Association between body mass index and cardiovascular disease mortality in east Asians and south Asians: pooled analysis of prospective data from the Asia Cohort Consortium

Diabetes is associated with increased liver cancer incidence and mortality in adults: A report from Asia Cohort Consortium

There has been growing evidence suggesting that diabetes may be associated with increased liver cancer risk. However, studies conducted in Asian countries are limited. This project considered data of 968,738 adults pooled from 20 cohort studies of Asia Cohort Consortium to examine the association between baseline diabetes and liver cancer incidence and mortality. Cox proportional hazard model and competing risk approach was used for pooled data. Two-stage meta-analysis across studies was also done. There were 839,194 subjects with valid data regarding liver cancer incidence (5654 liver cancer cases [48.29/100,000 person-years]), follow-up time and baseline diabetes (44,781 with diabetes [5.3%]). There were 747,198 subjects with valid data regarding liver cancer mortality (5020 liver cancer deaths [44.03/100,000 person-years]), follow-up time and baseline diabetes (43,243 with diabetes [5.8%]). Hazard ratio (HR) (95% confidence interval [95%CI]) of liver cancer diagnosis in those with vs. without baseline diabetes was 1.97 (1.79, 2.16) (p < .0001) after adjusting for baseline age, gender, body mass index, tobacco smoking, alcohol use, and heterogeneity across studies (n = 586,072; events = 4620). Baseline diabetes was associated with increased cumulative incidence of death due to liver cancer (adjusted HR (95%CI) = 1.97 (1.79, 2.18); p < .0001) (n = 595,193; events = 4110). A two-stage meta-analytic approach showed similar results. This paper adds important population-based evidence to current literature regarding the increased incidence and mortality of liver cancer in adults with diabetes. The analysis of data pooled from 20 studies of different Asian countries and the meta-analysis across studies with large number of subjects makes the results robust.

Different associations between body mass index and Alzheimer's markers depending on metabolic health

BACKGROUND

Increasing evidence supports the association between body mass index (BMI), Alzheimer's disease, and vascular markers. Recently, metabolically unhealthy conditions have been reported to affect the expression of these markers. We aimed to investigate the effects of BMI status on Alzheimer's and vascular markers in relation to metabolic health status.

METHODS

We recruited 1,736 Asians without dementia (71.6 ± 8.0 years). Participants were categorized into underweight, normal weight, or obese groups based on their BMI. Each group was further divided into metabolically healthy (MH) and unhealthy (MU) groups based on the International Diabetes Foundation definition of metabolic syndrome. The main outcome was Aβ positivity, defined as a Centiloid value of 20.0 or above and the presence of vascular markers, defined as severe white matter hyperintensities (WMH). Logistic regression analyses were performed for Aβ positivity and severe WMH with BMI status or interaction terms between BMI and metabolic health status as predictors. Mediation analyses were performed with hippocampal volume (HV) and baseline Mini-Mental State Examination (MMSE) scores as the outcomes, and linear mixed models were performed for longitudinal change in MMSE scores.

RESULTS

Being underweight increased the risk of Aβ positivity (odds ratio [OR] = 2.37, 95% confidence interval [CI] 1.13-4.98), whereas obesity decreased Aβ positivity risk (OR = 0.63, 95% CI 0.50-0.80). Especially, obesity decreased the risk of Aβ positivity (OR = 0.38, 95% CI 0.26-0.56) in the MH group, but not in the MU group. Obesity increased the risk of severe WMH (OR = 1.69, 1.16-2.47). Decreased Aβ positivity mediate the relationship between obesity and higher HV and MMSE scores, particularly in the MH group. Obesity demonstrated a slower decline in MMSE (β = 1.423, p = 0.037) compared to being normal weight, especially in the MH group.

CONCLUSIONS

Our findings provide new evidence that metabolic health has a significant effect on the relationship between obesity and Alzheimer's markers, which, in turn, lead to better clinical outcomes.

Risk Factors Associated With General and Abdominal Obesity Among South Asian Minorities in Hong Kong

South Asians have become a sizable ethnic minority in Hong Kong with unique health and social needs often being overlooked. Elevated obesity risk among South Asians has been highlighted in high-income Western settings; however, relevant local evidence is scarce. This cross-sectional study aims to explore the obesity prevalence and related risk factors among South Asians in Hong Kong. Between June 2022 and February 2023, 535 South Asian adults were recruited via territory-wide health outreach services, and completed a survey and anthropometric measurements on height, weight, and waist circumference. In our female-dominated sample (84.1% female; mean age = 41.0 ± 12.3 years), the observed prevalence of general obesity (body mass index [BMI] ≥ 27.5 kg/m2 for South Asians) and abdominal obesity (waist-to-height ratio [WHtR] > 50%) were 60.2% and 89.4%, respectively. Results from multivariable linear regressions showed that mean BMI and WHtR were significantly higher among women and Pakistani individuals (and Nepalese individuals for BMI only) but lower among better educated and employed respondents. Apart from age, household size, and marital status as common risk factors, having a healthier diet and higher physical activity level were also associated with lower WHtR. Notably, the associations of female gender and Pakistani ethnicity were attenuated after adjustments for socioeconomic and lifestyle factors. In conclusion, there was a high prevalence of obesity in South Asian participants in this study. The identified risk and protective factors could inform targeted services and community-based weight management programs to mitigate obesity and its associated cardiometabolic risks in this fast-growing but vulnerable community.

Conventional and genetic associations of BMI with major vascular and non-vascular disease incidence and mortality in a relatively lean Chinese population: U-shaped relationship revisited

BACKGROUND

Higher body mass index (BMI) is associated with higher incidence of cardiovascular and some non-cardiovascular diseases (CVDs/non-CVDs). However, uncertainty remains about its associations with mortality, particularly at lower BMI levels.

METHODS

The prospective China Kadoorie Biobank recruited >512 000 adults aged 30-79 years in 2004-08 and genotyped a random subset of 76 000 participants. In conventional and Mendelian randomization (MR) analyses, Cox regression yielded adjusted hazard ratios (HRs) associating measured and genetically predicted BMI levels with incident risks of major vascular events (MVEs; conventional/MR 68 431/23 621), ischaemic heart disease (IHD; 50 698/12 177), ischaemic stroke (IS; 42 427/11 897) and intracerebral haemorrhage (ICH; 7644/4712), and with mortality risks of CVD (15 427/6781), non-CVD (26 915/4355) and all causes (42 342/6784), recorded during ∼12 years of follow-up.

RESULTS

Overall, the mean BMI was 23.8 (standard deviation: 3.2) kg/m2 and 13% had BMIs of <20 kg/m2. Measured and genetically predicted BMI showed positive log-linear associations with MVE, IHD and IS, but a shallower positive association with ICH in conventional analyses. Adjusted HRs per 5 kg/m2 higher genetically predicted BMI were 1.50 (95% CI 1.41-1.58), 1.49 (1.38-1.61), 1.42 (1.31-1.54) and 1.64 (1.58-1.69) for MVE, IHD, IS and ICH, respectively. These were stronger than associations in conventional analyses [1.21 (1.20-1.23), 1.28 (1.26-1.29), 1.31 (1.29-1.33) and 1.14 (1.10-1.18), respectively]. At BMIs of ≥20 kg/m2, there were stronger positive log-linear associations of BMI with CVD, non-CVD and all-cause mortality in MR than in conventional analyses.

CONCLUSIONS

Among relatively lean Chinese adults, higher genetically predicted BMI was associated with higher risks of incident CVDs. Excess mortality risks at lower BMI in conventional analyses are likely not causal and may reflect residual reverse causality.

Adaptation Potential and Body Mass Index in Assessing the Vital Activity of the Population in Mountain Regions

Background

We aimed to evaluate the functional state of the population of the midlands and highlands of Alai region (Kyrgyzstan) on the basis of body mass index (BMI) and adaptation potential (AP). The characteristic of people with overweight and underweight are presented. A clean dependence of AP on BMI was revealed.

Methods

In Alai region (Kyrgyzstan), 285 citizens of Gulcha village (1.540 m above sea level) and 312 citizens of Sary-Tash village (3.200 m above sea level) were examined in July-August 2023. Blood pressure (BP) was generally measured at rest in the seated position. The BMI and AP were calculated.

Results

In the midlands and highlands BP correspond to the physiological norm. The AP scores in the midlands region for men was 2.32 points, for women - 2.38 points, but in highlands areas these values were slightly higher: for men - 2.52 points, for women - 2.42 points. The total BMI values for men in the midlands and highlands were 23.39 and 23.24 kg/m2 respectively, for women in the midlands this indicator became higher than normal (26.53 kg/m2), but in the highlands it corresponded to the norm (24.78 kg/m2).

Conclusion

It is necessary to determine the value of AP, BMI and type of self-regulation of blood circulation when assessing the functional state of residents living in mountain areas. In the highlands overweight, which is one of the significant risk factors for health disorders, with tension of regulatory mechanisms can become a trigger for the development of cardiovascular diseases.

Association between reproductive factors with lung cancer incidence and mortality: A pooled analysis of over 308,000 females in the Asia cohort consortium

Previous studies have investigated the association between reproductive factors and lung cancer risk; however, findings have been inconsistent. In order to assess this association among Asian women, a total of 308,949 female participants from 11 prospective cohorts and four Asian countries (Japan, Korea, China, and Singapore) were included. Cox proportional hazards regression models were used to estimate the hazard ratios (HR) and 95% confidence intervals (CIs). A total of 3,119 primary lung cancer cases and 2247 lung cancer deaths were identified with a mean follow-up of 16.4 years. Parous women had a lower risk of lung cancer incidence and mortality as compared with nulliparous women, with HRs of 0.82 (95% CI = 0.70-0.96) and 0.78 (95% CI = 0.65-0.94). The protective association of parity and lung cancer incidence was greater among ever-smokers (HR = 0.66, 95% CI = 0.49-0.87) than in never-smokers (HR = 0.90, 95% CI = 0.74-1.09) (P-interaction = 0.029). Compared with age at first delivery ≤20 years, older age at first delivery (21-25, ≥26 years) was associated with a lower risk of lung cancer incidence and mortality. Women who ever used hormone replacements had a higher likelihood of developing non-small cell lung cancer (HR = 1.31, 95% CI = 1.02-1.68), compared to those who never used hormone replacements. Future studies are needed to assess the underlying mechanisms, the relationships within these female reproductive factors, and the potential changes in smoking habits over time.

Prevalence, sociodemographic, and clinical correlates of underweight in a sample of Chinese male alcohol-dependent patients

BACKGROUND

Underweight is a significant symptom in alcohol-dependent patients, yet few studies have examined underweight in Chinese male patients. The current study aimed to identify the prevalence, sociodemographic, and clinical correlates of underweight in Chinese male patients with alcohol dependency.

METHODS

In this cross-sectional study, 405 male inpatients with alcohol dependence and 383 healthy male controls were recruited. Participants' demographic and clinical data, including anthropometric data, were collected. We first conducted univariate analysis to identify seven variables with significant differences between groups: smoking behavior, hospitalization, alcohol consumption, cerebral infarction, hypertension, Hamilton Depression Scale (HAMD) score, and Scale for Assessment of Negative Symptom (SANS) score. Then, binary logistic regression was used to assess their relationship with underweight, with a significance level of .05.

RESULTS

The prevalence of underweight was significantly higher in the study population than in the control group (2.99% vs. 2.87%; P < .001). Patients with underweight had significantly higher rates of smoking behavior and cerebral infarction, as well as higher scores of SANS and HAMD than non-underweight patients. The non-underweight patients had higher daily alcohol consumption and times of hospitalization. Furthermore, logistic regression analysis showed that smoking behavior [odds ratio (OR) = 2.84, 95% confidence interval (CI) = 1.03-7.80, P = .043)], cerebral infarction (OR = 5.20, 95% CI = 1.13-23.85, P = .036), SANS score (OR = 1.22, 95% CI = 1.16-1.28, P < .001), and HAMD score (OR = 1.06, 95% CI = 1.02-1.11, P = .005) were associated with underweight.

CONCLUSIONS

More than 20% of male alcohol-dependent patients in a Chinese sample were underweight. Some demographic and clinical variables independent correlates for underweight in alcohol-dependent patients. We need to focus on alcohol-dependent patients with smoking, cerebral infarction, depression, and more prominent negative symptoms.

Association of medical comorbidities in obese subjects diagnosed with heparin-induced thrombocytopenia

Objectives

Heparin-induced thrombocytopenia can occur in obese subjects. The medical comorbidities associated with obesity may contribute to the pathogenesis of this disease. It is unknown, however, which specific medical comorbidities and if higher odds of thrombosis are present in obese heparin-induced thrombocytopenia patients. We sought to determine whether obese heparin-induced thrombocytopenia subjects had higher odds of both comorbidities and thrombosis, hypothesizing that this patient population would have higher odds of both these conditions.

Methods

This was a multi-center retrospective study utilizing TriNetX©, an electronic health record database, in subjects aged 18-99 years diagnosed with heparin-induced thrombocytopenia. The cohort was divided into two groups (1) non-obese (body mass index < 30 kg/m2) and (2) obese (body mass index ⩾ 30 kg/m2). We evaluated patient characteristics, diagnostic, laboratory, medication, and procedure codes.

Results

A total of 1583 subjects (696 (44.0%) non-obese and 887 (56.0%) obese) were included. Obese subjects had higher odds of diabetes with complications (OR = 1.73, 95% CI = 1.35-2.22, p < 0.001) and without complications (OR = 1.81, 95% CI = 1.47-2.22, p < 0.001). This association was still present after correcting for demographic and clinical factors. There were no increased odds of thrombosis observed in the obesity group.

Conclusions

Our study found that obese heparin-induced thrombocytopenia subjects had higher odds of having a diabetes mellitus comorbidity, but did not have higher odds of thrombosis. Given obesity is considered a hypercoagulable state, further study may be needed to understand why obese subjects diagnosed with heparin-induced thrombocytopenia do not have higher rates of thrombosis.

Utility of the ACD-GENE-CLI Score in Asian Patients with Critical Limb Ischemia Undergoing Endovascular Interventions

AIMS

Critical limb ischemia (CLI) is an emerging public health threat and lacks a reliable score for predicting the outcomes. The Age, Body Mass Index, Chronic Kidney Disease, Diabetes, and Genotyping (ABCD-GENE) risk score helps identify patients with coronary artery disease who have cytochrome P450 2C19 (CYP2C19) polymorphism-related drug resistance and are at risk for cardiovascular adverse events. However, its application to CLI remains unknown. In this study, we aim to validate a modified ACD-GENE-CLI score to improve the prediction of major adverse limb events (MALEs) in patients with CLI receiving clopidogrel.

METHODS

Patients with CLI receiving clopidogrel post-endovascular intervention were enrolled prospectively in two medical centers. Amputation and revascularization as MALEs were regarded as the outcomes.

RESULTS

A total of 473 patients were recruited, with a mean follow-up duration of 25 months. Except for obesity, old age, diabetes, chronic kidney disease (CKD), and CYP2C19 polymorphisms were significantly associated with MALEs. Using bootstrap regression analysis, we established a modified risk score (ACD-GENE-CLI) that included old age (≥ 65 years), diabetes, CKD, and CYP2C19 polymorphisms. At a cutoff value of 8, the ACD-GENE-CLI score was superior to the CYP2C19 deficiency only, and the conventional ABCD-GENE score in predicting MALEs (area under the curve: 0.69 vs. 0.59 vs. 0.67, p=0.01). The diagnostic ability of the ACD-GENE-CLI score was consistent in the external validation. Also, Kaplan-Meier curves showed that in CYP2C19 deficiency, the ABCD-GENE and ACD-GENE-CLI scores could all differentiate patients with CLI who are free from MALEs.

CONCLUSIONS

The modified ACD-GENE-CLI score could differentiate patients with CLI receiving clopidogrel who are at risk of MALEs. Further studies are required to generalize the utility of the score.

Low body mass index is associated with adverse cardiovascular outcomes following PCI in India: ACC-NCDR registry

Objective

Registry-based prospective study was conducted to evaluate association of body mass index (BMI) with major adverse coronary events (MACE) following percutaneous coronary intervention (PCI).

Methods

Successive patients undergoing PCI were enrolled from April'19 to March'22 and classified into five BMI categories (<23.0,23.0-24.9,25.0-26.9,27.0-29.9, and ≥30.0 kg/m2). Clinical, angiographic features, interventions and outcomes were obtained by in-person or telephonic follow-up. Primary endpoints were (a) MACE(cardiovascular deaths, acute coronary syndrome or stroke, revascularization, hospitalization and all-cause deaths) and (b)cardiovascular deaths. Cox-proportionate hazard ratios(HR) and 95 % confidence intervals(CI) were calculated.

Results

The cohort included 4045 patients. Mean age was 60.3 ± 11y, 3233(79.7 %) were men. There was high prevalence of cardiometabolic risk factors. 90 % patients had acute coronary syndrome(STEMI 39.6 %, NSTEMI/unstable angina 60.3 %), 60.0 % had impaired ejection fraction(EF) and multivessel CAD. Lower BMI groups (<23.0 kg/m2) had higher prevalence of tobacco use, reduced ejection fraction(EF), multivessel CAD, stents, and less primary PCI for STEMI. There was no difference in discharge medications and in-hospital deaths. Median follow-up was 24 months (IQR 12-36), available in 3602(89.0 %). In increasing BMI categories, respectively, MACE was in 10.9,8.9,9.5,9.1 and 6.8 % (R2 = 0.73) and CVD deaths in 5.1,4.5,4.4,5.1 and 3.5 % (R2 = 0.39). Compared to lowest BMI category, age-sex adjusted HR in successive groups for MACE were 0.89,0.87,0.79,0.69 and CVD deaths 0.98,0.87,0.95,0.75 with overlapping CI. HR attenuated following multivariate adjustments.

Conclusions

Low BMI patients have higher incidence of major adverse cardiovascular events following PCI in India. These patients are older, with greater tobacco use, lower EF, multivessel CAD, delayed STEMI-PCI, and longer hospitalization.

Associations of general and central adiposity with hypertension and cardiovascular disease among South Asian populations: a systematic review and meta-analysis

BACKGROUND

The relevance of measures of general and central adiposity for cardiovascular disease (CVD) risks in populations of European descent is well established. However, it is less well characterised in South Asian populations, who characteristically manifest larger waist circumferences (WC) for equivalent body mass index (BMI). This systematic review and meta-analysis provide an overview of the literature on the association of different anthropometric measures with CVD risk among South Asians.

METHODOLOGY

MEDLINE and Embase were searched from 1990 to the present for studies in South Asian populations investigating associations of two or more adiposity measures with CVD. Random-effects meta-analyses were conducted on the associations of BMI, WC and waist-to-hip ratio (WHR) with blood pressure, hypertension and CVD. Quality assessment was performed using the Newcastle-Ottawa scale.

RESULTS

Titles and abstracts were screened for 7327 studies, yielding 147 full-text reviews. The final sample (n=30) included 2 prospective, 5 case-control and 23 cross-sectional studies. Studies reported generally higher risks of hypertension and CVD at higher adiposity levels. The pooled mean difference in systolic blood pressure (SBP) per 5 kg/m2 higher BMI was 3 mmHg (2.90 (95% CI 1.30 to 4.50)) and 6 mmHg (6.31 (95% CI 4.81 to 7.81) per 13 cm larger WC. The odds ratio (OR) of hypertension per 5 kg/m2 higher BMI was 1.33 (95% CI 1.18 to 1.51), 1.45 (95% CI 1.05 to 1.98) per 13 cm larger WC and 1.22 (95% CI 1.04 to 1.41) per 0.1-unit larger WHR. Pooled risk of CVD for BMI-defined overweight versus healthy-weight was 1.65 (95% CI 1.55 to 1.75) and 1.48 (95% CI 1.21 to 1.80) and 2.51 (95% CI 0.94 to 6.69) for normal versus large WC and WHR, respectively. Study quality was average with significant heterogeneity.

CONCLUSIONS

Measures of both general and central adiposity had similar, strong positive associations with the risk of CVD in South Asians. Larger prospective studies are required to clarify which measures of body composition are more informative for targeted CVD primary prevention in this population.

Impact of frailty on mortality and healthcare costs and utilization among older adults in South Korea

Frailty has become increasingly relevant in a rapidly aging society, highlighting the need for its accurate identification and exploring associated clinical outcomes. Using a multidimensional framework to estimate frailty in a sample of community dwelling older adults, its effect on mortality, incurred healthcare costs and utilization were investigated. We obtained data from the 2008-2018 Korean Longitudinal Study of Aging (KLoSA). After excluding individuals aged < 65 years and those with missing data, a total of 3578 participants were included in our study. Cox proportional hazard analysis was conducted to investigate the impact of frailty on all-cause mortality by generating hazard ratios (HRs) and population attributable risks (PARs). Healthcare utilization and out-of-pocket costs incurred by frailty were examined using the Generalized Linear Mixed Model (GLMM). Subgroup analyses were conducted according to frailty components. Among 3578 older adults, 1052 individuals died during a 10-year follow up period. Compared to the low risk frailty group, the moderate risk group (HR: 1.52, 95% CI:1.37-1.69) and severe risk group (HR: 3.10, 95% CI: 2.55-3.77) had higher risks for all-cause mortality. 27.4% (95% CI: 19.0-35.3%) of all-cause mortality was attributable to frailty, and the PARs ranged from 0.5 to 22.6% for individual frailty components. Increasing frailty levels incurred higher total healthcare costs and cost per utilization, including inpatient and outpatient costs. Frailty also increased likelihood of inpatient use, longer length of stay and more frequent outpatient visits. Among the frailty components, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) in particular were linked to elevated mortality, higher incurred healthcare costs and utilization. Frailty-tailored interventions are of utmost relevance to policy makers and primary caregivers as frailty threatens the ability to maintain independent living and increases risk of detrimental outcomes such as mortality and increased utilization and out-of-pocket costs of healthcare in older adults.

Reproductive Factors and Endometrial Cancer Risk Among Women

Importance

Despite evidence of an association between reproductive factors and endometrial cancer risk, prospective studies have been conducted mainly in non-Asian countries.

Objective

To assess the association between reproductive factors, such as number of deliveries, age at menarche, or menopause, and endometrial cancer risk.

Design, Setting, and Participants

This cohort study used pooled individual data from 13 prospective cohort studies conducted between 1963 and 2014 in the Asia Cohort Consortium. Participants were Asian women. Data analysis was conducted from September 2019 to April 2023.

Exposures

Reproductive factors were assessed using a questionnaire in each cohort.

Main Outcomes and Measures

The main outcome was time to incidence of endometrial cancer. A Cox proportional hazards model was used to calculate hazard ratios (HRs) and 95% CIs.

Results

A total of 1005 endometrial cancer cases were detected among 332 625 women (mean [SD] age, 54.3 [10.4] years) during a mean (SD) of 16.5 (6.4) years of follow-up. Increasing number of deliveries was associated with a decreased endometrial cancer risk in a dose-response manner (≥5 deliveries vs nulliparous [reference]: HR, 0.37; 95% CI, 0.26-0.53; P for trend < .001). Compared with menarche at younger than 13 years, menarche at 17 years or older had an HR of 0.64 (95% CI, 0.48-0.86; P for trend < .001). Late menopause (age ≥55 years) showed an HR of 2.84 (95% CI, 1.78-4.55; P for trend < .001) compared with the youngest age category for menopause (<45 years). Age at first delivery, hormone therapy, and breastfeeding were not associated with endometrial cancer risk.

Conclusions and Relevance

This large pooled study of individual participant data found that late menarche, early menopause, and a higher number of deliveries were significantly associated with a lower risk of endometrial cancer. These convincing results from Asian prospective studies add to the growing body of evidence for the association between reproductive factors and endometrial cancer.

Strikes and Gutters: Biomarkers and anthropometric measures for predicting diagnosed diabetes mellitus in adults in low- and middle-income countries

The management of diabetes necessitates the requirement of reliable health indices, specifically biomarkers and anthropometric measures, to detect the presence or absence of the disease. Nevertheless, limited robust empirical evidence exists regarding the optimal metrics for predicting diabetes in adults, particularly within low- and middle-income countries. This study investigates objective and subjective indices for screening diabetes in these countries.

METHODS

Data for this study was sourced from surveys conducted among adults (aged 18 years and above) in seventeen (17) countries. Self-reported diabetes status, fifty-four biomarkers, and twenty-six core and twenty-eight estimated anthropometric indices, including weight, waist circumference, body mass index, glycaemic triglycerides, and fasting blood glucose, were utilised to construct lasso regression models.

RESULTS

The study revealed variances in diabetes prediction outcomes across different countries. Central adiposity measures, fasting plasma glucose and glycaemic triglycerides demonstrated superior predictive capabilities for diabetes when compared to body mass index. Furthermore, fasting plasma or blood glucose, serving as a biomarker, emerged as the most accurate predictor of diabetes.

CONCLUSIONS

These findings offer critical insights into both general and context-specific tools for diabetes screening. The study proposes that fasting plasma glucose and central adiposity indices should be considered as routine screening tools for diabetes, both in policy interventions and clinical practice. By identifying adults with or at higher risk of developing diabetes and implementing appropriate interventions, these screening tools possess the potential to mitigate diabetes-related complications in low- and middle-income countries.

Relationship Among Diabetes, Obesity, and Cardiovascular Disease Phenotypes: A UK Biobank Cohort Study

OBJECTIVE

Obesity and diabetes frequently coexist, yet their individual contributions to cardiovascular risk remain debated. We explored cardiovascular disease biomarkers, events, and mortality in the UK Biobank stratified by BMI and diabetes.

RESEARCH DESIGN AND METHODS

A total of 451,355 participants were stratified by ethnicity-specific BMI categories (normal, overweight, obese) and diabetes status. We examined cardiovascular biomarkers including carotid intima-media thickness (CIMT), arterial stiffness, left ventricular ejection fraction (LVEF), and cardiac contractility index (CCI). Poisson regression models estimated adjusted incidence rate ratios (IRRs) for myocardial infarction, ischemic stroke, and cardiovascular death, with normal-weight nondiabetes as comparator.

RESULTS

Five percent of participants had diabetes (10% normal weight, 34% overweight, and 55% obese vs. 34%, 43%, and 23%, respectively, without diabetes). In the nondiabetes group, overweight/obesity was associated with higher CIMT, arterial stiffness, and CCI and lower LVEF (P < 0.005); these relationships were diminished in the diabetes group. Within BMI classes, diabetes was associated with adverse cardiovascular biomarker phenotype (P < 0.005), particularly in the normal-weight group. After 5,323,190 person-years follow-up, incident myocardial infarction, ischemic stroke, and cardiovascular mortality rose across increasing BMI categories without diabetes (P < 0.005); this was comparable in the diabetes groups (P-interaction > 0.05). Normal-weight diabetes had comparable adjusted cardiovascular mortality to obese nondiabetes (IRR 1.22 [95% CI 0.96-1.56]; P = 0.1).

CONCLUSIONS

Obesity and diabetes are additively associated with adverse cardiovascular biomarkers and mortality risk. While adiposity metrics are more strongly correlated with cardiovascular biomarkers than diabetes-oriented metrics, both correlate weakly, suggesting that other factors underpin the high cardiovascular risk of normal-weight diabetes.

Eating behaviors and incident cardiovascular disease in Japanese people: The population-based Panasonic cohort study 14

Evidence on common eating behaviors to support the prevention of cardiovascular disease (CVD) in Japanese people is insufficient. This retrospective cohort study aimed to investigate the association of diet behaviors (e.g., skipping breakfast, eating speed, snack after dinner, and alcohol consumption) with incident CVD in Japanese individuals. Employees of Panasonic Corporation who underwent the annual health checkups and without a history of CVD at baseline were enrolled. The main outcome was incident 3-point major adverse cardiovascular events (MACE). The secondary outcomes were incident coronary artery disease (CAD) and stroke. To assess the effect of BMI, the subgroup analysis was conducted. In total, 132,795 participants were included. Overall, 3,115, 1,982, and 1,165 participants developed 3-point MACE, CAD, and stroke, respectively. Skipping breakfast (HR: 1.13, 95% CI: 1.03-1.23) and fast eating (HR: 1.23, 95% CI: 1.04-1.47) were associated with 3-point MACE in the participants overall. Skipping breakfast (HR: 1.23, 95% CI: 1.10-1.37) and fast eating (HR: 1.38, 95% CI: 1.12-1.71) were also associated with 3-point MACE in participants with BMI < 25 kg/m². In contrast, in participants with BMI ≥ 25 kg/m², these associations were not detectable (P value for the interaction between subgroups = 0.09 [skipping breakfast] and 0.03 [fast eating], respectively). The diet behavior is a potential risk factor of incident CVD in Japanese people, particularly in those with BMI < 25 kg/m².

Clustering of metabolic and behavioural risk factors for cardiovascular diseases among the adult population in South and Southeast Asia: findings from WHO STEPS data

Background

The aim of this study is to assess the current status of metabolic and behavioural risk factors for cardiovascular diseases among the adult population in South and Southeast Asia using World Health Organization (WHO) STEPS data.

Methods

We used WHO STEPS surveys data in ten South and Southeast Asian countries. Weighted mean estimates of prevalence of five metabolic risk factors and four behavioural risk factors were calculated by country and overall region. We used random-effects meta-analysis to generate country and regional pooled estimates of metabolic and behavioural risk factors, using the DerSimonian and Laird inverse-variance method.

Finding

Around 48,434 participants aged 18-69 years were included in this study. Overall 32.00% (95% CI: 31.15-32.36) of individuals in the pooled sample had one metabolic risk factor, 22.10% (95% CI: 21.73-22.47) had two, and 12.38% had three or more (95% CI: 9.09-14.00). Twenty-four percent (95% CI: 20.00-29.00) of individuals in the pooled sample had only one behavioural risk factor, 49.00% (95% CI: 42.00-56.00) had two, and 22.00% had three or more (95% CI: 16.00-29.00). Risk of high three or more metabolic risk factors was higher among women, those of older age, and those with a higher education.

Interpretation

The existence of multiple metabolic and behavioural risk factors among the South and Southeast Asian population demand appropriate prevention strategies to halt the progress of non-communicable disease burden within the region.

Funding

Not applicable.

Ambient Air Pollution and All-Cause and Cause-Specific Mortality in an Analysis of Asian Cohorts

INTRODUCTION

Much of what is currently known about the adverse effects of ambient air pollution comes from studies conducted in high-income regions, with relatively low air pollution levels. The aim of the current project is to examine the relationship between exposure to ambient air pollution (as predicted from satellite-based models) and all-cause and cause-specific mortality in several Asian cohorts.

METHODS

Cohorts were recruited from the Asia Cohort Consortium (ACC). The geocoded residences of participants were assigned levels of ambient particulate material with aerodynamic diameter of 2.5 μm or less (PM2.5) and nitrogen dioxide (NO2) utilizing global satellite-derived models and assigned for the year of enrollment (or closest available year). The association between ambient exposure and mortality was established with Cox proportional hazard models, after adjustment for common confounders. Both single- and two-pollutant models were generated. Model robustness was evaluated, and hazard ratios were calculated for each cohort separately and combined via random effect meta-analysis for pooled risk estimates.

RESULTS

Six cohort studies from the ACC participated: the Community-based Cancer Screening Program (CBCSCP, Taiwan), the Golestan Cohort Study (Iran), the Health Effects for Arsenic Longitudinal Study (HEALS, Bangladesh), the Japan Public Health Center-based Prospective Study (JPHC), the Korean Multi-center Cancer Cohort Study (KMCC), and the Mumbai Cohort Study (MCS, India). The cohorts represented over 340,000 participants.

Mean exposures to PM2.5 ranged from 8 to 58 μg/m3. Mean exposures to NO2 ranged from 7 to 23 ppb. For PM2.5, a positive, borderline nonsignificant relationship was observed between PM2.5 and cardiovascular mortality. Other relationships with PM2.5 tended toward the null in meta-analysis. For NO2, an overall positive relationship was observed between exposure to NO2 and all cancers and lung cancer. A borderline association between NO2 and nonmalignant lung disease was also observed. The findings within individual cohorts remained consistent across a variety of subgroups and alternative analyses, including two-pollutant models.

CONCLUSIONS

In a pooled examination of cohort studies across Asia, ambient PM2.5 exposure appears to be associated with an increased risk of cardiovascular mortality and ambient NO2 exposure is associated with an increased cancer (and lung cancer) mortality. This project has shown that satellite-derived models of pollution can be used in examinations of mortality risk in areas with either incomplete or missing air pollution monitoring.

Impact of Lactiplantibacillus plantarum Inducia on metabolic and antioxidative response in cholesterol and BMI variable indices: randomised, double-blind, placebo-controlled trials

Probiotics may have potential in reducing cardiovascular disease (CVD) risk in middle-aged persons with borderline metabolic indices. The ability of potential probiotic Lactiplantibacillus plantarum Inducia to reduce CVD risk factors in persons with variable cholesterol and body mass indices (BMI) was assessed. In two parallel-armed double-blind placebo-controlled interventions (n=136) and (n=104), participants daily received either test yoghurt (Inducia) or placebo yoghurt. BMI, blood pressure, plasma glucose, cholesterol, high-sensitivity C-reactive protein (hs-CRP), oxidative stress and immunological markers were measured. Total counts of lactobacilli and L. plantarum Inducia were evaluated using real-time PCR. Significant reduction of total cholesterol, low density lipoprotein cholesterol (LDL-c) and non-high-density cholesterol occurred in both trials. The change in cholesterol (P=0.023) in persons with normal BMI and borderline cholesterol levels after four weeks of yoghurt consumption was detected. A difference was also found between placebo and test yoghurt groups (P=0.042) in LDL-c with normal BMI. Blood glucose reduction (P=0.01) and antioxidative effect was detected in overweight volunteers of the test yoghurt group. The suppression of oxidised LDL was associated with lowered oxidative stress index and total peroxide concentration values and faecal recovery of Inducia. The Inducia strain expresses antioxidative effect on blood lipids and has anti-glycaemic impact that allow to apply it as dietary probiotic supplement for the management of CVD risks in humans.

Effect of body mass index trajectory on lifetime risk of cardiovascular disease in a Chinese population: A cohort study

BACKGROUND AND AIMS

The longitudinal trajectories of body mass index (BMI) can reflect the pattern of BMI changes. Lifetime risk quantifies the cumulative risk of developing a disease over the remaining life of a person. We aimed to identify the trajectory of BMI and explore its association with cardiovascular disease (CVD) in the Chinese population.

METHODS AND RESULTS

A total of 68,603 participants with a mean age of 55.46 years were included from the Kailuan cohort in Tangshan, China, who were free of CVD and cancer and with repeated measurements of BMI from 2006 to 2010. A latent mixture model was used to identify BMI trajectories. An improved Kaplan-Meier estimator was used to predict the lifetime risk of CVD according to BMI trajectories. During a median follow-up of 7.0 years, 3325 participants developed CVD. Five BMI trajectories were identified at three index ages (35, 45, and 55) respectively. For index age 35 years, compared with the stable low-normal weight group (22.7% [95% CI, 20.0%-25.4%]), the stable high-normal weight (27.6% [25.6%-29.5%]), stable overweight (29.4% [27.4%-31.4%]), stable-low obesity (32.8% [30.0%-35.5%]), and stable-high obesity (38.9% [33.3%-44.5%]) groups had a higher lifetime risk of CVD (P < 0.05). We observed similar patterns for stroke and myocardial infarction. Similarly, the lifetime risk of CVD was higher in the long-term overweight and obese groups at 45 and 55 index ages.

CONCLUSIONS

Long-term overweight and obesity were associated with an increased lifetime risk of CVD. Our findings could assist in predicting the population burden of CVD.

Cystatin C-based eGFR predicts cardiovascular disease in patients with overweight/obesity and hyperglycemia

Background

Although many clinical parameters have been identified as predictors for cardiovascular disease (CVD) development in the general population, the accurate predictor for CVD in patients with obesity is still unknown.

Objective

The study aimed to explore an additional risk factor and predictor for CVD in patients with overweight/obesity considering the interaction of obesity-related pathophysiology.

Methods

The Japan Obesity and Metabolic Syndrome study, a multicenter prospective study, enrolled 787 outpatients, of which 318 eligible patients were analyzed. Patients with fasting plasma glucose (FPG) levels ≥6.11 and < 6.11 mmol/L were considered to have high FPG (HFPG) and normal FPG (NFPG), respectively. Thirty-six patients who developed CVD during the 5 years follow-up were assigned to the CVD group.

Results

Cox's proportional hazards model revealed no significant association between CVD and cystatin C-based estimated glomerular filtration rate (eGFRcys) or creatinine-based eGFR (eGFRcr) in the NFPG group. In the HFPG group, lower eGFRcys, but not eGFRcr, was significantly associated with CVD development. A generalized linear mixed model demonstrated greater reduction in eGFRcys levels over time with HFPG than with NFPG. Although the CVD group showed gradual reduction in eGFRcys levels, the non-CVD group-matched using propensity scores-did not show a decline in eGFRcys levels.

Conclusions

Lower eGFRcys levels may be more accurate than eGFRcr in predicting CVD development in patients with overweight/obesity and hyperglycemia. Furthermore, eGFRcys reduction over time is associated with CVD development.

Clinical Trial Registry Number

UMIN000000559.

Body mass index, waist circumference and cardiovascular diseases in transitional ages (40 and 66 years)

BACKGROUND

There is lack of data on effect modification by age on the association between body mass index (BMI) or waist circumference (WC) and cardiovascular diseases (CVDs). We aimed to investigate the impact of BMI and WC on incident CVDs in individuals aged 40 and 66 years.

METHODS

Overall, 2 430 510 participants who underwent a national health screening for transitional ages provided by the Korean National Health Insurance Service between 2009 and 2012 were included. The adjusted hazard ratios and 95% confidence intervals for myocardial infarction (MI), ischaemic stroke and CVDs as a composite outcome of MI and ischaemic stroke were calculated using multivariable Cox proportional hazard regression analysis.

RESULTS

During a mean follow-up of 7.7 years, 24 884 MI and 29 415 ischaemic stroke events occurred. Among participants aged 40 years, there was a J-shaped association of BMI with incident CVDs, MI and ischaemic stroke with nadir at BMI 18.5-22.9 kg/m2 (P for trend < 0.001 for all). Among those aged 66 years, there were significant U-shaped associations of BMI with CVDs and MI with nadir at a BMI of 23.0-24.9 kg/m2 (P for trend 0.013 and 0.017, respectively). WC was linearly associated with all study outcomes in both age groups (P for trend < 0.001). The impact of general and abdominal obesity on both study outcomes was more prominent in those aged 40 years than in those aged 66 years (P for interaction < 0.001).

CONCLUSIONS

To prevent cardiovascular risk, weight loss intervention should be cautiously implemented and individualized according to age. The maintenance of muscle mass may be essential in managing weight loss particularly in older population.

Association of sodium intake with adverse left atrial function and left atrioventricular coupling in Chinese

OBJECTIVES

High sodium intake is strongly associated with hypertension and obesity. This study aims to investigate the relationship between 24-h urinary sodium (a surrogate measure of sodium intake), ambulatory blood pressure parameters, left atrial function, and left atrioventricular coupling. Further, we intend to examine whether blood pressure and BMI might be mediators of the relationship between 24-h urinary sodium and subclinical cardiac function.

METHODS

Our study had 398 participants, all of whom were subjected to 24-h urine collection, 24-h ambulatory blood pressure measurement, and cardiac magnetic resonance imaging.

RESULTS

The average age of the participants was 55.70 ± 11.30 years old. The mean urinary sodium of the participants was 172.01 ± 80.24 mmol/24 h. After adjusting for age, sex, history of diabetes, smoking status, alcohol consumption, and use of diuretics, 24-h urinary sodium was correlated with multiple ambulatory blood pressure parameters, BMI, left atrial function, and the left atrioventricular coupling index (LACI) (P < 0.05). Mediation analysis showed that BMI explained 16% of the indirect effect of 24-h urinary sodium and left atrial function and 30% of the indirect effect of LACI. Independent of the mediator, 24-h urinary sodium had a significant direct effect on left atrial function and left atrioventricular coupling.

CONCLUSIONS

Higher 24-h urinary sodium was associated with a greater BMI as well as poor left atrial function and left atrioventricular coupling, and the BMI mediated the relationship between 24-h urinary sodium and subclinical left cardiac function. Furthermore, and more importantly, 24-h urinary sodium may have directly affected the left atrial function and left atrioventricular coupling independent of intermediary factors.

Impact of body mass index on in-hospital mortality for six acute cardiovascular diseases in Japan

Body mass index (BMI) distribution and its impact on cardiovascular disease (CVD) vary between Asian and western populations. The study aimed to reveal time-related trends in the prevalence of obesity and underweight and safe ranges of BMI in Japanese patients with CVD. We analyzed 5,020,464 records from the national Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination dataset over time (2012-2019) and evaluated BMI trends and the impact on in-hospital mortality for six acute CVDs: acute heart failure (AHF), acute myocardial infarction (AMI), acute aortic dissection (AAD), ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Patients were categorized into five groups using the WHO Asian-BMI criteria: underweight (< 18.5 kg/m²), normal (18.5-22.9 kg/m²), overweight at risk (23.0-24.9 kg/m²), obese I (25.0-29.9 kg/m²), and obese II (≥ 30.0 kg/m²). Age was significantly and inversely related to high BMI for all diseases (P < 0.001). The proportion of BMI categories significantly altered over time; annual BMI trends showed a significant and gradual increase, except AAD. In adjusted mixed models, underweight was significantly associated with a high risk of in-hospital mortality in all CVD patients (AHF, OR 1.41, 95% CI 1.35-1.48, P < 0.001; AMI, OR 1.27, 95% CI 1.20-1.35, P < 0.001; AAD, OR 1.23, 95% CI 1.16-1.32, P < 0.001; IS, OR 1.45, 95% CI 1.41-1.50, P < 0.001; ICH, OR 1.18, 95% CI 1.13-1.22, P < 0.001; SAH, OR 1.17, 95% CI 1.10-1.26, P < 0.001). Moreover, obese I and II groups were significantly associated with a higher incidence of in-hospital mortality, except AHF and IS. Age was associated with in-hospital mortality for all BMI categories in six CVD patients. BMI increased annually in patients with six types of CVDs. Although underweight BMI was associated with high mortality rates, the impact of obesity on in-hospital mortality differs among CVD types.

The risk of cardiovascular diseases after miscarriage, stillbirth, and induced abortion: a systematic review and meta-analysis

Aims

Miscarriage and stillbirth have been included in cardiovascular disease (CVD) risk guidelines, however heterogeneity in exposures and outcomes and the absence of reviews assessing induced abortion, prevented comprehensive assessment. We aimed to perform a systematic review and meta-analysis of the risk of cardiovascular diseases for women with prior pregnancy loss (miscarriage, stillbirth, and induced abortion).

Methods and results

Observational studies reporting risk of CVD, coronary heart disease (CHD), and stroke in women with pregnancy loss were selected after searching MEDLINE, Scopus, CINAHL, Web of Knowledge, and Cochrane Library (to January 2020). Data were extracted, and study quality were assessed using the Newcastle-Ottawa Scale. Pooled relative risk (RR) and 95% confidence intervals (CIs) were calculated using inverse variance weighted random-effects meta-analysis.Twenty-two studies involving 4 337 683 women were identified. Seven studies were good quality, seven were fair and eight were poor. Recurrent miscarriage was associated with a higher CHD risk (RR = 1.37, 95% CI: 1.12-1.66). One or more stillbirths was associated with a higher CVD (RR = 1.41, 95% CI: 1.09-1.82), CHD (RR = 1.51, 95% CI: 1.04-1.29), and stroke risk (RR = 1.33, 95% CI: 1.03-1.71). Recurrent stillbirth was associated with a higher CHD risk (RR = 1.28, 95% CI: 1.18-1.39). One or more abortions was associated with a higher CVD (RR = 1.04, 95% CI: 1.02-1.07), as was recurrent abortion (RR = 1.09, 95% CI: 1.05-1.13).

Conclusion

Women with previous pregnancy loss are at a higher CVD, CHD, and stroke risk. Early identification and risk factor management is recommended. Further research is needed to understand CVD risk after abortion.

Impact of Body Mass Index on Obesity-Related Cancer and Cardiovascular Disease Mortality; The Japan Collaborative Cohort Study

AIM

We aimed to examine the association of obesity-related cancer and cardiovascular disease (CVD) with body mass index (BMI) and the estimated population attributable fraction in lean Asians.

METHODS

We studied 102,535 participants aged 40-79 years without histories of cancer or CVD at baseline between 1988 and 2009. The cause-specific hazard ratios (csHRs) of BMI categories (＜18.5, 18.5-20.9, 21.0-22.9 [reference], 23.0-24.9, 25.0-27.4, and ≥ 27.5 kg/m2) were estimated for each endpoint. The events considered were mortalities from obesity-related cancer (esophageal, colorectal, liver, pancreatic, kidney, female breast, and endometrial cancer) and those from CVD (coronary heart disease and stroke). Population attributable fractions (PAFs) were calculated for these endpoints.

RESULTS

During a 19.2-year median follow-up, 2906 died from obesity-related cancer and 4532 died from CVD. The multivariable-adjusted csHRs (95% confidence interval) of higher BMI categories (25-27.4 and ≥ 27.5 kg/m2) for obesity-related cancer mortality were 0.93 (0.78, 1.10) and 1.18 (0.92, 1.50) in men and 1.25 (1.04, 1.50) and 1.48 (1.19, 1.84) in women, respectively. The corresponding csHRs for CVD mortality were 1.27 (1.10, 1.46) and 1.59 (1.30, 1.95) in men and 1.10 (0.95, 1.28) and 1.44 (1.21, 1.72) in women, respectively. The PAF of a BMI ≥ 25 kg/m2 for obesity-related cancer was -0.2% in men and 6.7% in women and that for CVD was 5.0% in men and 4.5% in women.

CONCLUSION

A BMI ≥ 25 kg/m2 is associated with an increased risk of obesity-related cancer in women and CVD in both sexes.

Obesity, Burden of Ischemic Heart Diseases and Their Ecological Association: The Case of Uzbekistan

Ischemic heart diseases are the leading cause of death in Uzbekistan. There are numerous risk factors affecting ischemic heart disease, and obesity is one of the major independent risk factors. This study is the first attempt to estimate the ecological association between obesity prevalence and the burden of ischemic heart disease between 1990 and 2019 in Uzbekistan. To define the prevalence of all obesity types, death, and incidences of ischemic heart disease for certain periods, the Joinpoint regression tool was used. A separate linear regression analysis was performed to analyze the relationship between obesity and ischemic heart disease mortality and morbidity. A positive linear relation was found between the prevalence of obesity types and incidence/death rates for both sexes (r = 0.59−0.87). All types of obesity were highly significant positive predictors of incidence of and death from ischemic heart disease (p < 0.0001). The slope (B1) suggested that for an increment in obesity prevalence of 1% among adults aged over 20, the incidence of ischemic heart disease increased by 40.2 (p < 0.0001) and 38.3 (p < 0.0001) per 100,000 persons for men and women, respectively. The current country-level conclusions are valuable, because it allows decision makers to draw specific conclusions, applicable at the state and local level for policymaking.

Changes in physical activity and adiposity with all-cause, cardiovascular disease, and cancer mortality

Background

The relationship between joint changes in physical activity and adiposity with mortality is not well understood. We examined the association of changes in these two established risk factors with all-cause (ACM), cardiovascular disease (CVD), and cancer mortality.

Methods

We used longitudinal data from Taiwan’s MJ Cohort, comprising 116,228 general population adults recruited from 1998-2013 with repeated measures 4.6 y (2.5) apart and followed up for mortality for 11.9 y (3.5). Physical activity, body mass index (BMI), waist circumference (WC), and body fat percentage (BF%) groups and changes were based on public health and clinical guidelines.

Results

Compared to stable-insufficient physical activity, increasing physical activity from any baseline level was associated with lower ACM (HR [95%CI]): 0.85 [0.74, 0.96]) and CVD mortality (0.72 [0.55, 0.93]) risk. This was approximately equal to meeting physical activity guidelines at both timepoints (eg: 0.71 [0.58, 0.88] for CVD mortality). Compared to stable-overweight/moderate adiposity, decreasing adiposity level attenuated but did not offset mortality risk for all three outcomes (eg: BMI = 0.95 [0.76, 1.16] for CVD mortality). Only maintaining a healthy adiposity level at both timepoints offset mortality risk (BMI = 0.75 [0.61, 0.89]) for CVD mortality). In the joint changes analyses, lower mortality risk was a consequence of increases in physical activity across adiposity change groups (eg: WC decrease = 0.57 [0.48, 0.67]; WC stability = 0.73 [0.66, 0.80], WC increase = 0.83 [0.72, 0.97] for ACM). Decreasing adiposity attenuated the negative associations of decreased physical activity (BF% = 1.13 [0.95, 1.35] for ACM).

Conclusions

We found a lower risk for ACM, CVD, and cancer mortality from increasing physical activity and an attenuation from decreasing adiposity regardless of baseline levels. The beneficial associations of joint changes were primarily driven by physical activity, suggesting lower mortality risk may be more immediate through physical activity improvements compared to adiposity improvements alone.

Trends for the Association between Body Mass Index and Risk of Cardiovascular Disease among the Japanese Population: The Circulatory Risk in Communities Study (CIRCS)

AIM

This study aimed to investigate whether the impact of body mass index (BMI) on the risk of cardiovascular disease (CVD) has changed among the 1960s, 1970s, 1980s, 1990s, and early 2000s in Japan.

METHODS

The study population consisted of residents in Japan aged 40-69 years who had no history of CVD. The baseline surveys have been conducted every year since 1963. We defined the first, second, third, fourth, and fifth cohorts as 1963-1969 (n=4,248), 1970-1979 (n=6,742), 1980-1989 (n=12,789), 1990-1999 (n=12,537), and 2000-2005 (n=9,140) respectively. The participants were followed up for a median of 15 years for each cohort to determine the incidence of CVD. We classified them into four categories (BMI ＜21.0, 21.0-＜23.0, 23.0-＜25.0, and ≥ 25.0 kg/m ²).

RESULTS

From 1963-1969 to 2000-2005, the prevalence of BMI ≥ 25.0 increased over time. Compared with BMI 23.0-＜25.0, the age-, sex- and community-adjusted hazard ratios (95% confidence interval [CIs]) of CVD for BMI ≥ 25.0 were 1.10 (0.77-1.57), 0.89 (0.68-1.18), 1.03 (0.85-1.26), 1.28 (1.04-1.58), and 1.36 (1.04-1.78)in the first, second, third, fourth, and fifth cohorts, respectively. The corresponding population attributable fractions were 2.0% (nonsignificant), -2.6% (nonsignificant), 0.9% (nonsignificant), 7.6%, and 10.9%. Further adjustment for systolic blood pressure and antihypertensive medication use in the fourth and fifth cohorts attenuated the associations, which may reflect that blood pressure may mediate the BMI-CVD association.

CONCLUSION

The proportion of CVD attributable to overweight/obesity has increased during the periods between 1963-1969 and 2000-2005. The significant associations between overweight/obesity and risk of CVD after the 1990s were mediated by blood pressure levels.

The influence of insulin on anticipation and consummatory reward to food intake: A functional imaging study on healthy normal weight and overweight subjects employing intranasal insulin delivery

Aberrant responses within homeostatic, hedonic and cognitive systems contribute to poor appetite control in those with an overweight phenotype. The hedonic system incorporates limbic and meso-limbic regions involved in learning and reward processing, as well as cortical regions involved in motivation, decision making and gustatory processing. Equally important within this complex, multifaceted framework are the cognitive systems involved in inhibitory control and valuation of food choices. Regions within these systems display insulin receptors and pharmacologically increasing central insulin concentrations using intranasal administration (IN-INS) has been shown to significantly reduce appealing food cue responsiveness and also food intake. In this work we describe a placebo-controlled crossover pharmacological functional magnetic resonance imaging (fMRI) study that looks at how IN-INS (160 IU) affects anticipatory and consummatory responses to sweet stimuli and importantly how these responses differ between healthy normal weight and overweight male individuals. This work shows that age matched normal weight and overweight (not obese) individuals respond similarly to both the anticipation and receipt of sweet stimuli under placebo conditions. However, increased central insulin concentrations produce marked differences between groups when anticipating sweet stimuli within the prefrontal cortex and midbrain as well as observed differences in the amygdala during consummatory responses.

Early menopause and a low body mass index are associated with an increased risk of coronary heart disease in Japanese women

OBJECTIVE

The primary objective was to investigate the association between early menopause and cardiovascular disease (CVD) prevalence in Japanese women. The secondary objective was to ascertain the association with CVD risk factors.

METHODS

In this cross-sectional study, 7,239 naturally menopausal women from the Yamagata Cohort Study who completed an annual health visit and questionnaire between 2009 and 2015 were divided into three groups according to their age at menopause (women experiencing menopause at <45, 45-49 y, and ≥ 50 y). The diagnosis of coronary heart disease (CHD) and stroke were made by self-report, while hypertension, hyperlipidemia, and diabetes mellitus, were diagnosed by vital signs and laboratory parameters. Logistic regression analysis was used to estimate the associations between age at menopause and CVD prevalence and CVD risk factors.

RESULTS

A total of 354 (4.9%) and 156 (2.2%) women reported a history of CHD and stroke, respectively. Women experiencing menopause at <45 years had a higher prevalence of CHD than those experiencing menopause at ≥50 years (OR 1.77, 95% CI 1.07-2.90; P = 0.023). Stroke, hypertension, diabetes mellitus, and hyperlipidemia were equally prevalent among the three groups. Significant interactions were observed between age at menopause and body mass index (BMI) (P = 0.025) and parity (P = 0.025). Among those with a BMI < 18.5 or parity ≥2, women experiencing menopause at <45 years had a significantly higher prevalence of CHD than those experiencing menopause at ≥50 years.

CONCLUSION

Early menopause and low BMI were associated with CHD in Japanese women.

Carotid intima-media thickness predicted the presence but not the severity or complexity of coronary artery disease in a South Asian population

BACKGROUND

Carotid intima-media thickness (CIMT) is considered a marker of atherosclerosis, but the data is lacking from the South Asian population. We aimed to study the relation of CIMT with the presence and severity of coronary artery disease (CAD) in this population.

METHODS

This was a prospective, single-center study of consecutive patients undergoing elective coronary angiography. Participants with >50% luminal stenosis in any major coronary artery were included in the CAD group and those with normal coronaries in the non-CAD group. Multivariate linear regression analysis was done to determine independent predictors of CAD. Pearson's correlation coefficients assessed correlations between CIMT and Syntax and Gensini score.

RESULTS

The mean CIMT was significantly much higher in the CAD group when compared to the non-CAD group (0.83±0.16 vs 0.61±0.14mm, p<0.001). On multivariable linear regression analysis only diabetes (β=0.208 and p=0.024), waist-hip ratio (β=0.178 and p=0.043), current smoker (β=0.293 and p=<0.001) and CIMT (β=0.217 and p=0.031) were independent predictors of CAD. The mean Gensini score in the CAD group was 48.59±34.25 and the mean Syntax score was 19.45±10.24. No significant relation was found between CIMT and Gensini score (r=0.009 and p=0.89), and Syntax score (r=-0.087 and p=0.171).

CONCLUSION

Mean CIMT is an independent predictor of CAD along with diabetes, waist-hip ratio, and smoking. However, CIMT was not related to the severity and complexity of the CAD as assessed by the Gensini score and Syntax score, respectively.

Body Mass Index Combined With Possible Sarcopenia Status Is Better Than BMI or Possible Sarcopenia Status Alone for Predicting All-Cause Mortality Among Asian Community-Dwelling Older Adults

Background

Body mass index (BMI) and sarcopenia are common indicators of nutritional status. Possible sarcopenia, defined as low muscle strength or performance, was recently introduced by the Asian Working Group for Sarcopenia (AWGS) in 2019. We investigated for association between all-cause mortality and BMI combined with possible sarcopenia severity in Asian older adults.

Methods

This study included a subpopulation (8,195 participants aged ≥60 years; male gender: 49.4%; mean age: 69.2 ± 6.8 years) from the Fourth Thai National Health Examination Survey (NHES-IV). BMI was classified using Asia-Pacific cut-offs. Possible sarcopenia was defined using quadriceps strength based on AWGS 2019 criteria, and possible sarcopenia severity was determined using study population quartile cut-offs. All-cause mortality data was derived from the national vital registry in 2020.

Results

The prevalence of underweight status and possible sarcopenia was 11.8 and 38.9%, respectively. Multivariate analysis showed underweight individuals with severe possible sarcopenia to be at highest risk for increased mortality [adjusted hazard ratio (aHR): 3.98, 95% confidence interval (CI): 2.89-5.48], and higher risk was found in men compared to women (aHR: 5.35, 95% CI: 1.19-8.97). Obese status without possible sarcopenia was an independent protective factor (aHR: 0.61, 95% CI: 0.38-0.97).

Conclusion

BMI combined with possible sarcopenia severity is a better predictor of mortality risk than either parameter alone.

Dyslipidemia management for primary prevention of cardiovascular events: Best in-clinic practices

Dyslipidemia is a fundamental risk factor for cardiovascular diseases (CVDs) and can worsen the prognosis, if unaddressed. Lipid guidelines are still evolving as dyslipidemia is affecting newer patient subsets. However, these guidelines are governed by regional demographics and ethnic data. Primary care practitioners (PCPs) are the first to offer treatment, and hence placed early in the healthcare continuum. PCPs shoulder a huge responsibility in early detection of dyslipidemia for primary prevention of future cardiovascular (CV) events. Therefore, as members of Cardiovascular RISk Prevention (CRISP) in Asia network, the authors intend to align and shape-up the daily clinical practice workflow for PCPs and have a goal-directed strategy for managing dyslipidemia. This paper reviews the major international lipid guidelines, namely the American and European guidelines, and the regional guidelines from Indonesia, Malaysia, Philippines, Thailand, and Vietnam to identify their commonalities and heterogeneities. The authors, with a mutual consensus, have put forth, best in-clinic practices for screening, risk assessment, diagnosis, treatment, and management of dyslipidemia, particularly to reduce the overall risk of CV events, especially in the Asian context. The authors feel that PCPs should be encouraged to work in congruence with patients to decide on best possible therapy, which would be a holistic approach, rather than pursuing a "one-size-fits-all" approach. Since dyslipidemia is a dynamic field, accumulation of high-quality evidence and cross-validation studies in the future are warranted to develop best in-clinic practices at a global level.

Association between Body Mass Index and Renal Outcomes Modified by Chronic Kidney Disease and Anemia: The Obesity Paradox for Renal Outcomes

Obesity-related nephropathy is associated with renal function progression. However, some studies have associated a high body mass index (BMI) with improved renal outcomes—this is referred to as the obesity paradox for renal outcomes, especially in relation to advanced chronic kidney disease (CKD). Central obesity can explain the obesity paradox in all-cause mortality. However, whether obesity or central obesity is associated with renal outcomes (renal replacement therapy or a 50% decline in the estimated glomerular filtration rate) in patients with advanced CKD remains unclear. Our study included 3605 Asian patients with CKD stages 1−5 divided into six groups according to their BMI (between 15 and 35 kg/m2). Through linear regression, BMI was positively associated with hemoglobin and albumin at CKD stages 4 and 5. In the competing risk Cox regression model, a high BMI (27.5−35 kg/m2) was associated with renal outcomes at CKD stages 1−3, but not stages 4 and 5. A high BMI was associated with renal outcomes in patients with hemoglobin ≥11 g/dL, but not <11 g/dL. A high waist-to-hip ratio was not associated with renal outcomes. We conclude that the CKD stage and anemia may explain the obesity paradox in renal outcomes in patients with CKD.

The obesity paradox is mostly driven by decreased noncardiovascular disease mortality in the oldest old in China: a 20-year prospective cohort study

National and international recommendations of healthy body mass index (BMI) are primarily based on evidence in young and middle-aged populations, with an insufficient representation of the oldest old (aged ≥80 years). Here, we report associations between BMI and mortality risk in 27,026 community-dwelling oldest old (mean age, 92.7 ± 7.5 years) in China from 1998 to 2018. Nonlinear curves showed reverse J-shaped associations of BMI with cardiovascular disease (CVD), non-CVD and all-cause mortality, with a monotonic decreased risk up to BMIs in the overweight and mild obesity range and flat hazard ratios thereafter. Compared to normal weight, overweight and obesity were significantly associated with decreased non-CVD and all-cause mortality, but not with CVD mortality. Similar associations were found for waist circumference. Our results lend support to the notion that optimal BMI in the oldest old may be around the overweight or mild obesity range and challenge the application of international and national guidelines on optimal BMI in this age group.

Associations of body mass index and hospital-acquired disability with post-discharge mortality in older patients with acute heart failure

OBJECTIVES

To investigate the effect of hospital-acquired disability (HAD) on all-cause mortality after discharge according to the body mass index (BMI) in older patients with acute decompensated heart failure.

METHODS

We included 408 patients aged ≥ 65 years who were hospitalized for acute decompensated heart failure and had undergone an acute phase of cardiac rehabilitation at the Sakakibara Heart Institute between April 2013 and September 2015 (median age: 82 years, interquartile range (IQR): 76-86; 52% male). Patients were divided into three groups based on BMI at hospital admission: underweight (< 18.5 kg/m²), normal weight (18.5 to 25 kg/m²), and overweight (≥ 25 kg/m²). HAD was defined as a decrease of at least five points at discharge compared to before hospitalization according to the Barthel Index.

RESULTS

The median follow-up period was 475 (IQR: 292-730) days, and all-cause mortality during the follow-up period was 84 deaths (21%). According to multivariate Cox regression analysis, being underweight (HR: 1.941, 95% CI: 1.134-3.321,P = 0.016) or overweight (HR: 0.371, 95% CI: 0.171-0.803,P = 0.012), with normal BMI as the reference, and HAD (HR: 1.857, 95% CI: 1.062-3.250,P = 0.030) were independently associated with all-cause mortality. Patients with HAD exhibited a significantly lower cumulative survival rate in the underweight group (P = 0.001) and tended to have a lower cumulative survival rate in the normal weight group (P = 0.072). HAD was not significantly associated with cumulative survival in the overweight group (P = 0.392).

CONCLUSIONS

BMI and HAD independently predicted all-cause mortality after discharge in older patients with acute decompensated heart failure. Furthermore, HAD was significantly associated with higher all-cause mortality after discharge, especially in the underweight group.

The utility of the Edmonton Obesity Staging System for the prediction of COVID-19 outcomes: a multi-centre study

BACKGROUND

Patients with obesity have an increased risk for adverse COVID-19 outcomes. Body mass index (BMI) does not acknowledge the health burden associated this disease. The performance of the Edmonton Obesity Staging System (EOSS), a clinical classification tool that assesses obesity-related comorbidity, is compared with BMI, with respect to adverse COVID-19 outcomes.

METHODS

1071 patients were evaluated in 11 COVID-19 hospitals in Mexico. Patients were classified into EOSS stages. Adjusted risk factors for COVID-19 outcomes were calculated and survival analysis for mechanical ventilation and death was carried out according to EOSS stage and BMI category.

RESULTS

The risk for intubation was higher in patients with EOSS stages 2 and 4 (HR 1.42, 95% CI 1.02-1.97 and 2.78, 95% CI 1.83-4.24), and in patients with BMI classes II and III (HR 1.71, 95% CI 1.06-2.74, and 2.62, 95% CI 1.65-4.17). Mortality rates were significantly lower in patients with EOSS stages 0 and 1 (HR 0.62, 95% CI 0.42-0.92) and higher in patients with BMI class III (HR 1.58, 95% CI 1.03-2.42). In patients with a BMI ≥ 25 kg/m2, the risk for intubation increased with progressive EOSS stages. Only individuals in BMI class III showed an increased risk for intubation (HR 2.24, 95% CI 1.50-3.34). Mortality risk was increased in EOSS stages 2 and 4 compared to EOSS 0 and 1, and in patients with BMI class II and III, compared to patients with overweight.

CONCLUSIONS

EOSS was associated with adverse COVID-19 outcomes, and it distinguished risks beyond BMI. Patients with overweight and obesity in EOSS stages 0 and 1 had a lower risk than patients with normal weight. BMI does not adequately reflect adipose tissue-associated disease, it is not ideal for guiding chronic-disease management.

Nutritional Health in Premenopausal Women: A Cross-Sectional Study from Turkey

Background

The aim of this study was to evaluate the nutritional habits of premenopausal women using the Food Consumption Frequency Questionnaire (FCFQ) and to evaluate the relationship between anthropometric measurements, lipid parameters, and the presence of anemia with the findings obtained.

Methods

This study was carried out in the internal medicine outpatient clinics of the Health Sciences University Bursa Yüksek İhtisas Training Research Hospital (located in Yıldırım districts) and Gürsu State Hospital (located in Gürsu districts) of Bursa province between 1 June-31 August 2019. We used clustered sampling in patient selection. One hundred seventy-one premenopausal participants aged between 18 and 55 who were known to be healthy and who came for routine control to the internal medicine outpatient clinics were included in the study. The FCFQ was used to determine how often the participants consumed different food groups in the last 1 month.

Results

Overweight participants were 29.20% and 17% were obese. 43.90% of the women had anemia and 65.50% of the women had iron deficiency. The milk-dairy products nutrition score of the group with triglycerides (TG) <150 mg/dL was higher than the group with TG ≥150 mg/dL (P = 0.029). The meat-egg-legumes nutrition score (2.11 ± 0.57) of the group with high density lipoprotein (HDL) ≥50 mg/dL was higher than the group with HDL <50 mg/dL (1.91 ± 0.58) (P = 0.04).

Conclusions

Anemia and obesity are high in premenopausal women. Community-based screening programs are needed to evaluate premenopausal women for anemia and obesity. Scales to assess the nutritional habits of the population are also needed in screening programs.

Combined Lifestyle Factors and Risk of All-Cause and Cause-Specific Mortality Among Participants in the Linxian Nutrition Intervention Trial: A Cohort, Observational Study

Background

Several studies have indicated that combinations of lifestyle and dietary factors are associated with risk of total mortality and death from cardiovascular disease and cancer, but limited data are available from long-term follow-up studies in China.

Methods

This study was a observational cohort study. We prospectively examined the associations of combined lifestyle factors and risk of total and cause-specific mortality in the Linxian General Population Nutrition Intervention Trial (NIT) cohort that included 29,584 healthy adults. A points system method was used to calculate a combined risk score of five lifestyle factors, including smoking, alcohol drinking, body mass index, vegetable intake and fruit intake. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs).

Results

Overall, adjusted hazard ratios for mortality increased progressively with an increasing combined risk score. Compared to individuals with a score of zero or one, HRs (95%CIs) for a score of five or above were 1.59 (1.44–1.75) for all-cause mortality, 1.67 (1.48–1.88) for heart disease, 1.69 (1.52–1.88) for stroke, and 1.34 (1.21, 1.47) for cancer. This association for mortality was seen consistently, regardless of gender and age at baseline.

Conclusions

A higher combined risk score was positively associated with risk of total, heart disease, stroke, and cancer mortality. These findings could provide further evidence for the idea that healthy lifestyle is the optimal way to reduce the risk of premature death, and encourage behavior change.

Adiposity and risks of vascular and non-vascular mortality among Chinese adults with type 2 diabetes: a 10-year prospective study

INTRODUCTION

Among individuals with diabetes, high adiposity has been associated with lower cardiovascular disease (CVD) mortality (the so-called 'obesity paradox' phenomenon) in Western populations, for reasons that are still not fully elucidated. Moreover, little is known about such phenomena in Chinese adults with diabetes among whom very few were obese. We aimed to assess the associations of adiposity with vascular and non-vascular mortality among individuals with diabetes, and compare these with associations among individuals without diabetes.

RESEARCH DESIGN AND METHODS

In 2004-2008, the prospective China Kadoorie Biobank recruited >512 000 adults from 10 areas in China. After ~10 years of follow-up, 3509 deaths (1431 from CVD) were recorded among 23 842 individuals with diabetes but without prior major diseases at baseline. Cox regression yielded adjusted HRs associating adiposity with mortality.

RESULTS

Among people with diabetes, body mass index (BMI) (mean 25.0 kg/m²) was positively log linearly associated with CVD incidence (n=9943; HR=1.19 (95% CI 1.15 to 1.22) per 5 kg/m²), but showed U-shaped associations with CVD and overall mortality, with lowest risk at 22.5-24.9 kg/m². At lower BMI, risk of death (n=671) within 28 days of CVD onset was particularly elevated, with an HR of 3.26 (95% CI 2.29 to 4.65) at <18.5 kg/m² relative to 22.5-24.9 kg/m², but no higher mortality risk at BMI ≥25.0 kg/m². These associations were similar in self-reported and screen-detected diabetes, and persisted after extensive attempts to address reverse causality and confounding. Among individuals without diabetes (mean BMI 23.6 kg/m²; n=23 305 deaths), there were less extreme excess mortality risks at low BMI.

CONCLUSIONS

Among relatively lean Chinese adults with diabetes, there were contrasting associations of adiposity with CVD incidence and with mortality. The high mortality risk at low and high BMI levels highlights, if causal, the importance of maintaining normal weight among people with diabetes.

Acute Myocardial Infarction in Young Men Under 50 Years of Age: Clinical Characteristics, Treatment, and Long-Term Prognosis

Aim

The prevalence of acute myocardial infarction (AMI) is increasing in young adults, especially in men. This study aims to compare the characteristics and explore the association between age and clinical outcomes in male adults who first experienced AMI.

Methods

A total of 2737 male patients with AMI were divided into three groups by age: <50, 50–65, and ≥65 years. Clinical characteristics and long-term results (all-cause and cardiac deaths, nonfatal MI, revascularization, nonfatal stroke, cardiac rehospitalization) were identified across different age subgroups. The association between age and the outcomes was assessed by Cox proportional hazard models.

Results

This population was followed up for a median of 36.7 months. Patients <50 years had a lower prevalence of diabetes (19.4%) and previous stroke (1.8%), while they were more often to be smokers (77.1%), obese (26%), dyslipidemia (74.7%), and with the single-vessel disease (16.2%). The risk of cardiovascular and all-cause death in patients ≥65 years was higher than patients <50 years, which was noticed through competing risk regression analysis after adjusting for confounding factors (adjusted HR 3.24; 95% CI 2.26–4.22, p=0.020 for cardiovascular death, adjusted HR 4.17; 95% CI 1.91–9.10, p<0.001 for all-cause death).

Conclusion

In conclusion, although men who suffered from first AMI under the age of 50 had lower mortality, they had a higher burden of modifiable traditional risk factors. The management of modifiable lifestyles should be addressed to all young AMI patients.

U-Shaped Association between Waist-to-Hip Ratio and All-Cause Mortality in Stage 3-5 Chronic Kidney Disease Patients with Body Mass Index Paradox

The obesity paradox, referring to the association of high body mass index (BMI) with low all-cause mortality risk, is found in patients with chronic kidney disease (CKD). Central obesity is associated with metabolic syndrome and may have better prognostic value than BMI for all-cause mortality. Whether central obesity is associated with all-cause mortality in cases of obesity paradox in CKD patients remains unknown. We included 3262 patients with stage 3–5 CKD, grouped into five quintiles (Q1–5) by waist-to-hip ratio (WHR). Low WHR and BMI were associated with malnutrition and inflammation. In Cox regression, high BMI was not associated with all-cause mortality, but BMI < 22.5 kg/m² increased the mortality risk. A U-shaped association between central obesity and all-cause mortality was found: WHR Q1, Q4, and Q5 had higher risk for all-cause mortality. The hazard ratio (95% confidence interval) of WHR Q5 and Q1 for all-cause mortality was 1.39 (1.03–1.87) and 1.53 (1.13–2.05) in male and 1.42 (1.02–1.99) and 1.28 (0.88–1.85) in female, respectively. Waist-to-height ratio and conicity index showed similar results. Low WHR or low BMI and high WHR, but not high BMI, are associated with all-cause mortality in advanced CKD.

Weight Change Since Age 20 and the Risk of Cardiovascular Disease Mortality: A Prospective Cohort Study

Aim: Weight change could have many health outcomes. This study aimed to investigate the association between weight change and mortality risk due to total cardiovascular disease (CVD), ischemic heart disease (IHD), and stroke among Japanese.

Methods: We used Suita Study data from 4,746 people aged 30-79 years in this prospective cohort study. Weight change was defined as the difference between baseline weight and weight at age 20. We used Cox proportional hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of total CVD, IHD, and stroke mortality for 1) participants with a weight change (＞10, 5 to 10, -5 to -10, and ＜-10 kg) compared to those with stable weight (-4.9 to 4.9 kg) and 2) participants who moved from one body mass index category (underweight, normal weight, or overweight) to another compared to those with normal weight at age 20 and baseline.

Results: Within a median follow-up period of 19.9 years, the numbers of total CVD, IHD, and stroke mortality were 268, 132, and 79, respectively. Weight loss of ＞10 kg was associated with the increased risk of total CVD mortality 2.07 (1.29, 3.32) and stroke mortality 3.02 (1.40, 6.52). Moving from normal weight at age 20 to underweight at baseline was associated with the increased risk of total CVD, IHD, and stroke mortality: 1.76 (1.12, 2.77), 2.10 (1.13, 3.92), and 2.25 (1.05, 4.83), respectively.

Conclusion: Weight loss, especially when moving from normal to underweight, was associated with the increased risk of CVD mortality.

Framingham Risk Score Assessment in Subjects with Pre-diabetes and Diabetes: A Cross-Sectional Study in Korea

Background

This study aimed to evaluate cardiovascular risk in subjects with pre-diabetes and diabetes in Korea.

Methods

In this pan-Korean, non-interventional, cross-sectional study, data were collected from medical records of 10 hospitals between November 2013 and June 2014. Subjects (aged ≥40 years) with medical records of dysglycemia and documentation of total cholesterol level, high-density lipoprotein cholesterol level, systolic blood pressure, and smoking status in the past 6 months were included. The primary endpoint was to determine the Framingham risk score (FRS). The relationships between FRS and cardiovascular risk factors, glycated hemoglobin, and insulin usage were determined by multiple linear regression analyses.

Results

Data from 1,537 subjects with pre-diabetes (n=1,025) and diabetes (n=512) were analyzed. The mean FRS (mean±standard deviation) in subjects with pre-diabetes/diabetes was 13.72±8.77. FRS was higher in subjects with diabetes than pre-diabetes (P<0.001). FRS in men with pre-diabetes was comparable to that in women with diabetes (13.80±7.37 vs. 13.35±7.13). FRS was elevated in subjects who consumed alcohol (2.66, P=0.033) and with obesity-class II (6.10, P=0.015) among subjects with diabetes (n=199), and was elevated in patients with left ventricular hypertrophy (11.10, P=0.005), those who consumed alcohol (3.06, P=0.000), were pre-obese (3.21, P=0.002), or were obesity-class I (2.89, P=0.002) among subjects with pre-diabetes (n=306) in comparison to subjects without these coexisting risk factors.

Conclusion

Overall, Korean subjects with pre-diabetes and diabetes have an increased cardiovascular risk, which is significantly higher in those subjects with diabetes than with pre-diabetes. The present data can be used to develop measures to prevent and manage cardiovascular complications in Koreans with impaired glucose metabolism.

Living alone and prediction of weight gain and overweight/obesity in university students: a retrospective cohort study

To assess the clinical impact of living alone on weight gain in university students. Participants: This retrospective cohort study included 17540 male and 8854 female university students admitted to a national university in Japan. Methods: An association between living arrangement and the incidence of weight gain ≥10% and overweight/obesity (body mass index (BMI) ≥25 kg/m²) was assessed using multivariable-adjusted Poisson regression models. Results: Weight gain was observed in 1889 (10.8%) male and 1516 (17.1%) female students during 3.0 and 2.9 years of the mean observational period, respectively. Living alone was identified as a significant predictor of weight gain (adjusted incidence rate ratio of living alone vs. living with family: 1.24 [1.13-1.36] and 1.76 [1.58-1.95] in male and female students, respectively) and was also as a predictor of overweight/obesity. Conclusions: University students living alone were at a significantly higher risk of weight gain and overweight/obesity than those living with family.

Longitudinal assessment between lifestyle-related risk factors and a composite cardiovascular disease (CVD) risk index among adolescents in Malaysia

The study aims to create a composite risk index of CVD among adolescents and examine the influence of demographic, socioeconomic and lifestyle-related risk factors on the composite risk index of biological CVD risk factors among adolescents in Malaysia. A Malaysian adolescent cohort of 1320 adolescents were assessed at 13, 15 and 17 years. Seven biological CVD risk factors with moderate correlation were identified, standardized and averaged to form a composite CVD risk index. Generalised estimating equation using longitudinal linear regression was used to examine the effects of changes in adolescent lifestyle-related risk factors on the composite CVD risk index over time. From the ages 13 to 17 years, physical fitness (β = − 0.001, 90% CI = − 0.003, 0.00002) and BMI (β = 0.051, 95% CI = 0.042, 0.060) were significant predictors of attaining high scores of CVD risk. Female (β = 0.118, 95% CI = 0.040, 0.197), Chinese (β = 0.122, 95% CI = 0.006, 0.239), Indians (β = − 0.114, 95% CI = − 0.216, − 0.012) and adolescents from rural schools (β = 0.066, 95% CI = − 0.005, 0.136) were also found to be considerably significant. A more robust and gender-specific intervention programme focusing on healthy lifestyle (including achieving ideal BMI and improving physical fitness) need to be implemented among school-going adolescents.