Waist and hip circumference are independently associated with the risk of liver disease in population-based studies

Effects of low-versus high-volume high-intensity interval training on glycemic control and quality of life in obese women with type 2 diabetes. A randomized controlled trial

Background/objective

Comparison between different training volumes of high-intensity interval training (HIIT) is understudied in type 2 diabetes. This study aimed to compare the effects of low- and high-volume HIIT on glycemic control, blood lipids, blood pressure, anthropometric adiposity measures, cardiorespiratory fitness, and health-related quality of life (HRQoL) in women with type 2 diabetes.

Methods

Seventy-two obese women with type 2 diabetes aged 36-55 were randomly assigned to a low-volume HIIT group (i.e., 2 × 4-min high-intensity treadmill exercise at 85%-90% of peak heart rate, with a 3-min active recovery interval in between), a high-volume HIIT group (i.e., 4 × 4-min high-intensity treadmill exercise at 85%-90% of peak heart rate, with three 3-min active recovery intervals in between), and a non-exercising control group. Patients in HIIT groups exercised three days a week for 12 weeks. All patients received oral hypoglycemic medications with no calorie restrictions. The outcome measures were glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), 2-hour postprandial blood glucose (2-hr PPBG), total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), waist circumference (WC), waist-to-hip ratio, time to maximal exhaustion determined from a maximal treadmill exercise test (i.e., a measure of cardiorespiratory fitness), and HRQoL assessed by the 12-item Short Form (SF-12) Health Survey.

Results

The low- and high-volume HIIT groups showed significant improvements in all outcome measures compared to the baseline and the non-exercising group (P < 0.05), except for DBP in the low-volume HIIT group (p > 0.05). Also, both low- and high-volume HIIT groups showed similar improvements in TC, HDL, SBP, DBP, BMI, WC, waist-to-hip ratio, and the SF-12 scores, with no significant between-groups difference (p > 0.05). The high-volume HIIT group, however, showed more significant improvements in HbA1c, FBG, 2-hr PPBG, TG, LDL, and treadmill time to maximal exhaustion than the low-volume HIIT group (p < 0.05). The non-exercising group showed non-significant changes in all outcome measures (p > 0.05).

Conclusion

Low-volume HIIT could be equally effective as high-volume HIIT for improving TC, HDL, blood pressure, anthropometric adiposity measures, and HRQoL in obese women with type 2 diabetes. Nevertheless, high-volume HIIT could have a greater impact on glycemic control, TG, LDL, and cardiorespiratory fitness in these patients.

Trial registration

ClinicalTrials.gov, NCT05110404.

Association of obesity profiles and metabolic health status with liver injury among US adult population in NHANES 1999-2016

The combined effect of obesity and metabolic abnormalities on liver injury is unclear. Aiming to address this knowledge gap, this cross-sectional study was conducted among 16,201 US adults. Multiple linear regression and logistic regression analyses were conducted to assess the associations of obesity profiles, metabolic health status, and weight change with the levels of liver enzymes. The analysis revealed that general obesity and abdominal obesity were positively associated with the levels of liver enzymes and the prevalence of abnormal liver enzymes (P and Ptrend < 0.05). The associations remained significant in both metabolically healthy and metabolically unhealthy subgroups. Additionally, the liver injury index levels of the metabolically unhealthy participants were higher than those of the metabolically healthy individuals within the non-obese, overweight/pre-abdominal obesity, and general/abdominal obesity subgroups (P and Ptrend < 0.05). Furthermore, the subgroup characterized by general/abdominal obesity and metabolic dysfunction exhibited the most robust association with the liver injury index compared to all other subgroups examined. In addition, positive associations were observed between the 1-year and 10-year weight changes and the levels of liver injury indicators (P and Ptrend < 0.05). In conclusion, this study demonstrates that both obesity and metabolic impairment are independently associated with liver injury, and their combined presence have an additional adverse effect on liver health. These findings underscore the importance of addressing both obesity and metabolic dysfunction in order to mitigate the risk of liver injury.

Waist-hip ratio is superior to BMI in predicting liver-related outcomes and synergizes with harmful alcohol use

BACKGROUND

Obesity is associated with liver disease, but the best obesity-related predictor remains undefined. Controversy exists regarding possible synergism between obesity and alcohol use for liver-related outcomes (LRO). We assessed the predictive performance for LROs, and synergism with alcohol use, of abdominal obesity (waist-hip ratio, WHR), and compared it to overall obesity (body mass index, BMI).

METHODS

Forty-thousand nine-hundred twenty-two adults attending the Finnish health-examination surveys, FINRISK 1992-2012 and Health 2000 studies, were followed through linkage with electronic healthcare registries for LROs (hospitalizations, cancers, and deaths). Predictive performance of obesity measures (WHR, waist circumference [WC], and BMI) were assessed by Fine-Gray models and time-dependent area-under-the-curve (AUC).

RESULTS

There are 355 LROs during a median follow-up of 12.9 years (509047.8 person-years). WHR and WC emerge as more powerful predictors of LROs than BMI. WHR shows significantly better 10-year AUC values for LROs (0.714, 95% CI 0.685-0.743) than WC (0.648, 95% CI 0.617-0.679) or BMI (0.550, 95% CI 0.514-0.585) both overall and separately among men and women. WHR is predictive also in BMI strata. Absolute 10-year risks of LROs are more dependent on WHR than BMI. Moreover, WHR shows a significant supra-additive interaction effect with harmful alcohol use for liver-related outcomes (excess 10-year cumulative incidence of 2.8% from the interaction), which is not seen between BMI and harmful alcohol use.

CONCLUSIONS

WHR is a better predictor than BMI or WC for LROs, and WHR better reflects the synergism with harmful alcohol use. WHR should be included in clinical assessment when evaluating obesity-related risks for liver outcomes.

Association Between the Dietary Inflammatory Index and the Risk of Fracture in Chinese Adults: Longitudinal Study

BACKGROUND

Chronic inflammation plays a crucial role in tissue injury, osteoporosis, and fracture. The dietary inflammatory index (DII) is a tool for assessing the potential for inflammation in the diet. However, the association between the DII and fractures remains controversial from previous studies.

OBJECTIVE

We aimed to explore the correlation between the DII and fracture risk in Chinese adults.

METHODS

We included 11,999 adults (5519 men and 6480 women) who were a part of the China Health and Nutrition Survey (1997-2015) prospective cohort. A 3-day, 24-hour meal review method was used to calculate the DII score. The fractures were identified using a questionnaire. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% CIs for fractures. Subgroup, sensitivity, and restricted cubic spline analyses were performed.

RESULTS

During the 18 years of follow-up (median follow-up 9.0 years), 463 men and 439 women developed fractures. The median DII score was 0.64 (IQR -1.74 to 1.46) for the total sample, 0.75 (IQR -1.68 to 1.50) for men, and 0.53 (IQR -1.79 to 1.42) for women. The DII score had a positive correlation with the risk of fracture among women but not among men. For men, after adjusting for covariates, the HRs for quintiles of DII were 1, 0.96 (95% CI 0.66-1.41), 1.05 (95% CI 0.74-1.49), 0.89 (95% CI 0.62-1.26), and 0.94 (95% CI 0.67-1.34; trend: P=.62). The HRs for women were 1, 1.13 (95% CI 0.72-1.79), 1.24 (95% CI 0.83-1.86), 1.51 (95% CI 1.02-2.22), and 1.62 (95% CI 1.10-2.39; trend: P=.004). The restricted cubic spline analysis showed a significant association between fracture risk and DII score in women (overall association: P=.01); as the DII scores were >0.53, HRs showed a significant upward trend. Women aged <50 years or who are nonsmokers, who are nondrinkers, or with nonabdominal obesity had a positive association between fracture risk and the DII score. In sensitivity analyses, after excluding people with diabetes or hypertension, there was still a positive association between fracture risk and the DII score in women. Among the DII components, the DII scores of protein (trend: P=.03), niacin (trend: P=.002), and iron (trend: P=.02) showed significant associations with the risk of fracture in women.

CONCLUSIONS

Proinflammatory diet consumption increased the fracture risk in Chinese women aged <50 years. The high consumption of anti-inflammatory foods and low consumption of proinflammatory foods may be an important strategy to prevent fractures in women.

Genetic and Environmental Influences on Serum Alanine Aminotransferase Level: A Chinese Twin Study

An abnormal alanine aminotransferase (ALT) level is predictive of disease and all-cause mortality and may indicate liver injury. Using twin modeling, the genetic and environmental factors that affect human serum ALT levels have been well studied for the populations in the different countries, and the results showed moderate-to-high heritability. However, the heritability of ALT level has not been explored in Chinese population. Thus, we recruited 369 pairs of twins (233 monozygotic and 136 dizygotic) from the Qingdao Twin Registry in China with a median age of 50 years (40-80 years). Correlation analysis and a structural equation model (SEM) were conducted to evaluate the heritability of ALT level. The data for age, gender, body mass index and alcohol consumption were set as covariates. Intrapair correlation in monozygotic twins was 0.64 (95%CI [.56, .71]) and 0.42 (95% CI [.28, .55]) in dizygotic twins. The SEM analysis indicated that 65% (95% CI [57%, 71%]) of the variation in ALT levels can be explained by additive genetics and 35% (95% CI [29%, 44%]) of the variation is attributed to unique environmental factors or residuals. Shared environmental influences were not significant. In conclusion, serum ALT variations exhibited strong genetic effects. The variation could also be explained by unique environmental factors. However, shared environmental factors have a minor impact on the serum ALT level.

Changes over time in the Chronic Liver Disease risk score predict liver-related outcomes: longitudinal analysis of the Whitehall II study

BACKGROUND AND AIMS

The Chronic Liver Disease (CLivD) risk score was recently shown to predict future advanced liver disease in the general population. We here investigated the impact of individual CLivD-score changes over time.

METHODS

Participants of both phase 3 (baseline, 1991-1994) and phase 5 (follow-up, 1997-1999) examinations of the Whitehall II study were followed for liver-related outcomes (hospitalization, cancer, death) until December 2019 through linkage with electronic healthcare registers. The CLivD score, its modifiable components (alcohol use, waist-hip ratio [WHR], diabetes, and smoking), and their individual changes were studied.

RESULTS

Among 6590 adults (mean age 50 years, 30% women) with a median 21-year follow-up, there were 80 liver outcomes. A rise in the CLivD score between baseline and follow-up examinations significantly increased the risk for liver-related outcomes (adjusted hazard ratio [aHR] 1.62, 95% confidence interval [CI] 1.01-2.60), more so in subjects with baseline intermediate-high CLivD scores (HR 2.4 for a CLivD-change) compared to minimal-low CLivD scores. Adverse changes over time in alcohol use and WHR, and new-onset diabetes also predicted liver outcomes. In contrast to WHR, changes in body weight (kg) showed a U-shaped association with liver outcomes.

CONCLUSIONS

A change in the CLivD score over time corresponds to a true change in the risk for liver-related outcomes, suggesting the usefulness of the CLivD score for assessing response to liver-directed lifestyle interventions. Changes in WHR predicted liver outcomes better than changes in body weight or waist circumference, independent of body mass index, supporting the WHR in assessing risk for future liver disease.

Alcohol consumption and metabolic syndrome: Clinical and epidemiological impact on liver disease

Alcohol use and metabolic syndrome are highly prevalent in the population and frequently co-exist. Both are implicated in a large range of health problems, including chronic liver disease, hepatocellular carcinoma, and liver-related outcomes (i.e. decompensation or liver transplantation). Studies have yielded mixed results regarding the effects of mild-moderate alcohol consumption on the risk of metabolic syndrome and fatty liver disease, possibly due to methodological differences. The few available prospective studies have indicated that mild-moderate alcohol use is associated with an increase in liver-related outcomes. This conclusion was substantiated by systems biology analyses suggesting that alcohol and metabolic syndrome may play a similar role in fatty liver disease, potentiating an already existing dysregulation of common vital homeostatic pathways. Alcohol and metabolic factors are independently and jointly associated with liver-related outcomes. Indeed, metabolic syndrome increases the risk of liver-related outcomes, regardless of alcohol intake. Moreover, the components of metabolic syndrome appear to have additive effects when it comes to the risk of liver-related outcomes. A number of population studies have implied that measures of central/abdominal obesity, such as the waist-to-hip ratio, can predict liver-related outcomes more accurately than BMI, including in individuals who consume harmful quantities of alcohol. Many studies even point to synergistic interactions between harmful alcohol use and many metabolic components. This accumulating evidence showing independent, combined, and modifying effects of alcohol and metabolic factors on the onset and progression of chronic liver disease highlights the multifactorial background of liver disease in the population. The available evidence suggests that more holistic approaches could be useful for risk prediction, diagnostics and treatment planning.

Chronic disease burden among Latino farmworkers in California

Farmworkers are an essential workforce to maintain California's extensive agricultural production. However, this mostly Latino, immigrant population is affected by high poverty rates and food insecurity, which increases their risk of chronic diseases. We analyzed clinical and interview data from three studies of Latino farmworkers in California: (1) the Mexican Immigration to California: Agricultural Safety and Acculturation (MICASA) study, (2) the PASOS SALUDABLES pilot intervention (PASOS Pilot), and (3) the PASOS Study, a cluster-randomized, controlled trial (PASOS RCT). We aimed to determine the prevalence of diet-related chronic health outcomes (obesity, elevated waist circumference, high blood pressure, and high total cholesterol) and identify sociodemographic and socioeconomic factors associated with these conditions in this population. A total of 1,300 participants were included in this study (452 from MICASA, 248 from PASOS Pilot, and 600 from PASOS RCT). Obesity prevalence ranged from 29.2 to 54.5% across samples; elevated waist circumference was observed in 29.4-54.0% of participants; high blood pressure was detected in 42.0-45.5% of participants; 23.7-25.8% of participants had high total cholesterol. Age was positively associated with each health outcome, although not for each sample; each additional year in age increased odds by 3-9%, depending on the outcome and sample. Females were at higher risk of obesity (one sample) and elevated waist circumference, but at lower risk of high blood pressure and high total cholesterol. Single, divorced or widowed participants (vs. married/living together) had 35 and 47% reduced odds of obesity and elevated waist circumference, respectively. Each additional year living in the US was associated with 3-6% increased odds of obesity, depending on the sample. Higher household income was associated with a reduction in odds of high total cholesterol up to 76% (one sample). These findings highlight the increased risk of chronic health conditions in Latino farmworkers, in particular for obesity, and among farmworkers who may lack access to health care, which represents a large proportion of this population. Differences in chronic health risks by sex suggest that clinical and public health responses might need to be sex-specific. Expansion of eligibility for supplemental nutrition programs for this low-income population could reduce their disease burden.

Validity of fatty liver disease indices in the presence of alcohol consumption

BACKGROUND & AIMS

Non-alcoholic fatty liver disease (NAFLD) and alcohol-related liver disease frequently coexist. While several blood-based indices exist for the detection of NAFLD, few studies have examined how alcohol use possibly impacts their diagnostic performance. We analysed the effects of alcohol use on the performance of indices for detecting fatty liver disease (FLD).

METHODS

We included participants from the Cardiovascular Risk in Young Finns Study (Finnish sample) and KORA study (German sample) who underwent abdominal ultrasound or magnetic resonance imaging, respectively, for detection of FLD and had serum analyses available for calculation of Fatty Liver Index (FLI), Hepatic Steatosis Index (HSI), Lipid Accumulation Product (LAP), and Dallas Steatosis Index (DSI). Alcohol use was estimated by questionnaires as mean daily consumption and binge drinking (Finnish sample only). Predictive performance for FLD was assessed according to alcohol consumption.

RESULTS

The study included 1426 (Finnish sample) and 385 (German sample) individuals, of which 234 (16%) and 168 (44%) had FLD by imaging. When alcohol consumption was <50 g/day, all indices discriminated FLD with area under the receiver operating characteristics (AUROC) of 0.82-0.88. AUROCs were 0.61-0.66 among heavy drinkers (>50 g/day). AUROCs decreased to 0.74-0.80 in the highest binge-drinking category (>2 times/week). Alcohol use correlated with FLI and LAP (r-range 0.09-0.16, p-range <.001-.02) in both samples and with DSI (r = 0.13, p < .001) in the Finnish sample.

CONCLUSIONS

Indices perform well and comparably for detection of FLD with alcohol consumption <50 g/day and with different binge-drinking behaviour.