and efficiency, bioelectrical impedance analysis is appropriate for obese pediatric patients.

TRIAL REGISTRATION

ClinicalTrials NCT02545764 . Registered 10 September 2015.

Low Diagnostic Accuracy of Body Mass Index-Based and Waist Circumference-Based References of Childhood Overweight and Obesity in Identifying Overfat among Chinese Children and Adolescents

This study aimed to investigate the diagnostic accuracy of body mass index- (BMI-) based and waist circumference- (WC-) based references for childhood overweight and obesity in screening overfat individuals among 2134 Chinese children and adolescents. In this study, overfat status was defined as over 25% body fat for boys and over 30% for girls. Childhood obesity or overweight was defined by four BMI-based references and two WC-based references. All BMI-based references for obesity showed low sensitivity (SE) (0.128–0.473) but high specificity (SP) (0.971–0.998) in detecting overfat individuals in the current population. SE values increased from 0.493 to 0.881 when BMI- and WC-based references for overweight were used to detect overfat individuals. All references for overweight showed high SP rates (0.816–0.966). To improve diagnostic accuracy for childhood obesity, further studies may define a cut-off value for childhood obesity specific for a local population and ethnicity by using health-related overfat data.