Obesity as assessed by body adiposity index and multivariable cardiovascular disease risk

Long- and Short-Term High-Intensity Interval Training on Lipid Profile and Cardiovascular Disorders in Obese Male Adolescents

This study investigated the effects of short-term and long-term periods (8 and 16 weeks) of high-intensity interval training (HIIT) on cardiovascular components, blood lipids, and 6-min walking test performance in obese young boys (age = 16.2 ± 0.7) with >34% body fat. The participants were split into two groups: severe obesity (SOG; n = 17) and moderate obesity (MOG; n = 16). All participants performed on a cycle ergometer for 16 weeks (3 times per week) of HIIT at 100% peak power output at the ventilatory threshold and recovered at 50% of peak power. Except for BMI, both groups improved all body composition measures after 16 weeks, with a higher percentage of change (Δ) in SOG. The 6-min walking test increased in both groups (p < 0.001). Furthermore, cardiovascular variables, blood lactate concentration at rest and after 5-min post-exercise, blood lipids, and insulin concentrations improved significantly in both groups. After 16 weeks, MOG significantly improved in HR_peak, blood glucose concentration, and rating of perceived exertion (RPE), but the percentage of change (Δ) was higher in SOG for all the other variables. SOG showed a higher (Δ) waist-to-hip ratio, maximum heart rate, resting heart rate, systolic blood pressure, blood lactate at 5-min post-exercise, and triglyceride concentrations after 8 and 16 weeks of training. In conclusion, a long-term HIIT program appears to be an appropriate training approach for obese boys with extra body fat. However, considering the RPE values, short-duration training sessions should be planned.

Family history, waist circumference and risk of ischemic stroke: A prospective cohort study among Chinese adults

BACKGROUND AND AIMS

The associations between genetic factors and waist circumference (WC) with stroke risk have been evaluated in Western studies. However, evidence of this association has rarely been reported in the Chinese population. This study aimed to evaluate the association between WC and family history of stroke (FHS) with ischemic stroke (IS) risk among Chinese adults and to further explore the potential interaction of these associations.

METHODS AND RESULTS

The China Kadoorie Biobank (CKB) study recruited 35,508 participants aged 30-79 years from the Qingdao urban area during 2004-2008. A total of 33,355 participants were included in study. Cox regression analysis was used to estimate the multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the independent and interactional associations between FHS and WC and IS risk. Participants with FHS had a 29% (HR = 1.29, 95% CI: 1.12-1.50) higher IS risk than those without FHS. Participants with excessive WC (85 cm for males and 80 cm for females) had a 78% (HR = 1.78, 95% CI: 1.51-2.10) higher IS risk than those with normal WC. The combined effect of FHS and excessive WC on IS was statistically significant (HR = 2.29, 95% CI: 1.84-2.86). The present study further found statistically significant multiplicative interactions of FHS and WC with IS risk (Pinteraction < 0.001).

CONCLUSION

The present study indicated that FHS and WC were significantly associated with an increased risk of IS. The association between FHS and IS was associated with excessive WC.

CIRCUIT TRAINING REDUCES CARDIOMETABOLIC RISK FACTORS IN WOMEN

ABSTRACT Introduction Combined training is more effective than an isolated modality in reducing cardiometabolic risk indicators. Objective To evaluate the effect of circuit training volume on anthropometric and biochemical risk indicators for cardiometabolic diseases in overweight women. Methods Thirty-two participants underwent 24 weeks of circuit training with free weights combined with aerobic exercise. The training volume during the 24 weeks was used to distribute the women into moderate-volume physical activity (MVA), low-volume physical activity (LVA) and control (CON) groups. Anthropometric indices (body mass, body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR)), blood glucose, insulin, insulin resistance (HOMA-IR), total cholesterol (TC), triglycerides, HDL-c, and LDL-c were evaluated at the beginning of the program and after 12 and 24 weeks. Results There was no interaction between training volume and time for any of the variables studied, but the intervention time influenced body mass (p=0.013) and BMI (p=0.012), and there was a tendency for participation time to reduce body mass (p=0.063) and BMI (p=0.062) after six months of intervention. The volume of the physical activity affected HDL-c (p=0.037), being significant (p=0.030) in the comparison between the MVA and CON groups. Additionally, there was a downward trend in HDL-c after six months of intervention (p=0.073), with a smaller reduction observed in the MVA group, indicating a protective role of moderate physical activity in the reduction of this lipid fraction. The association between physical activity volume and participation time resulted in a clinical improvement in total cholesterol (χ2 = 5.453, p = 0.02), with a higher probability of reaching clinically adequate values in the MVA group (OR = 0.126; 95%CI 0.019 - 0.827). Conclusion Training volume improved cardiometabolic risk factors in overweight women. Level of evidence II; Therapeutic Studies - Investigating the Results of Treatment.

Identification of the Best Anthropometric Index for Predicting the 10-Year Cardiovascular Disease in Southwest China: A Large Single-Center, Cross-Sectional Study

INTRODUCTION

This population-based cross-sectional study aimed to identify the best predictor of the 10-year cardiovascular (CV) high risk among old and new anthropometric indices.

METHODS

We investigated 76,915 adults older than 18 years of age living in southwest China. Ten obesity indices were calculated. The 10-year cardiovascular disease (CVD) risk was estimated using the Framingham risk score. Receiver operating characteristic curve analysis was performed to assess the ability of the anthropometric index to predict the 10-year high risk of CVD events.

RESULTS

The waist-to-hip ratio (WHR) had the highest area under the curve (AUC) value (0.711; sensitivity: 62.22%, specificity: 42.73%) in men, while the body fat index (BAI) had the lowest AUC value (0.624, sensitivity: 49.07%, specificity: 54.84%). The waist-to-height ratio (WHtR) and the body roundness index (BRI) showed the highest AUC value (0.751, sensitivity: 39.24%, 39.83%, specificity: 75.68%, 68.59%) in women, while the BAI showed the lowest AUC value (0.671, sensitivity: 53.15%, specificity: 57.14%).

CONCLUSIONS

The WHR was the best anthropometric measure for assessing the 10-year high risk of CVD in men, while the WHtR and BRI were the best measures for women. In men, the WHR should be < 0.88, and in women, the WHtR should be < 0.502 or the BRI should be < 3.41.

Comparison of anthropometric indicators as predictors of the percentage of fat mass in young people and older adults in Chile

OBJECTIVE

To verify whether triponderal mass index (TMI) has a greater accuracy than body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) as predictors of obesity in young people and older adults in a region of Chile.

MATERIAL AND METHODS

A cross-sectional descriptive study was carried out in 1176 adults (565 men and 611 women) from the Maule region (Chile). Their ages ranged from 20 to 80 years. The percentage of fat mass (%FM) was evaluated by means of dual energy X-ray absorptiometry (DXA). Weight, height and waist circumference (WC) were evaluated. TMI, BMI and WHtR were calculated.

RESULTS

The %FM predictions for BMI were 0.47% for men and 0.50% for women; for TMI, it was 0.50% for men and 0.51% for women; for WC, it was 0.28% for men and 0.21% for women; and finally, for WHtR, it was 0.28% in men and 0.21% in women. The area under the curve (AUC) for BMI was 0.85 in men and 0.85 in women; for TMI, it was 0.87 in men and 0.86 in women; for WHtR, it was 0.76 in men and 0.72 in women; and for WC, the AUC was 0.72 in men and 0.71 in women.

CONCLUSION

It was shown that TMI is the indicator that presented the greatest association with %FM and estimates body fat levels with greater precision than BMI, WC and WHtR. The results suggest its use and application as an indicator that discriminates obesity in young, middle-aged and elderly adults.

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.

Comparison of anthropometric indicators as predictors of the percentage of fat mass in young people and older adults in Chile

OBJECTIVE

To verify whether tri-ponderal mass index (TMI) has a higher accuracy than body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) as predictors of obesity in young people and older adults in a region of Chile.

MATERIAL AND METHODS

A cross-sectional descriptive study was carried out in 1,176 adult subjects (565 men and 611 women) from the Maule region (Chile). The age range was from 20 to 80 years old. The percentage of fat mass (%FM) was evaluated by means of dual energy X-ray absorptiometry (DXA). Weight, height and WC were evaluated. TMI, BMI and WHtR were calculated.

RESULTS

The predictions of %FM for BMI were 0.47% for men and 0.50% for women, for TMI it was 0.50% for men and 0.51% for women, for WC it was 0.28% for men and 0.21% for women, and finally, for the WHtR it was 0.28% in men and 0.21% in women. The area under the curve (AUC) for the BMI was 0.85 in both men and women, for the TMI, it was 0.87 in men and 0.86 in women, for the WHtR, in men it was 0.76 and in women it was 0.72, and for WC, the AUC in men was 0.72 and in women it was 0.71.

CONCLUSION

It was shown that TMI is the indicator that presented the greatest association with %FM and estimates body fat levels with greater precision than BMI, WC and WHtR. The results suggest its use and application as an indicator that discriminates obesity in young, middle and late-aged adults.

Predictive power of novel and established obesity indices for outcome in PAD during a five-year follow-up

BACKGROUND AND AIMS

Previous data show contradicting results regarding relevance of obesity on outcome in peripheral arterial disease (PAD). Thus, this study aims to evaluate the predictive power of obesity as measured by established and novel obesity indices (waist circumference WC, waist-hip ratio WHR, body-mass index BMI, body adiposity index BAI, visceral adiposity index VAI, weight-adjusted waist index WWI) in a PAD cohort.

METHODS AND RESULTS

In 367 patients with diagnosed PAD anthropometric parameters were assessed at study inclusion in an observational study. Mortality data was retrieved from the central death registry after five years. Outcome analyses were performed by multivariable Cox-regression models. 57 PAD patients (15.5%) died during the follow-up, of those 36 were categorized as cardiovascular origin. Patients from the all-cause mortality group were older, more often diabetics with a worse glucose control and had worse renal function. Obesity indices were not significantly different between the event and control group. None of the evaluated risk factors predicted cardiovascular or all-cause death after multivariable adjustment for age, gender, LDL-C, serum creatinine, systolic blood pressure, CRP, smoking habits, diabetes status and previous history of peripheral revascularisation (all-cause WC 1.007 (0.983-1.031), WHR 1.772 (0.106-29.595), BMI 1.006 (0.939-1.078), BAI 1.002 (0.945-1.063), VAI 1.019 (0.895-1.161), WWI 1.085 (0.831-1.416); cv-death WC 1.007 (0.978-1.036), WHR 0.382 (0.006-25.338), BMI 1.004 (0.918-1.098), BAI 1.034 (0.959-1.116), VAI 1.036 (0.885-1.213), WWI 1.061 (0.782-1.441)).

CONCLUSION

Obesity as risk marker estimated by indices both for general and visceral adiposity, does not predict mortality in a secondary prevention cohort of PAD patients.

Is Body Adiposity Index a Better and Easily Applicable Measure for Determination of Body Fat?

Objective: The BAI can be used to reflect %body fat. This study aimed to compare BAI with other methods used in the determination of body fat.Materials and Methods: A cross-sectional study was conducted in Turkish adults. BAI, BMI, WHR, WHtR, body weight, hip and waist circumference (WC), skinfold thicknesses (biceps, triceps, subscapular, suprailiac) were measured. Body fat was measured using Bioelectric Impedance Analysis.Results: The Bland-Altman analyses conducted in this study showed that for % body fat estimations, BIA was in excellent agreement with skinfold measurements (p = 0.131) without proportional bias (p = 0.082), but that BAI was not in agreement with BIA and skinfold measurement. There were a statistically significant positive correlation between BAI and other measurements in terms of females and males and also regardless of sex.Conclusion: BAI was not in agreement with BIA and skinfold measurement methods for % body fat estimations, it had a significantly stronger correlation with % fat calculated using BIA and skinfold thickness.

Association between body adiposity index and coronary risk in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

BACKGROUND & AIMS

The body adiposity index (BAI) was recently proposed as a better indicator of body adiposity than body mass index in adults. The association between BAI and cardiometabolic risk factors has been widely investigated. However, the strength and magnitude of these associations varied as a function of the endpoint evaluated, the study design, the population investigated, and the cut-off points used. The aim of this study was to investigate the association between BAI and coronary heart disease (CHD) risk in a large sample of Brazilian adults and to propose the most appropriate cut-off points for BAI for the identification of CHD risk in the adult Brazilian population.

METHODS

Data from 15,092 civil servants (54.4% women) from universities and research institutes in six Brazilian states were evaluated in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). All were aged 35-74 years at baseline. The Framingham coronary risk score was used to identify a very high risk of CHD (≥20% risk of CHD over the next 10 years) and a high risk of CHD (≥10% risk). BAI cut-off points capable of detecting a risk of CHD were determined using ROC curves and associations were tested using Poisson regression with robust variance, according to sex and age. Three multivariable models were examined.

RESULTS

BAI remained positively associated with a very high and high risk of CHD following adjustment for potential confounding factors in all the strata and multivariable models (p < 0.05), with the exception of model 3 (adjusted for education level and waist-to-hip ratio) for very a high risk of CHD in younger women (p = 0.06). In the adjusted models, the prevalence ratios for a very high and high risk of CHD, irrespective of age group, varied between 1.23 (95%CI: 1.09-1.39) and 1.64 (1.33-2.03) and 1.07 (1.03-1.12) and 1.47 (1.36-1.60) in men; and 1.57 (1.08-2.31) and 2.42 (1.36-4.31) and 1.29 (1.13-1.47) and 1.82 (1.54-2.15) in women, respectively. The optimal cut-off points of BAI to determine a risk of CHD were: 28.0 in men of both age groups, and 34.0 in younger women and 36.0 in older women to determine a very high risk; and 26.0 in younger men and 34.0 in women of both age groups to determine a high risk. BAI showed a reasonable ability to predict coronary risk in participants of the ELSA-Brasil (AUC>60%, except for the group of men of 60-74 years of age).

CONCLUSIONS

Higher BAI levels were found to be associated with a greater risk of developing CHD in both men and women of different ages participating in the ELSA-Brasil, suggesting that BAI may be a useful tool for screening for CHD risk in Brazilian adults.

New indexes of body fat distribution and sex-specific risk of total and cause-specific mortality: a prospective cohort study

Background

A number of prior studies have examined the association between anthropometric measures and mortality, but studies investigating the sex-specific predictive value of novel anthropometric measures on mortality are scarce so far. Therefore, we investigated the sex-specific relevance of the new anthropometric measures body adiposity index (BAI) and waist to height ratio (WHtR) as well as the common measures body mass index (BMI), waist circumference (WC), and waist to hip ratio (WHR) for cause-specific mortality risk.

Methods

The analysis was based on data from the German population based KORA (Cooperative Health Research in the Region of Augsburg) Augsburg cohort study. A total of 6670 men and 6637 women aged 25 to 74 years at baseline examination were included. During a mean follow-up period of 15.4 years, 2409 persons died. Via Cox proportional hazard regression, the associations between the different anthropometric measures and all cause-, cardiovascular disease (CVD)- and cancer mortality were assessed.

Results

BMI, WC, and WHR were significantly associated with all-cause and CVD-mortality in both sexes. WC and WHR were particularly associated with higher all-cause and CVD-mortality risk in women, while in men especially WHtR and BAI were strongly related to these outcomes. Females with WC, WHtR, and WHR measures in the 4th quartile compared with women in the 2nd quartile had a higher risk of death from cancer. Contrary, men in the lowest quartile of WC and WHtR in comparison to men in the 2nd quartile had a significantly elevated cancer mortality risk. BAI was no risk predictor for all-cause and cause-specific mortality in women.

Conclusions

Central obesity reflects higher all-cause and CVD-mortality risk particularly in women. BAI and WHtR seem to be valid as risk predictors for all-cause and especially CVD mortality in men but not women. There are marked sex-differences regarding cancer mortality risk for the different anthropometric measures.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5350-8) contains supplementary material, which is available to authorized users.

Body fat distribution and risk of incident ischemic stroke in men and women aged 50 to 74 years from the general population. The KORA Augsburg cohort study

Background

It remains controversial whether measures of general or abdominal adiposity are better risk predictors for ischemic stroke. Furthermore, so far it is unclear whether body fat mass index (BFMI) and fat free mass index (FFMI) are risk predictors for ischemic stroke. This study examined the sex-specific relevance of body mass index (BMI), BROCA Index, waist circumference (WC), waist-height ratio (WHtR), BFMI and FFMI for the development of ischemic stroke in a Caucasian population.

Material and methods

The prospective population-based cohort study was based on 1917 men and 1832 women (aged 50 to 74 years) who participated in the third (1994/95) or fourth (1999/2001) MONICA/KORA Augsburg survey. Subjects were free of stroke at baseline. Standardized anthropometric and bioelectric impedance measurements were obtained at baseline. Hazard ratios (HR) were estimated from Cox proportional hazard models.

Results

During a median follow-up of 9.3 years 128 ischemic strokes occurred in men and 81 in women, respectively. Coded as quartiles WC and WHtR were significantly associated with incident stroke in multivariable analyses in women (comparing the 4^th vs. the bottom quartile), but none of the adiposity measures was significantly associated with incident stroke in multivariable adjusted analyses in men. When anthropometric measures were used as continuous variables, these findings were confirmed. After multivariable adjustment the associations between obesity measures and incident ischemic stroke were statistically significant only for WC (HR 1.39, 95%CI 1.12-1.72) and WHtR in women (HR 1.39, 95%CI 1.12-1.73) per increase of 1 standard deviation. In both sexes the measures BFMI and FFMI were no independent predictors for incident ischemic stroke.

Conclusions

Abdominal obesity measures are independent predictors of incident ischemic stroke in women but not in men from the general adult population. Thus, it may be of particular importance for women to prevent central obesity in order to reduce their risk of ischemic stroke.

Validity of body adiposity index in predicting body fat in Brazilians adults

OBJECTIVES

The aim of this study was to compare various methods of assessing body compositions with body adiposity index (BAI) and to identify the validity of BAI as a predictor of body fat in Brazilian adults.

METHODS

This study included 706 individuals (average age 37.3 years, SD = 12.1). Anthropometric data included percent body fat obtained by skinfold thicknesses, bioelectrical impedance analysis and DXA. Body mass index (BMI), waist/hip ratio, and BAI were calculated. The correlation between variables was assessed by Pearson's correlation coefficient, and the Bland-Altman and Kaplan Meier graphic approaches were used to verify the agreement between BAI and DXA.

RESULTS

There was a strong correlation between BAI and BMI (r = 0.84 in men and r = 0.86 in women, P < .001), waist circumference (r = 0.77 in men and r = 0.75 in women, P < .001) percent fat by skinfold thicknesses (r = 0.71 in men and r = 0.71 in women, P < .001) and by DXA (r = 0.72 in men and r = 0.78 in women, P < .001). The Bland-Altman approach showed an overestimation of BAI in males and an underestimation in women using DXA as the reference method. The agreement between BAI and DXA through the Kaplan-Meier analysis was 41%.

CONCLUSIONS

It was found that BAI does not replace other measurements of body fat, but compared with more complex methods can be an alternative for estimating the body fat in the absence of these methods.

Home-based lifestyle intervention for rural adults improves metabolic syndrome parameters and cardiovascular risk factors: A randomised controlled trial

The presence of metabolic syndrome (MetS) increases the risk of developing type 2 diabetes and cardiovascular disease. Targeted interventions to reduce MetS for high risk populations are crucial for the prevention of these chronic diseases. This study evaluated the effectiveness of a 6-month home-based physical activity and diet intervention for rural adults with, or at risk of MetS. The randomised controlled trial was conducted in Albany and surrounding towns, Western Australia, 2014-2015. Participants were screened for MetS using the International Diabetes Federation criteria, and eligible participants were randomly assigned to the intervention (n=201) or control (n=200) group. The intervention group received printed and online programme materials and motivational support, and the control group was waitlisted to receive the programme after post-test data collection. Anthropometry, lipid profiles, glycaemic status, and blood pressure were measured at baseline and 6-months post-test. In total, 312 (77.8%) participants completed post-test data collection and were included in the anthropometric analysis, and 274 (68.3%) participants were included in the blood sample analysis. After controlling for confounders, the intervention group significantly improved their triglyceride (-0.10mM, p=0.002), total cholesterol (-0.09mM, p=0.02), and non-HDL cholesterol (-0.08mM, p=0.02) concentrations compared to the control group. Waist circumference (-2.11cm, p=0.03), waist-to-hip ratio (-0.01, p=0.04), weight (-0.70kg, p=0.01), and body mass index (-0.20kg/m(2), p<0.001) were also improved. These findings suggest that comprehensive home-based prevention programmes that include a combination of dietary and physical activity interventions are a promising means to prevent the onset of chronic disease in rural adults.

TRIAL REGISTRATION

anzctr.org.au Identifier: ACTRN12614000512628.

The Olivetti Heart Study: Predictive value of a new adiposity index on risk of hypertension, blood pressure, and subclinical organ damage

BACKGROUND AND AIMS

Recently, some studies have indicated that a new anthropometric index, body adiposity index (BAI), could be more strongly correlated with the percentage of body fat than BMI. However, the results on its role in predicting cardiovascular risk were not univocal. Therefore, the aim of our study was to compare the predictive role of BMI and BAI on risk of hypertension (HP), blood pressure (BP) changes, and subclinical organ damage after an 8-year follow-up, in a sample of adult men participating in the Olivetti Heart Study.

METHODS AND RESULTS

Participants were 350 untreated normotensive men without diabetes, examined twice at baseline (1994-95) and after 8 years of follow-up [2002-04]. BMI was expressed as kg/m(2). BAI was calculated according to the following formula: [(hip circumference (cm)/height(1.5) (m)) - 18]. Subclinical organ damage was detected by urinary albumin excretion (UAE) and left ventricular mass, evaluated by the Cornell product (CP). At baseline, BAI and BMI were both associated with diastolic blood pressure (DBP) and mean arterial pressure (MAP). After 8 years, both baseline BAI and BMI were associated with changes (Δ) in systolic BP, MAP and pulse pressure, while only BMI was also positively related to ΔDBP. Analysis of HP incidence showed that both indices were significant predictors of HP. In addition, both BAI and BMI were significantly associated with ΔUAE, but not with ΔCP. Analysis of the changes in BAI and BMI confirmed these results, as the two indices were significantly associated with risk of HP and changes in BP and UAE, but not with changes in CP.

CONCLUSIONS

In this sample of healthy adult men, BAI and BMI were significant predictors of risk of HP and changes in BP, after an 8-years follow-up. In addition both indices predicted UAE changes, but neither was associated with the CP changes.

Body shape, adiposity index, and mortality in postmenopausal women: Findings from the Women's Health Initiative

OBJECTIVE

Studies evaluating the relationship between body mass index (BMI) and mortality demonstrate a U-shaped association. To expand, this study evaluated the relationship between adiposity indices, a body shape index (ABSI) and body adiposity index (BAI), and mortality in 77,505 postmenopausal women.

METHODS

A prospective cohort analysis was conducted in the Women's Health Initiative to ascertain the independent relationships between adiposity indices and mortality in order to inform on the clinical usefulness of alternate measures of mortality risk. ABSI (waist circumference (cm)/[BMI(2/3) × height (cm)(1/2) ]), BAI (hip circumference (cm)/[height (m)(1.5) ] - 18), weight, BMI, and waist circumference (WC) were evaluated in relation to mortality risk using adjusted Cox proportional hazards regression models.

RESULTS

ABSI showed a linear association with mortality (HR, 1.37; 95% CI, 1.28-1.47 for quintile 5 vs. 1) while BMI and BAI had U-shaped relationships with HR of 1.30; 95% CI, 1.20-1.40 for obesity II/III BMI and 1.06, 95% CI, 0.99-1.13 for BAI. Higher WC (HR, 1.21; 95% CI, 1.13-1.29 for quintile 5 vs. 1) showed relationships similar to BMI.

CONCLUSIONS

ABSI appears to be a clinically useful measure for estimating mortality risk, perhaps more so than BAI and BMI in postmenopausal women.

Impact of a 3-year multi-centre community-based intervention on risk factors for chronic disease and obesity among free-living adults: the Healthy Alberta Communities study

BACKGROUND

Healthy Alberta Communities (HAC) was a 3-year community-based intervention to reduce lifestyle-related risk factors for chronic disease and obesity at a population-level. The current paper examines changes in blood pressure (BP) and anthropometric indicators within HAC communities compared to secular trends.

METHODS

Between 2006 and 2009, this community-academic partnership sought to create environments supportive of healthier dietary and physical activity behaviours within four diverse communities in Alberta, Canada. Height, weight, waist and hip circumference and BP were measured among 1554 and 1808 community residents at baseline (2006) and follow-up (2009), respectively. A comparison sample was drawn from a representative national survey. Samples were stratified by age and change between pre- and post-intervention was assessed using t-tests. Changes in parameters over time between groups were compared using meta-analysis. The net difference in change in outcomes (change in intervention communities minus change in comparison group) represented the effect of the intervention.

RESULTS

Adjusted systolic (SBP) and diastolic (DBP) BP declined within most age groups in HAC communities from pre- to post-intervention. The net decline in SBP was 1 mmHg in 20-39 year olds (p = 0.006) and 2 mmHg in 40-59 year olds (p = 0.001), while the net decline in DBP was 3 mmHg in 20-39 year olds (p < 0.001), 2 mmHg in 40-59 year olds (p < 0.001) and 3 mmHg in 60-79 year olds (p < 0.001). The net increase in the proportion of individuals with normal BP was 5.9 % (p < 0.001), while the net decline in the proportion of individuals with stage 1 hypertension was 4.5 % (p < 0.001). BMI and body weight were unchanged. There was a significant net increase in waist and hip circumference among 20-39 year olds within intervention communities.

CONCLUSIONS

Findings suggest HAC succeeded in shifting the population distribution of BP in a leftward direction. By contrast, anthropometric parameters remained unchanged or worsened within intervention communities. Therefore, while improvements in some clinical risk factors can be achieved through relatively diffuse and shorter-term community-level environmental changes, improvements in others may require interventions of greater intensity and duration. Evaluating the success of community-based interventions based on their efficacy in changing individual-level clinical indicators may, however, underestimate their potential.

Evaluation of body adiposity index as a predictor of aortic stiffness in multi-ethnic Asian population with type 2 diabetes

Cardiovascular disease is the leading cause of morbidity and mortality in type 2 diabetes mellitus. We evaluated the predictive ability of the recently developed body adiposity index for aortic stiffness, an intermediate endpoint of cardiovascular disease, in a cross-sectional multi-ethnic Asian type 2 diabetes mellitus cohort (N = 1408). AS was estimated using carotid-femoral pulse wave velocity measured by applanation tonometry. Body adiposity index was computed as hip circumference/(height)(1.5) - 18. Compared to body mass index, waist circumference and visceral fat area, body adiposity index displayed the weakest association with pulse wave velocity (r = 0.077, 0.096, 0.134 and 0.058, respectively; all p < 0.05). Interestingly, the relationship between measurements of obesity and pulse wave velocity was ethnic dependent - body mass index, body adiposity index, waist circumference and visceral fat area consistently predicted pulse wave velocity only in Indians but not others. In multi-variable analysis, body mass index was a significant determinant of pulse wave velocity in all ethnicities. In conclusion, body adiposity index is a weak predictor of aortic stiffness (when compared with body mass index) in Asians with type 2 diabetes mellitus.