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Sadafi S, Azizi A, Najafi F, Pasdar Y. Lipid accumulation product and type 2 diabetes risk: a population-based study. BMC Endocr Disord 2024; 24:147. [PMID: 39134995 PMCID: PMC11318136 DOI: 10.1186/s12902-024-01682-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 08/07/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND The Lipid Accumulation Product (LAP) is a measure that indicates excessive fat accumulation in the body. LAP has been the focus of research in epidemiological studies aimed at forecasting chronic and metabolic diseases. This study aimed to evaluate the association between LAP and type 2 diabetes mellitus (T2DM) among adults in western Iran. METHODS The study involved 9,065 adults who participated in the initial phase of the Ravansar non-communicable diseases study (RaNCD) cohort. To investigate the association between LAP and T2DM, multiple logistic regressions were employed. Additionally, the receiver operating characteristic (ROC) curve was used to evaluate LAP's predictive ability concerning T2DM. RESULTS The participants had an average age of 47.24 ± 8.27 years, comprising 49.30% men and 50.70% women. The mean LAP was 53.10 ± 36.60 for the healthy group and 75.51 ± 51.34 for the diabetic group (P < 0.001). The multiple regression analysis revealed that the odds of T2DM in the second quartile of LAP were 1.69 (95% CI: 1.25, 2.29) times greater than in the first quartile. Furthermore, the odds in the third and fourth quartiles were 2.67 (95% CI: 2.01, 3.55) and 3.73 (95% CI: 2.83, 4.92) times higher, respectively. The ROC analysis for predicting T2DM showed that the LAP index had an area under the curve (AUC) of 0.66 (95% CI: 0.64, 0.68). CONCLUSION A strong association was identified between elevated LAP levels and T2DM in the adult population of western Iran. LAP is recommended as a potential tool for screening diabetes susceptibility.
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Affiliation(s)
- Sepehr Sadafi
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Azizi
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
- Department of Community and Family Medicine, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Farid Najafi
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yahya Pasdar
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Verma S, Tiwari R, Verma N, Singh S, Sharma A. Anthropometry and blood biomarkers of diabetes and their possible association with obesity and metabolic syndrome. J Diabetes Metab Disord 2024; 23:509-517. [PMID: 38932840 PMCID: PMC11196461 DOI: 10.1007/s40200-023-01276-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/02/2023] [Indexed: 06/28/2024]
Abstract
Background Diabetes, a rapidly increasing heterogeneous disorder, is closely linked to the epidemic of obesity and metabolic syndrome (MetS). At present, we do not understand completely the blood biomarkers, molecular aetiology, and role of lifestyle modification and interventions to combat diabetes hand in hand with obesity and the MetS epidemic. Methods To measure different anthropometric and blood biomarkers in pre-diabetic and diabetic patients, we collected data and blood samples from patients in a hospital OPD. This was a cross-sectional study that included the identification of possible relationships between different parameters to predict early diagnostic markers of diabetes. Results We found increased body mass index (BMI), fasting blood glucose, neck, waist, and hip circumference, sagittal abdominal diameter, and skin fold thickness in the diabetic as compared to the pre-diabetic group. Also, serum uric acid and insulin resistance (HOMA-IR) values were significantly increased in diabetic individuals. We found a significant positive correlation between serum uric acid and BMI, fasting blood glucose, serum insulin, and HOMA-IR values. Conclusions Here, we found that pre-diabetic and diabetic patients have increased fasting glucose levels while we did not find any difference in insulin levels. Both pre-diabetic and diabetic patients show high serum uric acid, positively associated with a higher prevalence of diabetes and HOMA-IR. Uric acid may hence be an important parameter for early diagnostics. These findings may be used as a basis for future studies that aim to identify the mechanistic details of the association of uric acid with insulin signaling and hence better understanding of the phenomenon associated with diabetes. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01276-4.
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Affiliation(s)
- Shivam Verma
- Department of Physiology, King George’s Medical University, Lucknow, 226003 India
| | - Ritu Tiwari
- Department of Physiology, King George’s Medical University, Lucknow, 226003 India
| | - Narsingh Verma
- Department of Physiology, King George’s Medical University, Lucknow, 226003 India
| | - Shraddha Singh
- Department of Physiology, King George’s Medical University, Lucknow, 226003 India
| | - Aakansha Sharma
- Department of Zoology, University of Lucknow, Lucknow, 226007 India
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Laubner K. [From diabetes to sleep apnea: what obesity complications should we look for?]. Dtsch Med Wochenschr 2023; 148:949-956. [PMID: 37494560 DOI: 10.1055/a-1847-2632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
The prevalence of obesity has increased worldwide. For Germany, according to the "Study on Adult Health in Germany" (DEGS1) of the Robert Koch Institute from the years 2008-2011, the prevalence of a BMI ≥25 kg/m² was 67,1% for men and 53,0% for women, whereby the proportion of obesity, i.e. a BMI ≥30 kg/m² is 23, 3% for men and 23,9% for women. Compared to 1998, the prevalence of obesity in the same group was 18, 8% for men and 21,7% for women. Because of the increasing prevalence of overweight and obesity, the number of patients with obesity-associated comorbidities is correspondingly increasing. There is a close association between obesity and an increased risk of metabolic diseases, cardiovascular diseases, but also musculoskeletal diseases, some types of cancer and mental comorbidities. In addition, obesity might also lead to restrictions in activities of daily living, reduced quality of life, unemployment and early retirement. A knowledge of obesity-associated sequelae is therefore essential in order to specifically look for them, treat them and thereby improve patient care and ultimately morbidity and mortality of patients with obesity.
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Loosen SH, Krieg S, Krieg A, Luedde T, Kostev K, Roderburg C. Adult Body Height Is Associated with the Risk of Type 2 but Not Type 1 Diabetes Mellitus: A Retrospective Cohort Study of 783,029 Individuals in Germany. J Clin Med 2023; 12:jcm12062199. [PMID: 36983200 PMCID: PMC10053566 DOI: 10.3390/jcm12062199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023] Open
Abstract
Background: Diabetes mellitus is a major global health burden associated with high morbidity and mortality. Although a short adult body height has been associated with increased risk of type 2 diabetes (T2D), there are large inconsistencies between the studies. Therefore, we aimed to investigate the association between body height and T2D in a large cohort of adult outpatients in Germany. Methods: A total of 783,029 adult outpatients with available body height data from the Disease Analyzer (IQVIA) database were included in Germany between 2010 and 2020. The incidence of diabetes mellitus (type 1 and type 2) was evaluated as a function of the patients’ body height stratified by age, sex, and body-mass-index (BMI). Results: In both women and men in all age groups, incidence of T2D decreased with the increasing body height (<50, 51–60, 61–70, and >70 years). There was no association between the body height and the individual HbA1c value. In multivariable Cox regression analyses adjusted for patient age and BMI, hazard ratios for the development of T2D were 1.15 (95% CI: 1.13–1.17) for each 10 cm decrease in body height in women and 1.10 (95% CI: 1.09–1.12) in men. No significant association was found between body height and the development of T1D. Conclusions: We present the first data from a large cohort of outpatients in Germany, providing strong evidence for an association between adult body height and T2D. These data add to the current literature and might help in implementing body height into existing diabetes risk stratification tools to further reduce morbidity and mortality worldwide.
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Affiliation(s)
- Sven H. Loosen
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany (C.R.)
- Correspondence: (S.H.L.); (S.K.); Tel.: +49-211-81-16630 (S.H.L. & S.K.); Fax: +49-211-81-04489 (S.H.L. & S.K.)
| | - Sarah Krieg
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany (C.R.)
- Correspondence: (S.H.L.); (S.K.); Tel.: +49-211-81-16630 (S.H.L. & S.K.); Fax: +49-211-81-04489 (S.H.L. & S.K.)
| | | | - Tom Luedde
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany (C.R.)
| | - Karel Kostev
- Department of Surgery (A), University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany
| | - Christoph Roderburg
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany (C.R.)
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Phan DH, Vu TT, Doan VT, Le TQ, Nguyen TD, Van Hoang M. Assessment of the risk factors associated with type 2 diabetes and prediabetes mellitus: A national survey in Vietnam. Medicine (Baltimore) 2022; 101:e31149. [PMID: 36253989 PMCID: PMC9575745 DOI: 10.1097/md.0000000000031149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study aims to estimating the prevalence of type 2 diabetes and prediabetes among adult from 30 to 69 years old and assess the association of risk factor with the conditions. A total of 5244 aged 30 to 69 years old were participated in this cross-sectional study, using nationally representative sampling frame. All participants were taking blood sample to measure fasting blood glucose level and 2-hour postload oral glucose tolerance test by National Hospital of Endocrinology, Vietnam. Multinomial logistic regressions with baseline-category logit models were conducted to identify factors associated with diabetes and prediabetes among respondents. The prediabetes prevalence was in 17.9% and diabetes in 7.3%. Patients who were male (reference group vs female OR = 0.79; 95% CI: 0.64, 0.97), in the 50 to 59 years old group (OR = 1.60; 95% CI: 1.28, 2.00), have hypertension and WHR risk have higher prevalence to have prediabetes (OR = 1.31; 95% CI: 1.12, 1.53; OR = 1.37; 95% CI: 1.11, 1.70, respectively). Male patients (reference group vs female OR = 0.62; 95% CI: 0.45, 0.84), patients who were in 40 to 49; 50 to 59; 60 to 69 years old, those who were housewife (OR = 2.17; 95% CI: 1.43, 3.28; OR = 2.85; 95% CI: 1.91, 4.27; OR = 3.12; 95% CI: 2.08, 4.69; OR = 1.71; 95% CI: 1.22, 2.40, respectively). Diabetes have significant associated with participants have hypertension (OR = 1.19; 95% CI: 1.72, 2.70). The common factor directly related to prediabetes and diabetes in both genders is age. Other factors directly associated with prediabetes and diabetes include BMI, WHR, hypertension, educational level, and job.
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Affiliation(s)
| | - Trang Thu Vu
- Center for Population Health Sciences, Hanoi University of Public Health, Hanoi, Vietnam
- * Correspondence: Trang Thu Vu, Center for Population Health Sciences, Hanoi University of Public Health, Hanoi, Vietnam (e-mail: )
| | - Vu Tuan Doan
- National Hospital of Endocrinology, Hanoi, Vietnam
| | | | | | - Minh Van Hoang
- Center for Population Health Sciences, Hanoi University of Public Health, Hanoi, Vietnam
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Shu L, Zhao Y, Shen Y, Jia L, Zhang J. Interaction analysis of lipid accumulation product and family history of diabetes on impaired fasting glucose and diabetes risk in population with normotension in Eastern China: a community-based cross-sectional survey. Arch Public Health 2022; 80:217. [PMID: 36183132 PMCID: PMC9526958 DOI: 10.1186/s13690-022-00972-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 09/23/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Lipid accumulation product (LAP) is considered to be a new convenient useful indicator to assess the visceral fat. Therefore, we aimed to evaluate the risk factors of impaired fasting glucose (IFG) and diabetes, and explore the possible interacting influences of LAP with other factors on the risk of IFG and diabetes among Chinese normotension adults. METHODS A multistage stratified cluster sampling method was conducted to select urban residents in Bengbu, China. For each eligible participant, data on questionnaire survey, anthropometric measurements and laboratory tests were obtained. The effects of body mass index (BMI), waist circumference (WC), waist to height ratio (WHtR) and LAP for predicting IFG and diabetes were performed by multiple logistic regressions and receiver operating characteristic (ROC) analyses. The interaction effects were evaluated by relative excess risk of interaction (RERI), attributable proportion due to interaction (AP) and synergy index (SI). RESULTS Six thousand, four hundred sixty-seven normotension subjects (2695 men and 3772 women) were enrolled in our study, the prevalence of IFG and diabetes were 9.37% and 14.33%, respectively. When assessed using ROC curve analysis, LAP exhibited higher diagnostic accuracy for identifying IFG and diabetes than BMI, the area under the AUC curve was 0.650 (95% CI: 0.637 to 0.662). After adjustment for age, sex, educational level and other confounding factors, multivariate logistic regression analyses indicated that subjects with the fourth quartile of LAP were more likely to develop IFG (adjusted OR: 2.735, 95% CI: 1.794-4.170) and diabetes (adjusted OR: 1.815, 95% CI: 1.297-2.541) than those with the first quartile. A significant interaction between LAP and family history of diabetes was observed in participants (RERI = 1.538, 95%CI: 0.167 to 3.612; AP = 0.375, 95%CI: 0.118 to 0.631; SI = 1.980, 95%CI: 1.206 to 3.251). However, a significant interaction between LAP and abdominal obesity was indicated by the value of RERI (1.492, 95%CI: 0.087 to 3.723) and AP (0.413, 95%CI: 0.014 to 0.756), but not the value of SI (1.824, 95%CI: 0.873 to 3.526). CONCLUSION Our results demonstrated that there might be synergistic effect between LAP and family history of diabetes on the risk of IFG and diabetes.
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Affiliation(s)
- Li Shu
- grid.252957.e0000 0001 1484 5512School of Public Health, Bengbu Medical College, Bengbu, Anhui Province China
| | | | - Yanqi Shen
- grid.252957.e0000 0001 1484 5512School of Public Health, Bengbu Medical College, Bengbu, Anhui Province China
| | - Linlin Jia
- grid.252957.e0000 0001 1484 5512School of Public Health, Bengbu Medical College, Bengbu, Anhui Province China
| | - Jiaye Zhang
- grid.252957.e0000 0001 1484 5512School of Public Health, Bengbu Medical College, Bengbu, Anhui Province China
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Song W, Hu Y, Yuan J, Wei Y, Cheng Z, Liu J, Xu J, Wang X. Gender Differences Between the Phenotype of Short Stature and the Risk of Diabetes Mellitus in Chinese Adults: A Population-Based Cohort Study. Front Endocrinol (Lausanne) 2022; 13:869225. [PMID: 35450422 PMCID: PMC9016201 DOI: 10.3389/fendo.2022.869225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/08/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Previous studies have shown that there are significant regional and gender differences in the association between the phenotype of short stature and diabetes mellitus (DM). The purpose of this study was to investigate the gender difference between the phenotype of short stature and the risk of DM in the Chinese population. METHODS The sample included 116,661 adults from 32 locations of 11 cities in China, of which the average height of men and women was 171.65 and 160.06 cm, respectively. Investigators retrospectively reviewed annual physical examination results for follow-up observations and set confirmed DM events as the outcome of interest. Multivariate Cox regression, restricted cubic spline, and piecewise regression models were used to check the association between height and DM risk. RESULTS During an average observation period of 3.1 years, there were 2,681 of 116,661 participants who developed new-onset DM, with a male to female ratio of 2.4 to 1. After full adjustment for confounders, we confirmed that there was a significant negative correlation between height and DM risk in Chinese women (HR per 10 cm increase: 0.85, 95% CI: 0.74-0.98), but not in men (HR per 10 cm increase: 1.16, 95% CI: 0.98-1.14). Additionally, through restricted cubic spline and piecewise regression analysis, we determined that the height of 157-158 cm may be the critical point for short stature used to assess the risk of DM in Chinese women. CONCLUSIONS In the Chinese population, female short stature phenotype is related to increased DM risk, among which 157-158 cm may be the saturation effect point of female short stature for predicting DM risk.
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Affiliation(s)
- Wei Song
- Department of Endocrinology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Yaqin Hu
- Department of Endocrinology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Jiao Yuan
- Department of Endocrinology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Ying Wei
- Department of Pharmacy, Nanchang First Hospital, Nanchang, China
| | - Zongyou Cheng
- Department of Endocrinology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Jingdong Liu
- Department of Endocrinology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Jixiong Xu
- Department of Endocrinology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoyu Wang
- Department of Endocrinology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
- *Correspondence: Xiaoyu Wang,
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Wiese ML, Aghdassi AA, Lerch MM, Steveling A. Excess Body Weight and Pancreatic Disease. Visc Med 2021; 37:281-286. [PMID: 34540944 DOI: 10.1159/000517147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/14/2021] [Indexed: 12/13/2022] Open
Abstract
Background Excess body weight (EBW) is a risk factor for various acute and chronic conditions. Conversely, the "obesity paradox" suggests a protective effect of higher body weight on some disease outcomes. This article discusses the role of EBW along the disease continuum of pancreatitis and pancreatic cancer (PC) in terms of incidence and outcome. Summary Comparison of findings is hampered by the use of different methods to assess EBW. Nevertheless, in acute pancreatitis (AP) and PC, EBW, especially visceral obesity, presents a distinct risk factor and predictor of a negative outcome. Findings of a protective effect likely result from nonconsideration of fat distribution or other confounders. Regarding chronic pancreatitis (CP), few studies indicate lower incidence and a better outcome with higher body mass. However, there is insufficient evidence to confirm the existence of an obesity paradox. The precise mechanisms of how EBW affects the disease continuum require further elucidation but both common and disease-specific effects seem involved. Key Messages EBW is associated with higher incidence and a negative outcome in AP and PC. The association with CP is less conclusive. Thus, maintaining normal weight is advisable at any stage of the disease continuum.
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Affiliation(s)
- Mats L Wiese
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Ali A Aghdassi
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Antje Steveling
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
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Joseph JJ, Kluwe B, Echouffo-Tcheugui JB, Zhao S, Brock G, Kline D, Odei JB, Kalyani RR, Bradley DP, Hsueh WA, Sims M, Golden SH. Association of Adiposity With Incident Diabetes Among Black Adults in the Jackson Heart Study. J Am Heart Assoc 2021; 10:e020716. [PMID: 34493073 PMCID: PMC8649535 DOI: 10.1161/jaha.120.020716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background The prognostic value of anthropometric, adipokine, and computed tomography measures of adiposity to predict diabetes in Black, specifically by normoglycemia versus prediabetes, remains incompletely understood. Methods and Results Among Black participants without diabetes in the JHS (Jackson Heart Study), waist circumference [WC], body mass index, adiponectin, leptin, and leptin:adiponectin ratio were standardized in sample 1 (2422 participants at baseline [2000–2004]) and WC, body mass index, visceral adipose tissue (VAT), subcutaneous adipose tissue, and liver attenuation in 1537 participants at examination 2 (2005–2008) (sample 2). Hazard ratios (HRs) for diabetes were estimated using interval‐censored Cox modeling adjusting for traditional risk factors and validated with the C index. Over 5 years, 300 and 122 incident diabetes cases occurred in sample 1 and sample 2, respectively. In sample 1 and sample 2, a 1‐SD higher log‐leptin:adiponectin ratio and VAT had the strongest associations (HR, 1.95 [95% CI, 1.67–2.27] and 1.76 [95% CI, 1.52–2.04]) and discriminatory power (C index 0.68 [95% CI, 0.64–0.71] and C index 0.67 [95% CI, 0.61–0.74]) with diabetes. The normoglycemic compared with the prediabetes group had a 1.3 to 1.9 times greater magnitude of associations with diabetes for WC, liver attenuation, and VAT (P interaction <0.10). In sample 2, C indices for WC (HR, 0.84; 95% CI, 0.73–0.95), VAT (HR, 0.91; 95% CI, 0.85–0.98), and liver attenuation (HR, 0.90; 95% CI, 0.77–1.00) were greater than HbA1c (HR, 0.74; 95% CI, 0.57–0.90) in normoglycemia, whereas HbA1c was best in prediabetes (HR, 0.72; 95% CI, 0.66–0.78). Conclusions Overall, among Black adults, multiple measures of adiposity were associated with incident diabetes with modest predictive ability. In Black patients with normoglycemia, WC, liver attenuation, and VAT may appropriately identify those at high risk for diabetes, whereas HbA1c was the best predictor in individuals with prediabetes.
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Affiliation(s)
| | - Bjorn Kluwe
- College of Medicine The Ohio State University Columbus OH
| | - Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism Johns Hopkins University School of Medicine Baltimore MD
| | - Songzhu Zhao
- College of Medicine The Ohio State University Columbus OH
| | - Guy Brock
- College of Medicine The Ohio State University Columbus OH
| | - David Kline
- College of Medicine The Ohio State University Columbus OH
| | - James B Odei
- College of Public Health The Ohio State University Columbus OH
| | - Rita R Kalyani
- Division of Endocrinology, Diabetes and Metabolism Johns Hopkins University School of Medicine Baltimore MD
| | | | - Willa A Hsueh
- College of Medicine The Ohio State University Columbus OH
| | - Mario Sims
- University of Mississippi Medical Center Jackson MS
| | - Sherita H Golden
- Division of Endocrinology, Diabetes and Metabolism Johns Hopkins University School of Medicine Baltimore MD
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The Influence of Anthropometric Indices and Intermediary Determinants of Hypertension in Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115646. [PMID: 34070454 PMCID: PMC8197532 DOI: 10.3390/ijerph18115646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 11/17/2022]
Abstract
Hypertension is a major public health burden in Bangladesh. However, studies considering the underlying multifaceted risk factors of this health condition are sparse. The present study concurrently examines anthropometric parameters and intermediary factors influencing hypertension risk in Bangladesh. Using the 2018 World Health Organisation (WHO) STEPwise approach to non-communicable disease risk factor surveillance (STEPS) study conducted in Bangladesh and involving 8019 nationally representative adult respondents, bivariate and multivariate logistic regression analyses were performed to determine the association between anthropometrics, other intermediary factors and hypertension. The regression results were presented using the odds ratio (OR) and adjusted odds ratio (AOR) at 95% confidence intervals (CIs). The risk of hypertension was higher among females and males who were 40 years and older. However, among females, those who were age 60 years and older were more than twice and thrice more likely to be hypertensive compared to those in the younger age groups (18–39, 40–59). Females who were obese (body mass index [BMI], waist to hip ratio [WHR], waist to height ratio [WHtR]) or had high waist circumference [WC] were twice as likely to be hypertensive. Males and females who were physically active, consuming more fruits and vegetables daily and educated had lower odds of developing hypertension. Key findings suggest that the association between anthropometric indices (body mass index [BMI], waist to hip ratio [WHR], waist to height ratio [WHtR]), waist circumference [WC]), other intermediary determinants (e.g., education, physical activity) and hypertension exist across gender and with increasing age among adults in Bangladesh. Developing appropriate public health interventions (e.g., regular assessment of anthropometric parameters) for early identification of the risk and pattern of hypertension through appropriate screening and diagnosis is required to meet the specific health needs of the adult Bangladesh population.
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Association between dairy product intake and body composition among South Asian adults from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Br J Nutr 2020; 126:1100-1109. [PMID: 33308330 DOI: 10.1017/s0007114520005061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
South Asians, who are at a disproportionately greater risk of atherosclerotic CVD (ASCVD), represent a rapidly growing population in the USA. The relationship between dairy products, a major component of South Asian diets, and body composition - an established risk factor for ASCVD, is unclear. The aim of the present study was to examine associations between dairy intake and multiple measures of body composition (BMI, waist and hip circumference, waist:hip ratio, abdominal lean mass, subcutaneous, visceral, and intermuscular fat areas) among South Asian adults in the USA. A baseline analysis was conducted using existing data from the Mediators of Atherosclerosis in South Asians Living in America cohort. In women, the highest (>1·9 servings/d) v. lowest (<1 serving/d) tertile of dairy intake was associated with 53 % lower odds of a waist circumference >80 cm (95 % CI 0·25, 0·89, Pfor trend<0·05). No associations were observed between dairy intake and measures of body composition. However, >3 servings of low-fat yogurt/week was associated with a 9·9 cm2 lower visceral fat area (95 % CI -19·07, -0·72, P<0·05) and 2·3 cm2 lower intermuscular fat area (95 % CI -3·76, -0·79, P<0·05) as compared with those with three servings/week. Milk and cheese were not associated with body composition measures. These analyses suggest that higher consumption of low-fat yogurt is associated with lower visceral and intermuscular fat in the whole sample, and women with higher dairy intake have lower waist circumference. Our study supports dietary incorporation of dairy products, and recognises the utility of multidimensional measures of central adiposity.
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Atayoglu AT, Inanc N, Başmisirli E, Çapar AG. Evaluation of the Finnish Diabetes Risk Score (FINDRISC) for diabetes screening in Kayseri, Turkey. Prim Care Diabetes 2020; 14:488-493. [PMID: 32029385 DOI: 10.1016/j.pcd.2020.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/08/2020] [Accepted: 01/14/2020] [Indexed: 12/19/2022]
Abstract
AIM Diabetes is a major health problem worldwide, as its prevalence is increasing dramatically. Lifestyle modification can delay or prevent the onset of type 2 diabetes. Therefore, screening for prediabetes and type 2 diabetes risk through an assessment of risk factors is important. The objective of the study was to investigate the risk for type 2 diabetes using the Finnish Diabetes Risk Score (FINDRISC) in Kayseri. METHODS In total, 1500 adults aged 18 years or older were interviewed using the FINDRISC as Diabetes Risk Questionnaire and fasting serum glucose levels. The findings of FINDRISC were grouped according to gender and a score of 15 and above was accepted as a high risk in terms of Type 2 diabetes. RESULTS 13.5% of the participants were in the high- risk group. There was a statistically significant relationship between total FINDRISC score and gender (p < 0.001). While 15.2% of the women were in the high -risk group, 12.4% of the men were in the high- risk group. The percentage of women in the low-risk group (35.9%) is less than the men with low- risk of diabetes (38.5%). As the BMI increased, the individuals were found to have a high risk evaluated with the use of FINDRISC. 14.3% of women with waist circumference >88 and 6.7% of men with waist circumference >102 were in the high- risk group. (p < 0.001) CONCLUSIONS: Risk of diabetes was found to be higher with the FINDRISC score as the BMI and waist circumference increased. FINDRISC can be used in the primary care for this purpose; fast and easy to be applied.
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Affiliation(s)
- A Timucin Atayoglu
- Department of Family Medicine, Medical Faculty, International Medipol University, Istanbul, Turkey.
| | - Neriman Inanc
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Naci Yazgan University, Kayseri, Turkey.
| | - Eda Başmisirli
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Naci Yazgan University, Kayseri, Turkey.
| | - Aslı Gizem Çapar
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Naci Yazgan University, Kayseri, Turkey.
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Toro-Huamanchumo CJ, Pérez-Zavala M, Urrunaga-Pastor D, De La Fuente-Carmelino L, Benites-Zapata VA. Relationship between the short stature and the prevalence of metabolic syndrome and insulin resistance markers in workers of a private educational institution in Peru. Diabetes Metab Syndr 2020; 14:1339-1345. [PMID: 32755833 DOI: 10.1016/j.dsx.2020.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/15/2020] [Accepted: 07/09/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Short stature has been linked with the development of metabolic syndrome (MetS). However, only one study has been conducted in Latin American adults. We aimed to assess the association between short stature and MetS in workers of a private educational institution in Peru. In addition, we evaluated the association between height and surrogate markers of insulin resistance (IR). METHODS We performed an analytical cross-sectional study. We categorized the height in tertiles and evaluated MetS according to the Latin American Diabetes Association statement. We used the triglycerides and glucose (TyG) index and the triglycerides to HDL-cholesterol (TG/HDL-c) ratio as IR markers. We elaborated crude and adjusted Poisson generalized linear models to evaluate the association between height tertiles and MetS. For the IR markers, we carried out crude and adjusted linear regressions. RESULTS We analyzed 1080 participants and the overall prevalence of MetS was 16.2%. In the adjusted Poisson generalized linear model, using the high tertile as a reference, we found statistically significant differences in the prevalence of MetS with the low and intermediate tertile (aPR = 2.03; 95%CI: 1.48-2.77 and aPR = 1.41; 95%CI: 1.01-1.99; respectively). In the gender-stratified analysis, we found statistical significance between height and MetS when comparing high and low tertile for both genders. For IR markers, we found an inverse association between the height and TyG index (aβ = -0.14; 95%CI: 0.19 to -0.10) and TG/HDL-c ratio (aβ = -0.62; 95%CI: 0.84 to -0.39). When we stratified by gender, the association for both secondary outcomes and height remained statistically significant in both groups. CONCLUSIONS We found an association between short stature and the prevalence of MetS and IR markers. We need studies with national representative samples to define the threshold of short stature with better sensitivity and specificity for the screening of MetS.
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Affiliation(s)
- Carlos J Toro-Huamanchumo
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Miriam Pérez-Zavala
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Diego Urrunaga-Pastor
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Luciana De La Fuente-Carmelino
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Vicente A Benites-Zapata
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru.
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Ilunga Tshiswaka D, Agala CB, Guillory AJ, Walters B, Mbizo J. Risk factors associated with age at diagnosis of diabetes among noninstitutionalized US population: the 2015-2016 National Health and Nutrition Examination Survey. BMC Public Health 2020; 20:1121. [PMID: 32677929 PMCID: PMC7364782 DOI: 10.1186/s12889-020-09231-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 07/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Demographic and anthropometric factors associated with the age at diagnosis of diabetes have not been extensively studied. Much of the literature using anthropometric measures has been associated with other health factors such as obesity and coronary heart disease. The purpose of this study was to assess the relationship between different sets of anthropometric factors and age of diabetes diagnosis in the United States. METHODS Using the NHANES 2015-2016 data set, weighted linear regression analysis was performed on observations from 600 qualified individuals with diabetes to study associations between anthropometric and demographic factors and the age of diabetes diagnosis. RESULTS Results of our analysis support the evidence of significant relationships between the anthropometric characteristics and demographic factors and age at diabetes diagnosis. Specifically, age at diagnosis of diabetes is predicted to decrease by 1.03 (p < 0.01) and 0.91 (p < 0.01) years when BMI and upper leg length go up by one unit each, respectively. Similarly, age at diagnosis of diabetes decreases by 0.02 years and by 1.72 years when refrigerated glucose serum increases by 1 mg/dL (p < 0.05) and when household size increases by one person, respectively. Male respondents were diagnosed with diabetes 3.41 years later than their female counterparts. Conversely, age at diagnosis of diabetes increases by 1.24 years when the average sagittal abdominal diameter goes up by 1 cm (p < 0.05). In addition, Mexican American respondents were diagnosed 5.00 years younger than the non-Hispanic White counterparts. CONCLUSIONS Our findings show that anthropometric factors, including BMI, refrigerated glucose serum and upper leg length increase have an inverse linear association with age of diabetes diagnosis. The results of this study can help improve the efficiency of the methods of health professionals attempting to lower the rate of diabetes diagnoses.
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Affiliation(s)
- Daudet Ilunga Tshiswaka
- Department of Public Health, Usha Kundu, MD College of Health, University of West Florida, 11000 University Parkway, Pensacola, FL, 32514, USA.
| | - Chris B Agala
- School of Medicine, University of North Carolina at Chapel-Hill, 211B Cameron Ave, Chapel-Hill, NC, 27516, USA
| | - A J Guillory
- Department of Public Health, Usha Kundu, MD College of Health, University of West Florida, 11000 University Parkway, Pensacola, FL, 32514, USA
| | - Breanna Walters
- Department of Public Health, Usha Kundu, MD College of Health, University of West Florida, 11000 University Parkway, Pensacola, FL, 32514, USA
| | - Justice Mbizo
- Department of Public Health, Usha Kundu, MD College of Health, University of West Florida, 11000 University Parkway, Pensacola, FL, 32514, USA
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Kant R, Yadav P, Kishore S. Gender diversity of insulin sensitivity markers among patients of type 2 diabetes mellitus in northern India: A cross-sectional analytical study. J Family Med Prim Care 2020; 9:3315-3320. [PMID: 33102289 PMCID: PMC7567213 DOI: 10.4103/jfmpc.jfmpc_400_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/25/2020] [Accepted: 05/20/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diabetes mellitus is a worldwide health problem with more than 80% diabetics living in LMIC. Biological and psychosocial factors are also responsible for gender diversity in T2DM which highlights the need for action to combat T2DM in India. The current study was undertaken to evaluate the gender diversity of insulin sensitivity markers among patients of T2DM in northern India and secondly, to assess and compare the quality of life among T2DM patients in northern India. MATERIAL AND METHODS It was a cross-sectional analytical study enrolling 78 patients from tertiary care teaching hospital, India. Inclusion criteria was patients within the age group of 18-60 years, diagnosed with T2DM and on insulin therapy. Case reporting form, anthropometric measures, laboratory investigations, and diabetes quality of life (DQoL) instruments were used for data collection for the period of 3 months. RESULTS The mean age of T2DM patients for males was 48.00 ± 9.92 years and for females was 49.96 ± 10.39 years. Male and female patients were 50% and 50%, respectively. WHR (P = 0.032), DBP (P = 0.000), body fat % (P = 0.04), and duration of diabetes (P = 0.001) had statistically significant association with insulin resistance (binary logistic regression analysis (P-value <0.05). Results show the statistically significant difference between means of WHR (t value = 4.702, P = 0.000) and body fat % (t value = 3.035, P = 0.000) in male and female T2DM patients (Independent't'-test) (P-value <0.05). CONCLUSIONS The study concludes that WHR, DBP, body fat %, and duration of diabetes were significant markers of insulin sensitivity. WHR and body fat % were the differential insulin sensitivity markers in male and female patients of T2DM in northern India. Diabetes adversely affects the quality of life in a nearly similar pattern in both male and female patients.
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Affiliation(s)
- Ravi Kant
- Department of Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | - Poonam Yadav
- College of Nursing, AIIMS, Rishikesh, Uttarakhand, India
| | - Surekha Kishore
- Department of Community and Family Medicine, AIIMS, Rishikesh, Uttarakhand, India
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Fan Y, Wang R, Ding L, Meng Z, Zhang Q, Shen Y, Hu G, Liu M. Waist Circumference and its Changes Are More Strongly Associated with the Risk of Type 2 Diabetes than Body Mass Index and Changes in Body Weight in Chinese Adults. J Nutr 2020; 150:1259-1265. [PMID: 32006008 DOI: 10.1093/jn/nxaa014] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/11/2019] [Accepted: 01/14/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The associations of different adiposity indicators and short-term adiposity change with diabetes risk are not fully elucidated. OBJECTIVE We aimed to assess the independent and joint effects of different baseline adiposity indicators and short-term body adiposity change on the risk of type 2 diabetes. METHODS We prospectively followed 10,419 Chinese adults aged 20-80 y in 2008-2012. Incident diabetes was diagnosed based on fasting glucose, 2-h glucose, or glycated hemoglobin (HbA1c) after an oral glucose tolerance test using the American Diabetes Association standard. Cox proportional hazard regression models were used to assess the associations of adiposity indicators and adiposity change with diabetes risk. RESULTS During a mean follow-up of 2.8 y, we identified 805 type 2 diabetes cases. Baseline BMI, waist circumference, and waist-height ratio (WHtR) were all positively associated with diabetes risk. The area under the curve was significantly greater for waist circumference (0.624) and WHtR (0.627) than for BMI (0.608) (P <0.05). Compared with subjects with stable adiposity levels (±2 kg or ± 3 cm in changes in body weight or waist circumference) from baseline to Year 1, those subjects with the most weight gain or the most waist circumference gain had a 1.53-fold or 1.37-fold greater risk of diabetes; those with the most weight loss had a 46% lower risk of diabetes. Furthermore, regardless of baseline weight status, weight or waist circumference change in the first year was associated with diabetes risk. CONCLUSION Abdominal adiposity indicators, waist circumference and its change, are more strongly associated with the risk of type 2 diabetes than general adiposity indicators, BMI, and changes in body weight among Chinese adults.
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Affiliation(s)
- Yuxin Fan
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China.,Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Ruodan Wang
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Li Ding
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhaowei Meng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Qing Zhang
- Department of Health Management, Tianjin Medical University General Hospital, Tianjin, China
| | - Yun Shen
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.,Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Six People's Hospital, Shanghai, China
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Ming Liu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
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Al Ssabbagh M, Geldsetzer P, Bärnighausen T, Deckert A. The relationship between adult height and diabetes in India: A countrywide cross-sectional study. J Diabetes 2020; 12:158-168. [PMID: 31420914 DOI: 10.1111/1753-0407.12977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/31/2019] [Accepted: 08/11/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND One major aspect of the epidemiological transition happening in India is the increased diabetes prevalence. Poor environmental conditions in early childhood potentially can increase the risk of developing diabetes in adulthood. Adults' height as an indirect indicator might reflect such conditions. In this paper, we investigate the relationship between adult height as a proxy for early childhood conditions and the risk of developing diabetes in India. METHODS This cross-sectional study used national representative data of the latest National Family Health Survey (2015-2016), comprising 512 616 women aged 20 to 49 and 87 281 men aged 20 to 54. We applied the multivariable fractional polynomials approach in logistic regression models to allow for nonlinear relationships between height and diabetes, separated by sex. Additionally, we fitted logistic regression models with height categories. Fixed effects linear probability models were used to control for potential confounding. RESULTS The study revealed a linear relationship between increasing height and increasing diabetes risk among men. Among women, the shortest were at the highest risk (not significant). CONCLUSIONS Among Indian men, being taller increases the risk of developing diabetes, which contradicts findings from other countries. In contrast, the shortest women seem to be at the greatest risk. Hence, public health interventions in India might be well advised to focus more on the nutrition status of young girls.
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Affiliation(s)
- Majd Al Ssabbagh
- Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Pascal Geldsetzer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Till Bärnighausen
- Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Africa Health Research Institute, Mtubatuba, South Africa
| | - Andreas Deckert
- Institute of Global Health, Heidelberg University, Heidelberg, Germany
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Yuan Y, Xie H, Sun L, Wang B, Zhang L, Han H, Yao R, Sun Y, Fu L. A Novel Indicator of Children's Lipid Accumulation Product Associated with Impaired Fasting Glucose in Chinese Children and Adolescents. Diabetes Metab Syndr Obes 2020; 13:1653-1660. [PMID: 32523365 PMCID: PMC7234967 DOI: 10.2147/dmso.s238224] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/15/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Diabetes is one of the most prevalent noncommunicable diseases worldwide. Children's lipid accumulation product (CLAP) is a novel indicator to show children's lipid accumulation and is effectively associated with metabolic syndrome among children and adolescents. The aim of the present study was to explore an association between CLAP and impaired fasting glucose (IFG) in Chinese children and adolescents. METHODS A total of 683 children and adolescents aged 8-15 years were recruited using the stratified cluster sampling method in this cross-sectional study and were measured for body height, weight, waist circumference (WC), abdominal skinfold thickness (AST), triglycerides (TG), fasting plasma glucose, dietary behaviors and physical activities. A logistic regression model and receiver operating characteristic (ROC) curve were used to compare the effects of CLAP for predicting IFG. RESULTS The prevalence of IFG in children and adolescents was 13.8%: 16.9% in boys and 10.1% in girls (P<0.05). The CLAP, height, weight, WC, AST, waist-to-height ratio (WHtR), and TG among boys with IFG were significantly higher than those among boys without IFG (P<0.05). The area under the ROC curve of CLAP for predicting IFG (0.637 (0.562-0.712)) was higher than those of WC, WHtR, AST, and TG. The cutoff point of P 75 CLAP was the optimal value to predict IFG among boys, and the OR (95% CI) was 2.48 (1.40-4.42) and area under the ROC curve was 0.595 (0.513-0.676). CONCLUSION The CLAP was a novel indicator associated with IFG in Chinese boys, and it performed better than WC, WHtR, AST and TG.
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Affiliation(s)
- Yongting Yuan
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, People’s Republic of China
| | - Hong Xie
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, People’s Republic of China
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Anhui, People’s Republic of China
| | - Lili Sun
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, People’s Republic of China
| | - Bangxuan Wang
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, People’s Republic of China
| | - Li Zhang
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, People’s Republic of China
| | - Hui Han
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, People’s Republic of China
| | - Rongying Yao
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, People’s Republic of China
| | - Yehuan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Anhui, People’s Republic of China
- Yehuan Sun Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Meishan Road, Hefei230032, Anhui, People’s Republic of China Email
| | - Lianguo Fu
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, People’s Republic of China
- Correspondence: Lianguo Fu Department of Child and Adolescents Health, School of Public Health, Bengbu Medical College, 2600 East Sea Avenue, Bengbu233030, Anhui, People’s Republic of ChinaTel +8613195529639Fax +86-5523175215 Email
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Wittenbecher C, Kuxhaus O, Boeing H, Stefan N, Schulze MB. Associations of short stature and components of height with incidence of type 2 diabetes: mediating effects of cardiometabolic risk factors. Diabetologia 2019; 62:2211-2221. [PMID: 31501920 PMCID: PMC6861343 DOI: 10.1007/s00125-019-04978-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/16/2019] [Indexed: 01/30/2023]
Abstract
AIMS/HYPOTHESIS This study aimed to evaluate associations of height as well as components of height (sitting height and leg length) with risk of type 2 diabetes and to explore to what extent associations are explainable by liver fat and cardiometabolic risk markers. METHODS A case-cohort study within the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study comprising 26,437 participants who provided blood samples was designed. We randomly selected a subcohort of 2500 individuals (2029 diabetes-free at baseline and with anamnestic, anthropometrical and metabolic data for analysis). Of the 820 incident diabetes cases identified in the full cohort during 7 years of follow-up, 698 remained for analyses after similar exclusions. RESULTS After adjustment for age, potential lifestyle confounders, education and waist circumference, greater height was related to lower diabetes risk (HR per 10 cm, men 0.59 [95% CI 0.47, 0.75] and women 0.67 [0.51, 0.88], respectively). Leg length was related to lower risk among men and women, but only among men if adjusted for total height. Adjustment for liver fat and triacylglycerols, adiponectin and C-reactive protein substantially attenuated associations between height and diabetes risk, particularly among women. CONCLUSIONS/INTERPRETATION We observed inverse associations between height and risk of type 2 diabetes, which was largely related to leg length among men. The inverse associations may be partly driven by lower liver fat content and a more favourable cardiometabolic profile.
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Affiliation(s)
- Clemens Wittenbecher
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Olga Kuxhaus
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Norbert Stefan
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department of Internal Medicine, Division of Endocrinology, Diabetology, and Nephrology, University of Tübingen, Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany.
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.
- Institute of Nutritional Sciences, University of Potsdam, Nuthetal, Germany.
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Khader Y, Batieha A, Jaddou H, El-Khateeb M, Ajlouni K. The performance of anthropometric measures to predict diabetes mellitus and hypertension among adults in Jordan. BMC Public Health 2019; 19:1416. [PMID: 31664979 PMCID: PMC6820979 DOI: 10.1186/s12889-019-7801-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 10/17/2019] [Indexed: 01/22/2023] Open
Abstract
Objectives This study aimed to evaluate and compare the abilities of waist circumference (WC), body mass index (BMI), hip circumference (HC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) to predict recently and previously diagnosed diabetes and hypertension and assess their appropriate cut-off values among Jordanian adults. Methods Data from the 2017 cardiovascular risk factors survey were analyzed to achieve the study objective. The survey collected extensive data from a national population-based sample of Jordanian residents. A structured questionnaire was used to collect sociodemographic variables and clinical data. Blood samples were taken for biochemical measurements. Anthropometric characteristics were measured by the same team of trained field researchers. Results This study included a total of 1193 men and 2863 women. Their age ranged from 18 to 90 year with a mean (SD) of 43.8 (14.2) year. WHtR performed better than other anthropometric measures and had a good ability (AUC > 0.80) among women and fair ability among men to predict newly diagnosed diabetes and previously diagnosed diabetes and hypertension. The appropriate cut-off points for anthropometric measures among women were 92 cm form WC, 104 cm for HC, 30 Kg/m2 for BMI, 0.85 for WHR, and 0.60 for WHtR. For men, the appropriate cut-off points were 100 cm for WC, 104 cm for HC, 27 Kg/m2 for BMI, 0.93 for WHR, and 0.57 for WHtR. Conclusion WHtR performed better than other anthropometric measures in predicting diabetes and hypertension among adult population in Jordan. We recommend WHtR as a measure of choice with a cut-off value of 0.6 for women and 0.57 for men to predict diabetes and hypertension among Jordanians.
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Affiliation(s)
- Yousef Khader
- Department of Public Health, Jordan University of Science and Technology, P.O.Box 3030, Irbid, 22110, Jordan.
| | - Anwar Batieha
- Department of Public Health, Jordan University of Science and Technology, P.O.Box 3030, Irbid, 22110, Jordan
| | - Hashem Jaddou
- Department of Public Health, Jordan University of Science and Technology, P.O.Box 3030, Irbid, 22110, Jordan
| | - Mohammed El-Khateeb
- The National Center for Diabetes, Endocrinology and Genetics, The Jordan University, Amman, Jordan
| | - Kamel Ajlouni
- The National Center for Diabetes, Endocrinology and Genetics, The Jordan University, Amman, Jordan
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Yan G, Li F, Elia C, Zhao Y, Wang J, Chen Z, Yuan H, Lu Y. Association of lipid accumulation product trajectories with 5-year incidence of type 2 diabetes in Chinese adults: a cohort study. Nutr Metab (Lond) 2019; 16:72. [PMID: 31641369 PMCID: PMC6802349 DOI: 10.1186/s12986-019-0399-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/24/2019] [Indexed: 12/12/2022] Open
Abstract
Background Lipid accumulation product (LAP) is an index describing the overaccumulation of lipid. Baseline LAP was used for type 2 diabetes (T2D) prediction in previous studies. But the longitudinal trajectories of LAP, which reflect the efficacy of patients' lipid-lowering treatment and lifestyle improvement, have rarely been studied. The aim of this study is to explore the association of lipid accumulation product trajectories with 5-year incidence of type 2 diabetes. Methods This cohort study included 4508 non-diabetic participants with a median age of 42 years. Using the group-based trajectory modeling (GBTM), LAP from 2011 to 2016 were determined and identified as three trajectories: low (n = 3639), moderate (n = 800), and high (n = 69). Baseline LAP was divided into groups by percentiles and tertiles respectively for the comparison of LAP trajectories. The associations between 5-year T2D incidence and LAP trajectories and baseline LAP were both assessed by generalized linear models. Results From 2011 to 2016, 169 participants developed T2D (the 5-year incidence of 3.8%). For participants with low, moderate, and high trajectories, the incidence of T2D was 2.1, 10.0, and 15.9%, respectively. A significant trend was observed in the relative risks (RRs) of 5-year incident T2D in participants with moderate (RR, 1.95; 95% CI: 1.41-2.70) and high LAP trajectory (RR, 2.20; 95% CI: 1.12-4.30) in the fully adjusted model (p for trend< 0.001). However, there were no statically significant trends in RRs in different tertiles of baseline LAP found after full adjustments. Conclusion The trajectories of LAP has an independent effect on 5-year T2D incidence beyond LAP measured at baseline.
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Affiliation(s)
- Guangyu Yan
- 1Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan 410013 People's Republic of China
| | - Fei Li
- 1Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan 410013 People's Republic of China
| | - Christelle Elia
- 2Department of Life Science and Medicine, King's College London, WC2R 2LS, London, UK
| | - Yating Zhao
- 3Health Management Center, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan 410013 People's Republic of China
| | - Jiangguang Wang
- 3Health Management Center, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan 410013 People's Republic of China
| | - Zhiheng Chen
- 3Health Management Center, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan 410013 People's Republic of China
| | - Hong Yuan
- 1Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan 410013 People's Republic of China
| | - Yao Lu
- 1Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan 410013 People's Republic of China.,2Department of Life Science and Medicine, King's College London, WC2R 2LS, London, UK
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Wang Z, He S, Chen X. Capacity of different anthropometric measures to predict diabetes in a Chinese population in southwest China: a 15-year prospective study. Diabet Med 2019; 36:1261-1267. [PMID: 31215075 DOI: 10.1111/dme.14055] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2019] [Indexed: 02/05/2023]
Abstract
AIM To investigate whether conicity index, abdominal volume index, body adiposity index, body roundness index, cardiometabolic index and lipid accumulation product compared with waist circumference could predict future diabetes in a 15-year prospective study. METHODS The data were collected in 1992 and recollected in 2007 from the same group of 687 individuals. Anthropometric indices and biochemical data were obtained. Cox's proportional hazards regression models were used to estimate the hazard ratios of anthropometric measures. The discriminatory power of anthropometric measures for incident diabetes were assessed by Harrell's C-statistic. RESULTS During follow-up, 74 participants were newly diagnosed with diabetes. In multivariable Cox regression analysis after adjusting potential for confounders, log10 -conicity index [HR: 1.67 (95% CI: 1.31-2.11) per sd; P < 0.0001], log10 -abdominal volume index [HR: 1.95 (95% CI: 1.50-2.55) per sd; P < 0.0001], log10 -body adiposity index [HR: 1.82 (95% CI: 1.33-2.50) per sd; P < 0.0001], log10 -body roundness index [HR: 2.16 (95% CI: 1.63-2.88) per sd; P < 0.0001], log10 -cardiometabolic index [HR: 1.70 (95% CI: 1.39-2.09) per sd; P < 0.0001], log10 -lipid accumulation product [HR: 2.06 (95% CI: 1.56-2.73) per sd; P < 0.0001] and log10 -waist circumference [HR: 1.99 (95% CI: 1.51-2.46) per sd; P < 0.0001] were significantly associated with incident diabetes. Additionally, lipid accumulation product had the highest Harrell's C-statistic at 0.715 (95% CI: 0.656-0.775), followed by body roundness index at 0.714 (95% CI: 0.658-0.770) and cardiometabolic index at 0.704 (95% CI: 0.643-0.764) then by waist circumference at 0.701 (95% CI: 0.644-0.759). CONCLUSIONS Conicity index, abdominal volume index, body adiposity index, body roundness index, cardiometabolic index and lipid accumulation product were independent predictors of future diabetes. The discriminatory power of body roundness index, cardiometabolic index and lipid accumulation product for diabetes prediction were higher than that of waist circumference.
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Affiliation(s)
- Z Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - S He
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - X Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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Shrestha S, Rasmussen SH, Pottegård A, Ängquist LH, Jess T, Allin KH, Bjerregaard LG, Baker JL. Associations between adult height and type 2 diabetes mellitus: a systematic review and meta-analysis of observational studies. J Epidemiol Community Health 2019; 73:681-688. [DOI: 10.1136/jech-2018-211567] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BackgroundAlthough short adult height is generally associated with increased risks of type 2 diabetes mellitus (T2DM), there are large inconsistencies across studies. The aims of this study were to describe and quantify currently available evidence on the association between adult height and T2DM, to examine whether the reported associations differ by sex, and to examine the shapes of the height and T2DM associations.MethodsRelevant literature was identified using PubMed (1966–May 2018), EMBASE (1947–May 2018) and Google Scholar (May 2018). We identified cross-sectional and cohort studies with original publications on human subjects, which were included in a random-effects meta-analysis.ResultsFrom 15 971 identified sources, 25 studies met the inclusion criteria for the systematic review (N=401 562 individuals). From these 25 studies, 16 (9 cross-sectional studies and 7 cohort studies) were included in the meta-analysis (n=261 496 individuals). The overall random-effects meta-analysis indicated an inverse association between adult height and T2DM (effect estimate=0.88, 95% CI 0.81 to 0.95). No sex differences in the associations between adult height and T2DM were found (effect estimate for men: 0.86, 95% CI 0.75 to 0.99; effect estimate for women: 0.90; 95% CI 0.80 to 1.01; p value for sex interaction=0.80). Due to lack of data, results on the shape of the association between height and T2DM were inconclusive.ConclusionsShorter height is associated with an increased risk of T2DM and the association does not significantly differ by sex. The currently available data are insufficient to support conclusions regarding the shape of the association between height and T2DM.Trial registration numberCRD42017062446.
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Talukder A, Akter N, Sazzad Mallick T. Exploring Association Between Individuals' Stature and Type 2 Diabetes Status: Propensity Score Analysis. ENVIRONMENTAL HEALTH INSIGHTS 2019; 13:1178630219836975. [PMID: 30911220 PMCID: PMC6425527 DOI: 10.1177/1178630219836975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 02/13/2019] [Indexed: 06/09/2023]
Abstract
In this article, relationship between respondents' height and occurrence of diabetes has been investigated. This study uses Bangladesh Demographic and Health Survey (BDHS) 2011 data collected from an observational study. Considering height (tall/normal/short) based on percentiles separately for men and women, logistic regression model was fitted to the propensity score (PS)-adjusted weighted data. No significant relationship between respondents' height and diabetes was observed. We also found that the occurrence of diabetes significantly varies with respect to sex, education level, wealth index, body mass index (BMI), and region/division. As, in general, women are shorter than men by nature, we strongly argue that height categories should be defined separately whenever estimation of the effect of height on some response is of interest.
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Affiliation(s)
- Ashis Talukder
- Statistics Discipline, Khulna University, Khulna, Bangladesh
| | - Najiba Akter
- Department of Statistics, University of Dhaka, Dhaka, Bangladesh
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Koncz V, Geldsetzer P, Manne‐Goehler J, Wendt AS, Teufel F, Subramanian S, Bärnighausen T, De Neve J. Shorter Height is Associated with Diabetes in Women but not in Men: Nationally Representative Evidence from Namibia. Obesity (Silver Spring) 2019; 27:505-512. [PMID: 30801987 PMCID: PMC6646871 DOI: 10.1002/oby.22394] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/18/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This study aimed to test the hypothesis that attained adult height, as an indicator of childhood nutrition, is associated with diabetes in adulthood in Namibia, a country where stunting is highly prevalent. METHODS Data from 1,898 women and 1,343 men aged 35 to 64 years included in the Namibia Demographic and Health Survey in 2013 were analyzed. Multiple logistic regression models were used to calculate odds ratios (ORs) and 95% CIs of having diabetes in relation to height. The following three models were considered: Model 1 included only height, Model 2 included height as well as demographic and socioeconomic variables, and Model 3 included body mass index in addition to the covariates from Model 2. RESULTS Overall crude diabetes prevalence was 6.1% (95% CI: 5.0-7.2). Being taller was inversely related with diabetes in women but not in men. In Model 3, a 1-cm increase in women's height was associated with 4% lower odds of having diabetes (OR, 0.96; 95% CI: 0.94-0.99; P = 0.023). CONCLUSIONS Height is associated with a large reduction in diabetes in women but not in men in Namibia. Interventions that allow women to reach their full growth potential may help prevent the growing diabetes burden in the region.
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Affiliation(s)
- Viola Koncz
- Institute of Global Health, Medical Faculty and University HospitalHeidelberg UniversityHeidelbergGermany
- IBE Institute for Medical Information Processing, Biometry and EpidemiologyLudwig Maximilian University of MunichMunichGermany
| | - Pascal Geldsetzer
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Jennifer Manne‐Goehler
- Department of MedicineBeth Israel Deaconess Medical Center, Harvard Medical SchoolBostonMassachusettsUSA
| | - Amanda S. Wendt
- Institute of Global Health, Medical Faculty and University HospitalHeidelberg UniversityHeidelbergGermany
| | - Felix Teufel
- Institute of Global Health, Medical Faculty and University HospitalHeidelberg UniversityHeidelbergGermany
| | - S.V. Subramanian
- Department of Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Center for Population and Development StudiesHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Till Bärnighausen
- Institute of Global Health, Medical Faculty and University HospitalHeidelberg UniversityHeidelbergGermany
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
| | - Jan‐Walter De Neve
- Institute of Global Health, Medical Faculty and University HospitalHeidelberg UniversityHeidelbergGermany
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Hou X, Chen S, Hu G, Chen P, Wu J, Ma X, Yang Z, Yang W, Jia W. Stronger associations of waist circumference and waist-to-height ratio with diabetes than BMI in Chinese adults. Diabetes Res Clin Pract 2019; 147:9-18. [PMID: 30144478 DOI: 10.1016/j.diabres.2018.07.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 06/26/2018] [Accepted: 07/23/2018] [Indexed: 01/21/2023]
Abstract
AIMS To compare the magnitude of associations of the obesity indicators with the risk of prediabetes and diabetes. METHODS We performed an individually region-, sex-, and age-matched case and control analysis involving 42 918 Chinese adults aged 20-88 years (6876 matched prediabetes and normal glucose regulation [NGR] groups and 2873 matched newly diagnosed diabetes mellitus [NDM] and NGR groups). RESULTS Compared with their respective NGR controls, the participants with prediabetes or NDM had significantly higher mean levels of obesity indices as follows: waist circumference (cm), 85.3 vs. 81.8 and 87.9 vs. 82.9; waist-to-height ratio (WHtR), 0.531 vs. 0.509 and 0.546 vs. 0.514; and body mass index (BMI) (kg/m2), 25.4 vs. 24.1 and 25.9 vs. 24.2 (all P < 0.001). The odds ratios (95% confidence intervals) of NDM with waist circumference, WHtR, and BMI per standard deviation (SD) increase were 1.88 (1.80-1.97), 1.88 (1.80-1.97), and 1.69 (1.62-1.76) in the total population. CONCLUSIONS Mean differences in the three obesity indices were around 0.3 SD between matched prediabetes cases and NGR controls, and around 0.5 SD between matched NDM cases and NGR controls. Waist circumference and WHtR were more strongly associated with diabetes than BMI among Chinese adults.
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Affiliation(s)
- Xuhong Hou
- Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Siyu Chen
- Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Gang Hu
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA
| | - Peizhu Chen
- Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Jingzhu Wu
- Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Xiaojing Ma
- Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Zhaojun Yang
- Department of Endocrinology and Metabolism, China-Japan Friendship Hospital, Yinghua Dongjie, Chaoyang District, Beijing 100029, China
| | - Wenying Yang
- Department of Endocrinology and Metabolism, China-Japan Friendship Hospital, Yinghua Dongjie, Chaoyang District, Beijing 100029, China
| | - Weiping Jia
- Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China.
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27
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Zhao Q, Zhang K, Li Y, Zhen Q, Shi J, Yu Y, Tao Y, Cheng Y, Liu Y. Capacity of a body shape index and body roundness index to identify diabetes mellitus in Han Chinese people in Northeast China: a cross-sectional study. Diabet Med 2018; 35:1580-1587. [PMID: 30059165 DOI: 10.1111/dme.13787] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2018] [Indexed: 12/21/2022]
Abstract
AIM To assess the capacity of a body shape index and body roundness index to identify people with diabetes mellitus and those with prediabetes, and to determine whether a body shape index and/or body roundness index is superior to the traditional overall adiposity index, BMI, in Han Chinese people in Northeast China. METHODS A total of 15 078 participants were enrolled from Jilin province in 2012 using a multi-stage stratified random cluster sampling method. Demographic data were collected, and anthropometric indices and biochemical indices were measured. Receiver-operating characteristic curves were used to compare the validity of each anthropometric index, and the area under the receiver-operating characteristic curve was calculated for each anthropometric index. RESULTS Body roundness index had the highest areas under the receiver-operating curve for prediabetes, diagnosed diabetes and undiagnosed diabetes in both men and women (all P<0.01). The optimum threshold values for body roundness index for prediabetes, undiagnosed diabetes and diagnosed diabetes, respectively, were 2.8, 3.7 and 3.3 in men, and 3.4, 3.8 and 3.6 in women. The cumulative proportions of prediabetes, undiagnosed diabetes and diagnosed diabetes identified by the optimum threshold values of body roundness index were 79.2%, 67.5% and 77.0% (82.3%, 62.5% and 75.3% in men; 74.6%, 74.9% and 78.3% in women), respectively. CONCLUSIONS BMI, a body shape index and body roundness index may identify the presence of diabetes. Among the three anthropometric indices, BMI had the weakest association with diabetes. Body roundness index is an alternative index for assessing diabetes in Han Chinese people in Northeast China.
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Affiliation(s)
- Q Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - K Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Y Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Q Zhen
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - J Shi
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Y Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Y Tao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Y Cheng
- Cardiovascular Centre, First Hospital of Jilin University, Changchun, China
- Laboratory for Cardiovascular Diseases, First Hospital of Jilin University, Changchun, China
| | - Y Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
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Salehinia F, Abdi H, Hadaegh F, Serahati S, Valizadeh M, Azizi F, Hosseinpanah F. Abdominal obesity phenotypes and incident diabetes over 12 years of follow-up: The Tehran Lipid and glucose study. Diabetes Res Clin Pract 2018; 144:17-24. [PMID: 30036611 DOI: 10.1016/j.diabres.2018.07.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 06/14/2018] [Accepted: 07/17/2018] [Indexed: 12/14/2022]
Abstract
AIMS To investigate future diabetes in different abdominal obesity phenotypes during 12 years of follow-up. METHODS For this population-based cohort, 7982 adults without diabetes including 3533 men and 4449 women, aged ≥20 years were selected from the Tehran Lipid and Glucose Study. Abdominal obesity was defined according to the national cutoffs for waist circumference (WC). Metabolic health was defined as having ≤1 metabolic abnormality based on Joint Interim Statement (JIS) criteria other than WC. Participants were classified into 4 groups of abdominal obesity phenotypes: Metabolically healthy non-abdominal obese (MHNAO), metabolically healthy abdominal obese (MHAO), metabolically unhealthy non-abdominal Obese (MUNAO), and metabolically unhealthy abdominal obese (MUAO). RESULTS In total, 1018 cases of incident diabetes occurred. Compared to the MHNAO phenotype, based on multivariate Cox regression models, diabetes risk was increased in all unhealthy phenotypes except the MUNAO phenotype in men. Regarding the association of the MHAO phenotype with incident diabetes, borderline statistical significance in men [HR 1.5 (95% CI: 1.0-2.36), p-value: 0.07] and statistical significance in women [HR 1.68 (95% CI: 1.08-2.6)] were detected. CONCLUSIONS In addition to unhealthy phenotypes except the MUNAO phenotype in men, the MHAO phenotype is also associated with incident diabetes, highlighting the importance of preventive strategies in this subgroup of abdominally obese subjects.
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Affiliation(s)
- Farahnaz Salehinia
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Devision of Endocrinology, Department of Internal Medicine, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hengameh Abdi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Serahati
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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30
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Lee BJ, Ku B. A comparison of trunk circumference and width indices for hypertension and type 2 diabetes in a large-scale screening: a retrospective cross-sectional study. Sci Rep 2018; 8:13284. [PMID: 30185890 PMCID: PMC6125465 DOI: 10.1038/s41598-018-31624-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/21/2018] [Indexed: 12/14/2022] Open
Abstract
Anthropometric indices determine important risk factors for many chronic diseases. However, to date, no study has simultaneously analyzed the capabilities of trunk circumference and width indices to identify hypertension and type 2 diabetes in a large-scale screening study. The objectives of this study were to examine the associations of hypertension and - diabetes with circumference and width indices measured at the five identical positions (axillary, chest, rib, waist, and pelvic) and to compare the capabilities of circumference and width indices to identify the two diseases. Data were obtained from the Korean Health and Genome Epidemiology Study database. The associations and abilities of the circumference indices to identify diabetes were greater than those for hypertension. Overall, trunk circumference indices displayed stronger associations with and greater abilities to identify hypertension and diabetes than did trunk width indices at the five positions. In the comparative analysis between index pairs of circumference and width in patients with diabetes, significant differences were shown at all five positions and in the adjusted analysis of axillary, chest, rib, and pelvic positions. Therefore, width indices should not be used as an alternative indicator of type 2 diabetes in either men or women, except when measured at the waist.
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Affiliation(s)
- Bum Ju Lee
- Korea Institute of Oriental Medicine, Future Medicine Division, Deajeon, 305-811, Republic of Korea.
| | - Boncho Ku
- Korea Institute of Oriental Medicine, Future Medicine Division, Deajeon, 305-811, Republic of Korea
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Burns RJ, Deschênes SS, Schmitz N. Associations Between Depressive Symptoms and Indices of Obesity in Adults With Prediabetes and Normal Blood Glucose Levels: Results From the Emotional Health and Wellbeing Study. Can J Diabetes 2018; 42:626-631. [PMID: 30126710 DOI: 10.1016/j.jcjd.2018.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/22/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study describes associations between depressive symptoms and indices of obesity in a community sample of adults with prediabetes. The strengths of these associations were compared to those observed in individuals with normal blood glucose levels. METHODS Cross-sectional data came from the baseline assessment of the Emotional Health and Wellbeing Study. Participants were classified as meeting the American Diabetes Association criteria for prediabetes (n=1,152) or normal blood glucose levels (n=1,567). Indices of obesity included body mass index, waist circumference and fat mass index. RESULTS After adjusting for sociodemographic covariates, greater depressive symptoms were associated with greater body mass index, waist circumference and fat mass index. These associations were stronger in participants with prediabetes compared to participants with normal blood glucose levels. The pattern of results observed for body mass index and waist circumference held after controlling for self-reported fruit and vegetable consumption, physical activity and sedentary time, but the strength of the interaction was attenuated for fat mass index. CONCLUSIONS Depressive symptoms were more strongly associated with indices of obesity in people with prediabetes than in people with normal blood glucose levels. Depressive symptoms may be a barrier to weight management in people with prediabetes.
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Affiliation(s)
- Rachel J Burns
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada.
| | - Sonya S Deschênes
- Douglas Mental Health University Institute, Verdun, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Norbert Schmitz
- Douglas Mental Health University Institute, Verdun, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Departmentof Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Jafari-Koshki T, Arsang-Jang S, Aminorroaya A, Mansourian M, Amini M. Risk modeling in prospective diabetes studies: Association and predictive value of anthropometrics. Diabetes Metab Syndr 2018; 12:563-567. [PMID: 29650347 DOI: 10.1016/j.dsx.2018.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/26/2018] [Indexed: 11/21/2022]
Abstract
AIMS This study aimed to introduce and apply modern statistical techniques for assessing association and predictive value of risk factors in first-degree relatives (FDR) of patients with diabetes from repeatedly measured diabetes data. METHODS We used data from 1319 FDR's of patients with diabetes followed for 8 years. Association and predictive performance of weight (Wt), body mass index (BMI), waist and hip circumferences (WC and HC) and their ratio (WHR), waist-height ratio (WHtR) and a body shape index (ABSI) in relation to future diabetes were evaluated by using Cox regression and joint longitudinal-survival modeling. RESULTS According to Cox regression, in total sample, WC, HC, Wt, WHtR and BMI had significant direct association with diabetes (all p < 0.01) with the best predictive ability for WHtR (concordance probability estimate = 0.575). Joint modeling suggested direct associations between diabetes and WC, WHR, Wt, WHtR and BMI in total sample (all p < 0.05). According to LPML criterion, WHtR was the best predictor in both total sample and females with LPML of -2666.27 and -2185.67, respectively. However, according to AUC criteria, BMI had the best predictive performance with AUC-JM = 0.7629 and dAUC-JM = 0.5883 in total sample. In females, both AUC criteria indicated that WC was the best predictor followed by WHtR. CONCLUSION WC, WHR, Wt, WHtR and BMI are among candidate anthropometric measures to be monitored in diabetes prevention programs. Larger multi-ethnic and multivariate research are warranted to assess interactions and identify the best predictors in subgroups.
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Affiliation(s)
- Tohid Jafari-Koshki
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Road Traffic Injury Research Center, Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahram Arsang-Jang
- Department of Epidemiology and Biostatistics, School of Health, Qom University of Medical Sciences, Qom, Iran
| | - Ashraf Aminorroaya
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Marjan Mansourian
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Masoud Amini
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Zafari N, Lotfaliany M, Mansournia MA, Khalili D, Azizi F, Hadaegh F. Optimal cut-points of different anthropometric indices and their joint effect in prediction of type 2 diabetes: results of a cohort study. BMC Public Health 2018; 18:691. [PMID: 29866083 PMCID: PMC5987476 DOI: 10.1186/s12889-018-5611-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 05/25/2018] [Indexed: 01/02/2023] Open
Abstract
Background To determine the anthropometric indices that would predict type 2 diabetes (T2D) and delineate their optimal cut-points. Methods In a cohort study, 7017 Iranian adults, aged 20–60 years, free of T2D at baseline were investigated. Using Cox proportional hazard models, hazard ratios (HRs) for incident T2D per 1 SD change in body mass index (BMI), waist circumference (WC), waist to height ratio (WHtR), waist to hip ratio (WHR), and hip circumference (HC) were calculated. The area under the receiver operating characteristics (ROC) curves (AUC) was calculated to compare the discriminative power of anthropometric variables for incident T2D. Cut-points of each index were estimated by the maximum value of Youden’s index and fixing the sensitivity at 75%. Using the derived cut-points, joint effects of BMI and other obesity indices on T2D hazard were assessed. Results During a median follow-up of 12 years, 354 men, and 490 women developed T2D. In both sexes, 1 SD increase in anthropometric variables showed significant association with incident T2D, except for HC in multivariate adjusted model in men. In both sexes, WHtR had the highest discriminatory power while HC had the lowest. The derived cut-points for BMI, WC, WHtR, WHR, and HC were 25.56 kg/m2, 89 cm, 0.52, 0.91, and 96 cm in men and 27.12 kg/m2, 87 cm, 0.56, 0.83, and 103 cm in women, respectively. Assessing joint effects of BMI and each of the obesity measures in the prediction of incident T2D showed that among both sexes, combined high values of obesity indices increase the specificity for the price of reduced sensitivity and positive predictive value. Conclusions Our derived cut-points differ between both sexes and are different from other ethnicities. Electronic supplementary material The online version of this article (10.1186/s12889-018-5611-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Neda Zafari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Lotfaliany
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Non-Communicable Disease Control, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Esmaeily H, Tayefi M, Ghayour-Mobarhan M, Amirabadizadeh A. Comparing Three Data Mining Algorithms for Identifying
the Associated Risk Factors of Type 2 Diabetes. IRANIAN BIOMEDICAL JOURNAL 2018; 22:303-11. [PMID: 29374085 PMCID: PMC6058191 DOI: 10.29252/ibj.22.5.303] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Increasing the prevalence of type 2 diabetes has given rise to a global health burden and a concern among health service providers and health administrators. The current study aimed at developing and comparing some statistical models to identify the risk factors associated with type 2 diabetes. In this light, artificial neural network (ANN), support vector machines (SVMs), and multiple logistic regression (MLR) models were applied, using demographic, anthropometric, and biochemical characteristics, on a sample of 9528 individuals from Mashhad City in Iran. Methods: This study has randomly selected 6654 (70%) cases for training and reserved the remaining 2874 (30%) cases for testing. The three methods were compared with the help of ROC curve. Results: The prevalence rate of type 2 diabetes was 14% in our population. The ANN model had 78.7% accuracy, 63.1% sensitivity, and 81.2% specificity. Also, the values of these three parameters were 76.8%, 64.5%, and 78.9%, for SVM and 77.7%, 60.1%, and 80.5% for MLR. The area under the ROC curve was 0.71 for ANN, 0.73 for SVM, and 0.70 for MLR. Conclusion: Our findings showed that ANN performs better than the two models (SVM and MLR) and can be used effectively to identify the associated risk factors of type 2 diabetes.
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Affiliation(s)
- Habibollah Esmaeily
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Tayefi
- Department of Modern Sciences and Technologies, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Ghayour-Mobarhan
- Biochemistry of Nutrition Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Amirabadizadeh
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, South Khorasan, Iran
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Ehrampoush E, Arasteh P, Homayounfar R, Cheraghpour M, Alipour M, Naghizadeh MM, Hadibarhaghtalab M, Davoodi SH, Askari A, Razaz JM. New anthropometric indices or old ones: Which is the better predictor of body fat? Diabetes Metab Syndr 2017; 11:257-263. [PMID: 27578617 DOI: 10.1016/j.dsx.2016.08.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 08/22/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The percent and distribution of body fat are important factors in the pathogenesis of numerous diseases. Our aim was to investigate common anthropometric indices in their relationship with body fat content. METHODS In a cross-sectional study 1360 healthy individuals (580 men and 780 women) in a cluster sampling, from Ahvaz, Iran, body fat content (using bioelectrical impedance) and anthropometric measurements [weight, waist circumference, a body shape index, abdominal volume index, body adiposity index, conicity, body mass index, hip circumference, waist to hip ratio and waist to height ratio] was obtained. The ROC curve analysis was used to compare each index with body fat percent. RESULTS Significant difference was found between men and women in all anthropometric parameters (p < 0.001). Women displayed higher percentages in the overweight and obese categories (33.6% vs. 32.9% and 26.4% vs. 22.1%, respectively). In both men and women, the strongest correlations were seen between body fat percent and BMI, AVI and WHtR (r>7.9 and p<0.001). BMI, WHtR and AVI in men and BAI, BMI and WHtR in women showed the most accuracy for estimating body fat percent, respectively. CONCLUSION All anthropometric parameters could predict body fat percent with relatively good power, however BMI, WHtR and AVI are more powerful predictors. Based on our findings, we suggest using the AVI and WHtR instead of other indexes, as they are better able to assess the accumulation of fat in the abdominal area and are able to more accurately assess body fat percent, which are indicators of chronic disease.
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Affiliation(s)
- Elham Ehrampoush
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran; Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Arasteh
- Department of MPH, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Reza Homayounfar
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran; Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Makan Cheraghpour
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Meysam Alipour
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | | | - Sayed Hosein Davoodi
- National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Jalaledin Mirzay Razaz
- National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Kollerits B, Lamina C, Huth C, Marques-Vidal P, Kiechl S, Seppälä I, Cooper J, Hunt SC, Meisinger C, Herder C, Kedenko L, Willeit J, Thorand B, Dähnhardt D, Stöckl D, Willeit K, Roden M, Rathmann W, Paulweber B, Peters A, Kähönen M, Lehtimäki T, Raitakari OT, Humphries SE, Vollenweider P, Dieplinger H, Kronenberg F. Plasma Concentrations of Afamin Are Associated With Prevalent and Incident Type 2 Diabetes: A Pooled Analysis in More Than 20,000 Individuals. Diabetes Care 2017; 40:1386-1393. [PMID: 28877915 DOI: 10.2337/dc17-0201] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 07/09/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The human vitamin E-binding glycoprotein afamin is primarily expressed in the liver and has been associated with prevalent and incident metabolic syndrome. These data were in line with observations in transgenic mice. We thus investigated whether afamin concentrations are associated with prediabetes, type 2 diabetes, and insulin resistance (IR). RESEARCH DESIGN AND METHODS Individual-level baseline (n = 20,136) and follow-up data (n = 14,017) of eight prospective cohort studies were investigated. Study-level data were combined using random-effects meta-analyses. Main outcomes were prevalent and incident type 2 diabetes, prediabetes, and IR. Discrimination and reclassification of participants was analyzed for incident type 2 diabetes. RESULTS Mean afamin concentrations between studies ranged from 61 to 73 mg/L. The eight studies included 1,398 prevalent and 585 incident cases of type 2 diabetes. Each increase of afamin by 10 mg/L was associated with prevalent type 2 diabetes (odds ratio [OR] 1.19 [95% CI 1.12-1.26], P = 5.96 × 10-8). Afamin was positively associated with IR assessed by HOMA-IR (β 0.110 [95% CI 0.089-0.132], P = 1.37 × 10-23). Most importantly, afamin measured at baseline was an independent predictor for 585 incident cases of type 2 diabetes (OR 1.30 [95% CI 1.23-1.38], P = 3.53 × 10-19) and showed a significant and valuable gain in risk classification accuracy when added to this extended adjustment model. CONCLUSIONS This pooled analysis in >20,000 individuals showed that afamin is strongly associated with IR, prevalence, and incidence of type 2 diabetes independent of major metabolic risk factors or parameters. Afamin might be a promising novel marker for the identification of individuals at high risk for the development of type 2 diabetes.
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Affiliation(s)
- Barbara Kollerits
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudia Lamina
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Cornelia Huth
- Institute of Epidemiology II, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ilkka Seppälä
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland.,Department of Clinical Chemistry, University of Tampere School of Medicine, Tampere, Finland
| | - Jackie Cooper
- Centre for Cardiovascular Genetics, British Heart Foundation Laboratories, University College London, London, U.K
| | - Steven C Hunt
- Cardiovascular Genetics Division, University of Utah School of Medicine, Salt Lake City, UT.,Department of Genetic Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Christa Meisinger
- Institute of Epidemiology II, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Christian Herder
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ludmilla Kedenko
- First Department of Internal Medicine, Paracelsus Private Medical University, Salzburg, Austria
| | - Johann Willeit
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Barbara Thorand
- Institute of Epidemiology II, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Doreen Dähnhardt
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Doris Stöckl
- Institute of Epidemiology II, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Karin Willeit
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Roden
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Wolfgang Rathmann
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Bernhard Paulweber
- First Department of Internal Medicine, Paracelsus Private Medical University, Salzburg, Austria
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland.,Department of Clinical Physiology, University of Tampere School of Medicine, Tampere, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland.,Department of Clinical Chemistry, University of Tampere School of Medicine, Tampere, Finland
| | - Olli T Raitakari
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland.,Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Steve E Humphries
- Centre for Cardiovascular Genetics, British Heart Foundation Laboratories, University College London, London, U.K
| | - Peter Vollenweider
- Department of Medicine, Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Hans Dieplinger
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria.,Vitateq Biotechnology GmbH, Innsbruck, Austria
| | - Florian Kronenberg
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
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Bjerregaard LG, Jensen BW, Baker JL. Height at Ages 7-13 Years in Relation to Developing Type 2 Diabetes Throughout Adult Life. Paediatr Perinat Epidemiol 2017; 31:284-292. [PMID: 28590597 DOI: 10.1111/ppe.12366] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Short adults have an increased risk of type 2 diabetes. Although adult height results from childhood growth, the effects of height and growth trajectories during childhood are sparsely investigated. We investigated sex-specific associations between childhood height, growth and adult type 2 diabetes, including potential influences of birthweight and childhood body mass index (BMI). METHODS We followed 292 827 individuals, born 1930-83, from the Copenhagen School Health Records Register in national registers for type 2 diabetes (11 548 men; 7472 women). Weights and heights were measured at ages 7-13 years. Hazard ratios (HR) of type 2 diabetes (age ≥30 years) were estimated without and with adjustment for birthweight and BMI. RESULTS In men, associations between height and type 2 diabetes changed from inverse for below-average heights at age 7 years to positive for above-average heights at 13 years. No consistent associations were observed among women. These associations were not affected by birthweight. After adjustment for BMI, below-average childhood heights were inversely associated with type 2 diabetes among men (HR range: 0.91-0.93 per z-score) but above-average heights were not. Among women, after adjustment for BMI, below- and above-average heights in childhood were inversely associated with type 2 diabetes (HR range: 0.91-0.95). Greater height growth from 7 to 13 years was positively associated with type 2 diabetes in men and women. CONCLUSIONS After adjustment for BMI, short childhood height at all ages and greater growth during childhood are associated with an increased risk of type 2 diabetes, suggesting that this period of life warrants mechanistic investigations.
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Affiliation(s)
- Lise G Bjerregaard
- Department of Clinical Epidemiology (formerly Institute of Preventive Medicine), Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Britt W Jensen
- Department of Clinical Epidemiology (formerly Institute of Preventive Medicine), Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Jennifer L Baker
- Department of Clinical Epidemiology (formerly Institute of Preventive Medicine), Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, Section on Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Hingle MD, Wertheim BC, Neuhouser ML, Tinker LF, Howard BV, Johnson K, Liu S, Phillips LS, Qi L, Sarto G, Turner T, Waring ME, Thomson CA. Association between Dietary Energy Density and Incident Type 2 Diabetes in the Women's Health Initiative. J Acad Nutr Diet 2017; 117:778-785.e1. [PMID: 28065634 PMCID: PMC5409868 DOI: 10.1016/j.jand.2016.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 11/16/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dietary energy density, or energy available in relation to gram intake, can inform disease risk. OBJECTIVE The objective of this study was to investigate the association between baseline dietary energy density and risk of incident type 2 diabetes in postmenopausal women. DESIGN Dietary energy density, weight status, and type 2 diabetes incidence were prospectively characterized in a large cohort of postmenopausal women participating in one or more clinical trials or an observational study. PARTICIPANTS/SETTING The study involved 161,808 postmenopausal women recruited to the Women's Health Initiative observational study or clinical trials at 40 centers across the United States between 1993 and 1998. MAIN OUTCOME MEASURES The primary outcome was incident type 2 diabetes. STATISTICAL ANALYSES PERFORMED The association between dietary energy density quintiles and incident diabetes was tested using Cox proportional hazards regression. RESULTS A total of 143,204 participants without self-reported diabetes at enrollment completed baseline dietary assessment and were followed for 12.7±4.6 years. Risk of diabetes developing was 24% greater for women in the highest dietary energy density quintile compared with the lowest after adjusting for confounders (95% CI 1.17 to 1.32). Body mass index (calculated as kg/m2) and waist circumference mediated the relationship between dietary energy density and diabetes. In waist circumference-stratified analysis, women in dietary energy density quintiles 2 to 5 with waist circumferences >88 cm were at 9% to 12% greater risk of diabetes developing compared with women with waist circumference ≤88 cm. CONCLUSIONS In this prospective study, a higher baseline dietary energy density was associated with higher incidence of type 2 diabetes among postmenopausal women, both overall, and in women with elevated waist circumference.
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Hardy DS, Stallings DT, Garvin JT, Xu H, Racette SB. Best anthropometric discriminators of incident type 2 diabetes among white and black adults: A longitudinal ARIC study. PLoS One 2017; 12:e0168282. [PMID: 28141847 PMCID: PMC5283673 DOI: 10.1371/journal.pone.0168282] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/28/2016] [Indexed: 01/05/2023] Open
Abstract
Objective To determine which anthropometric measures are the strongest discriminators of incident type 2 diabetes (T2DM) among White and Black males and females in a large U.S. cohort. Methods We used Atherosclerosis Risk in Communities study data from 12,121 participants aged 45–64 years without diabetes at baseline who were followed for over 11 years. Anthropometric measures included a body shape index (ABSI), body adiposity index (BAI), body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), waist to height ratio (WHtR), and waist to hip to height ratio (WHHR). All anthropometric measures were repeated at each visit and converted to Z-scores. Hazard ratios and 95% confidence intervals adjusted for age were calculated using repeated measures Cox proportional hazard regression analysis. Akaike Information Criteria was used to select best-fit models. The magnitude of the hazard ratio effect sizes and the Harrell’s C-indexes were used to rank the highest associations and discriminators, respectively. Results There were 1,359 incident diabetes cases. Higher values of all anthropometric measures increased the risk for development of T2DM (p < 0.0001) except ABSI, which was not significant in White and Black males. Statistically significant hazard ratios ranged from 1.26–1.63 for males and 1.15–1.88 for females. In general, the largest hazard ratios were those that corresponded to the highest Harrell’s C-Index and lowest Akaike Information Criteria values. Among White and Black males and females, BMI, WC, WHR, and WHtR were comparable in discriminating cases from non-cases of T2DM. ABSI, BAI, and WHHR were inferior discriminators of incident T2DM across all race-gender groups. Conclusions BMI, the most commonly used anthropometric measure, and three anthropometric measures that included waist circumference (i.e., WC, WHR, WHtR) were the best anthropometric discriminators of incident T2DM across all race-gender groups in the ARIC cohort.
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Affiliation(s)
- Dale S. Hardy
- Institute of Public and Preventive Health, Augusta University, Augusta, Georgia, United States of America
- * E-mail:
| | - Devita T. Stallings
- School of Nursing, Saint Louis University, St. Louis, Missouri, United States of America
| | - Jane T. Garvin
- College of Nursing, Augusta University, Augusta, Georgia, United States of America
| | - Hongyan Xu
- Department of Biostatistics and Epidemiology, Augusta University, Augusta, Georgia, United States of America
| | - Susan B. Racette
- Program in Physical Therapy and Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
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40
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Prediction of cold and heat patterns using anthropometric measures based on machine learning. Chin J Integr Med 2016; 24:16-23. [PMID: 28035540 DOI: 10.1007/s11655-016-2641-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To examine the association of body shape with cold and heat patterns, to determine which anthropometric measure is the best indicator for discriminating between the two patterns, and to investigate whether using a combination of measures can improve the predictive power to diagnose these patterns. METHODS Based on a total of 4,859 subjects (3,000 women and 1,859 men), statistical analyses using binary logistic regression were performed to assess the significance of the difference and the predictive power of each anthropometric measure, and binary logistic regression and Naive Bayes with the variable selection technique were used to assess the improvement in the predictive power of the patterns using the combined measures. RESULTS In women, the strongest indicators for determining the cold and heat patterns among anthropometric measures were body mass index (BMI) and rib circumference; in men, the best indicator was BMI. In experiments using a combination of measures, the values of the area under the receiver operating characteristic curve in women were 0.776 by Naive Bayes and 0.772 by logistic regression, and the values in men were 0.788 by Naive Bayes and 0.779 by logistic regression. CONCLUSIONS Individuals with a higher BMI have a tendency toward a heat pattern in both women and men. The use of a combination of anthropometric measures can slightly improve the diagnostic accuracy. Our findings can provide fundamental information for the diagnosis of cold and heat patterns based on body shape for personalized medicine.
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Sardarinia M, Akbarpour S, Lotfaliany M, Bagherzadeh-Khiabani F, Bozorgmanesh M, Sheikholeslami F, Azizi F, Hadaegh F. Risk Factors for Incidence of Cardiovascular Diseases and All-Cause Mortality in a Middle Eastern Population over a Decade Follow-up: Tehran Lipid and Glucose Study. PLoS One 2016; 11:e0167623. [PMID: 27930696 PMCID: PMC5145170 DOI: 10.1371/journal.pone.0167623] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 11/17/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND To examine the association between potentially modifiable risk factors with cardiovascular disease (CVD) and all-cause mortality and to quantify their population attributable fractions (PAFs) among a sample of Tehran residents. METHODS Overall, 8108 participants (3686 men) aged≥30 years, were investigated. To examine the association between risk factors and outcomes, multivariate sex-adjusted Cox proportional hazard regression analysis were conducted, using age as time-scale in two models including general/central adiposity: 1)adjusted for different independent variables including smoking, education, family history of CVD and sex for both outcomes and additionally adjusted for prevalent CVD for all-cause mortality 2)further adjusted for obesity mediators (hypertension, diabetes, lipid profile and chronic kidney disease). Separate models were used including either general or central adiposity. RESULTS During median follow-up of >10 years, 827 first CVD events and 551 deaths occurred. Both being overweight (hazard ratio (HR), 95%CI: 1.41, 1.18-1.66, PAF 13.66) and obese (1.51, 1.24-1.84, PAF 9.79) played significant roles for incident CVD in the absence of obesity mediators. Predicting CVD, in the presence of general adiposity and its mediators, significant positive associations were found for hypercholesterolemia (1.59, 1.36-1.85, PAF 16.69), low HDL-C (1.21, 1.03-1.41, PAF 12.32), diabetes (1.86, 1.57-2.27, PAF 13.87), hypertension (1.79, 1.46-2.19, PAF 21.62) and current smoking (1.61, 1.34-1.94, PAF 7.57). Central adiposity remained a significant positive predictor, even after controlling for mediators (1.17, 1.01-1.35, PAF 7.55). For all-cause mortality, general/central obesity did not have any risk even in the absence of obesity mediators. Predictors including diabetes (2.56, 2.08-3.16, PAF 24.37), hypertension (1.43, 1.11-1.84, PAF 17.13), current smoking (1.75, 1.38-2.22, PAF 7.71), and low education level (1.59, 1.01-2.51, PAF 27.08) were associated with higher risk, however, hypertriglyceridemia (0.83, 0.68-1.01) and being overweight (0.71, 0.58-0.87) were associated with lower risk. CONCLUSIONS Modifiable risk factors account for more than 70% risk for both CVD and mortality events.
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Affiliation(s)
- Mahsa Sardarinia
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samaneh Akbarpour
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Epidemiology & Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Lotfaliany
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Non-Communicable Disease Control, School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Farideh Bagherzadeh-Khiabani
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Bozorgmanesh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Sheikholeslami
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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42
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On association between diabetes status and stature of individual in Bangladesh: an ordinal regression analysis. Int J Diabetes Dev Ctries 2016. [DOI: 10.1007/s13410-016-0522-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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43
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Segal-Lieberman G, Segal P, Dicker D. Revisiting the Role of BMI in the Guidelines for Bariatric Surgery. Diabetes Care 2016; 39 Suppl 2:S268-73. [PMID: 27440842 DOI: 10.2337/dcs15-3018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - Pesach Segal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Dicker
- Internal Medicine D and Obesity Clinic, Hasharon Hospital, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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44
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Wells JCK, Pomeroy E, Walimbe SR, Popkin BM, Yajnik CS. The Elevated Susceptibility to Diabetes in India: An Evolutionary Perspective. Front Public Health 2016; 4:145. [PMID: 27458578 PMCID: PMC4935697 DOI: 10.3389/fpubh.2016.00145] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 06/24/2016] [Indexed: 01/11/2023] Open
Abstract
India has rapidly become a "diabetes capital" of the world, despite maintaining high rates of under-nutrition. Indians develop diabetes at younger age and at lower body weights than other populations. Here, we interpret these characteristics in terms of a "capacity-load" model of glucose homeostasis. Specifically, we assume that glycemic control depends on whether the body's "metabolic capacity," referring to traits, such as pancreatic insulin production and muscle glucose clearance, is able to resolve the "metabolic load" generated by high levels of body fat, high dietary glycemic load, and sedentary behavior. We employ data from modern cohorts to support the model and the interpretation that elevated diabetic risk among Indian populations results from the high metabolic load imposed by westernized lifestyles acting on a baseline of low metabolic capacity. We attribute this low metabolic capacity to the low birth weight characteristic of Indian populations, which is associated with short stature and low lean mass in adult life. Using stature as a marker of metabolic capacity, we review archeological and historical evidence to highlight long-term declines in Indian stature associated with adaptation to several ecological stresses. Underlying causes may include increasing population density following the emergence of agriculture, the spread of vegetarian diets, regular famines induced by monsoon failure, and the undermining of agricultural security during the colonial period. The reduced growth and thin physique that characterize Indian populations elevate susceptibility to truncal obesity, and increase the metabolic penalties arising from sedentary behavior and high glycemic diets. Improving metabolic capacity may require multiple generations; in the meantime, efforts to reduce the metabolic load will help ameliorate the situation.
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Affiliation(s)
- Jonathan C K Wells
- Childhood Nutrition Research Centre, UCL Institute of Child Health , London , UK
| | - Emma Pomeroy
- McDonald Institute for Archaeological Research, University of Cambridge , Cambridge , UK
| | | | - Barry M Popkin
- Nutrition Department, Gillings Global School of Public Health, University of North Carolina School of Public Health , Chapel Hill, NC , USA
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Kautzky-Willer A, Harreiter J, Pacini G. Sex and Gender Differences in Risk, Pathophysiology and Complications of Type 2 Diabetes Mellitus. Endocr Rev 2016; 37:278-316. [PMID: 27159875 PMCID: PMC4890267 DOI: 10.1210/er.2015-1137] [Citation(s) in RCA: 1077] [Impact Index Per Article: 134.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The steep rise of type 2 diabetes mellitus (T2DM) and associated complications go along with mounting evidence of clinically important sex and gender differences. T2DM is more frequently diagnosed at lower age and body mass index in men; however, the most prominent risk factor, which is obesity, is more common in women. Generally, large sex-ratio differences across countries are observed. Diversities in biology, culture, lifestyle, environment, and socioeconomic status impact differences between males and females in predisposition, development, and clinical presentation. Genetic effects and epigenetic mechanisms, nutritional factors and sedentary lifestyle affect risk and complications differently in both sexes. Furthermore, sex hormones have a great impact on energy metabolism, body composition, vascular function, and inflammatory responses. Thus, endocrine imbalances relate to unfavorable cardiometabolic traits, observable in women with androgen excess or men with hypogonadism. Both biological and psychosocial factors are responsible for sex and gender differences in diabetes risk and outcome. Overall, psychosocial stress appears to have greater impact on women rather than on men. In addition, women have greater increases of cardiovascular risk, myocardial infarction, and stroke mortality than men, compared with nondiabetic subjects. However, when dialysis therapy is initiated, mortality is comparable in both males and females. Diabetes appears to attenuate the protective effect of the female sex in the development of cardiac diseases and nephropathy. Endocrine and behavioral factors are involved in gender inequalities and affect the outcome. More research regarding sex-dimorphic pathophysiological mechanisms of T2DM and its complications could contribute to more personalized diabetes care in the future and would thus promote more awareness in terms of sex- and gender-specific risk factors.
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Affiliation(s)
- Alexandra Kautzky-Willer
- Gender Medicine Unit (A.K.-W., J.H.), Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria; and Metabolic Unit (G.P.), Institute of Neuroscience, National Research Council, 35127 Padua, Italy
| | - Jürgen Harreiter
- Gender Medicine Unit (A.K.-W., J.H.), Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria; and Metabolic Unit (G.P.), Institute of Neuroscience, National Research Council, 35127 Padua, Italy
| | - Giovanni Pacini
- Gender Medicine Unit (A.K.-W., J.H.), Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria; and Metabolic Unit (G.P.), Institute of Neuroscience, National Research Council, 35127 Padua, Italy
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46
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Kuehnapfel A, Ahnert P, Loeffler M, Broda A, Scholz M. Reliability of 3D laser-based anthropometry and comparison with classical anthropometry. Sci Rep 2016; 6:26672. [PMID: 27225483 PMCID: PMC4880916 DOI: 10.1038/srep26672] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 05/05/2016] [Indexed: 12/31/2022] Open
Abstract
Anthropometric quantities are widely used in epidemiologic research as possible confounders, risk factors, or outcomes. 3D laser-based body scans (BS) allow evaluation of dozens of quantities in short time with minimal physical contact between observers and probands. The aim of this study was to compare BS with classical manual anthropometric (CA) assessments with respect to feasibility, reliability, and validity. We performed a study on 108 individuals with multiple measurements of BS and CA to estimate intra- and inter-rater reliabilities for both. We suggested BS equivalents of CA measurements and determined validity of BS considering CA the gold standard. Throughout the study, the overall concordance correlation coefficient (OCCC) was chosen as indicator of agreement. BS was slightly more time consuming but better accepted than CA. For CA, OCCCs for intra- and inter-rater reliability were greater than 0.8 for all nine quantities studied. For BS, 9 of 154 quantities showed reliabilities below 0.7. BS proxies for CA measurements showed good agreement (minimum OCCC > 0.77) after offset correction. Thigh length showed higher reliability in BS while upper arm length showed higher reliability in CA. Except for these issues, reliabilities of CA measurements and their BS equivalents were comparable.
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Affiliation(s)
- Andreas Kuehnapfel
- LIFE Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Haertelstrasse 16-18, 04107 Leipzig, Germany
| | - Peter Ahnert
- LIFE Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Haertelstrasse 16-18, 04107 Leipzig, Germany
| | - Markus Loeffler
- LIFE Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Haertelstrasse 16-18, 04107 Leipzig, Germany
| | - Anja Broda
- LIFE Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Haertelstrasse 16-18, 04107 Leipzig, Germany
| | - Markus Scholz
- LIFE Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Haertelstrasse 16-18, 04107 Leipzig, Germany
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Cui R, Qi Z, Zhou L, Li Z, Li Q, Zhang J. Evaluation of serum lipid profile, body mass index, and waistline in Chinese patients with type 2 diabetes mellitus. Clin Interv Aging 2016; 11:445-52. [PMID: 27143868 PMCID: PMC4841420 DOI: 10.2147/cia.s104803] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE People with type 2 diabetes are at an increased risk of hypertension, arteriosclerosis, heart disease, and stroke. Glucose intolerance (insulin resistance) is the main feature of type 2 diabetes. Obesity leads to insulin resistance, dyslipidemia, etc. The aim of this study was to assess the biochemical parameters and measures of obesity in type 2 diabetes mellitus (T2DM). METHODS A total of 2,273 males and 6,547 females previously healthy volunteers (aged 41-95 years old) were recruited by open invitation. The basic information, including age, sex, height, weight, body mass index (BMI), waistline, hipline, menstrual cycle, and medical history, was collected by questionnaire survey and physical examination. Serum lipid profile, liver transaminase, blood glucose, postprandial blood glucose, and hemoglobin A1c were obtained after 12 hours of fasting. RESULTS According to our results, diabetic patients presented serum lipid abnormality. Elevated triglyceride (TG) levels (≥1.7 mmol/L) were noted in 19.69% of males and 20.40% of females, and reduced high-density lipoprotein cholesterol (HDL-C) levels (≤1.15 mmol/L) were noted in 21.96% of males and 15.74% of females. The combination of elevated TG and reduced HDL-C was the most prevalent of the combined lipid abnormalities. In contrast, no differences were observed in the levels of low-density lipoprotein cholesterol and total cholesterol. Moreover, there were statistically significant differences in the levels of BMI and waistline between T2DM and non-T2DM participants. After adjustment for BMI, logistic regression analysis revealed that the subjects with BMI ≤20 kg/m(2) and >30 kg/m(2) had a significantly elevated hazard ratio of T2DM compared with participants having a BMI range of 20-30 kg/m(2) in both males and females. However, there was a significant difference between T2DM patients and non-T2DM patients in waistline (χ (2)=8.57, P<0.001) than in BMI parameter (χ (2)=6.29, P<0.001). CONCLUSION The present study shows for the first time that low levels of HDL-C, high levels of TG, and abnormal levels in BMI and waistline increase the risk of type 2 T2DM in Chinese people.
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Affiliation(s)
- Rongtao Cui
- Surgical Research, Department of Orthopedic and Trauma Surgery, Duisburg-Essen University Hospital, Essen, Germany
| | - Zhiming Qi
- Department of Orthopedics, Dalian Central Hospital, Dalian, People’s Republic of China
| | - Lin Zhou
- Department of Orthopedics, Dalian Central Hospital, Dalian, People’s Republic of China
| | - Zuohong Li
- Department of Orthopedics, Dalian Central Hospital, Dalian, People’s Republic of China
| | - Qing Li
- Department of Orthopedics, Dalian Central Hospital, Dalian, People’s Republic of China
| | - Junyong Zhang
- Department of Gastroenterology, Shandong Provincial Hospital, Jinan, People’s Republic of China
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Xue H, Wang C, Li Y, Chen J, Yu L, Liu X, Li J, Cao J, Deng Y, Guo D, Yang X, Huang J, Gu D. Incidence of type 2 diabetes and number of events attributable to abdominal obesity in China: A cohort study. J Diabetes 2016; 8:190-8. [PMID: 25619275 DOI: 10.1111/1753-0407.12273] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 12/28/2014] [Accepted: 01/10/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The aim of the present study was to estimate the incidence of type 2 diabetes (T2D) and the number of diabetes events attributable to abdominal obesity in China. METHODS A cohort study was conducted in a sample of 24,996 Chinese adults aged 35-74 years, with 19.9% of subjects lost to follow-up. Waist circumference (WC) was measured at baseline in 1998 and 2000-01, and abdominal obesity was defined as WC ≥ 90 cm in men and ≥80 cm in women. Information on incident diabetes was collected during follow-up in 2007-08. We estimated the number of T2D events attributed to abdominal obesity using confounder-adjusted population-attributable risk, incidence of diabetes, and the population size of China in 2010. RESULTS After a mean follow-up of 8.0 years, the age-standardized incidence of T2D was 9.6 and 9.2 per 1000 person-years in men and women, respectively. Abdominal obesity accounted for 28.1% (95% confidence interval [CI] 14.8%, 40.5%) of incident diabetes among men and 41.2% (95% CI 28.3%, 52.6%) among women using the diagnostic criteria of abdominal obesity recommended by the International Diabetes Federation. We estimated that, in 2010, 2.4 (95% CI 1.5, 3.2) million diabetes events were attributable to abdominal obesity: 1.0 (95% CI 0.5, 1.4) million in men and 1.4 (95% CI 1.0, 1.8) million in women. CONCLUSIONS Abdominal obesity is a major risk factor for T2D. Strengthening programs and initiatives for preventing and controlling obesity focusing on lifestyle changes should be a priority in the national strategy to reduce diabetes burden in China.
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Affiliation(s)
- Haifeng Xue
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Food and Environment, School of Public Health, Qiqihar Medical University, Qiqihar, China
| | - Chao Wang
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Li
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jichun Chen
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ling Yu
- Fujian Provincial People's Hospital, Fuzhou, China
| | - Xiaoqing Liu
- Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China
| | - Jianxin Li
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Cao
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Deng
- Sichuan Centre for Disease Control and Prevention, Chengdu, China
| | | | - Xueli Yang
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianfeng Huang
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dongfeng Gu
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Haftenberger M, Mensink GB, Vogt S, Thorand B, Peters A, Herzog B, Hartwig S, Greiser KH, Ittermann T, Schipf S, Völzke H, Merz B, Nöthlings U, Koch M, Neamat-Allah J, Katzke V, Kaaks R, Boeing H, Bachlechner U, Scheidt-Nave C, Schienkiewitz A. Changes in Waist Circumference among German Adults over Time - Compiling Results of Seven Prospective Cohort Studies. Obes Facts 2016; 9:332-343. [PMID: 27701174 PMCID: PMC5644885 DOI: 10.1159/000446964] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 05/16/2016] [Indexed: 11/19/2022] Open
Abstract
AIM This study aims to quantify longitudinal changes in waist circumference (WC) among adults aged 45-64 years in Germany. METHODS Data of 15,444 men and 17,207 women from one nationwide and six regional prospective German cohort studies were analyzed. The sex-specific mean change in WC per year of follow-up was assessed for each study separately. Findings from the cohort-by-cohort analysis were combined by applying meta-analytic methods. Progression to central obesity (WC ≥ 102 cm in men and ≥ 88 cm in women) within a standardized period of 10 years was described for each study. RESULTS The estimated mean change in WC per year of follow-up for all cohorts combined was 0.53 (95% confidence interval 0.29-0.76) cm/year for men and 0.63 (0.48-0.77) cm/year for women, but varied between the included studies. Within 10 years, about 20% of individuals with low WC (<94 cm in men; <80 cm in women) and about 50% of individuals with intermediate WC (94-102 cm in men; 80-88 cm in women) progressed to central obesity. CONCLUSION The increase in mean WC with aging along with a profound increase of central adiposity is obviously and may have several adverse health effects. Obesity prevention programs should also focus on abdominal obesity.
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Affiliation(s)
- Marjolein Haftenberger
- Robert Koch Institute, Department of Epidemiology and Health Reporting, Berlin, Germany
- *Marjolein Haftenberger, Department of Epidemiology and Health Reporting, Robert Koch Institute Berlin, Postbox 65 02 61, 13302 Berlin, Germany,
| | - Gert B.M. Mensink
- Robert Koch Institute, Department of Epidemiology and Health Reporting, Berlin, Germany
| | - Susanne Vogt
- Institute of Epidemiology II, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - Barbara Thorand
- Institute of Epidemiology II, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Beatrice Herzog
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Saskia Hartwig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
- German Center for Diabetes Research (DZD), Halle, Germany
| | - Karin Halina Greiser
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
- Department of Cancer Epidemiology, German Cancer Research Center (DKFZ) in the Helmholtz-Association, Heidelberg, Germany
| | - Till Ittermann
- Institute for Community Medicine, University of Greifswald, Greifswald, Germany
| | - Sabine Schipf
- Institute for Community Medicine, University of Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University of Greifswald, Greifswald, Germany
- German Center of Cardiovascular Research, Partner Site Greifswald, Greifswald, Germany
| | - Benedikt Merz
- Department of Nutrition and Food Sciences, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
| | - Ute Nöthlings
- Department of Nutrition and Food Sciences, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
| | - Manja Koch
- Institute of Epidemiology, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Jasmine Neamat-Allah
- Department of Cancer Epidemiology, German Cancer Research Center (DKFZ) in the Helmholtz-Association, Heidelberg, Germany
| | - Verena Katzke
- Department of Cancer Epidemiology, German Cancer Research Center (DKFZ) in the Helmholtz-Association, Heidelberg, Germany
| | - Rudolf Kaaks
- Department of Cancer Epidemiology, German Cancer Research Center (DKFZ) in the Helmholtz-Association, Heidelberg, Germany
| | - Heiner Boeing
- German Institute of Human Nutrition, Potsdam-Rehbrücke, Nuthetal, Germany
| | - Ursula Bachlechner
- German Institute of Human Nutrition, Potsdam-Rehbrücke, Nuthetal, Germany
| | - Christa Scheidt-Nave
- Robert Koch Institute, Department of Epidemiology and Health Reporting, Berlin, Germany
| | - Anja Schienkiewitz
- Robert Koch Institute, Department of Epidemiology and Health Reporting, Berlin, Germany
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Furer A, Afek A, Beer Z, Derazne E, Tzur D, Pinhas-Hamiel O, Reichman B, Twig G. Height at Late Adolescence and Incident Diabetes among Young Men. PLoS One 2015; 10:e0136464. [PMID: 26305680 PMCID: PMC4549289 DOI: 10.1371/journal.pone.0136464] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 08/03/2015] [Indexed: 02/05/2023] Open
Abstract
Background Short stature was suggested as a risk factor for diabetes onset among middle age individuals, but whether this is the case among young adults is unclear. Our goal was to assess the association between height and incident diabetes among young men. Methods and Findings Incident diabetes was assessed among 32,055 men with no history of diabetes, from the prospectively followed young adults of the MELANY cohort. Height was measured at two time points; at adolescence (mean age 17.4±0.3 years) and grouped according to the US-CDC percentiles and at young adulthood (mean age 31.0±5.6 years). Cox proportional hazards models were applied. There were 702 new cases of diabetes during a mean follow-up of 6.3±4.3 years. There was a significant increase in the crude diabetes incidence rate with decreasing adolescent height percentile, from 4.23 cases/104 person-years in the <10th percentile group to 2.44 cases/104 person-years in the 75th≤ percentile group. These results persisted when clinical and biochemical diabetes risk factors were included in multivariable models. Compared to the 75th≤ percentile group, height below the 10th percentile was associated with a hazard ratio (HR) of 1.64 (95%CI 1.09–2.46, p = 0.017) for incident diabetes after adjustment for age, body mass index (BMI), fasting plasma glucose, HDL-cholesterol and triglyceride levels, white blood cells count, socioeconomic status, country of origin, family history of diabetes, sleep quality and physical activity. At age 30 years, each 1-cm decrement in adult height was associated with a 2.5% increase in diabetes adjusted risk (HR 1.025, 95%CI 1.01–1.04, p = 0.001). Conclusions Shorter height at late adolescence or young adulthood was associated with an increased risk of incident diabetes among young men, independent of BMI and other diabetes risk factors.
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Affiliation(s)
- Ariel Furer
- Department of Medicine I, Tel-Aviv Medical Center, Tel-Aviv, Israel
- The Israel Defense Forces Medical Corps, Tel Hashomer, Israel
| | - Arnon Afek
- Israel Ministry of Health, Jerusalem, Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zivan Beer
- Department of Medicine I, Tel-Aviv Medical Center, Tel-Aviv, Israel
- The Israel Defense Forces Medical Corps, Tel Hashomer, Israel
| | - Estela Derazne
- The Israel Defense Forces Medical Corps, Tel Hashomer, Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorit Tzur
- The Israel Defense Forces Medical Corps, Tel Hashomer, Israel
| | - Orit Pinhas-Hamiel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrinology and Metabolism Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Brian Reichman
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Women and Children's Health Research Unit, Gertner Institute, Tel Hashomer, Israel
| | - Gilad Twig
- The Israel Defense Forces Medical Corps, Tel Hashomer, Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Medicine B, Sheba Medical Center, Tel Hashomer, Israel
- The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
- * E-mail:
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