Visceral, general, abdominal adiposity and atherogenic index of plasma in relatively lean hemodialysis patients

Cut points of the conicity index as an indicator of abdominal obesity in individuals undergoing hemodialysis: An analysis of latent classes

OBJECTIVES

Abdominal obesity favors the involvement of cardiometabolic complications in renal patients on hemodialysis. Thus, the aim of the study was to identify the cut-points of the conicity index in individuals undergoing hemodialysis.

METHODS

This was a cross-sectional study carried out with 953 individuals undergoing hemodialysis in clinics in a metropolitan region of southeastern Brazil. The conicity index was calculated using the following mathematical equation: waist circumference/0.109 × √weight/height. The receiver operating characteristic (ROC) curve was calculated from the analysis of latent classes by cross-validation through a latent variable of abdominal obesity. This latent variable was defined using the response pattern of the observed anthropometric variables considering the presence and absence of abdominal obesity: waist circumference, waist-to-height ratio, and body shape index. The cut-points identified were elucidated by the area under the curve (AUC), Youden index, sensitivity, and specificity.

RESULTS

The cut-points for the conicity index found for both sexes were similar, resulting in a cut-point for men of 1.275 (AUC, 0.921; Youden index, 0.666), with a sensitivity and specificity of 83% and 83.6%, and a cut-point for women of 1.285 (AUC, 0.921; Youden index, 0.679), with a sensitivity and specificity of 78.6% and 89.3%, respectively.

CONCLUSIONS

The conicity index showed high discriminatory power for the identification of abdominal obesity in hemodialysis patients, therefore it can be a simple and easily accessible tool to be incorporated into clinical practice in this population.

Central obesity as assessed by conicity index and a-body shape index associates with cardiovascular risk factors and mortality in kidney failure patients

Background

Anthropometric indices of central obesity, waist circumference (WC), conicity index (CI), and a-body shape index (ABSI), are prognostic indicators of cardiovascular (CV) risk. The association of CI and ABSI with other CV risk indices, markers of nutritional status and inflammation, and clinical outcomes in chronic kidney disease (CKD) stage 5 (CKD5) patients was investigated.

Methods

In a cross-sectional study with longitudinal follow up of 203 clinically stable patients with CKD5 (median age 56 years; 68% males, 17% diabetics, 22% with CV disease, and 39% malnourished), we investigated CI and ABSI and their associations with atherogenic index of plasma (AIP), Framingham CV risk score (FRS), Agatston scoring of coronary artery calcium (CAC) and aortic valve calcium (AVC), handgrip strength (HGS), high sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6). CV events (CVE) and all-cause mortality during up to 10-years follow up were analyzed by multivariate survival analysis of restricted mean survival time (RMST).

Results

Chronic kidney disease patients with middle and highest CI and ABSI tertiles (indicating greater abdominal fat deposition), compared to those with the lowest CI and ABSI tertiles, tended to be older, more often men and diabetic, had significantly higher levels of hsCRP, IL-6, AIP, FRS, CAC and AVC scores. CI and ABSI were positively correlated with CAC, FRS, AIP, hsCRP and IL-6. Both CI and ABSI were negatively correlated with HGS. In age-weighted survival analysis, higher CI and ABSI were associated with higher risk of CVE (Wald test = 4.92, p = 0.027; Wald test = 4.95, p = 0.026, respectively) and all-cause mortality (Wald test = 5.24, p = 0.022; Wald test = 5.19, p = 0.023, respectively). In RMST analysis, low vs. high and middle tertiles of CI and ABSI associated with prolonged CVE-free time and death-free time, and these differences between groups increased over time.

Conclusion

Abdominal fat deposit indices, CI and ABSI, predicted CV outcomes and all-cause mortality, and were significantly associated with the inflammatory status in CKD patients.

Exploring the relationships between anthropometric indices of adiposity and physical performance in middle-aged and older Brazilian women: a canonical correlation analysis

OBJECTIVES

This study analyzed the influence of anthropometric indices of adiposity on the physical performance of middle-aged and older women.

METHODS

A cross-sectional study was conducted among 368 women from 50 years to 80 years old. Anthropometric and biochemical characteristics were analyzed, and physical performance was evaluated. The statistical analysis used measures of central tendency and dispersion for descriptive data, Pearson correlations to demonstrate the initial associations between the variables, and canonical correlation (CC) to evaluate the relationship between the set of anthropometric adiposity indices and performance-related variables.

RESULTS

The participants had a mean age of 58.57±8.21 years, a visceral adiposity index of 7.09±4.23, a body mass index of 29.20±4.94 kg/m2, and a conicity index of 1.33±0.07. The average handgrip strength was 25.06±4.89 kgf, gait speed was 1.07±0.23 m/s, and the mean Short Physical Performance Battery (SPPB) score was 10.83±1.36. The first canonical function presented the highest shared variance, CC, and redundancy index (cumulative percentage of variance, 82.52; Wilks' lambda, 0.66; CC, 0.532; p<0.001). From the analysis of this canonical function, the conicity index (-0.59) displayed inverse correlations with handgrip strength (0.84) and the SPPB (0.68), as well as a direct correlation with gait speed (-0.43).

CONCLUSIONS

In middle-aged and older women, there was an inverse relationship between the conicity index and muscle strength and power, while a direct relationship was found between the same index and gait speed.

Visceral adiposity indicators and cardiovascular risk in hemodialytic patients

OBJECTIVE

Cardiovascular diseases represent the main cause of death in chronic kidney disease (CKD). We aimed to evaluate the prevalence and association of the hypertriglyceridemia-waist phenotype (HWP) and visceral adiposity index (VAI) with cardiometabolic risk factors (CR) in patients with CKD on hemodialysis (HD).

METHODS

The study is based on a cross-sectional design with 265 HD patients in two cities in northeastern Brazil. The VAI was calculated considering the variables body mass index (BMI), waist circumference (WC), triglycerides (TG) and high density lipoprotein cholesterol (HDL-c). HWP was defined as the concomitant elevation of WC and TG. The Poisson Regression Model with robust variance estimation was adjusted considering a hierarchical approach for explanatory variables. Prevalence ratios (PR) were also estimated. The level of significance adopted was 5%.

RESULTS

In our study HWP and VAI prevalence's were 29.82% and 58.49%, respectively. In the final model, there was an association between VAI and female gender (PR = 1.46; p < 0.0001) and high body fat (% BF) (PR = 1.33; p < 0.0019). HWP was associated with females (PR = 1.80; p = 0.002), alcohol consumption (PR = 1.58; p = 0.033), obesity (PR = 1.89; p = 0.0001), high %BF (PR = 1.76; p = 0.012) and reduced HDL-c (PR = 1.48; p = 0.035).

CONCLUSION

The HWP stood out as the association with more CR factors, representing a promising method for tracking cardiometabolic risk in HD patients, mainly female.

Cutoff points of adiposity anthropometric indices for low muscle mass screening in middle-aged and older healthy women

Background

The reduction of female sex hormones causes changes in the contractile properties of muscles as well as infiltration of fat in the muscle tissue. This results in a consequent decline in muscle strength. These changes are related to higher levels of functional impairment and physical disability. In this sense, several anthropometric indices have been used to quantify body and visceral fat. Thus, the objective of this paper is to propose cutoff points for adiposity anthropometric indices in order to identify low muscle mass, as well as to analyze the relationship between these indices and low muscle mass in middle-aged and older women.

Methods

Cross-sectional analytical study carried out in the Northeast of Brazil. The sample was formed by 593 women between 40—80 years old. Data collection included anthropometric assessment (BMI: Body Mass Index – WC: Waist Circumference – WHR: Waist-to-hip Ratio – WHtR: Waist-to-height Ratio – CI: Conicity Index – BAI: Body Adiposity Index – VAI: Visceral Adiposity Index – LAP: Lipid Accumulation Product), bioimpedance test and biochemical dosage. Moreover, sociodemographic data and practice of physical activity were collected. Descriptive statistics, Student's t-test, ROC curves, chi-squared and logistic regression were performed.

Results

The participants had a mean age of 53.11 (8.89) years, BMI of 28.49 (5.17) kg/m² and WC of 95.35 (10.39). The prevalence of low muscle mass was 19.4%. Based on sensitivity and specificity of adiposity anthropometric indices, cutoff points were developed to identify the presence of low muscle mass (p < 0.05), except for VAI. After logistic regression, WC (OR = 6.2; CI 95%: 1.4—28.1), WHR (OR = 1.8; CI: 1.0—3.4), WHtR (OR = 5.0; CI 95%: 1.0—23.7) and BAI (OR = 14.5; CI 95%: 6.6—31.7) were associated with low muscle mass.

Conclusions

All anthropometric indices, except VAI, showed adequate accuracy in identifying low muscle mass in women, especially those that took into account WC. This suggests that they can become accessible and also be cost-effective strategies for assessing and managing health outcomes related to muscle mass analysis.

Low-grade chronic inflammation is attenuated by exercise training in obese adults through down-regulation of ASC gene in peripheral blood: a pilot study

Background

Obesity is characterized by low-grade chronic inflammation and an excess of adipose tissue. The ASC gene encodes a protein that is part of the NLRP3 inflammasome, a cytosolic multiprotein complex that is associated with inflammation and metabolic alterations. To our knowledge, there is no evidence regarding ASC gene activity in obese adults in response to lifestyle modifications.

Purpose

To evaluate the effect of hypocaloric diet and moderate-intensity structured exercise intervention on ASC gene expression and inflammatory markers in obese adults.

Methods

Thirty-seven obese individuals aged 25 to 50 years were randomized to the hypocaloric diet exercise group or hypocaloric diet group. The participants underwent a 4-month follow-up. Electrical bioimpedance was used for body composition analysis. Biochemical data were analyzed by dry chemistry and insulin levels by ELISA. ASC gene expression from peripheral blood was performed using real-time PCR. Dietary data was collected through questionnaires and analyzed using the Nutritionist Pro™ software. Quantification of cytokines was conducted using Bio-Plex Pro™ Human cytokine. The Astrand-Ryhming test was used to estimate the maximum oxygen volume and design the moderate-intensity structured exercise program ~ 75% heart rate (HR)

Results

After the intervention, both study groups significantly improved body composition (decreased weight, fat mass, waist circumference and abdominal obesity, p < 0.05). Besides, the diet-exercise group significantly decreased ASC mRNA expression, MCP-1, and MIP-1β inflammatory cytokines compared to the diet group (p < 0.05). While in the diet group, MCP-1 and IL-8 exhibited significantly decreased levels (p < 0.05). In the diet-exercise group, a positive correlation between the atherogenic index and waist circumference was found (r = 0.822, p = 0.011), and a negative correlation was observed between the delta of ASC mRNA expression and IL-10 levels at the end of the intervention (r = − 0.627, p = 0.019).

Conclusion

Low-grade chronic inflammation was attenuated through individualized exercise prescription and our findings highlight the role of the ASC gene in the inflammation of obese adults.

Trial registration

ClinicalTrials.gov, number NCT04315376. Registered 20 March 2020—retrospectively registered

Comparison of visceral, general and central obesity indices in the prediction of metabolic syndrome in maintenance hemodialysis patients

PURPOSE

We aimed to compare the predictive ability of the anthropometric indices reflecting general, central and visceral obesity for identification of metabolic syndrome (MetS) in maintenance hemodialysis (MHD) patients.

METHODS

A multicenter, cross-sectional study that consisted of 1603 adult MHD patients (54.6 ± 16 years) was conducted in Guizhou Province, Southwest China. Eight anthropometric obesity indexes including body mass index (BMI), waist circumference (WC), waist-height ratio (WHtR), conicity index (Ci) and visceral adiposity index (VAI), lipid accumulation product (LAP), a body shape index (ABSI) and body roundness index (BRI) were recorded. MetS was defined based on the criteria of the International Diabetes Federation. Participants were categorized into four groups according to quartiles of different obesity indices. Binary logistic regression analyses were used to evaluate the associations between the eight obesity parameters and MetS. Receiver operator curve (ROC) analyses were used to identify the best predictor of MetS.

RESULTS

The eight anthropometric obesity indexes were independently associated with MetS risk, even after adjustment for age, sex, educational status and history of smoking. The ROC analysis revealed that all the eight obesity indices included in the study were able to discriminate MetS [all area under the ROC curves (AUCs) > 0.6, P < 0.05]. LAP showed the highest AUC and according to the maximum Youden indexes, the cut off values for men and women were 27.29 and 36.45, respectively. The AUCs of LAP, VAI, ABSI, BRI, WC, WHtR, Ci and BMI were 0.88, 0.87, 0.60, 0.78, 0.79, 0.78, 0.69 and 0.76 for men, and 0.87, 0.85, 0.65, 0.79, 0.81, 0.79, 0.73 and 0.76 for women, respectively. There was no significant difference in the AUC value between LAP and VAI, BRI/WHtR and BMI in men and between BRI/WHtR and BMI in women. The AUC value for WHtR was equal to that for BRI in identifying MetS.

CONCLUSIONS

Visceral obesity marker LAP followed by VAI was the most effective predictor of MetS while ABSI followed by CI was the weakest indicator for the screening of MetS in MHD patients. BRI could be an alternative obesity measure to WHtR in assessment of MetS. LAP may be a simple and useful screening tool to identify individuals at high risk of MetS particularly in middle-aged and elderly Chinese MHD patients.

LEVEL OF EVIDENCE

Level V, descriptive study.

Are Obesity Indices Useful for Detecting Subclinical Atheromatosis in a Middle-Aged Population?

OBJECTIVE

There is a close relationship between excess adiposity and cardiovascular disease. Although body mass index (BMI) is the most used approach to estimate excess weight, other anthropometric indices have been developed to measure total body and abdominal adiposity. Here, our objective was to assess the usefulness of these anthropometric indices to detect subclinical atheromatous disease.

METHODS

A cross-sectional study with 6,809 middle-aged subjects (mean age, 57 [53-63] years) with low to moderate cardiovascular risk from the ILERVAS project. Measures of total body fat (BMI, Clínica Universidad de Navarra - Body Adiposity Estimator [CUN-BAE], and Deurenberg's formula) and central adiposity (waist and neck circumferences, conicity index, waist-to-height ratio, Bonora's equation, the A body adiposity index, and body roundness index) were performed in all participants. Bilateral carotid and femoral ultrasound vascular studies allowed the identification of subjects with plaque. -Results: All measured indices were significantly higher in males with subclinical carotid or femoral plaques (p ≤ 0.021 for all). Also, a positive and significant correlation between all indices and the number of affected territories was found (p ≤ 0.013 for all). From the ROC analysis, all measurements identified patients with asymptomatic atheromatosis but none of them helped make clinical decisions. Regarding females, the results were less conclusive.

CONCLUSION

Obesity indices are related to subclinical atheromatosis, especially in men, in a large cohort of middle-aged subjects. However, the indices could not detect the presence of arterial plaque, so, when used in isolation, are unlikely to be decisive.

Metabolic Syndrome, and Particularly the Hypertriglyceridemic-Waist Phenotype, Increases Breast Cancer Risk, and Adiponectin Is a Potential Mechanism: A Case-Control Study in Chinese Women

Objective: To investigate the association between metabolic syndrome and breast cancer and to elucidate the potential mechanism underlying this association. Patients and Methods: Based on baseline data drawn from 21 hospitals in 11 provinces of China, we performed a case-control study among 1,127 women (595 cases and 532 controls), divided into premenopausal, and postmenopausal subgroups. Student's t test, Pearson's χ² test, and logistic regression analyses were performed to ascertain the association between breast cancer and metabolic syndrome, including all of its components. In addition, we attempted to clarify the potential role of adiponectin in this association. Results: Among the components of metabolic syndrome, abnormal waist circumference was the component that markedly increased breast cancer risk in premenopausal women (OR 1.447, 95% CI 1.043-2.006). Metabolic syndrome with clusters of special risk factors showed an association with breast cancer risk. Among all these components of metabolic syndrome, the hypertriglyceridemic-waist (HW) phenotype significantly increased breast cancer risk (OR 1.56, 95% CI 1.02-2.39), regardless of menopausal status, rendering it a strong predictor of breast cancer. Total adiponectin levels and high-molecular-weight adiponectin were reversely associated with metabolic syndrome. In addition, total adiponectin levels among breast cancer patients were much lower than among controls (6.67 ± 3.05 vs. 8.01 ± 4.18, p = 0.014) only in the HW phenotype subgroup. Furthermore, the HW phenotype was associated with increased risk of estrogen receptor/progesterone receptor-positive (ER+/PR+) and -negative (ER-/PR-) breast cancer, with a 51% (OR 1.51, 95% CI 1.03-2.21) and 69% (OR 1.69, 95% CI 1.05-2.72) increase, respectively. However, there was no significant association between the HW phenotype and the ER+/PR- subtype. These results suggested that low adiponectin levels may be a mechanism that explains the association between the HW phenotype and breast cancer risk. Conclusion: Metabolic syndrome with special cluster factors is related to breast cancer risk; in particular, the HW phenotype can be regarded as a strong predictor of breast cancer. As an important factor involved in fat metabolism, adiponectin may strongly predict metabolic syndrome, especially the HW phenotype and breast cancer. Further research into this mechanism and epidemiological studies are needed. This study provides new evidence for the role of a healthy lifestyle in preventing breast cancer.